Nerve injuries (palsies) in the upper limb Flashcards
c5,6 supply which muscles? waiters tip = what palsy? what position? do children recover?
Deltoid, shoulder muscles, brachialis and biceps
Erb-Duchennes plasy
adducted arm, felxed, pronated wrist and extended arm .
Yes, children have a good chance of recovery
claw hand/klumpkes pasy = what position?
Resting position, the little and ring finger natually in a flexed position
what roots axillary? supply what? how injured?
C5,6.
Supplies Deltoid and Teres Minor muscles and regimental badge area.
Injured shoulder dislocation and fractures of the surgical neck of the humerous.
Why do we check regimental badge area before reducing a shoulder dislocation? axillary nerve injury issues and recovery
We need to check if there is already loss of sensation and axillary nerve injury prior to our interventions. Can recover but will take time and as it will take time will see deltoid muscle wastage.
What does the radial nerve branch into? And what is it’s course?
Radial grove of the humerus, passing medially to laterally. Supplies Brachioradialis, and extensor carpi radialis longus and brevis then divides into motor (PIN - Posterior interosseus nerve) and Superficial Radial Nerve
How can we test fine touch for radial nerve issues?
Doral aspect of thumb
Contents of Carpal tunnel?
9 tendons and a nerve
-FDS (Flexor digitorum Superficialis), FDP (Flexor Digitorum Profundus), flexor pollisis longus
-median nerve
Causes of carpal tunnel?
Anyhting that is going to compress it!
-remember to check for hypothyroidism.
-inflammatory (rheumatoid, gout, tb, amyloid)
-Metabolic (preg, mucopolysaccharidoses, hypothyroidimsm)
-Swellings, (ganglion, fibroma, lipoma)
Trauma (distal radium fracture)
-developmental
Carpal tunnel syndrome: Symptoms and how to assess for?
Pain(eslp noturnal)/parasthesia (where median nerve supplies (palmar thumb, index, midddle and 1=0.5 ring finger and pal space below. Dorsal aspect = index, middle and 0.5 ring fingers -> No palms.
How to do tinnels and phalens test?
Tinnels test: Press relatively hard with your middle finger onto wrist where carpal tunnel is. If positive iwll feel shooting pain down wrist.
Phalens test = inverse prayer hands, so back to back and poining down. Hold to 30s-2m and see if they have any shooting pain/discomfort.
Caroal tunnel treatment
Can splint it, treat underlying cause or give injections.
Main stay of treatment however is surgery to release the pressure.
How does ulnar nerve enter hand?
Through guyon canal
What nerve is in “funny bone”, what is the canal called?
Cubital tunnel (between medial epicondyle and olecrannon (ulnar nerve)
Ulnar muscle wasting affects where? What do we see in ulnar nerve compression?
Wasting of msucle in the first webspace. Can also see guttering (loss of muscle between finger bones) and hypothenar wasting.
fromets test
Pinch paper and keep it as it is tried to take it away. Tests adductor pollicis (ulnar nerve). If it sin’;t strong enough then wil try to use flexor polluicis longus and thumb will bend (positive froments)
