neuro pathologies UE Flashcards
Traction injury of lower brachial plexus
Klumpke’s paralysis
Claw hand - thumb on the same plane as palm, whole hand, both median and ulnar (C8-T1)
Injury to the superior roots of brachial plexus
Erb-Duchenne palsy (C5-C6)
Waiter’s tip postion
Radial nerve leisions
Clavicle, axillary, radial groove, supinator
Posterior motor brach “Posterior interosseus nerve”: it enters supinator and travels down the lateral Radius to the wrist
Superficial branch: travels down the posterior forearm to the hand
Radial nerve lesions causes
Fractures at spiral radial groove
- dislocations of head of radius, humeroradial or radioulnar joint
- Post surgical complications
- compression
Radial nerve related pathologies
Crutch palsy at axilla
Saturday night palsy at spiral groove of humerus from direct pressure against a firm object
Posterior interosseuous syndrome: comes off in front of the lateral epicondyle of humerus
compression in arcade/canal of Frohse, motor nerve, get wrist drop
Cheiralgia parasthetica: compression of superficial branch of radial nerve as it passes under tendon of brachioradialis
If injury is proximal to elbow….
both sensory and motor affected,
if injury is distal to elbow…
Only sensory or motor is affected
what causes cheiralgia paresthetica
Cast, hand cuffed compression swelling
Median Nerve lesions
Path Under pronator teres, under carpal tunnel and end between 2nd and third fingers
Median nerve lesions causes
Fractures at elbow, wrist and carpals
Dislocations at elbow, wrist, carpals
Compressions
Trauma
Symptoms of Median nerve lesions
Ape hand - thumb in same plane as rest of hand since there is no opposition (wasting of thenar eminence)
- oath hand - you see when you make a fist only digit 4 & 5 can be flexed
- can’t grasp objects (keep dropping things)
- can’t pronate forearm, flex PIPs, flex DIPs of digit #2, 3
- Weak wrist flexion weak thumb movements
- altered sensation on digit 1, 2, 3, and half of 4
Median legion pathologies
Ligament of struthers
Pronator Teres Syndrome
Anterior interosseus syndrome
Carpal tunnel syndrome
Where is ligament of struthers
Runs from an abnormal supr on shaft of humerus to medial epicondyle. Median nerve can be pinched/compressed above elbow as it passes under - only 1% of populaton
What is pronator teres syndrome
Compressed at proximal attachment of pronator teres
Aching in forearm
numbness in thumb and index - some weakness in thenar mm
What is anterior interosseous syndrome
Branch of median nerve
Motor nerve - motor loss of FPL, lat 11/2 of FDP, pronator quadratus
Paralysis of flexors in index finger and thumb at tip, so reverse froment’s sign, can’t touch them together at tip, touch at distal knacles.
Can be entrapped it passes between 2 heads of pronator teres.
What is carpal tunnel syndrom
Most common entrapment condition in the arm
compression through carpal tunnel at wrist
Numbness and tingling in digit #1,2,3 and half of 4
Distinguishing feature = presence of nocturnal symptoms that wake person up
Muscle weakness and clumsiness of thumb and fingers
later get thenar muscle wasting
How the compression of median nerve in carpal tunnel occurs?
size of the tunnel decrease
Size of the contents passing through increases
Carpal tunnel structures and tendons
Flexor retinaculum forms roof
Fexor retinaculum attaches to scaphoid tubercle and trapezium
Carpal bones form floor
Median nerve, Flextor digitorum superficialis, profundus and flexor pollicis longus (9 tendons and 1 nerve)
Ulnar nerve leisons
path
Ulnar nerve lesions causes
fractures at medial epicondyle, mid-forearm, wrist dislocations of elbow
Post surgical complications (badly positioned arm while under anesthetics)
Compression -resting elbow on hard surface
- wearing tight wrist band
-cycling
-repetitive actions, trauma
Ulnar nerve lesions symptoms
Ulnar claw hand - baby finger hyper extended and abducted at MCP and flexed at iP
- ring finger is hyper extended at MCP and flexed at IP (loss of lumbricals)
- atropy of interosseous mm
- muscle wasting of hypothenar
- Altered sensation in little finger and medial half of ring ringer (palmar and dorsal)
- Froment’s sign is positive
Froment’s sign
Hold paper between thum and index finger
can’t do it without using adductor pollicis
a patient flex thumb to use flex pollicis longus
tardy ulnar palsy
ulnar palsy is common complication of fractures of elbow
- a late tardy ulnar palsy can occur years after a fracture
- it’s associated with callus formation or a valgus deformity of the elbow
- these produce a gradual stretching of nerve in ulnar groove of medial epicondyle
Thoracic outlet syndrome
Compression of brachal plexus from structures in the thracic outlet (from interscalene triangle to inferior border of axilla)
-subclavian aa and vv may also be compressed
Thoracic outlet syndrome path
Brachial plexus travels with the subclavian aa between anterior and medial scalene
subclavian vv joins and neurovascular bundle goes below clavicle and under pec minor insertion and down arm
TOS causes
poor posture c spine /clavicle dislocation cervical rib pec minor scalens whiplash systemic disease - RA, DM, hyothyroid pregnancy
TOS symptoms
Pain, numbness, weakness, tingling in arm or across upper thoracic area or over scapula
Trophic changes in tissue with blood vessel compression
TOS locations (5)
1 Presence of cervical rib - additional rib at C7
2 Anterior scalene syndrome - compression btw ant & middle scalene
3 Interscalene triangle - ant, middle scalanes, rib 1, brachial plexus and subclavian artery pass through only (subclavian vein is anterior)
4 Costoclavicular syndrome- compression btw coracoid process and pec minor
5 Pectoralis minor syndrome
Travell’s test and Addison’s test
Travell’s test (middle scalene) Extend, rotate arm, turn head away from the arm - check radial pulse
Addision’s test (anterior scalene) Extend, rotate arm, turn head toward the arm - check radial pulse
