Injuries

1
Injuries
2
Injuries of brachial plexus

• Long thoracic nerve
• Damage to serratus anterior
• Wining of scapula
• http//www.drnathwingingscapula.com/index.php?refe
  rrerovertureheadlineDr_Nath_Winging_Scapulakey
  wordswinged_scapulaOVRAWlong20thoracic20nerve
  OVKEYlong20thoracic20nerveOVMTCstandard

3
(No Transcript)
4
Injuries of brachial plexus

• Upper brachial plexus damage could be caused by
  fall from above because of an accident (above) or
  excessive stretching during delivery.

5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
Upper brachial plexus

• The most common damaged spinal components are C5
  and C6. The spinal nerves may be yanked out of
  the spinal cord. Muscles that could be affected
  Deltoid (abduction, axillary nerve, C5, 6),
  Infraspinatus (lateral rotation, suprascapular
  nerve, C(4), 5, 6 ), Teres minor (lateral
  rotationAxillary nerve, C5, 6), Subscapularis
  (medial rotation, upper and lower subscapular
  nerve, C5, 6, 7), Coracobrachialis
  (musculocutaneous - C6, 7), Biceps Brachii
  (musculocutaneous nerve - C5, C6), Brachialis
  (musculocutaneous nerve a small branch of
  radial nerve - C5, C6) , supernator (radial nerve
  C5, C6, C(7)), also extensors are affected more
  by flexors. Typical position arm hangs by the
  sides in medial rotation.

10
(No Transcript)
11
Lower brachial plexus

• Lower brachial plexus damage can be caused by
  forceful pull of upper limb during birth, Or by
  grasping a limb during falling

12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
Lower brachial plexus

• Lower brachial plexus (inferior trunk, C8, T1)
  may be affected. Symptoms are mostly related to
  the injury of ulnar nerve, i.e. impairment of
  wrist flexion and digital movements

16
(No Transcript)
17
(No Transcript)
18
Radial nerve damage

• Poorly fitted crutches (too long) may injure the
  posterior cord of the brachial plexus. Often only
  the radial nerve is affected. As a result, the
  triceps, anconeus, and the extensor muscles of
  the wrist are paralyzed (brachioradialis,
  extensor carpi radialis longus, extensor carpi
  radialis brevis, extensor digitorum, extensor
  digiti minimi, extensor carpi ulnaris, Supinator,
  abductor pollicis longus, extensor pollicis
  brevis, extensor pollicis longus, extensor
  indicis) -- a condition referred as wrist drop.

19
(No Transcript)
20
Median nerve damage

• Median nerve damage at hand (as in carpal tunnel
  syndrome) Abductor pollicis brevis, Flexor
  pollicis brevis, Opponens pollicis, Lumbricals I,
  II

21
(No Transcript)
22
(No Transcript)
23
Median at arm

• Median nerve damage at arm
• Pronator teres, Flexor carpi radialis, Palmaris
  longus, Flexor digitorum superficialis, Flexor
  digitorum profundus, I, II, Flexor pollicis
  longus, Pronator quadratus

24
Ulnar at hand

• Ulnar nerve damage at hand
• Adductor pollicis, Abductor digiti minimi, Flexor
  digiti minimi brevis, Opponens digiti minimi,
  Lumbricals III, IV, Dorsal interossei 1-4,
  Palmar interossei 

25
Ulnar at hand

• Ulnar nerve damage at arm
• Palmaris brevis, Flexor carpi ulnaris, Flexor
  digitorum profundus, III, IV,

26
Other branches

• thoracodorsal nerve (C6, 7, 8) Latissimus Dorsi
• dorsal scapular, C4, 5 Rhomboids
• Long thoracic, C5, 6, 7, 8 Serratus anterior
• suprascapular nerve, C(4), 5, 6 Infraspinatus,
  Supraspinous muscle
• axillary nerve, C5, 6 Deltoid, Teres minor

27
Carpal tunnel syndrome

• Any lesion that significantly reduce the size of
  the carpal tunnel formed by flexor retinaculum
  (e.g., inflammation, arthritis, dislocation) may
  cause the compression of median nerve. Early
  symptoms include tingling (paresthesia), absence
  of tactile sensation (anesthesia), or diminished
  sensation (hypoesthesia) in the digits. Since
  median nerve sends a palmar cutaneous branch
  superficial to the flexor retinaculum, so the
  sensory impairment of palm is rarely seen. Most
  patients are 40-60 years old and more common in
  women, some caused by pregnancy.

28
Carpal tunnel syndrome

• There is often a progressive loss of coordination
  and strength in the thumb, owing to the weakness
  of abductor pollicis brevis and opponents
  pollicis. In severe cases of compression of
  median nerve, there may be wasting or atrophy of
  the thenar muscles. Partial or complete division
  of flexor retinaculum (carpal tunnel release) is
  the cure. Medical approach includes split,
  cortisol shot, resolve after delivery.

29
Elbow tendonitis (tennis elbow, lateral
epicondylitis)

• Elbow tendonitis is a painful musculoskeletal
  condition that may follow repetitive forceful
  pronation-supination of the forearm. Clinical
  symptoms include pain and point of tenderness at
  or distal to the lateral epicondyle of the
  humerus and it is caused by the premature
  degeneration of the common extensor attachment of
  the superficial extensor muscles of the forearm.
  Commonly seen in persons who play tennis because
  of the repeated strenuous contraction of the
  extensor muscles, especially during the backhand
  stroke. These movements strain the common
  extensor tendon of these muscles and produce
  inflammation of the lateral epicondyle. Treatment
  options are immobilization, anti-inflammatory
  drugs, and surgical (tendon, bone, removal,
  de-re-attachment of muscles)

30
(No Transcript)
31
(No Transcript)
32
(No Transcript)
33
Other conditions

• Fracture of radius
• Radial styloid process fracture

34
(No Transcript)
35
Rotator cuff muscles

• Four muscles
• Supraspinatus
• Infrespinatus
• Teres minor
• Subscapularis

36
(No Transcript)
37
(No Transcript)
38
(No Transcript)
39
Mallet or Baseball Finger

• Sudden extreme flexion of interphalangeal joint

40
(No Transcript)
41
(No Transcript)
42
Subluxation and Dislocation

• Preschoolers, especially girls vulnerable
• Pulled elbow

43
(No Transcript)