upper limb lower limb. lesions of the brachial plexus fractures
TRANSCRIPT
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GROSS ANATOMY WEB
EXUpper limb
Lower limb
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UPPER LIMB Lesions of the Brachial Plexus Fractures
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Injury to C5-6 at Erb’s point Muscles paralysed – Deltoid, biceps, brachialis, barachioradialis Posture – waiter’s tip
deformity Mechanism of injury : fall on
shoulder or excessive pulling of head of new born during delivery
Erb-Duchenne’s Palsy
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KLUMPKE’S PALSY Injury to C8-T1 Muscles paralyzed – small muscles of hand Deformity Claw hand Mechanism : Sudden superior pull on upper
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Symptoms:
Clawed hand due to loss of innervation of Intrinsic muscle of the hand
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RADIAL NERVE
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WRIST-DROP
The characteristic clinical sign of radial nerve injury is wrist-drop.
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FRACTURE OF THE HUMERAL SHAFT
A midhumeral fracture may injure the radial nerve in the radial groove in the humeral shaft.
Fracture is not likely to paralyze the triceps because of the high origin of the nerves to two of its three heads.
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SATURDAY NIGHT PALSY
WRIST DROP
Radial Nerve Injury in Axilla:
Mechanism:
1.Crutches pressing in axilla
2.Saturday night palsy!
Main Effect:
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AXILLARY NERVE
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NOTE THE LEFT DELTOID MUSCLE ATROPHY.
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MEDIAN NERVE
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Carpal Tunnel syndrome
Common in computer professionals.
Due to constant dorsiflexion of wrist while typing the keyboard
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ULNAR NERVE
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ROTATOR CUFF MUSCLES
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FRACTURES Clavicle Humerus Radius Scaphoid
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Junction of Medial 2/3rd and Lateral 1/3rd
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HUMERUS FRACTURES Fracture of
Surgical Neck of Humerus
Damage to Axillary nerve and Post. Circumflex humoral Artery
Fracture of Mid Shaft Humerus
Damage to Radial Nerve and Deep artery of Arm
Fracture of Medial Epicondyle
Damage to Ulnar Nerve
Fracture of Supracondylar part:
Damage to median nerve and Brachial artery
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Overall : Dorsal Displacement of Wrist and Hand
Specifically: Dorsal and Proximal Displacement of Distal segment of fractured radius
Fall on Out stretched Hand
This is more common in older person
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CASE 1
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CASE 4
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CASE 5
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LOWER LIMB
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LOWER LIMB Nerve lesions in lower limb Injuries of hip, knee and ankle joint
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BRANCHES OF THE LUMBAR PLEXUS
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BRANCHES OF THE SACRAL PLEXUS
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NERVE INJURIES
Injury to femoral nerve Injury to obturator nerve Injury to superior gluteal nerve Injury to inferior gluteal nerve Injury to sciatic nerve Injury to tibial nerve Injury to common fibular nerve Injury to deep fibular nerve Injury to superficial fibular nerve
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INJURY TO FEMORAL NERVE
Weakness of hip flexion Iliopsoas, rectus femoris, and sartorius
Knee extension Quadriceps femoris
Loss of sensation over anterior thigh and medial leg and foot
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INJURY TO SUPERIOR GLUTEAL NERVE
Loss of thigh abduction & medial rotationGluteus medius,
gluteus minimus, and tensor fasciae latae
Positive Trendelenburg sign
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INJURY TO INFERIOR GLUTEAL NERVE
Weakened hip extension Gluteus maximus
Most noticeable when climbing stairs or standing from a seated position
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INJURY TO COMMON FIBULAR NERVE Footdrop and loss
of eversion May cause sensory
loss over lateral leg and dorsum of foot
CausesDirect trauma as
nerve passes superficially around neck of fibula
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JOINTS Hip joint Knee joint Ankle joint
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Posterior dislocationPosterior tearing of joint
capsule Dislocated femoral head
lies on posterior surface of ischium
Occurs in head-on collision
Damage to Ischiofemoral ligament
Complications Sciatic nerve may
damage.
DISLOCATION OF HIP JOINT
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KNEE JOINT Unhappy triad Anterior drawer sign Posterior drawer sign
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UNHAPPY TRIAD(TCL,MEDIAL MENISCUS AND ACL)
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KNEE JOINT INJURIES
Anterior drawer sign: This injury causes the free tibia to slide anteriorly under the fixed femur.
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POSTERIOR DRAWER SIGN:
PCL ruptures allow the free tibia to slide posteriorly under the fixed femur.
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ANKLE JOINT
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ANKLE INJURIES
The lateral ligament is injured because it is much weaker than the medial ligament.
The anterior talofibular ligament part of the lateral ligament is most vulnerable and most commonly torn during ankle sprains.
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CASE 1
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CASE 2
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CASE 3 During a football game, a player sustains a powerful
blow to the lateral side of his weight-bearing leg. He experiences excruciating knee pain and is unable to walk. The three structures most likely to be injured are the
Anterior cruciate and lateral collateral ligaments and the lateral meniscus
Anterior cruciate and medial collateral ligaments and the medial meniscus
Posterior cruciate and lateral collateral ligaments and the lateral meniscus
Posterior cruciate and medial collateral ligaments and the lateral meniscus
Posterior cruciate and medial collateral ligaments and medial meniscus