Transcript Clinical Correlates UE 2008

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, mainly
Brachioradialis
Reflex
C7, mainly
Upper Brachial Plexus Injury – “Erb-Duchenne Palsy”
A 33-year-old male presents two weeks following a motorcycle crash with the
main complaint of limited functional use of his right arm. Physical exam reveals
a 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 right
shoulder and neck, sustaining significant skin abrasions to the area of his right
lateral 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 curvaturesimilar to that of
a dinner fork.
Distal fragment
of radius
overrides the
rest of the
bone…leading
to this abnormal
deformity/curvat
ure.
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