PBL 16: Soft Tissue Flashcards
Soft Tissue Injuries
Skin
Subcutaneous fat
Muscles
Tendons
Ligaments
Types of STI
Most can occur due to inflammatory conditions, trauma or overuse
Mechanism of STI
Direct injury
Long term wear and tear
Repetitive strain injury
Shoulder ACJ dislocation
Shoulder dislocation
Shoulder rotator cuff tear
Long head of biceps tear
Elbow dislocation
Distal biceps tendon tear
Knee ACL tear
Knee collateral ligaments and meniscus
Quadriceps tendon
Patella tendon
Whiplash - injury to the ligaments of the neck
Low back pain
Myofascial pain
Tendinopathy - pain arising from strain or injury to tendons
Tenosynovitis - inflammation of the synovial lining of the tendon sheath
Assessment of STI
History
Examination
Investigations - X-rays, Ultrasound scan, CT scan (to investigate associated fracture) , MRI scan
Treatment - Analgesia, RICE (rest ice compression elevation) Immobilise (using splints), Physiotherapy, Surgical repair, education and information
In some cases local steroid injections can also be used as this will help reduce inflammation - especially helpful in cases caused by an inflammatory condition. NSAIDs can also be useful in this case.
The management of STI depends on:
Mechanism of injury
Site of injury
Extent and depth of wounds
Types of tissue involved including nerves and blood vessels
Extent of tissue devitalisation
Any contamination
Possibility of retained foreign bodies
Acromioclavicular joint dislocation
On x-ray - clavical bone moves superiorly - ligaments rupture/ break so dislocation occurs
Pain in shoulder and see in deformity - See x-ray look at bone and bones around it
Mechanism of injury
Deformity
Sling for 6 weeks
Physiotherapy
Surgery in severe cases
Education - risks and benefits of each types of treatment
Distal Biceps Rupture
Biceps origin is at shoulder at socket and coricord tip and inserts into radial tuberosity
Hook test - finger on lateral edge of tendon and pull
MRI / ultrasound
Sling and physio
Surgical reconstruction
Education - explain risks and benefits - if not reconstructed loses 30-40% of supination power
ACL Injury
Dynamic knee valgus ruptures ACL
Anterior draw test about a week old injury
Lachman’s test - can you slide tibia anterior to the femur
MRI if doubt
Patient factors - age, activity, job
Usually conservative treatment in brace and physiotherapy
Surgical reconstruction
Education
Tendo achilles rupture
Injury history, previous heel pain
Examination
Ultrasound / MRI
Patient characteristics
If tendon has more force pushed through than possible it ruptures
Tear can be partial or complete
Calf squeeze test / Thomson calf squeeze test shows plantar flexion unless achilles is ruptured
Boot for 3 months
Surgical reconstruction - high performance patients
Push off strength only slightly better if surgically reconstructed
Education
Discuss the basic epidemiology, presentation, investigation, management and prognosis of fibromyalgia
What is fibromyalgia?
Fibromyalgia is a long-term condition that causes pain and tenderness all over your body.
Thought to be caused by nervous system in your brain and spine not being able to control or process pain signals from other parts of your body. (Pathophysiology is poorly understood)
Epidemiology
Prevalence in the UK 2-5%
Can occur at any age but it increases in prevalence with age and peaks at 7% in women 70+
Common in women
Risk factors include:
unresolved psychosocial distress e.g. previous abuse, marital disharmony, alcoholism /illness in family
poor sleep
previous injury/assault
Presentation
Generalised pain and tenderness all over the body, particularly affects the trunk, back and neck.
Significant finding on examination is the presence of soft-tissue tenderness
Investigation
Difficult to diagnose (role of investigations is in the exclusion of other condition)
Management
Education
Physiotherapy
CBT
Drug therapy (e.g. amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
Prognosis
You should expect to manage fibromyalgia symptoms for a long time — maybe for the rest of your life. Some people with fibromyalgia experience fewer flare-ups with milder symptoms after they find treatments that work for them.
