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Locomotor > Overview of the upper limb > Flashcards

Overview of the upper limb Flashcards

1
Q

can you live without a shoulder or elbow

A

shoulder not that important

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2
Q

the shoulder forms…

A

• Shoulder forms foundation from which the upper limb can move

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3
Q

describe the movements that the shoulder allows

A
  • the large range of movement in the shoulder allows the hand to be positioned in a wide area
  • they anchor the arm to the trunk
  • forms a mobile pectoral girdle this allows a wider range of movement that is possible for the limb
  • clavicle and scapula can move to get extra movement
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4
Q

what do we depend on the elbow for

A

washing, dressing, eating and drinking

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5
Q

is the elbow very stable yes or no

A
  • Very stable joint
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6
Q

what is the hand used for

A
  • Holds objects (dexterity and grasp)
  • Touches objects (sense organ)
  • Communication
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7
Q

where do the muscles that move the fingers originate In

A
  • Partially in the hand – intrinsic – used for fine movement
  • Partially in forearm -extrinsic – for power
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8
Q

what are the two types of grip

A

power grip and precisions grips

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9
Q

what grips make up power grips

A

• Cylindrical grip, spherical grip, hook grip, lateral prehension

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10
Q

describe the position of the power grip

A

• All fingers flex around object, thumb curled round to press against acts as safety bar to hold those fingers closed, or meet fingers
- can allow you to hold an object in the palm of the hand

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11
Q

what do the hypothenar muscles do in the power grip

A

• Hypothenar muscles stabilise medial side of palm against handle.

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12
Q

what do the wrist extensors do in the power grip

A

• Wrist extensors active - provide stable base - this gives the tendons a good working range

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13
Q

which grip is more primitive, the power grip or precision grip

A

• the power grip is Most primitive (present in new born babies
- precision grips take longer to be able to perform as they are more complicated as they require a combination of movements - it develops at around 9 months

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14
Q

what power grip is the thumb not involved in

A

• Thumb isn’t aways involved when you are carrying the handle of a bag this is called a hook grip

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15
Q

describe the precision grip

A
  • Object held between tip of thumb and 1,2, or 3 fingers
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16
Q

what re the muscles that are involved in the precision grip

A
  • Intrinsic muscles involved, co-operate with long flexors and extensor muscles
  • Flexions and extension – combination of movements, therefore it takes time to develop and be able to perform these types of movements
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17
Q

what grip is non prehensile

A

Hook grip is non prehensile whereas every other movement is prehensile

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18
Q

the radial nerve is the ..

A
  • This is the biggest terminal branch of the brachia’s plexus
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19
Q

what does the radial nerve innervate

A
  • It innervates all the extensor muscles of the upper limb

- It also innervates anything in the posterior compartment

20
Q

where does the radial nerve run

A
  • Runs between the medial and lateral head of triceps, it runs between the insertion points next to the humerus this is the spiral group – this is also the radial group
  • It then goes into the anterior part of the elbow and back into the posterior part of the forearm
21
Q

what is another word for spiral group

A

radial group

22
Q

what is the most common cause of radial nerve damage

A
  • Most common region where the radial nerve gets injured is a midshaft humerus fracture – goes along the point where the radial nerve goes along the bone
23
Q

what is a clinical presentation of radial nerve damage

A

wrist drop

24
Q

what is cause of wrist drop

A
  • compression or damage to the radial nerve
    • No extension of wrist and digits - unopposed action of FDS and FDP
    • Only weak flexion at DIP joint from intrinsic muscles of hand
    • Sometimes they can extend the elbow, depends on where the radial nerve comes up the triceps – may not completely lose extension of the elbow
  • not able to form a power grip as this needs an extended grip
25
Q

what is the cause of Saturday nigh palsy

A
  • Radial nerve in armpit or upper arm is compressed or stretched
  • Usually as a result of falling asleep with arm hanging\
  • This can give you wrist drop
26
Q

is Saturday nigh palsy permanent or not

A

• This is not permenanet and will once the compression has eased and the blood supply is better it will regrow and sensory innervtion will come back

