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Upper Limb
Lecture 3
36
Anatomy
Graduate
04/03/2011

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Term
Symptoms of acute compartment syndrome
Definition
4 P's: pallor, pulselessness, paresthesias and paralysis (pain out of proportion to injury)
-tx with fasciotomy
Term
Groove in humerus
Definition
in a pt with osteomalacia, the brachial artery may leave a groove looking a like a false fracture on xray
Term
radiculopathy
Definition
preplexus lesion; single root lesion or injury 'more dermatomal and myotomal like'
Term
mononeuropathy
Definition
postplexus or terminal nerve lesion causing paresis/paralysis and anesthesia
Term
Hereditary brachial plexus neuropathy
Definition
Acute onset of shoulder pain and loss of brachial plexus function during the immediate postpartum period; FHx of similar events; recurrent but benign.
Term
Neoplastic component of brachial neuropathy
Definition
CA or tumor development in the plexus. C8 and T1 are favored with the CA moving up.
Term
neurapraxia
Definition
temporary failure of conduction without loss of axonal continuity. Spontaneous recovery with good recovery of function (within minutes to hours)
Term
Axonotmesis
Definition
Lesion resulting in wallerian degeneration, without loss of endoneurial tubes. Spontaneous recovery with good recovery of function (several months to over a year)
Term
Neurotmesis
Definition
Axons and endoneurial tubes are disrupted. Both partial retrograde and complete anterograde wallerian degeneration. Surgical repair needed. Mismatch repair results in partial recovery of function.
Term
Autononous dermatomal region of C5
Definition
upper lateral arm over deltoid
Term
Autononous dermatomal region of C6
Definition
pad of thumb
Term
Autononous dermatomal region of C7
Definition
pad of index finger
Term
Autononous dermatomal region of C8
Definition
pad of little finger
Term
Autononous dermatomal region of T1
Definition
skin over medial epicondyle
Term
Now, what happens if you lesion just the sensory components of a single spinal nerve, e.g., C6?
Definition
Lesioning spinal nerve C6, its ventral ramus, or its dorsal root, will produce hypesthesia distributed in all cutaneous “patches” having the C6 dermatome. However, there will be severe hypesthesia or even anesthesia in the autonomous region of the C6 dermatome (skin over thenar eminence and thumb pad).
Term
What happens if a terminal nerve or its cutaneous branch is lesioned?
Definition
Lesioning the terminal cutaneous nerve (e.g., the cutaneous brs. of the musculocutaneous nerve) produces severe hypesthesia and even anesthesia of the dermatomes represented in its patch because both the dermatomes and their overlaps are carried in that cutaneous nerve and thus, are “knocked out”
Term
C5 controls
Definition
AB-duction at the shoulder
Term
C6 controls
Definition
supination of the hand and flexion at the elbow
Term
C7 controls
Definition
extension at the elbow
Term
C8 controls
Definition
deep F/E of thumb
Term
T1 controls
Definition
AB/AD duction of fingers in the hand
Term
subscapular notch syndrome
Definition
“Can’t start” abduction (first 15°); weakness of external rotation; shoulder pain; atrophy of supraspinatus and infraspinatus.
Term
Long thoracic nerve injury
Definition
Paralysis: winging of vertebral border of scapula with pushing; unable to elevate or abduct arm >90
Term
mobile wad muscles
Definition
brachiradialis, carpi radialis longus and carpi radialis brevis
Term
Posterior interosseous syndrome (supinator syndrome)
Definition
Wrist extension possible, but can’t extend digits properly.
Term
Wartenbergs Syndrome
Definition
Entrapment of superficial radial nerve as it emerges between the tendons of the brachioradialis and extensor carpi radialis longus (Tinel
sign).
Term
de Quervain’s tenosynovitis
Definition
(inflammation of the tendon sheaths in first extensor compartment of the wrist). Passive volar bending of thumb stretches the inflammed tendons producing pain (positive Finkelstein’s test).
Term
radial tunnel syndrome
Definition
pain is more distal, generally over the mobile wad. In addition, provocative tests such as resistance to supination, and resistive extension of middle finger produces pain over radial tunnel.
Term
best test to dx radial nerve lesion
Definition
The single best test for a radial nerve lesion is having the patient dorsally raise the thumb from a flat surface (extensor pollicis longus). The patient will not be able to perform this test with a severe radial nerve lesion.
Term
Adson Test
Definition
een when the head is turned to the side during deep inspiration, when there is loss of the radial pulse in the arm- used to dx thoracic outlet syndrome (scalene syndrome)
Term
Allen test
Definition
observing capillary refill of digits after exsanguinating hand for an ARTERIAL thoracic outlet syndrome
Term
Paget-Schroetter Syndrome
Definition
Stenosis over the clavicle
Term
waiter tip sign
Definition
Arm is adducted, medially rotated; forearm is extended and pronated- + in Erb-Duchenne Palsy
Term
Reynauds Syndrome
Definition
Abnormal episodic vasospasm of the digits in response to cold exposure. Upon warming, the affected digits undergo reactive hyperemia, becoming engorged with blood. There is a characteristic biphasic or triphasic color response of the affected digits: pallor to cyanosis and upon rewarming, rubor (redness). During the hyperemic phase (rubor), there is considerable pain and throbbing.
Term
Popeye Sign
Definition
Rupture of bicipital tendon from the bicipitolabral complex or from the radial tuberosity- bicep appears to be in contracted state but it isnt
Term
+ posterior fat pad sign
Definition
indicates elbow fx
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