Discuss the basic epidemiology, presentation, investigation, management and prognosis of chronic fatigue
Epidemiology
Its global prevalence, ranging between 0.4% and 2.5%
observed in 20–40 year olds
Most common in active women
Presentation
debilitating fatigue with associated myalgias
tender lymph nodes
Arthralgias
Chills
Deverish feelings
Investigation
FBC
ESR
CRP
Can’t really tell from any tests but its diagnosed by elimination
Management
Balanced diet
Medication (antidepressents)
Physical activity
Naps
Prognosis
5% of people recover
Discuss the basic epidemiology, presentation, investigation, management, and prognosis of bursitis
Overview
· Condition around that makes area around a joint or bone painful, red, swollen due to inflammation of bursa
· Affects both adult + children
· Commonly affects feet, shoulders, elbows, knees, hips
o Can affect around any joint + stop individual from being able to move that part of the body properly
· Can be idiopathic, part of systemic inflammatory disease, due to injury, infection, gout
· Common types: olecranon bursitis, prepatellar bursitis, trochanteric bursitis
· Bursa => small sacs of fibrous tissue that line up with synovial membrane + secrete synovial fluid
o Reduce friction where ligaments + tendons pass over bone
Epidemiology
· Mainly caused by friction or pressure applied to bursa
Examples
· Olecranon Bursitis:
o Caused by excessive friction at the elbow
o Infection can also occur which causes there to be pain on elbow flexion
o On examination, bursa is swollen + tender
o Only aspirate bursal fluid in cases of sepsis to guide antibiotic treatment
- Do not routinely aspirate as patient may develop chronic sinus which takes couple months to settle down
o Local corticosteroid injection can help in non-septic cases
o Anti-inflammatory medication is preferable in most cases
· Prepatellar/Infrapatellar Bursitis (Housemaid’s Knee):
o Common in people who spend a lot of time kneeling + putting pressure on their knees
o Hot, red swelling develops over the prepatellar bursitis (front of patella) or infrapatellar bursitis (patella tendon)
o Pain when knee is in active extension
o Aspirate fluid to exclude infection + gout
o Treatment includes rest
o Recurrent episodes may need surgical excision of bursa
o Antibiotic therapy should be given in cases of sepsis present
· Trochanteric Bursitis:
o Located lateral to greater trochanter of femurs + allows movement of fascia lata (deep fascia of thigh) over trochanter
o Inflamed bursa causes pain over affected trochanter which is exacerbated by movement
o Patients may complain of hip pain
o Treatment includes physiotherapy and steroid injections used in more severe cases
o Persistent trochanteric bursitis may require surgery
Presentation
· Areas close to joint/directly over bone:
o Red/swollen
o Hot/sore
o Painful (dull ache)
o Sensitive + painful if you press/ move it
o Stiffness
· Acute bursitis:
o Tenderness, pain when muscles adjacent to inflamed bursa work
· Chronic Bursitis:
o Swelling with minimal pain
Investigation
· Examine affected area
o Clinician may question about recent injuries, history of joint problems, individual’s job
· Ultrasound to confirm diagnosis
o Helps to differentiate from Baker’s cyst
· If bursitis due to an infection, aspiration may be recommended to be tested in lab to determine what infection it is + best way to treat
· Can also be referred to physiotherapist for an assessment
Management
· NSAIDs/painkillers to treat pain + inflammation
· Refer to physiotherapist who can assess the patient’s condition + provide exercises to treat specific problem
· Aspiration helps relieve some pressure in bursa which helps reduce the pain felt
o Steroid may be injected after aspiration to help reduce swelling
· If bursitis thought to be caused by an infection, doctors will prescribe antibiotics
· If chronic/ recurrent bursitis, patient may be referred for intravenous antibiotics/ surgery excision at a hospital
