anatomy slides 4b
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| ***Injury proximal to the origin of Triceps | *No extension of elbow (elbow is flexed)
*No triceps reflex
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| Injury proximal to the origin of Triceps: ***Wrist drop | (all extensor muscles and the
Supinator are paralyzed), thumb is flexed
and adducted
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| Injury proximal to the origin of Triceps: Injury proximal to the origin of Triceps: | dorsolateral lower brachial
region, posterior surface of forearm,
dorsum of the hand and radial side of
proximal phalanges
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| Injury of the nerve in radial groove: | In fractures of humerus
Triceps muscle is usually functioning
Wirst drop and sensory loss in
dorsolateral aspect of the forearm and hand
Plus all other problems mentioned above
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| Nerve injury in forearm: | Here the deep radial nerve is injured (wrist drop)
Extension of the thumb and metacarpal joints is
disturbed. Sensation is usually preserved
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| Median Nerve injury: Above the elbow: Muscles in the arm are not affected Forearm and hand muscles are affected 1- All flexors of the wrist are paralyzed except? | Flexor carpi ulnaris and ulnar part of Flexor
digitorum profundus.
3- Thumb flexors and abductor paralyzed but not
Adductor (ulnar N.) (ape hand)
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| (ape hand) | Thumb flexors and abductor paralyzed but not
Adductor (ulnar N.)
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| Median Nerve injury: Above the elbow: (HAND OF PAPAL BENEDICTION) | 1st and 2nd Lumbricals lost function and all together,
inability to fully flex index and middle finger
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| Injury at wrist Joint: (suicide or injury e.g.: hand out of car’s window) | Short muscles of the thumb paralyzed, not adductor.
Thenar muscles atrophy (flattened, ape hand)
Flexor pollicis longus functioning
Sensory loss over Medial N. area
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| Ulnar nerve injury: At wrist: (Claw hand) | 1- Fingers are hyperextended at metacarpophalangeal joints
and flexed at interphalangeal joints (paralysis of interossei
MM and 2 medial lumbricals
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| Ulnar nerve injury: Tendon of flexor digitorum perfundus (2 medial ones) paralyzed, Therefore ? | flexion of the ring and little finger
is not possible at distal phalangeal joints
3- Small muscles of the little finger are paralyzed
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| Ulnar nerve injury: at wrist Abduction and Adduction of the fingers are ? | impaired
( paralysis of interossei MM, piano playing,
writing.. Impaired)
5- Sensory loss over ulnar innervating area
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| Ulnar nerve injury: Injury at elbow: | Paralysis of flexor carpi ulnaris and medial portion of Flexor digitorum profundus
Ulnar deviation of the wrist is weakened, hand is abducted and extended
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| Ulnar nerve injury: Injury at elbow: Abduction and Adduction of the fingers are ? | impaired
( paralysis of interossei MM, piano playing,
writing.. Impaired)
5- Sensory loss over ulnar innervating area.
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| Infraclavicular region (Deltopectoral triangle) | Borders: 1- Clavicle, 2- Deltoid,
3- Pectoralis major
Skin innervation: medial, intermediate and
Lateral supraclavicular nerves (cervical plexus)
On deltoid region: innervation by axillary nerve
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| Axillary region: (Pyramidal shape) Borders: | Pectoralis Major, Latis dorsi, ribs and
intercostal muscles, humerus and
coracobrachialis
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| Volkmann's ischemic contracture is a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm | lack of blood flow to the forearm. occurs when there is increased pressure due to swelling(compartment syndrome)
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| Lymph nodes of the Axillary region: Arranged in 5 groups: | Pectoral, medial, apical,
central and subscapular
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| Drainage of Lymph nodes of the Axillary region: | subclavian lymphatic
trunk to right lymphatic duct to
right venous angle
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| ***Importance of Lymph nodes of the Axillary region | Breast Cancers may
give metastasis to the axillary
lymph node (75% of breast’s
lymphatics drain here).
Removal of the lymph nodes
may be necessary
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| Mastectomy: | removal of the
breast
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| Lymphangitis | n infection of the lymph vessels
Red streaks from infected area to the armpit or groin (may be faint or obvious)
Enlarged lymph nodes (glands) above the area of red streaks -- usually in the elbow, armpit, or groin
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| Medial bicipital groove: Between biceps and intermuscular septa Contents: | Median N, Brachial artery and veins and
basilic vein, medial cutaneous antebrachial
nerve and ulnar N. medially
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| Radial nerve is found | deep in the
posterior brachial region in radial
groove of humerus accompanied
by deep brachial A and V.
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| Dorsum of the Hand: | Radial artery (9) enters the Snuffbox and
gives a dorsal branch which produces the
dorsal arterial arch of the hand.
Then it gives the principal artery of the thumb
and then a main branch to join the deep
palmar arch.
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| Snuffbox: borders: | Tendon of extensor pollicis longus (superior)
tendons of the ext. pollicis brevis and
abductor pollicis longus (inferiorly).
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| Contents of snuffbox: | 9- Radial artery
8- Superficial radial N.
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