Upper limb Lower limb.  Lesions of the Brachial Plexus  Fractures

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Transcript of Upper limb Lower limb.  Lesions of the Brachial Plexus  Fractures

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Upper limb Lower limb Slide 2 Lesions of the Brachial Plexus Fractures Slide 3 Slide 4 Slide 5 5 Injury to C5-6 at Erbs point Muscles paralysed Deltoid, biceps, brachialis, barachioradialis Posture waiters tip deformity Mechanism of injury : fall on shoulder or excessive pulling of head of new born during delivery Erb-Duchennes Palsy Slide 6 6 Slide 7 7 Injury to C8-T1 Muscles paralyzed small muscles of hand Deformity Claw hand Mechanism : Sudden superior pull on upper Slide 8 Symptoms : Clawed hand due to loss of innervation of Intrinsic muscle of the hand Slide 9 Slide 10 The characteristic clinical sign of radial nerve injury is wrist-drop. Slide 11 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. Slide 12 SATURDAY NIGHT PALSY WRIST DROP Radial Nerve Injury in Axilla: Mechanism: 1.Crutches pressing in axilla 2.Saturday night palsy! Main Effect: Slide 13 Slide 14 Slide 15 Slide 16 16 Carpal Tunnel syndrome Common in computer professionals. Due to constant dorsiflexion of wrist while typing the keyboard Slide 17 Slide 18 18 Slide 19 Slide 20 Clavicle Humerus Radius Scaphoid Slide 21 21 Junction of Medial 2/3 rd and Lateral 1/3rd Slide 22 22 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 Slide 23 23 Overall : Dorsal Displacement of Wrist and Hand Specifically: Dorsal and Proximal Displacement of Distal segment of fractured radius Fall on Out stretched Hand This is more common in older person Slide 24 24 Slide 25 Slide 26 Slide 27 Slide 28 Slide 29 Slide 30 Nerve lesions in lower limb Injuries of hip, knee and ankle joint Slide 31 Slide 32 Slide 33 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 Slide 34 Weakness of hip flexion Iliopsoas, rectus femoris, and sartorius Knee extension Quadriceps femoris Loss of sensation over anterior thigh and medial leg and foot Slide 35 Loss of thigh abduction & medial rotation Gluteus medius, gluteus minimus, and tensor fasciae latae Positive Trendelenburg sign Slide 36 Weakened hip extension Gluteus maximus Most noticeable when climbing stairs or standing from a seated position Slide 37 Slide 38 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 Slide 39 Hip joint Knee joint Ankle joint Slide 40 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. Slide 41 Unhappy triad Anterior drawer sign Posterior drawer sign Slide 42 Slide 43 Anterior drawer sign: This injury causes the free tibia to slide anteriorly under the fixed femur. Slide 44 PCL ruptures allow the free tibia to slide posteriorly under the fixed femur. Slide 45 Slide 46 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. Slide 47 Slide 48 Slide 49 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