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Published byStephan Branscomb Modified over 10 years ago
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Gross anatomy Web ex Upper limb Lower limb
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Upper limb Lesions of the Brachial Plexus Fractures
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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
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Klumpke’s palsy Injury to C8-T1
Muscles paralyzed – small muscles of hand Deformity Claw hand Mechanism : Sudden superior pull on upper
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Clawed hand due to loss of innervation of Intrinsic muscle of the hand
Symptoms: Clawed hand due to loss of innervation of Intrinsic muscle of the hand
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Radial nerve
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wrist-drop The characteristic clinical sign of radial nerve injury is wrist-drop.
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Fracture of the Humeral Shaft
A midhumeral fracture may injure the radial nerve in the radial groove in the humeral shaft. Fracture is not likely to paralyze the triceps because of the high origin of the nerves to two of its three heads.
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Main Effect: Radial Nerve Injury in Axilla: Mechanism:
SATURDAY NIGHT PALSY Radial Nerve Injury in Axilla: Mechanism: Crutches pressing in axilla Saturday night palsy! Main Effect: WRIST DROP
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Axillary nerve
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Note the left deltoid muscle atrophy.
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Median nerve
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Carpal Tunnel syndrome
Common in computer professionals. Due to constant dorsiflexion of wrist while typing the keyboard
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Ulnar nerve
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Rotator cuff muscles
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Fractures Clavicle Humerus Radius Scaphoid
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Junction of Medial 2/3rd and Lateral 1/3rd
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Humerus Fractures 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 study Fracture of Supracondylar part: Damage to median nerve and Brachial artery
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Overall : Dorsal Displacement of Wrist and Hand
Fall on Out stretched Hand Overall : Dorsal Displacement of Wrist and Hand Specifically: Dorsal and Proximal Displacement of Distal segment of fractured radius This is more common in older person
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Case 1
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Case 4
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Case 5
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Lower limb
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Lower limb Nerve lesions in lower limb
Injuries of hip, knee and ankle joint
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branches of the Lumbar plexus
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branches of the Sacral plexus
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Nerve Injuries 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
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Injury to femoral 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
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Injury to superior gluteal nerve
Loss of thigh abduction & medial rotation Gluteus medius, gluteus minimus, and tensor fasciae latae Positive Trendelenburg sign
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Injury to inferior gluteal nerve
Weakened hip extension Gluteus maximus Most noticeable when climbing stairs or standing from a seated position
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Injury to common fibular nerve
Footdrop and loss of eversion May cause sensory loss over lateral leg and dorsum of foot Causes Direct trauma as nerve passes superficially around neck of fibula
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Joints Hip joint Knee joint Ankle joint
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Dislocation of hip 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.
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Knee joint Unhappy triad Anterior drawer sign Posterior drawer sign
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Unhappy triad(TCL,MEDIAL MENISCUS AND ACL)
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Knee Joint Injuries Anterior drawer sign: This injury causes the free tibia to slide anteriorly under the fixed femur.
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Posterior drawer sign:
PCL ruptures allow the free tibia to slide posteriorly under the fixed femur.
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Ankle joint
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Ankle Injuries 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.
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Case 1
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Case 2
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Case 3 During a football game, a player sustains a powerful blow to the lateral side of his weight-bearing leg. He experiences excruciating knee pain and is unable to walk. The three structures most likely to be injured are the Anterior cruciate and lateral collateral ligaments and the lateral meniscus Anterior cruciate and medial collateral ligaments and the medial meniscus Posterior cruciate and lateral collateral ligaments and the lateral meniscus Posterior cruciate and medial collateral ligaments and the lateral meniscus Posterior cruciate and medial collateral ligaments and medial meniscus
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