· Ice packs => can be applied on swollen areas
· Padding => If bursitis is around knee, thick foam cushion/ knee pads can help reduce pressure to make knees less painful
· Footwear => Comfortable, properly fitted shoes helps to relieve pressure on swollen bursae in feet
Prognosis
· Bursitis can be treated but can come back
o Prevention:
-Manage weight => if overweight, causes more pressure to be put on bursa
-Clean cut properly to prevent infection
-Use padded foam cushions to reduce pressure on joints
-Wear properly fitting shoes + use insoles
- Take regular breaks from activity that put bursa under pressure
Discuss the basic epidemiology, presentation, investigation, management, and prognosis of Carpal Tunnel Syndrome
Overview
· Due to compression of median nerve as it passes through the carpal tunnel in the wrist
· Most common upper limb mononeuropathy
· Common and usually presents with paraesthesia and/or sensory loss of first three fingers (thumb, index, middle) and lateral half of fourth finger (ring)
· Can progress to loss of motor function with hand weakness, wasting of thenar eminence, weakness in thumb abduction
Epidemiology
· Common in adults
· Estimated 3:1 female to male ratio
· Bilateral involvement is commonly involved
o Usually worse in dominant hand
Aetiology
· Due to compression of median nerve as it passes through carpal tunnel in the wrist
· Compression usually due to anatomic compression + inflammation
Risk Factors
· Vast majority are idiopathic – typically female age 35-55
· Traumatic (post wrist fracture/lunate dislocation)
· Diabetes mellitus
· Pregnancy (common)
· Hypothyroid (rare)
· Osteoarthritis
· Rheumatoid Arthritis (synovitis)
· Chronic Renal Failure
· Repetitive strain injury
· Spare occupying lesion (ganglion, tumour)
Presentation
· Usually, gradual onset of symptoms
· Initially symptoms are intermittent and worsen during the night
· CTS causes sensory symptoms in distribution of palmar digital cutaneous branch of median nerve which affects palmar aspects + full fingertips of the thumb, index, middle and lateral half of ring finger
· Sensory symptoms: numbness, paraesthesia (pins and needles/tingling), burning sensation, pain
· Motor symptoms of CTS affect thenar muscles:
o Weakness of thumb movements
o Weakness of grip strength
o Difficulty with fine movements involving the thumb
o Wasting of thenar muscles (muscle atrophy)
Investigation
· Nerve Conduction Studies:
o Primary investigation for establishing diagnosis
o Small electrical current applied by electrode to median nerve on one side of carpal tunnel
o Recording electrodes, on other side of carpal tunnel, over the median nerve record the electrical current that reaches them
o Demonstrates how well signals are passing through carpal tunnel along the median nerve
· Special Tests:
o Phalen’s Test => flex wrist + hold there for at least 30 seconds
-Positive result => position triggers sensory symptoms of carpal tunnel with numbness + paraesthesia in the median nerve distribution
o Tinel’s Test => percuss distal to proximal along course of median nerve
- Positive result => sensory symptoms of CTS triggered with numbness + paraesthesia in median nerve distribution
o Durkin’s compression test => flex wrist + put pressure on carpal tunnel
Management
· Resting
· Wrist splints that maintain a neutral position – can be worn at night for minimum of 4 weeks
· Steroid injections
· Surgery
o Performed by open (vertical incision in wrist) or endoscopic (keyhole) surgery
o Flexor retinaculum (transverse carpal ligament) is cut to release pressure on the median nerve
Prognosis
· After post-carpal tunnel release surgery:
o 50% full recovery
o 30% much better
o 10% slightly better
o 6% worse
Discuss the origin and propagation of an action potential and how electrical impulses are transmitted.
Resting membrane potential
Dynamic when at equilibrium
Sodium ATPase Pump: 2K+ into cell, 3Na+ out of cell.
