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MSK 💪🏾 > Upper Limb Clinical Cases > Flashcards

Upper Limb Clinical Cases Flashcards

1
Q

Shoulder – adducted and internally rotated-Loss of – abduction

A

Supraspinatus-Suprascapular (C5,6)

-Deltoid-Axillary (C5,6)

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2
Q

Shoulder – adducted and internally rotated-Loss of – external rotation

A

Infraspinatus-Suprascapular (C5,6

Teres minor-Axillary (C5,6)

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3
Q

Elbow – extended Loss of – flexion

A

Anterior compartment of
arm-Musculocutaneous
(C5,6,7)

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4
Q
  • Erb’s Palsy
A

-• Damage to Upper Brachial Plexus C5,C6(C7)
-Arm adducted and internally rotated,
forearm extended and pronated

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5
Q
  • Erb’s Palsy-• Sensory loss
A

along lateral border of limb
(C5,6,+/
-7 dermatomes)

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6
Q

Erb’s Palsy- Clinically involved nerves are:

A 
Suprascapular: inability to initiate
abduction and loss of external rotation
• Axillary: loss of abduction to 90
degrees and external rotation
• Musculocutaneous: loss of forearm
flexion and weakened forearm supination
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7
Q

lower brachial plexus injury-

A

Damage to lower parts of brachial plexus - C8 / T1 lower trunk or medial cord
-Klumpke’s (KlumpkeDejerine) Palsy

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8
Q

lower brachial plexus injury-Ulnar

A

FCU, med ½ FDP, most intrinsic muscles of hand, loss of sensation in medial hand

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9
Q

lower brachial plexus injury-Med cut N of arm

A

Loss of sensation along medial aspect of arm

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10
Q

lower brachial plexus injury-Med cut N of forearm

A

Loss of sensation along medial aspect of forearm

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11
Q

lower brachial plexus injury-Medial head of median

A

LLOAF muscles

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12
Q

Lower Brachial Plexus C8 / T1-Sensory loss

A

medial
border of hand and forearm
and arm (C8 and T1
dermatomes)

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13
Q

Midshaft of humerus fracture-• What nerve is most likely injured and
what motor and sensory deficits are most
likely present?

A

• Radial nerve in radial groove

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14
Q

Radial Nerve-Origin

A

From posterior cord

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15
Q

Radial Nerve-• Motor supply:

A 
• Supplies extensors of the forearm, wrist
and digits (via the radial n., deep radial n.
and posterior interosseous n.)
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16
Q

Radial Nerve- Sensory supply:

A

• Arm – posterior and lower lateral
• Forearm – posterior
• Hand – dorsum of hand / lateral 2 ½ digits
(proximal part of these digits)

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17
Q

Radial Nerve Injury-Injury in Axilla -motor

A

Loss of ability to extend
the elbow joint.
• Wrist drop • Impaired grip strength

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18
Q

Radial Nerve Injury-Injury in Axilla-Sensory loss:

A 
• Arm – posterior and lower
lateral
• Forearm
– posterior
• Hand
– dorsum of hand
-
lateral 2 ½ digits (proximal
part of these digits)
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19
Q

Radial Nerve Injury-Injury at the midshaft of the humerus-motor

A

-Retain ability to extend the
elbow joint
-Wrist drop • Impaired grip strength

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20
Q

Radial Nerve Injury-Injury at the midshaft of

the humerus-Sensory loss:

A 
• Arm - variable • Forearm – posterior • Hand – dorsum of hand
-
lateral 2 ½ digits
(proximal part of these
digits)
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21
Q

Median Nerve-Origin:

A

lateral & medial cords

22
Q

Median Nerve-• Course:

A

• Crosses anterior to elbow through cubital fossa
• Supplies all muscles in superficial and intermediate flexor
compartment of forearm except FCU
• Just distal to the elbow, gives off the anterior
interosseous
• Supplies the deep flexor compartment except ulnar
half of FDP
•Through carpal tunnel into the hand

23
Q

Median Nerve-•motor innervation

A
  • palmar digital branches - 2 lumbricals (1st and 2nd)

* recurrent branch - OAF muscles

24
Q

Median Nerve-•sensory innervation

-•palmar digital branches

A

•palmar digital branches - lateral 3 ½ fingers
palmar side and their distal phalanx on the dorsal
side

25
Q

Median Nerve-•sensory innervation

-•palmar cutaneous branch

A

•palmar cutaneous branch - mid-palm (comes off
median in forearm and does not pass through carpal
tunnel)

26
Q

Median Nerve Injury-Injury at/or above elbow

A

Weakened wrist flexion
-Thenar wasting
-Ulnar deviation (FCU unopposed) • Loss of flexion of index and middle
fingers at DIP and PIP joints (FDP
and FDS)
• Loss of pronation • Loss of opposition of thumb • Loss of flexion of the thumb • Weakened abduction of thumb

27
Q

Median Nerve Injury-Injury at/or above elbow-Sensory loss:

A

• Palmar aspects of thumb, index, middle,
and half of ring finger up to the DIP on
the dorsal aspect

