Part 1. Upper limb Lower limb Thorax Lesions of the Brachial Plexus Fractures.
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Transcript of Part 1. Upper limb Lower limb Thorax Lesions of the Brachial Plexus Fractures.
AnatomyAnatomy
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 PalsyErb-Duchenne’s Palsy
8
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
19
Clavicle Humerus Radius Scaphoid
22
Junction of Medial 2/3rd 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 Fracture of Medial Medial EpicondyleEpicondyle
Damage to Damage to Ulnar Ulnar NerveNerve
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.
26
27
Fall on Out stretched Fall on Out stretched HandHand
This is more common in older person
28
Nerve lesions in lower limb Injuries of hip, knee and ankle joint
Injury to femoral nerve Injury to femoral nerve Injury to obturator nerveInjury to obturator nerve Injury to superior gluteal nerve Injury to superior gluteal nerve Injury to inferior gluteal nerve Injury to inferior gluteal nerve Injury to sciatic nerve Injury to sciatic nerve Injury to tibial nerve Injury to tibial nerve Injury to common fibular nerve Injury to common fibular nerve Injury to deep fibular nerve Injury to deep fibular nerve Injury to superficial 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 rotationGluteus 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 fossaLoss of plantar flexion of foot (mainly
gastrocnemius and soleus) Weakened inversion (tibialis posterior),
Footdrop and loss of eversion
CausesDirect trauma as
nerve passes superficially around neck of fibula
Hip joint Knee joint Ankle joint
Posterior dislocationPosterior 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 : 6th rib 8th rib 10th vert Pleura : 8th 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 Which wall infarctioninfarction
Which artery Which artery blockedblocked
DiaphragmatDiaphragmatic or inferior ic or inferior surfacesurface
Proximal RCA or Proximal RCA or Rt. marginalRt. marginal
Posterior Posterior surfacesurface
Distal RCA, PDADistal RCA, PDA
Anterior wallAnterior wall LADLAD
Lateral WallLateral Wall Cx, Lt. marginal Cx, Lt. marginal or diagonal br of or diagonal br of LADLAD
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