More Na outside cell
More K inside cell
More Ca2+ outside cell
More chloride outside cell
resting potential at -70mv
Stimulus opens some voltage gated Na+ channels
All or nothing threshold reached at -55mv
Depolarisation
More VG Na+ channels open, Na flows into cell
VG Na+ channels close, VG K+ channels open and K flows out of cell
Repolarisation
Hyperpolarisation - refractory period occurs here
Back to resting membrane potential
Describe synaptic transmission in the somatic and autonomic nervous systems
The Somatic Nervous System:
Voluntary Control
Sensory and motor supply to skin, muscles and joints
Common neurotransmitter: acetylcholine
The Autonomic Nervous System:
Involuntary Control
Smooth muscle, glands and specialised effector cells e.g. pacemaker cells in heart
E.g. heart rate, blood pressure
Split into sympathetic and parasympathetic nervous system
Sympathetic Nervous System
Flight or Fight
Activated during exercise or in stressful situations that are a threat to survival
Increases energy expenditure and inhibits digestion
Actions:
↑ heart rate
Dilation of pupils
Inhibits salivation and peristalsis
Increased glucose production
Parasympathetic Nervous System
Rest and digest
Neurons involved in this system are the “cranial nerves” but only III, VII, IX, and X
Actions:
Decrease in heart rate
Constriction of pupils
Stimulates saliva flow and peristalsis
Stimulates bile release instead of glucose
Synapses:
Chemical or Electrical
Electrical Synapses
Formed by gap junctions, made up of one connexon from each connecting cell
Gap junctions allow the flow of ions and small molecules between cytoplasm of connecting cells
Allow rapid and bi-directional flow of currents between adjacent neurons
Predominantly found in cardiac and smooth muscle
Chemical Synapses
Unidirectional
E.g. the synapse between the end of the motor neurone and the muscle
Between neurons, the synapse is a junction between the terminal bouton of the axon of one neuron and the target cell
A synaptic cleft separates the presynaptic membrane of the terminal bouton and postsynaptic membrane of the target cell
Presynaptic terminal has synaptic vesicles, which contain the chemical neurotransmitter, and its membrane has an active zone where synaptic vesicles can dock and release the transmitter
Postsynaptic membrane has a postsynaptic density packed with receptors that can bind the transmitter
Synaptic Transmission At Neuromuscular Junctions (Neurotransmission):
The action potential arrives at the presynaptic terminal and triggers voltage-gated calcium channels in the presynaptic terminal
Ca2+ enters the cell and triggers the release of the neurotransmitter (Acetylcholine) from a synaptic vesicle into the synaptic cleft
The transmitter diffuses across the synaptic cleft and binds to its receptors on the postsynaptic membrane (Nicotinic Acetylcholine receptor - ligand gated ion channel)
Binding of the transmitter and receptors alters the conductance of the postsynaptic cells, allowing ions (mainly Na+) to rush in and producing a postsynaptic potential
A muscle action potential is propagated over the muscle cell membrane (sarcolemma) and down through the transverse tubules to the inner aspects of the muscle fibre
The transmitter is transported back into the neuron
The synaptic vesicle is recycled and reloaded with the transmitter
Describe the cardiovascular and respiratory changes that occur during exercise
Respiratory system during exercise
To meet the increased oxygen demand
Increase in ventilation rate
Increased in tidal volume
VO2(Max)
Increases in exercise past VO2max result in increased lactic acid accumulation
Training can increase VO2max
Age
Decreases after 25
Sex
Lower for females
Activity
Improves with activity
Control of Cardiac Output
Stroke volume
The amount of blood expelled by the heart in each beat
CVS: Central venous pressure changes diastolic filling pressure, more blood available to fill heart
TPR: Total peripheral resistance changes ability to expel blood into arterial system
Benefits of exercise and reducing Cardiovascular Disease risk
Reduced blood pressure
Increased circulating HDL and reduced Triglycerides
Changes in arterial wall homeostasis reducing atherosclerotic disease
Improved aortic valve function and reduction in calcification
Increased ventricular chamber wall thickness
Increased red cells (to a point)
Changes in cardiac vasculature to increase oxygen availability
Remodelling of the heart retains contractile function in exercise, unlike pathological remodelling which does not.
Discuss how the structure of muscle relates to its function
There are 3 types of muscle within the body: Skeletal (striated), smooth and cardiac.
