Question | Answer |
***Injury proximal to the origin of Triceps | *No extension of elbow (elbow is flexed)
*No triceps reflex |
Injury proximal to the origin of Triceps:
***Wrist drop | (all extensor muscles and the
Supinator are paralyzed), thumb is flexed
and adducted |
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 |
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 |
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 |
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) |
(ape hand) | Thumb flexors and abductor paralyzed but not
Adductor (ulnar N.) |
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 |
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 |
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 |
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 |
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 |
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 |
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. |
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 |
Axillary region: (Pyramidal shape)
Borders: | Pectoralis Major, Latis dorsi, ribs and
intercostal muscles, humerus and
coracobrachialis |
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) |
Lymph nodes of the Axillary region:
Arranged in 5 groups: | Pectoral, medial, apical,
central and subscapular |
Drainage of Lymph nodes of the Axillary region: | subclavian lymphatic
trunk to right lymphatic duct to
right venous angle |
***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 |
Mastectomy: | removal of the
breast |
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 |
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 |
Radial nerve is found | deep in the
posterior brachial region in radial
groove of humerus accompanied
by deep brachial A and V. |
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. |
Snuffbox: borders: | Tendon of extensor pollicis longus (superior)
tendons of the ext. pollicis brevis and
abductor pollicis longus (inferiorly). |
Contents of snuffbox: | 9- Radial artery
8- Superficial radial N. |