28
Q

Thenar wasting

A

Thenar eminence is flattened due to atrophy of thumb

OAF muscles

29
Q

Median Nerve Injury-Injury at or above elbow

A

-BENEDICTION HAND
- when patient
attempts to make a fist
-attempts to make a fist
• The index and middle fingers stay
straight
-• The ring and little fingers flex
-Thumb remains in plane of palm

30
Q

Median Nerve Injury-Injury at wrist

A 
• Flexor muscles in forearm are
NOT paralyzed so no
benediction hand.
• Wrist flexion, forearm pronation
and long flexor of thumb all
intact
• LLOAF muscles of intrinsic hand
are paralyzed:
• Atrophy of thenar muscles: • Loss of opposition of thumb • Weakened abduction and flexion
of thumb
31
Q

Carpal Tunnel Syndrome

A

Entrapment syndrome causing increased
pressure in the carpal tunnel
• Compresses the median nerv

32
Q

Carpal Tunnel Syndrome-Sensory deficits

A

Paresthesia in the median
nerve distribution in the hand (except central
palm which is supplied by the palmar cutaneous
branch), nocturnal pain common

33
Q

Carpal Tunnel Syndrome-Motor deficits

A

Loss of function to muscles

supplied by median nerve in the hand

34
Q

positive Tinel sign

A

n refers to distally radiating pain and/or paresthesia

elicited by percussing a superficial peripheral nerve

35
Q

The Phalen maneuver

A

performed by apposing the wrists
in goo of flexion. Paresthesia in the hand within 60 seconds is
considered a positive test

36
Q

Median Nerve Injury-Injury in proximal palm:
laceration to the base of the
thumb

A 
• Recurrent branch • Motor only nerve • Flexor muscles in forearm are
NOT paralyzed
• OAF muscles of intrinsic hand are
paralyzed
• Atrophy of thenar muscles, loss of
opposition, weakened flexion and
abduction of thumb
• No sensory loss
37
Q

Fracture of the hook of the hamate-Which neurovascular structures are at most
risk?

A

Ulnar nerve, artery and vein

38
Q

Ulnar Nerve-Motor innervation

A

Deep motor branch to all the muscles of the

hand except LLOAF

39
Q

Ulnar Nerve-Sensory innervation

A 
• Superficial cutaneous branch
- sensory to the
palmar medial 1 ½ digits
• Dorsal cutaneous branch: sensory to the
dorsal medial 2 ½ digits
40
Q

Ulnar Nerve-Course

A

• At distal third of the forearm gives a
dorsal cutaneous branch
• Divides into superficial branch and deep
branch

41
Q

Ulnar Nerve Injury-Injury at or above elbow

A 
Paralysis of FCU; hand
deviates radially
• Paralysis of ulnar ½ FDP;
lose flexion of ring & little
fingers at DIP (FDS still
intact for flexion at PIP)
42
Q

Ulnar Nerve Injury-Injury at or above elbow-Sensory loss:

A

• Medial palmar 1 ½ & dorsal 2 ½

digits

43
Q

Ulnar Nerve Injury

A 
Paralysis of hypothenar
muscles
• Paralysis of 3rd and 4th
lumbricals: decreased
flexion of at MCP and
decreased extension at
IP joints of ring and
little finger
• Paralysis of all
interosseous muscles –
’metacarpal guttering’
• Loss of adduction of
thumb
44
Q

Ulnar Nerve Injury-At Anterior Wrist

A 
• No paralysis of FCU or ulnar ½ of
FDP
• Paralysis of hypothenar muscles • Paralysis of 3rd and 4th
lumbricals: decreased flexion of
at MCP and decreased extension
at IP joints of ring and little
finger
• Paralysis of all interosseous
muscles
–’metacarpal guttering’
• Loss of adduction of thumb
45
Q

Ulnar Nerve Injury-At Anterior Wrist-Sensory loss:

A

Palmar part of little & 1/2 of

ring fingers

46
Q

Right Ulnar Nerve Damage-Froment’s Test

A 
Patient can’t “hold on”
to the paper with
adductor muscle, but
FPL and FPB are intact
(median) which allows
for “holding on” by
FLEXING the
interphalangeal joint of the thumb
47
Q

Fracture of surgical neck of humerus-What neurovascular structures are
most likely damaged?

A

• Axillary nerve and posterior humeral

circumflex artery

48
Q

Axillary Nerve- Origin:

A

• From posterior cord

49
Q

Axillary Nerve-Motor supply:

A

• Supplies deltoid and teres minor

50
Q

Axillary Nerve-Sensory supply:

A

Upper lateral part of arm

51
Q

Axillary Nerve-Signs and symptoms of injury

A
  • Decreased lateral rotation
  • Decreased abduction
  • Loss of sensation to the lateral shoulder
52
Q

Humeral Fractures

A
  • Surgical neck
  • Mid-shaft
  • Supracondylar fractures
  • Medial epicondyle

MSK 💪🏾 (36 decks)

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