Cardiac muscle is all connected, so that it all contracts together for a beat.
Smooth muscle- peristalsis. This is a series of wave-like contractions. This is used in the GI system to help force food down. Also used within arteries to push blood through.
Skeletal Muscle:
Most abundant of the three
Provides force for movement (primary function)
Under voluntary control of the nervous system
Major storage for water (80% of the body’s water), glucose and intracellular ions such as potassium
It converts chemical energy to mechanical and in the process produces heat- aiding thermoregulation process
Strength is mainly determined by size
Cross sectional area of fibres in a muscle is proportional to the strength that can be generated
Long fibres good for rapid movement
Short fibres good for large forces
Structure:
Tendon
Epimysium- muscle
Perimysium- fascicle
Endomysium- fibre
Type I, IIa, IIb
Slow twitch (Type 1):
Oxidative
Red
Prolonged endurance activity
Fast twitch Type 2a:
Red
Either endurance or rapid force production
Quickly fatigue
An intermediate fiber
Fast twitch type 2b: (Can be seen as 2x)
White
Rapid force production
Quickly fatigue
Type 1 fibres are more predominant in people mainly partaking in aerobic activities, type IIb in anaerobic activities, and IIa in activities where both aspects are required.
More powerful contractions come from type IIb fibres, as they respire anaerobically- inefficient but produces energy very quickly. They are white in colour due to a lack of myoglobin. They have a lower mitochondria count as they don’t require oxygen primarily for their contractions. High number of fibres in a motor unit. Very abundant in powerlifters.
Type I fibres are high in myoglobin and mitochondria to maximise oxygen to the fibres, due to respiring aerobically. There are less fibres to a motor unit to allow for resting and more deliberate, precise actions, with less power. These types of fibres are very abundant in a marathon runner.
Type IIa are effectively in between each of these for all aspects. By athletic training, they can be modified to work as type I or type IIx. These kind of fibres would be very abundant in footballers.
So, depending on what fibres a muscle is predominantly made of will contribute to the function.
Describe the muscles involved and differentiate their role in movement of the shoulder girdle as opposed to the shoulder joint
Shoulder girdle:
3 bones:
scapula
clavicle
humerus
4 articulations::
Sternoclavicular
Acromioclavicular
Glenohumeral
Scapulothoracic (The scapulothoracic joint is not a true anatomical joint but is rather considered as a unit that gathers the sternoclavicular and acromioclavicular (AC) joints )
Role: attaches the upper limbs to axial skeleton and provides a wide range of arm movement
Shoulder joint:
Glenohumeral joint
Ball and socket synovial joint between scapula and humerus
Between head of humerus and glenoid fossa
Head of humerus is a lot bigger than the glenoid fossa so only 1/3 - 1/2 of the humeral head is in contact with the glenoid fossa at one time
The muscles of the shoulder which support and produce movements of the shoulder girdle
2 groups:
Anterior axio-appendicular muscles (pectoral muscles)
Posterior axio-appendicular muscles
Extrinsic muscles
Superficial muscles
Deep muscles
Intrinsic muscles
Anterior axio-appendicular muscles
Pectoralis major:
Origin:
Clavicular head: anterior medial clavicle
Sternocostal: sternum
Abdominal: anterior rectus sheath
Insertion: crest of greater tubercle of humerus
Innervation: lateral + medial pectoral nerves
Function: arm adduction, arm internal rotation, arm flexion, arm extension and draws scapula anteroinferiorally
- Pectoralis minor:
Origin: superficial anterior costal cartilages of ribs 3-5
Insertion: medial border and coracoid process of scapula
Innervation: medial and lateral pectoral nerves
Function: draws scapula anteroinferiorally and anchors it to the thoracic cage - Subclavius
Origin: sternal end of rib 1
Insertion: Anteroinferior surface of the middle part of clavicle
Innervation: subclavian nerve
Function: depressed and holds clavicle in position - Serratus anterior
Origin: ribs 1- 8/9/10 (superior, middle and inferior part)
Insertion: anterior scapula
Innervation: long thoracic nerve
Function: draw scapula anterolaterally, suspend scapula and rotate scapulaPosterior axio-appendicular muscles:
Extrinsic muscles:
Superficial:
Trapezius (large triangular muscle on the posterior neck and thorax)
Origin:
Descending part (superior fibres) : middle third of superior nuchal line
Transverse part (middle fibres): spinous processes of vertebrae T1-T4
Ascending part: spinous processes of vertebrae T5-T12
Insertion:
Descending part: lateral third of clavicle
Transverse part: medial aspect of the acromion and to the superior crest of spine of scapula.
