Clinical Correlations – Upper Limb

During this surgery – what is at risk? If injured what would occur?Where are they from, where do they go?

C5, C6

C6, mainlyBrachioradialisReflex

C7, mainly

Upper Brachial Plexus Injury – “Erb-Duchenne Palsy”

A 33-year-old male presents two weeks following a motorcycle crash with themain complaint of limited functional use of his right arm. Physical exam revealsa right arm that is adducted and internally rotated with some flexion of the wrist. History reveals that during the accident he landed on the upper rightshoulder and neck, sustaining significant skin abrasions to the area of his rightlateral neck down to his acromion process.

Klumpke Palsy   Klumpke palsy may produce several abnormal postures. Classically, it produces flexion and supination of the elbow, extension of the wrist, hyperextension of the metacarpophalangeal joints, and flexion of the interphalangeal joints with the “claw hand” posture.  This presentation is rarely seen in the newborn period. Klumpke syndrome usually manifests in the newborn period as weakness restricted to or mainly involving the hand.  In many occasions, there are no reflex or spontaneous movements of the intrinsic hand muscles.

Scaphoid fracture: Pain in snuff box. Can get avascular necrosis to proximal end of bone. Common fracture in falls when patient catches him/herself with an outstretched arm.

Colles fracture:Common in the elderly; usu. in a fall, from outstretched hand. Will see a dorsal curvature-similar to that of a dinner fork. Distal fragment of radius overrides the rest of the bone…leading to this abnormal deformity/curvature.

Pulse points of Upper Limb:-Axillary a. in axilla-Brachial a. mid-arm-Brachial a. in cubital fossa-Radial a. distal forearm-Radial a. in snuff box-Ulnar a. in distal forearm

Tinel’s Sign (test): Percussion of nerves

Phalen’s sign: mov’t to flex wrist that puts Pressure on carpal tunnel & median Nerve.

Ulnar Claw: Ulnar nerve injury. If injured at the elbow, would see radial deviation upon flexion and clawing would be less severe (less drastic) Why? Because FDP & FCU innervated by the ulnar nerve…lumbricals, interossei not working, so flexor of the digits will take over. FDS of these fingers (innervated by median nerve) takes over. If ulnar nerve injured at wrist, more severe.

Froment’s sign

Ape Hand

Wrist drop: radial nerve, will have loss of sensation across dorsum of hand-thumb and forefinger