Scapular neuropathies Flashcards
long thoracic neve: mm palsy, physical weakness, scapular po
mm palsy- Serrates ant
wekaness- arm flex, wall push uo
po- Displaced med and sup
Spinal accessory- mm palsy, weakness, scapular pos
Traps
weak- Arm abduction, ext rot
Scap sup angle more laterally displaced
Dorsal scap- mm palsy, physical exam weakness, scapular pos
rhomboids
weak scapular retraction/elevation
Inf angle more lat displaced
Conservative therapy of scapular overall
advise to avoid- overhead activity, activities that cause pain, not to stretch serrates ant
ROM exercises in supine pos
Potential brance
avg spontaneous recovery of scapular probs
6-24m spontaneous recovery
stretch induced neuropraxia happens when
Nerve can tolerate 10% increase in resting length, after this stretch induced neuropraxia develops
what are some sig injury sites for axillary n
injury to quadrangular space
dislocation causing injury to axillary nerve
what does axillary n innervate and palsy
Inn- deltoid, terres minor
palsy- weakness of shoulder abduction
weak ext rot
mechanism of quadrangular space syndrom
repeated overhead activity
what is the mc complication of humerus fx
axillary nerve injury
how long is the average
often full recovery in 7 m
inn of dorsal scapular nerve
rhomboids and lev scap
sites of injury or entrapment of dorsal cap nerve (3)
- Entrapped within the scalenus medius mm
- Medial scapular border
- Toxic injuryy during brachial plexus block
pain distribution oin dorsal scapular nerve injury
Over medial border of scapular, intrascap pain, shoulder and arm pain
Clinical features of dorsal scapular never injury
- weakness of arm abduction
- medial scapular winging
- possible atrophy
- aggravation w ipsilateral flex and extension
Common mechanism for supra scapular neuropathy
shoulder compression injuries (carrying material on shoulder, backpack etc)
weakness of suprascap nerve palsy
Wasting of supra/infra spinatus (c5,6)
signs of suprascap n injiry
pt will have a common progressive dull burning arching pain in peter-lateral shoulder
weakness in external rot and or abduction
exam findings in suprascap n injury
- Weak resisted external rot
- observed atrophy
- pain at AC jt
- palpation tenderness at the psterosuperior scapular
conservative tx for suprascap compression/dysfunction
- pain and inflammation management
- pos of relief, avoid re injury
- therapy for rotator cuff, scapular mobs and strengthening
- conservatibe for up to 12m
What is erbs palsy an injury of
axillary nerve
musculocutaneous nerve
suprascap nerve
C5/6roots
presentation of erbs palsy
forward rotated shoulder
upper arm redness
waiter tip deformits
horner syndrome
What is Klumpke palsy
injury and partial palsy of the lower roots of the brachial plexus (c8/t1)
Palsy of hand, shoulder and arm mm
Presentation of klumpke palsy
Severe limb atrophy
claw like hand