Ascending part: medial end of spine of scapula.
Innervation: spinal accessory nerve
Function:
Descending part: draws scapula superomedially, rotates head
Transverse part: draws scapula medially
Ascending part: draws scapula inferomedially
- Latissimus dorsi:
Origin:
Vertebral part: spinous processes of vertebrae T7-S1 and the thoracolumbar fascia.
Iliac part: posterior third of the crest of the ilium, a part of the bony pelvis.
Costal part: ribs 9-12
Scapular part: inferior angle of scapula
Insertion: inter tubercular sulcus of humerus between pectorals major and teres major
Innervation: thoracodorsal nerve
Function: arm adduction, internal rotation, extension, respiration
Deep:
- Levator scapulae:
Origin: transverse processes of the vertebrae C1-C4
Insertion: medial border of the scapula
Innervation: anterior rami of spinal nerves and dorsal scapular nerve
Function: elevate and retract the shoulder girdle at the scapulothoracic joint - Rhomboid muscles:
Origin:
Rhomboid minor: nuchal ligament and the spinous processes of the vertebrae C7-T1
Rhomboid major: spinous processes of T2-T5 vertebrae
Insertion:
Rhomboid minor: root of the spine of scapula
Rhomboid major: medial border of the scapula from inferior angle to root of spine of scapula.
Innervation: dorsal scapular nerve
Function: Scapulothoracic joint: Draws scapula superomedially, Rotates glenoid cavity inferiorly; Supports position of scapula
Intrinsic muscles:
Deltoid muscle - triangular, spans clavicle, acromion, spine of scapula + surround the glenohumeral joint on all sides
Origin:
Acromial part (middle fibres): acromion
Clavicular part (anterior fibres): lateral third of clavicle
Scapula spinal part (posterior fibres): spine of scapula
Insertion: deltoid tuberosity of humerus
Innervation: axillary nerve
Function:
Acromial part: abducts arm
Clavicular part: stabilisation, flexion and internal rotation of arm
Scapula spinal part: stabilisation, extension and external rotation of arm
- Teres major:
Origin: inferior angle and lower lateral border of scapula
Insertion: intertubercular sulcus of humerus
Innervation: lower subscapula nerve
(Rotator cuff muscles) - 4 muscles which enclose the glenohumeral joint by forming the cuff around it supraspinatus, infraspinatus, teres minor, subscapularis
- Supraspinatus:
Origin: supraspinatus fossa of scapula
Insertion: greater tubercle of humerus
Innervation: suprascapular nerve
Function: internal rotation of the arm and abduction of the arm - Infraspinatus
Origin: infraspinatus fossa of scapula
Insertion: greater tubercle of humerus
Innervation: suprascapular nerve
Function: external rotation of arm - Teres minor:
Origin: lateral border of scapula
Insertion: greater tubercle of humerus
Innervation: axillary nerve
Function: external rotation an adduction of arm - Subscapularis muscle
Origin: Subscapula fossa
Insertion: lesser tubercle of humerus
Innervation: upper and lower subscapular nerve
Describe the course and relations of the main nerves of the upper limb and the loss of cutaneous and motor function that would occur should the median, ulnar, musculocutaneous, radial and axillary nerves be damaged at various levels within the upper limb
The musculocutaneous nerve innervates the brachialis, the biceps and the coracobrachialis muscle and is a branch of the brachial plexus and originates from the C5,6 and 7 nerve roots
It travels through the coracobrachialis and between the biceps and brachialis, then travels past the elbow to innervate the skin of the lateral forearm, the biceps and brachialis both flex the arm at the elbow joint. The coraco brachialis muscle can be used for either flexion or adduction of the shoulder joint.
