Week 3 Flashcards
Cutaneous inner actions refer to areas innervated by specific peripheral nerves which can contain fibers from ________spinal nerve roots
Multiple spinal nerve roots
An area of skin which is innervated by a single spinal nerve?
Dermatomes
True or false?
Vast majority of patients with plexus injuries are otherwise healthy unless disabled by pain, generally remain active and are able to carry out ADL’s with the use of one hand?
True
What Are the biomechanical principles?
To prevent deformity
To correct deformity
Position limb to obtain maximal function
5 degrees of supination
What are some patient considerations?
~Most patients Re independent with one hand but bilateral activities should be facilitated
~Device shouldn’t interfere with remains ability
~Device needs to allow independent donning/doffing
~Cost must be considered vs. length of use & potential for benefit
Axillary nerve injury is the loss of active __________________
Sensory loss on lateral side of proximal arm
Shoulder abduction and flexion
Orthotic assistance is limited to functional arm support to decrease gravitational pull on the Glenohumeral joint- deltoid and teres minor for what nerve injury?
Axillary nerve injury
Due to loss of biceps and brachialis, the patient loses all useful elbow flexor strength and can be compensated if the pronator teres and brachii radialis are well contained is what nerve lesion injury?
Musculocutaneous Nerve lesion
Radial nerve lesion is also known as?
Wrist drop - loss of extensor muscles
What are the three levels of radial nerve lesion?
Below the elbow
Mid-humerus
Axillary level
The finger and thumb Extensors and long thumb abductor loses motor function is what level of radial nerve lesion?
Below the elbow
What orthotic treatment is recommended for radial nerve lesion below the elbow?
HO or WHO
With IP extension assist (MP extension stop if patient becomes hyper mobile at MP joint)
Wrist extensor paralysis is added to the absence of finger and wrist extensor control which greatly affects grasp and pinch coordination because the finger Flexors cannot contract sufficiently to maintain grasp is what level of radial nerve lesion?
Radial nerve lesion mid humerus
What is the orthotic treatment recommendation for radial nerve lesion mid humerus?
Static control at the wrist to counteract the effects of gravity and pull of the finger Flexors as they contract
Static WHO
In addition to wrist and hand Extensors, when the lesion occurs at the axillary level, the triceps motor function becomes affected is what level of radial nerve lesion?
Radial nerve lesion axillary level
What are the most common mechanisms of injury for radial nerve lesion -axillary level?
Poorly fit crutches
Falling asleep with arm over a chair -Saturday night palsy
What are the ulnar nerve lesion levels of involvement?
Wrist
Elbow or above
Absent intrinsic muscle action in the ring and little finger and sensory loss of palmar and dorsal aspect of 5th digit and 1/2 of 4th digit is what level of ulnar nerve lesion?
Wrist
What is the common mechanism of injury for a ulnar nerve injury -wrist?
Is a cut horizontally at the wrist -suicide attempt
Claw hand or ulnar palsy is also referred to as?
An intrinsic minus hand
Volkmann’s ischemic contracture occurs when?
There is a lack of blood flow (ischemia) to the forearm
For ulnar nerve lesion-wrist the claw hand position of the fingers can be readily corrected with an?
Orthotic MP extension stop
The flexor Digitorum profundus muscle (of the 4th and 5th fingers) loses motor function, in addition to the intrinsic hand muscles is what ulnar nerve injury level?
Elbow and above
Due to paralysis of the flexor carpi ulnaris, the hand will deviate________ during radiocarpal flexion?
Radially
What is the most common mechanism of injury for a ulnar nerve injury of elbow or abov?
Fracture of the medial epicondyle of the humerus
What are the two sites of median nerve lesion injury involvement?
Wrist
Elbow or above
The __________________ is the absolute pathway for all sensory fibers from critical areas, which also includes the radial side of the index finger
Median nerve lesion
The median nerve motor supply include what muscles?
The thumb intrinsic muscles and the extrinsic Flexors of the thumb, index and middle finger
Only the thumb intrinsics ( Lumbricals to index and middle finger ) are paralyzed is what median nerve lesion level?
Wrist
What is the mechanism of injury for median nerve injury of the wrist?
A horizontal cut on the wrist -suicide attempt
Carpal tunnel syndrome
For a median nerve injury the patient will present with _________?
Ape hand Patient will have sensory loss on the palmAr and dorsal aspects of the: palmar aspect of the thumb Index Middle 1/2 ring finger
Weakened wrist flexion ( hand will radially deviate) Loss of : flexion at digits 1-3 Pronation Thumb abduction Thumb opposition
Median nerve injury-elbow and above
What is the mechanism of injury for median nerve injury of the elbow and above?
