Transcript saturday night palsy wrist drop

Anatomy
Part 1
 Upper
limb
 Lower limb
 Thorax
 Lesions
of the Brachial Plexus
 Fractures
Erb-Duchenne’s Palsy
 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
7
8
 Injury
to C8-T1
 Muscles paralyzed – small muscles of hand
 Deformity Claw hand
 Mechanism : Sudden superior pull on upper limb
9
Symptoms:
Clawed hand due to loss of innervation of
Intrinsic muscle of the hand
The characteristic
clinical sign of
radial nerve injury
is wrist-drop.
SATURDAY NIGHT PALSY
Radial Nerve Injury in
Axilla:
Mechanism:
1.Crutches pressing in
axilla
2.Saturday night palsy!
Main Effect:
WRIST DROP
Carpal Tunnel
syndrome
Common in computer
professionals.
Due to constant
dorsiflexion of wrist while
typing the keyboard
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19
 Clavicle
 Humerus
 Radius
 Scaphoid
Junction of Medial 2/3rd and Lateral 1/3rd
22
 Fracture
of
Surgical Neck of
Humerus
 Damage to
Axillary nerve
and Post.
Circumflex
humoral Artery
 Fracture
of
 Fracture of
Mid Shaft
Medial
Humerus
Epicondyle
 Damage to

Damage to
Radial Nerve
Ulnar Nerve
and Deep
artery of Arm
Fracture of Supracondylar part:
Damage to median nerve and Brachial artery
23
A midhumeral fracture
may injure the radial
nerve in the radial
groove in the humeral
shaft.
26
Fall on Out stretched Hand
This is more
common in
older person
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28
 Nerve
lesions in lower limb
 Injuries of hip, knee and ankle joint
 Injury
 Injury
 Injury
 Injury
 Injury
 Injury
 Injury
 Injury
 Injury
to femoral nerve
to obturator nerve
to superior gluteal nerve
to inferior gluteal nerve
to sciatic nerve
to tibial nerve
to common fibular nerve
to deep fibular nerve
to superficial fibular 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
 Difficulty
adducting thigh
 Decreased sensation over upper medial
thigh
 Loss
of thigh abduction
& medial rotation

Gluteus medius, gluteus
minimus, and tensor
fasciae latae
 Positive
sign
Trendelenburg
 Weakened

hip extension
Gluteus maximus
 Most
noticeable when climbing stairs or
standing from a seated position
 Weakened
hip extension and
knee flexion
 Inability to dorsiflex,
plantar flex, evert, or invert
foot
 Loss of cutaneous
sensation over leg and foot
except medial area supplied
by saphenous nerve
 In


Popliteal fossa
Loss of plantar flexion of foot (mainly
gastrocnemius and soleus)
Weakened inversion (tibialis posterior),

Footdrop and loss of
eversion
 Causes

Direct trauma as
nerve passes
superficially around
neck of fibula
 Hip
joint
 Knee joint
 Ankle joint
 Posterior

dislocation
Posterior 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.
 Unhappy
triad
 Anterior drawer sign
 Posterior drawer sign
 Anterior
drawer
sign: This injury
causes the free
tibia to slide
anteriorly under
the fixed femur.
 PCL
ruptures
allow the free
tibia to slide
posteriorly under
the fixed femur.
 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.
 Lungs
 Heart
 Mediastinum
 1.Pulmonary
artery
 2. Two pulmonary
veins
 3. Main bronchus
 4. Bronchial vessels
 5. Nerves and
lymphatics.
Has its own Bronchus
 Has its own Pulmonary
artery (Blue)
 Drains to multiple
pulmonary veins (Red)
between segments

 Lungs
:
 Pleura :
MCL
6th rib
8th rib
MAL
Vertebral
8th rib
10th vert
10 th rib 12 th vert
1. Diaphragmatic
(inferior) surface
on which the
pyramid rests
 2. Anterior
(sternocostal)
surface oriented
anteriorly
 3.Right pulmonary
surface
 4.Left pulmonary
surface.

 Coronary
artery circulation
Which wall
infarction
Which artery
blocked
Diaphragmatic Proximal RCA or Rt.
or inferior
marginal
surface
Posterior
surface
Distal RCA, PDA
Anterior wall
LAD
Lateral Wall
Cx, Lt. marginal or
diagonal br of LAD
True Posterior wall
infarct
Antero-lateral infract
Diaphragmatic or
Inferior wall infarct
Anterior wall infarct
1.
2.
3.
4.
5.
6.
Right Atrium.
Left Atrium.
Right Ventricle.
Left Ventricle.
Descending Aorta.
Transverse Process of
T7.
7. Right Bronchus.
8. Left Bronchus