Orthopedic Flashcards
Muscles innervated by musculocutaneous nerve
BBC
Root of radial nerve
C5-T1
Muscles supplied by main radial nerve and by posterior interosseous nerve( PIN)
BEAT
Brachioradialis
Extensor Carpi radialis (compartment 2)
Anconeus
Triceps
PIN
Extensor compartments 13456
Sensory loss of radial nerve
Coin in snuff box
Sensory loss of radial nerve
Coin in snuff box
State of metacarpophalangeal joints if radial nerve is cut in axilla
Loss of extension
State of interphalangeal joints if radial nerve is cut in axilla
Can be extended by action of lumbricals(median and ulnar nerve)
Nerve supply of long head of triceps
Axillary+radial
Nerve of all forearm flexors
All by median
Extension
Except flexor Carpi ulnaris and material half of flexor digitorum profunda
Muscles supplied by ulnar nerve
MAFIA
Medial 2 lumbricals
Abductor digiti minimi,opponens d.minimi
Flexor digiti minimi,
Flexor digitorum profunda (medial 2)
Interossei
Adductor pollicis
Nerve to pronator teres
Median nerve
Root of ulnar nerve
C8-T1
Nerve passing beneath flexor Carpi ulnaris along it
Ulnar nerve
Relation of ulnar nerve to flexor retinaculum
Superficial to it
Within Guyon’s canal
Epicondyles and redial and ulnar nerve
R anterior to epicondyle then goes Dorsal
U posterior to epicondyle then goes Volar
Basis of ulnar paradox
More PROXIMAL injury causes simultaneous paralysis of flexor digitorum profunda
Nerve to
Adductor pollicis
Abductor pollicis brevis
Abductor pollicis Longus
Ad. Po. Ulnar
Ab. Po. Br. Median
Ab. Po. Lo. PIN (Radial)
Nerves behind marriage stability
Ulnar+Median+Radial
Sign of Erb’s palsy and injured nerve
WAITER’S tip
Nerve root injury of C5 C6 by hyper lateral extension of neck
*Paralysis of
Deltoid
Biceps
Brachialis
Coracoacromial
*Causing
Weakness of shoulder abduction (not completely lost because other adductor are intact and patient learns swinging of arm)
Loss of elbow flexion and week supination
Sensory loss over lateral aspect of arm
Klumpke’s palsy
Root lesion of C8,T1 by hyper abduction of shoulder joint
(ulnar paralysis) There is sympathetic interruption with absent of sweating
Features
Claw hand
Wrist drop
Cervical sympathetic nerve injury may cause
Horner’s syndrome maybe associates with T1 lesion
Ipsilateral -
Ptosis
Miosis
Anhydrosis
Relation of median nerve to brachial artery
LAM
Lateral
Anterior
Medial
Only thenar muscle supplied by ulnar nerve
Adductor pollicis
Affected part of spinal cord by poliomyelitis
Anterior horn segment wise, so an example like—total deltoid paralysis
So no sensory loss
Muscles attaching scapula to chest wall and maintaining normal scapular control
Trapeziu
Levator scapulae
Rhomboid major& minor
Pectoralis minor
Omohyoid
Serratus anterior (long T. C5-7 injury from axillary node biopsy, radical mastectomy, sports stretch injury,viral infection causing winging)
Latissimus dorsi (mild winging of scapula with weakness of shoulder abduction)
Global muscle wasting of hand
Damage to both median and ulnar nerve with damage to T1 nerve root
Syringomyelia,motor neuron disease
Structures superficial to flexor retinaculum
From medial to lateral
Ulnar nerve
Ulnar artery
Palmaris Longus
Structures inside flexor retinaculum other than tendons
Only median nerve
Termination of ulnar artery
After passing superficial to flexor retinaculum it divides into superficial and deep volar arterial arches
Relation of ulnar artery
Less on—
BRACHIALIS
Flexor digitorum profundus
Deep to—
Pronator teres (also median nerve runs below it)
Flexor Carpi radialis
Palmaris Longus
What separates ulnar artery from median nerve
Ulnar head of pronator teres
What separates ulnar artery from ulnar nerve
Ulnar head of pronator teres
Relation of radial nerve and radial artery
There is no relation between them apart from name
Root of radial nerve
C5-T1
As it arrives from posterior cord
Artery twisted to radial nerve and where
Profunda brachii
Along radial groove of humerus
At what level of ulnar nerve injury will cause more severe manifestation
1. Behind medial epicondyle
2. At Guyon’s canal
At Guyon’s canal—more clawing & inability to put the hand in writing position
Due to ulnar paradox (the upper the injury the more loss of small branches leading to paralysis of flexor digiti profunda)
Only good thing about ulnar paradox
Distal lesion may produce more prominent manifestation but as injured nerve is of smaller diameter so it’ll heal comparatively faster
Rate of nerve regretting is 1mm per day
Only good thing about ulnar paradox
Distal lesion may produce more prominent manifestation but as injured nerve is of smaller diameter so it’ll heal comparatively faster
Rate of nerve regretting is 1mm per day
Muscles having motor supply purely from main radial nerve
Brachioradialis
Extensor Carpi radialis longus and brevis
Content of Guyon’s canal
Guyon’s canal protects the ulnar artery and nerve as they travel from the wrist to the hand.
Mnemonic for extensor compartments of wrist 3—2—1
Ex.Po. Ex.Ca.Ra. Ex.Po. Ab.Po.
Longus Brevis Longus Brevis Longus
(3) ( 2 ) ( 1 )
Use of extensor Carpi radialis longus tendon
In tension graft
Because this muscle is less used
Relation of extensor compartments with anatomical snuff box
Medial border formed by 3rd compartment
Lateral border formed by 1st compartment
Floor formed by 2nd compartment
Supply of flexor Carpi radialis
Median nerve
Supply of extensor Carpi ulnaris
Posterior interosseous branch of radial nerve
Zones of extensor side of hand
9
Odd zones are joints starting from distal
Zones of flexor side of hand
There are flexor tendon pulleys in the fingers that are named A1-A5, and consists of annular ligament pulleys, and cruciate pulleys named C1-C3 i.e. The flexor tendon pulley system. The thumb only has two pulleys that are described as A1 and A2.
5 zones
Starting form distal end
1. From insertion of FDS to tip of finger
2. From FDS insertion to A2 pulley
3. From A2 pulley to the bugging of carpal tunnel
4. Carpal tunnel
5. Proximal to carpal tunnel
Causes of capital tunnel syndrome and symptoms and test
Myxedema
Rheumatoid arthritis
Acromegaly
Multiple myeloma
Nephrotoxic syndrome
Amyloidosis
DM
Gout
Pseudogout
Alcoholism
Wrist fracture
Females over forty are more prone
Pregnancy may predispose
Symptom
Loss of grip control
Due to loss of function of opponens pollicis
Test
Phalen test
Tinel test
