upper limb injuries

Question 1

Causes of acute nerve injury in the upper limb ?

Answer 1

• trauma - blunt (e.g. fracture & dislocation ) , penetrating (e.g. bullet, glass, knife)
• iatrogenic - during surgery , complication of other treatment form
• rare things - cancers

Question 2

What does power grip require ?

Answer 2

• all nerve
• flexion of all fingers of the hand
• wrist extended

Question 4

when a nerve is damaged , what happens to anything aupplying proximally / distal to injury ?

Answer 4

proximally = retain normal innervation & function
distal = not be innervated & therefore lose function

Question 5

Motor functions of radial nerve and muscle involved ?

Answer 5

• extend elbow - triceps
• flex elbow - brachioradialis
• extend fingers & thumb - wrist extensors
• extend fingers & thumb - extensors of small digits & thumbs
• supinate forearm - supinator

Question 6

What are the 5 possible radial nerve injuries ?

Answer 6

1. armpit injury: incorrect use of crutches
2. mid-humerus injury: spiral groove fracture
3. laceration injury: superficial radial nerve
4. injury to deep radial nerve
5. injury to posterior interosseous nerve (radial n. branch , injury at mid-forearm)

Question 7

With radial nerve injuries which 6 areas should be considered for a deficit ?

Answer 7

1. elbow extension
2. wrist extension
3. supination
4. power grip
5. thumb and digits extension
6. sensory to 1st dorsal web-space

Question 8

possible deficits from armpit injury , radial nerve injury ?
1. elbow extension
2. wrist extension
3. supination
4. power grip
5. thumb and digits extension
6. sensory to 1st dorsal web-space

Answer 8

1. loss
2. loss
3. reduced
4. loss (weak grip only)
5. loss
6. loss (may be sensation to other aspects of dorsum of hand where overlap from other nerves happen )

Question 9

Why is supination with armpit injury (radial nerve injury) only reduced ?

Answer 9

biceps-flexor and supinator = musculocutaneous nerve

Question 10

possible deficits from spiral groove fracture, radial nerve injury ?
1. elbow extension
2. wrist extension
3. supination
4. power grip
5. thumb and digits extension
6. sensory to 1st dorsal web-space

Answer 10

1. normal - cos triceps not damaged
2. loss
3. reduced
4. loss (weak grip only)
5. loss
6. loss

Question 11

possible deficits from superficial radial nerve, radial nerve injury ?
1. elbow extension
2. wrist extension
3. supination
4. power grip
5. thumb and digits extension
6. sensory to 1st dorsal web-space

Answer 11

1. normal
2. normal
3. normal
4. normal
5. normal
6. loss - superficial branch damaged

Question 12

possible deficits from injury to deep radial nerve, radial nerve injury ?
1. elbow extension
2. wrist extension
3. supination
4. power grip
5. thumb and digits extension
6. sensory to 1st dorsal web-space

Answer 12

1. normal
2. reduced
3. reduced
4. reduced
5. loss
6. normal

Question 13

possible deficits from injury to posterior interosseous nerve , radial nerve injury ?
1. elbow extension
2. wrist extension
3. supination
4. power grip
5. thumb and digits extension
6. sensory to 1st dorsal web-space

Answer 13

1. normal
2. normal
3. normal
4. reduced
5. loss
6. normal

Question 14

What are the 4 median nerve injuries ?

Answer 14

• high lesion
• anterior interosseous nerve (injury distal to elbow joint)
• carpal tunnel syndrome
• median recurrent nerve (branch of median n. innervates thenar group and lumbricals)

Question 15

With median nerve injuries what needs to be considered of where a deficit could be ?

Answer 15

1. pronation
2. wrist flexion
3. DIP joints
4. opposition of thumb
5. sensory to ventral index finger

Question 16

Possible deficit if high lesion median nerve injury ?
1. pronation
2. wrist flexion
3. DIP joints
4. opposition of thumb
5. sensory to ventral index finger

Answer 16

1. loss
2. reduced (some flexion from FCU, ulnar aspect of FDP)
3. loss
4. loss (opponens pollicis)
5. loss

Question 17

Possible deficit if anterior interosseous median nerve injury ?
1. pronation
2. wrist flexion
3. DIP joints
4. opposition of thumb
5. sensory to ventral index finger

Answer 17

1. reduced
2. normal
3. loss
4. normal
5. normal

Question 18

Possible deficit if carpal tunnel syndrome median nerve injury ?
1. pronation
2. wrist flexion
3. DIP joints
4. opposition of thumb
5. sensory to ventral index finger

Answer 18

1. normal
2. normal
3. normal
4. loss
5. loss

Question 19

Possible deficit if median recurrent nerve median nerve injury ?
1. pronation
2. wrist flexion
3. DIP joints
4. opposition of thumb
5. sensory to ventral index finger

Question 20

With median nerve lesions that affect the thumb, what can the thumb not do ?

Answer 20

fully abduct