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Chapter 6 (Upper extremity/ hand musculoskeletal /burn
Nerve Palsies - Klumpke's Palsy
Nerve
C8 to T1 Roots
Lower Trunk
Causes
Upward Arm Force during Delivery
Adult Trauma
Grabbing Tree Branch to Break a Fall
Muscle Affected
Intrinsic Hand Muscles
Presentation
Claw Hand
1 min
Nerve Palsies - Median Claw
Nerve
Distal Median Nerve
Causes
Carpal Tunnel Syndrome
Deficit
Unable to Extend Thumb, Pointer and Middle Finger
Presentation
Clawing of Digits 1-3
Tinels Sign
Phalens Sign
Complication
Atrophy of Thenar Eminence
2 mins
Nerve Palsies - OK Gesture
Nerve
Proximal Ulnar Nerve
Causes
Fracture Medial Epicondyle of Humerus (proximal injury)
Deficit
Unable to Flex 4th and 5th Digits
Presentation
Trouble Making a Fist
Resembles OK gesture
Complication
Hypothenar Atrophy
2 mins
Nerve Palsies - Pope's Blessing
Nerve
Proximal Median Nerve
Causes
Supracondylar Fracture of Humerus
Functional Deficit
Loss of Flexion of Thumb, Pointer and Middle Finger
Presentation
Trouble Making a Fist
Hand Resembles Popes Blessing on Flexion
Complications
Atrophy of Thenar Eminence
1 min
Nerve Palsies - Thoracic Outlet Syndrome
Nerve
Compression of Brachial Plexus
Compression of Subclavian Vessels
Causes
Cervical Rib Abnormality
Trauma
Weight Lifters
Pancoast Tumor
Presentation
Edema
Claw Hand
Pain
1 min
Nerve Palsies - Ulnar Claw
Nerve
Distal Ulnar Nerve
Causes
Fracture Hook of Hamate (distal injury)
Cyclists
Compression Guyon's Canal
Functional Deficit
Unable to Extend 4th and 5th Digits
Presentation
Hand Resembles Ulnar Claw on Extension
Complications
Atrophy of Hypothenar Eminence
1 min
Nerve Palsies - Winged Scapula
Nerve
Long Thoracic Nerve
Causes
Axillary Node Dissection in Mastectomy
Stab Wound
Muscle Affected
Serratus Anterior
Functional Deficit
Scapula Cannot Anchor to Thorax
Presentation
Inability to Raise Arm Above Head
1 min
Upper Limb - Anterior Forearm Muscles
Superficial Muscles
Pronator Teres
Palmaris Longus
Flexor Carpi Radialis
Flexor Carpi Ulnaris
Intermediate Muscles
Flexor Digitorum Superficialis
Deep Muscles
Flexor Pollicis Longus
Flexor Digitorum Profundus
Pronator Quadratus
2 mins
Upper Limb - Arm Muscles
Anterior Superficial Muscles
Biceps Brachii
Anterior Deep Muscles
Coracobrachialis
Brachialis
Posterior Superficial Muscles
Long Head of Triceps Brachii
Lateral Head of Triceps Brachii
Posterior Deep Muscles
Medial Head of Triceps Brachii
2 mins
Upper Limb Bones - Humerus
Characteristics
Greater Tubercle
Lesser Tubercle
Anatomic Neck
Surgical Neck
Deltoid Tuberosity
Epicondyles
Coronoid Fossa
Capitulum
Olecranon Fossa
Trochlea
3 mins
Upper Limb Bones - Ulna and Radius
Characteristics
Ulna
Olecranon Process
Coronoid Process
Trochlear Notch
Radial Notch
Styloid Process of Ulna
Head of the Ulna
Radius
Radial Head
Neck
Radial Tuberosity
Styloid Process
Ulnar notch
Listers (aka Dorsal) Tubercle
3 mins
Nursemaid's Elbow (Radial Head Subluxation)
Pathophysiology
Radial Head Subluxation
Inferiorly Under Annular Ligament
Axial Traction on Forearm
Pulled or Lifted by the Hand or Forearm
Children Aged (1-4 Years Old)
Signs & Symptoms
Extended & Pronated Forearm
Refusal to Bend Elbow
Treatment
Manual Reduction
Hyperpronation of Forearm
Gentle Supination of Elbow at 90 Degrees Flexion
No Immobilization
3 mins
Musculoskeletal Crossed Syndromes
Upper Crossed Syndrome
Upper Crossed Syndrome
Thoracic Kyphosis
Forward Head
Scapular Winging
Protracted Shoulders
Lower Crossed Syndrome
Lower Crossed Syndrome
Lumbar Lordosis
Anterior Pelvic Tilt
Increased Hip Flexion
Posture
Postural Muscles
Phasic Muscles
Scoliosis
3 mins
Hand Muscles
Characteristics
Opponens Pollicis
Abductor Pollicis Brevis
Flexor Pollicis Brevis
Flexor Digiti Minimi Brevis
Abductor Digiti Minimi Brevis
Opponens Digiti Minimi
Lumbricals
Interossei (Palmar and Dorsal)
Palmaris Brevis
Adductor Pollicis
2 mins
Anterior Shoulder Dislocation
Axillary Nerve Damage
Axillary Artery
Rotator Cuff Injury
Supraspinatus Tendon
Anterior Glenohumeral Ligament
Anatomic Lesions
Bankart's Lesion
Hill-Sachs Lesion
1 min
Neck and Shoulder Muscles
Superficial
Splenius Capitis
Trapezius
Rhomboid Minor
Rhomboid Major
Deltoid
Latissimus Dorsi
Levator Scapulae
Deep
Supraspinatus
Infraspinatus
Teres Minor
Teres Major
2 mins
Brachial Plexus Cords
Lateral Cord
Lateral Pectoral Nerve
Posterior Cord
Upper Subscapular Nerve
Thoracodorsal Nerve
Lower Subscapular Nerve
Medial Cord
Medial Pectoral Nerve
Medial Cutaneous Nerve of Arm and Forearm
1 min
Brachial Plexus Divisions
Anterior (Division)
Posterior (Division)
27 secs
Brachial Plexus Trunks
Superior Trunk
Suprascapular Nerve
Middle Trunk
Inferior Trunk
1 min
Supracondylar Fracture Of Humerus
Mechanism
Fall On Outstretched Hand (FOOSH)
More Common In Children
Signs & Symptoms
Elbow Pain & Swelling
Diagnosis
X-ray Shows Elbow Effusion
Anterior Sail Sign
Posterior Fat Pad Sign
Treatment
Non-displaced: Splint And Sling
Displaced: Closed Reduction With Percutaneous Pin Placement
Considerations
Compartment Syndrome
Volkmann Ischemic Contracture
Brachial Artery Injury
Median Nerve Palsy
Cubitus Varus Deformity
3 mins
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