27
Q

what is the cause of radial nerve palsy in newborns

A
  • Secondary to prolonged pressure on inferior arm by pelvic brim
  • Wrist drop
  • Inability to extend thumb and MCP of all digits
  • Weak extension of the elbow
28
Q

when is radial nerve palsy in newborns reversed

A
  • After about 2 weeks to 2 months they gain back innervation again
29
Q

what does the median nerve innervate

A
  • Innervates the antieror plexus and goes to the thenar muscles at the base of the thumb
30
Q

where does the median nerve run

A
  • This is in the anterior compartment
  • Doesn’t do anything in the arm
  • Runs with brachial artery
  • Goes into the forearm
31
Q

where can you injure the median nerve

A
  • Can injure it at the elbow where it becomes superficial – supercondyle fracture to the humerus, humerus and proximal region has moved into the humerus – stretch or lacterate the medial nerve high
  • Everything distal to that point is lost
32
Q

what happens if you have high median nerve damage

A
  • Loss of flexion of MCP digits 2-3
  • Loss of flexion of PIP in digits 1-3
  • Loss of DIP flexion digits 2-3
  • Weak PIP flexion of digits 4-5
  • Can flex DIP of digits 4-5
  • Because ulnar nerve innervates medial FDP and FCU – can still flex fingers 4 and 5 – little finger and ring finger
33
Q

what is the hand caused when it has damage to the median nerve

A

hand of benediction

34
Q

how can you test for damage to the median nerve

A
  • ask the patient to make a fist
  • then you can see which area of the hand is being effected
  • then you get the hand of benedicition – thumb index finger and middle finger do not move
35
Q

what causes low median nerve damage

A

carpal tunnel syndrome

36
Q

how symptoms are caused with low median nerve damage

A
  • progressive loss of co-ordination and strength in thumb
  • causes compression to the median nerve all the long flexor muscles can still work,
  • can make a thirst but the thumb doesn’t work very much, loose ability to oppose the thumb
37
Q

what is the most common site of nerve lesions to the upper limb

A

– medial epicondyle of humerus therefore it effects the ulnar nerve

38
Q

what does damage to the ulnar nerve cause

A

claw hand

39
Q

what muscles are effected in the ulnar nerve damage

A 
–	flexor carpi ulnaris, 
–	medial half of FDP, 
–	medial two lumbricals, 
–	all interossei (palmar and dorsal)
–	adductor pollicis
40
Q

what does the ulnar nerve innervate in the hand

A

– all the instrinsic muscles of the hand except the thenar muscles innervated by the ulnar nerve

41
Q

what is more severe in an ulnar nerve injury a high lesion or low lesion

A

low lesion

42
Q

describe what happens with a high lesion in an ulnar nerve injury

A

both intrinsic hand and FDP weak so clawing milder

43
Q

describe what happens with a low lesion in an ulnar nerve injury

A

only intrinsic muscles weak means clawing is more severe

44
Q

what happens in cubital tunnel syndrome

A
  • Cubital tunnel syndrome – high all muscle lost
45
Q

what happens in guyot’s anal syndrome

A
  • Guyon’s anal syndrome – low – FDP pulls digit 4 and 5 in flexion
46
Q

what are the presentations of ulnar nerve lesions

A
  • Muscle atrophy of the intrsic muscles of hand
  • Most obvious in 1st dorsal interosseus web, thenar not effected
  • Even in long term the thenar muscle is still there
  • Loose intrinsic muscles for precisois grip
  • Muscle atrophy of FCU and medial FDP
47
Q

how do you test motor control of the hand

A
  • Test extension and the power of exntesion in the wrist
  • Median nerver – making a this and what the thumb does – opposition and flexion of the thumb
  • Ulnar – abduction and adduction – ask them to hold a piece of paper between two fingers or ask them to spread fingers apparat and resist you pushing them in

Locomotor (22 decks)

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