Upper Limb Anatomy Clinical stuff

Question 1

Erb’s Palsy

Answer 1

Damage to C5-6

Increased angle between neck and shoulder

Leads to weakened shoulder abduction and flexion, arm hanging by side of body, medial rotation of the arm, pronated forearm and flexed wrist

Presents as Waiter’s Tip

Question 2

Klumpke’s Palsy

Answer 2

Damage to C8-T1 (a component of the ulnar, radial and median nerves)

Caused by excessive abduction of arm, or pancoast tumour

Weakened intrinsic hand muscles, loss of medial arm sensation

Presents as a claw hand

Memory: Klumpke has a “L” in it = Lower root dage

Question 3

Musculocutaneous nerve damage

Answer 3

Loss of sensation in arm and lateral forearm

Loss of movement: elbow flexion

Question 4

Axillary nerve damage

Answer 4

Loss of sensation to the shoulder region - “regimental patch”

Loss of movement: abduction from 15-90°

Injury to the surgical neck of the humerus

Question 5

Median nerve damage

Answer 5

Loss of sensation to the lateral 3.5 fingers (thumb side)

Loss of movement: wrist flexion, lateral finger metacarpophalangeal flexion and interphalangeal extension (lumbricals) and thenar eminence muscles

Memory tools

TH(enar) = TH(umb)

The median nerve innervates the LOAF muscles in the hand:

Lateral lumbricals

Opponens pollicis

Abductor pollicis

Flexor pollicis

Question 6

Carpal Tunnel syndrome

Answer 6

Tendonitis of the flexor retinaculum, lunate dislocation (FOOSH)

Affects thenar eminence: numbness, tingling/sensory loss, atrophy of the thenar eminence

Is a median nerve damage problem. Is a proxmal lesion

Question 7

Distal lesion to the median nerve

Answer 7

Presents with hand of benediction, patient can’t make a fist if you ask them to. The lateral lumbricals and thumb stay extended

May be caused by supracondylar fracture of the humerus

Question 8

Radial nerve damage

Answer 8

Loss of sensation to the posterior arm and forearm, below the fingertips of the medial 3.5 fingers on the back of the hand (dorsal)

Loss of motor: elbow and wrist extension

Injury to the body of the humerus (as this runs in the radial groove)

Damage leads to wrist drop (inability to extend wrist and fingers)

Can be caused by Saturday night palsy

Compression of nerve in the axilla

Present with wrist drop (loss of the extensors for the wrist)

Question 9

Ulnar nerve damage

Answer 9

Loss of sensation to medial 1.5 fingers and medial forearm

Loss of motor: wrist flexion (the medial side), hypothenar eminence, medial finger metacarpophalangeal flexion and interphalangeal extension (lumbricals) and finger abduction and adduction (interossei)

Proximal damage leads to ulnar claw hand (e.g medial epicondyle fracture)

Patient can’t make a open their hand fully if you ask them to. The medial digits (4th and 5th fingers) cannot be extended. Differs from hand of benediction in that the patient can flex their thumb

Distal damage (e.g hook of hamate fracture/Guyton compression)

Clawing with no change in ability of fingers to flex

Question 10

The innervation from the different branches of the BP

Answer 10

below

Question 11

Clavicle fractures

Answer 11

Most commonly at the lateral third of the clavicle

May impact subclavian artery/vein

May be caused by a FOOSH

Question 12

Scapular fractures

Answer 12

Rare, may be caused by high energy trauma

May affect suprascapular nerve (needed for abduction and external rotation)

Question 13

Humerus fractures

Answer 13

Surgical:

Axillary nerve

Circumflex artery

Mid shaft:

Radial nerve

Deep brachial artery

Question 14

Fractures of the Ulnar and radius

• Colles
• monteggia
• Galeazzi
• Smiths

Answer 14

Colles fracture (Also known as a dinner fork deformity)

• May result from falling with the wrist in extension (FOOSH)
• Fracture of radius distally, with distal radial fragment moving dorsally

Monteggia fracture

• Fracture of the ulnar bone with dislocation of the radial head (the fractured ulnar bone is what pushes the radial head out)

Galeazzi fracture

• Fracture of distal part of the radius with dislocation of distal radio-ulnar joint
• Ulna remains intact

Smith’s fracture

• May result from falling with the wrist in flexion
• Fracture of the distal radius, with distal radial fragment, with the fragment orientated in different directions

Question 15

Fractures of the hand

Answer 15

Scaphoid fracture

• Most frequently fractured carpal bone, FOOSH
• Risk of avascular necrosis as the scaphoid is supplied distally to proximally

Hamate fracture

• Ulnar nerve close to hook of hamate, damage to nerve may lead to decreased grip strength

Metacarpal and phalangeal fracture

• Metacarpals closely bounded and tend to be stable
• DIstal phalanx injuries painful, have close relation to the flexor tendons

Question 16

Inflammation clinical issues

• Tennis elbow
• Golfers elbow
• students elbow

Answer 16

Tennis elbow [lateral epicondylitis]

• Overuse injury to lateral epicondyle of the humerus, repetitive forearm and elbow activities
• Inflammation of the extensor carpi radialis brevis tendon
• Symptoms:
• Dull pain and tenderness at outer elbow
• Weak wrist extension, as wrist extensors attach to the lateral epicondyle

Golfer’s elbow [medial epicondylitis]

• Pain where the flexor tendons of forearm connect to medial epicondyle at the elbow
• S_ymptoms:_
• Tenderness at the inner elbow
• Weak wrist flexion, as wrist flexors attach to the medial epicondyle

Student’s elbow [bursitis]

• Swelling of bursa supporting the olecranon
• Most commonly caused by repeated pressure over time

Question 17

Thoracic outlet syndrome

Winging of the scapula

Rotator cuff injuries

Answer 17

Thoracic outlet syndrome

• Thoracic outlet: the space between the collarbone and first rib
• Compression of the vasculature and nerves in the thoracic outlet, leading to shoulder and neck pain, finger numbness

Winging of the scapula

• Paralysis of the serratus anterior as a result of injury to the long thoracic nerve
• Prominent when person leans on hand or presses it against a wall

Rotator cuff injuries

• Instability of the glenohumeral joint, supraspinatus most commonly ruptured