Due to supra condylar humeral fracture
For a median nerve injury of the elbow and above the patient can present with?
Ape hand
Hand of benediction - also known as the popes hand
Ape hand occurs when the Thenar eminence is __________
Flattened
Occurs when the patient attempts to make a fist and the index and middle fingers remain extended, while the 4th and 5th fingers flex
Hand of benediction
What are the 4 types of brachial plexus injuries that occur at birth?
Neuroma
Rupture
Avulsion
Neuro praxia
What is a neuroma?
Nerve root has attempted to heal on its own
The neuroma is the scar tissue that grows around and decreases the signal strength sent to the muscles
What is a rupture?
Where the nerve is torn but not at the spinal attachment
What is an Avulsion?
Occurs when the nerve root is torn at the location where it exits (vertebra foramen)
What is neuropraxia?
Occurs when the nerve is damaged (stretched but not torn)
Presents with adducted and internally rotated shoulder, extended elbow and pronated wrist (waiter’s tip” presentation)
Occurs in about 0.7 in1000 births
Erb’s palsy
What portion of the brachial plexus is affected in Erb’s palsy?
Upper portion of the brachial plexus
C5, C6
What is the mechanism of injury for Erb’s palsy?
In most cases is traction on the plexus during delivery
In Erb’s palsy treatment should be deferred for ____ to ______ days, then physical therapy and splinting should be undertaken
7 to 10 days
Caused by a sudden shoulder abduction motion and loss of ulnar nerve sensory areas
Klumpke’s palsy
What is the treatment recommendation for klumpke’s palsy?
Most patients do well with a WHO
What is the portion of the brachial plexus is klumpke’s palsy?
Lower segment involvement (loss of hand intrinsic muscles)
C7,8, T1
Due to impingement of the ulnar nerve in klumpke’s palsy, patients will present a “__________” and?
Claw hand”
Wrist in extreme extension because of the un opposed wrist extensors
Hyperextension of MCP due to loss of hand intrinsic muscles
Flexion of IP joints due to loss of hand intrinsic muscles
Patients with C 1-3 Level impairment can perform what ADL’s?
Total dependence on caregiver
What are some recreational activities can C 1-3 level impairments can do?
Discussion groups, spectator sports, reading and painting (by mouth)
What is the available movement for C 1-3 Level impairment?
Neck control
What are some orthotic treatment recommendation for C 1-3 Level Impairment?
Positional WHO’s
Resting hand splint
Patients with C 4 Level impairment can perform what ADL’s?
Total dependence ( may incorporate external power systems
What recreational activities can C4 Level impairment can do?
Discussion groups, spectator sports, reading and painting (by mouth)
What are the available muscles for a C4 Level impairment?
Diaphragm and trapezius
What are the orthotic treatment recommendations for a C4 Level impairment?
Mobile arm support, powered tenodesis WHO and or static WHO
Patients with C 5 Level impairment can perform what ADL’s?
Can independently feed, groom, and complete light home-keeping duties
What recreational activities can C5 level impairment do?
Board games, card games, art and crafts
What are the available muscles for a C 5 level impairment?
Deltoid, biceps, supinator, rotator cuff group, don’t have wrist Extensors
What is the orthotic treatment recommendation for a C5 level impairment?
Mobile arm support (initially), ratchet WHO or Powered tenodesis WHO
Patients with C 6 Level impairment can perform what ADL’s?
Can independently feed, grooming, independent transfer and driving (hand control)
What recreational activities can C 6 level impairment do?
Wheelchair sports, archery, gardening
What are the available muscles for C 6 Level impairment?
extensor carpi radialis Longus and Brevis
Pronator teres
Pectoralis major
What are the orthotic treatment recommendations for C6 level impairment?
Wrist driven- WHO
Patients with C 7 Level impairment can perform what ADL’s?
Total independence and driving car with hand controls
What recreational activities can a C7 level impairment do?
Wheelchair sports
Archery
Gardening
What are the muscles are available for C7 level impairment?
Triceps, latissimus dorsi, extensor Digitorum, flexor carpi radialis, flexor Digitorum
What are the orthotic treatment recommendations for a C7 level impairment?
Wrist driven WHO (initially)
Static WHO
Patients with C8-T1 Level impairment can perform what ADL’s?
Total independence and driving car with hand controls
What recreational activities can C8-T1 impairments do?
Wheelchair sports
What muscles are available for C8-T1 impairments?
Interossei, Lumbricals, Thenar and hypothenar muscles
What is the orthotic recommendation for C8-T1 level impairment?
HO (initially)