Damage to the musculocutaneous nerve can cause sensory loss where it innervates the lateral forearm as well as weakness in arm flexion. The most common cause of injury to the musculocutaneous nerve is damage to the brachial plexus, however it can occasionally by
Median nerve originates from the C6,7,8 and T1 roots of the spine, turning into the lateral and medial cords of the brachial plexus and innervates the anterior forearm muscles and the lumbricals of the index and middle fingers in addition to the thenar eminence muscles which control the thumb.
The median nerve also innervates the anterior thumb, index, middle and half of ring finger + the distal joints on the posterior side.
The nerve can become damaged at the elbow via a fracture of the humerus and the patient will usually present with loss of flexion in the thumb, index and middle finger, this is called the hand of benediction.
If the nerve is damaged at the wrist this is usually due to carpal tunnel syndrome which is where the nerve can be pinched or compressed by as it travels under the transverse carpal ligament at the wrist and this can cause symptoms of pain numbess and tingling in the (3.5) fingers (innervated by the nerve) or arm. If only the branch of median nerve that innervates the thumb is affected, this will mean the thumb cannot oppose or move properly and the muscle will waste, this is called ape hand. The lumbricles of the index and middle finger will also be affected meaning the patient cannot fully extend their fingers.
ULNAR NERVE
The ulnar nerve innervates the anterior muscles for the 5th and ring finger as well as most of the intrinsic hand muscles apart from the thenar eminence and lumbricals on the other 3 fingers.
It provides aT sensory supply for the 5th finger and ½ the ring finger on the anterior and posterior side.
There is a superficial and deep branch of the ulnar nerve, the superficial supplies sensation to skin and the deep innervates muscles.
If thye ulnar nerve becomes compressed at the elbow, this is called cubital tunnel syndrome where the nerve is compressed which can be caused by overuse. Usual symptoms are numbness or tingling in the ring and smallest finger, clumsiness and weak grip, general hand pain or elbow pain. It will also mean the thumb cannot adduct and the fingers cannot abduct or adduct. As the nerve goes over the elbow, you can bang it and this creates the tingling symptoms, aka banging your funny bone.
Opposite to the median nerve, the lumbricals of the ring and 5th finger will be paralysed and this the patient will not be able to extend those fingers properly.
If the nerve becomes compressed at the wrist will have similar symptoms as compression at elbow however it usually has a different caused such as cycling or doing pushups.
RADIAL NERVE
Originates from the posterior cord of the brachial plexus and C5-T1 nerve roots.
It branches into the deep branch and superficial branch in the forearm where the deep branch innervates the posterior muscles of the forearm and the superficial is for skin sensation.
The radial nerve is the extensor nerve for the entire posterior arm including the tricep and finger extensor muscles, moreover it provides sensory function to the medial posterior hand up to the 3 + ½ finger reaching up the posterior arm to the tricep.
Radial nerve injury can cause finger drop where either due to weakness or paralysis the fingers cannot be properly extended, if the damage is very high up the nerve the patient can also experience paralysis of the triceps and can experience sensory loss of the posterior forearm and hand.
Axillary
THe axillary nerve originates from the C5-6 fibres of the spine and the posterior cord of the posterior division of the brachial plexus. It innervates the deltoid muscle as well as the teres minor muscle which is part of the rotator cuff. It also provides sensation to the lateral shoulder.
If the nerve becomes damaged or compressed eg if the nerve is compressed in the quadrangular space can present with vague shoulder pain and weakness of the teres minor or deltoid muscles.
It has a posterior and anterior branch, the anterior wraps around the neck of humorous which innervates the deltoid muscle. The posterior branch supplies the teres minor muscle and posterior deltoid and ends supplying sensation to the lateral shoulder.
