Fractutes And Nerve Entrapments Flashcards
What nerve is most frequently injured during a clavicle fracture and where?
Ulnar nerve where it passes between the first rib and fractured clavicle
What nerve is most commonly injured during a humeral shaft fracture?
Radial nerve - 90% recover spontaneously
Clinical signs and symptoms of typical brachial plexus injuries… Upper trunk
Suprascapular, musculocutaneous, and axillary nerves (parts of median and radial)
Weakness in shoulder flexion, abduction and extension; elbow flexion, supination and probation; wrist flexion
Numbness and paresthesia of lateral forearm, hand and thumb and index fingers
Clinical signs and symptoms of typical brachial plexus injuries… Middle trunk
RARE
Weakness in radial nerve distribution
Involves the tricep sparing the bracioradialis
Clinical signs and symptoms of typical brachial plexus injuries… Lower trunk
Motor weakness in ulnar nerve distribution and C8 components of the radial nerve, muscles innervated by distal median (thenar and lumbricals)
Sensory of medial forearm, media hand and ring and little finger
Clinical signs and symptoms of typical brachial plexus injuries… Posterior and anterior divisions
Rare in isolation
Clinical signs and symptoms of typical brachial plexus injuries… Lateral cord
Similar to upper trunk sparing suprascapular nerve and upper trunk contributions to the axillary and radial nerves
Weakness in elbow flexion, supination and pronation; wrist flexion
Numbness in lateral forearm
Clinical signs and symptoms of typical brachial plexus injuries… Medial cord
Similar to lower trunk sparing C8 contribution to radial nerve. Finger extension is normal
What are the differences in a C5-6 injury and a lateral cord lesion?
Upper trunk lesion spares the dorsal scapular (rhomboids) and the long thoracic nerve (SA)
Lateral cord lesion spares the suprascapular nerve
What are symptoms of Pancoast’s tumor?
Sensory changes in the medial forearm and hand, including digits 4&5.
Intrinsic wasting, Horner syndrome, history of night pain
Risk: smokers, not trauma
What is Horner syndrome?
Unilateral enophthalmos (sunken eyeball), ptosis (drooping eyelid), miosos (contraction of the pupil) and flushing of the face
What is the subclass of the distal third clavicle fractures?
Type I - non displaced bc ligaments are intact
Type II- detachment of the coracoclavicular ligaments from the medial fragment and displacement of the fracture.
Type III - involves the articular surface of the AC joint, non displaced. Leads to degeneration
