dr tatheer zahra assistant professor anatomy nerves of upper limb & their lesions
TRANSCRIPT
BRACHIAL PLEXOPATHY Can refer to involvement
of the entire plexus, or parts of the plexus– Trunk lesion– Cord lesion
Distribution of weakness and numbness depends upon the part of the plexus affected
PATTERN OF INJURY
Pattern of root contribution to the plexus:
– Upper trunk lesion: Sensory loss in C5 & C6
– Middle trunk lesion: Sensory loss in C7
– Lower trunk lesion: Sensory loss in the combined C8 & T1 dermatomes
PRINCIPLES OF LOCALIZATION Certain sites are prone to nerve entrapments/injuries
– Nerve opposing bone ~ Ulnar nerve at the elbow– Closed spaces ~ Carpal tunnel– Adjacent structures ~ Median nerve at the elbow, adjacent
to the brachial artery Order in which branches arise Movements at specific joints
– Single nerveoElbow extension ~ Radial
– Multiple nervesoElbow flexion ~ Musculocutaneous, Median
A: VARIATIONS IN BRACHIAL PLEXUS:
Prefixed brachial plexus Post fixed brachial plexus
B: BRACHIAL PLEXUS INJURIES:
Incomplete paralysis Complete paralysis Erb-Duchenne palsy Backpacker’s palsy Klumpke paralysis
C: BRACHIAL PLEXUS BLOCK:
Affection of:1 -Most of the small muscles of the hand (T1)
2 -Ulnar flexors of the flexor compartment of forearm are partially affected (C8)
Complete claw hand
MEDIAN NERVE INJURYA- Above Elbow:1- Loss of pronation2-Week flexion3-Ulnar deviation4-Inability to flex thumb5-Inability to oppose fingers6-Inability to flex middle digits7-Inability to flex Index middle fingers
-Sensory loss-Ape hand deformity
B- Above Wrist:1- No Loss of pronation2- No Week flexion3- No Ulnar deviation4- No Inability to flex thumb5- Inability to oppose fingers6- No Inability to flex middle digits7- No Inability to flex index and middle fingers
-Sensory loss -Ape hand deformity
Flexed little and ring
Extended index and
middle
Adducted and extended
thumbFlat thenareminence
ULNAR NERVE INJURYA - Above Elbow:
1- Week flexion2- Loss of adduction3- Inability to adduct thumb4- Inability to put the hand in writing position
- Sensory loss- Partial claw hand deformity
B - Above Wrist:
1- No Week flexion2- No Loss of adduction3- Inability to adduct thumb4- Inability to put the hand in writing position
- Sensory loss to fingers only- Partial claw hand deformity is moreprominent (Ulnar paradox)
Symptoms Tingling Numbness Pain on the outside or middle of the forearm; this sensation
of discomfort may run all the way to the little finger.
Treatment Anti-inflammatory medications Wrist splints Therapeutic exercises
HANDLEBAR NEUROPATHY
An inability to oppose the thumb to the little finger can result from damage to the ________ nerve.
a)Axillaryb)Musculocutaneous c)Radiald)Ulnare)Median
Hyperextension of the proximal phalanges of the little and ring fingers can result from damage to the ________ nerve.
a)Ulnarb)Axillaryc)Radiald)Mediane)Musculocutaneous
Wrist drop can result from damage to the ________ nerve.
a)Medianb)Ulnarc)Radiald)Anterior interosseouse)Axillary
REFERENCESCinical Anatomy By Regions, By RICHARD S.
SNELL, 8th edition
Clinical Oriented Anatomy, By KEITH L. MOORE & ARTHUR F. DALLEY, 5th edition
LAST’S Anatomy, By CHUMMY S SINNATAMBY, Churchill Livingstone, 11th edition
GRAY’s Anatomy, 40th edition