Part 1

 Upper limb  Lower limb  Thorax

 Lesions of the Brachial Plexus  Fractures

7  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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9  Injury to C8-T1  Muscles paralyzed – small muscles of hand  Deformity Claw hand  Mechanism : Sudden superior pull on upper limb

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 WRIST DROP Radial Nerve Injury in Axilla: Mechanism: 1.Crutches pressing in axilla 2.Saturday night palsy! Main Effect:

17 Carpal Tunnel syndrome Common in computer professionals. Due to constant dorsiflexion of wrist while typing the keyboard

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 Clavicle  Humerus  Radius  Scaphoid

22 Junction of Medial 2/3 rd and Lateral 1/3rd

23  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

A midhumeral fracture may injure the radial nerve in the radial groove in the humeral shaft.

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27 Fall on Out stretched Hand This is more common in older person

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 Nerve lesions in lower limb  Injuries of hip, knee and ankle joint

 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

 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 Trendelenburg sign

 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

MCL MAL Vertebral  Lungs : 6 th rib 8 th rib 10 th vert  Pleura : 8 th rib 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 or inferior surface Proximal RCA or Rt. marginal Posterior surface Posterior surface Distal RCA, PDA Anterior wall LAD Lateral Wall Cx, Lt. marginal or diagonal br of LAD

Diaphragmatic or Inferior wall infarct True Posterior wall infarct Anterior wall infarct Antero-lateral infract

1.Right Atrium. 2.Left Atrium. 3.Right Ventricle. 4.Left Ventricle. 5.Descending Aorta. 6.Transverse Process of T7. 7.Right Bronchus. 8.Left Bronchus