GROSS ANATOMY WEB

EXUpper limb

Lower limb

UPPER LIMB Lesions of the Brachial Plexus Fractures

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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 Palsy

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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

Symptoms:

Clawed hand due to loss of innervation of Intrinsic muscle of the hand

RADIAL NERVE

WRIST-DROP

The characteristic clinical sign of radial nerve injury is wrist-drop.

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.

SATURDAY NIGHT PALSY

WRIST DROP

Radial Nerve Injury in Axilla:

Mechanism:

1.Crutches pressing in axilla

2.Saturday night palsy!

Main Effect:

AXILLARY NERVE

NOTE THE LEFT DELTOID MUSCLE ATROPHY.

MEDIAN NERVE

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Carpal Tunnel syndrome

Common in computer professionals.

Due to constant dorsiflexion of wrist while typing the keyboard

ULNAR NERVE

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ROTATOR CUFF MUSCLES

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

Fracture of Supracondylar part:

Damage to median nerve and Brachial artery

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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

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CASE 1

CASE 4

CASE 5

LOWER LIMB

LOWER LIMB Nerve lesions in lower limb Injuries of hip, knee and ankle joint

BRANCHES OF THE LUMBAR PLEXUS

BRANCHES OF THE SACRAL PLEXUS

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

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

INJURY TO SUPERIOR GLUTEAL NERVE

Loss of thigh abduction & medial rotationGluteus medius,

gluteus minimus, and tensor fasciae latae

Positive Trendelenburg sign

INJURY TO INFERIOR GLUTEAL NERVE

Weakened hip extension Gluteus maximus

Most noticeable when climbing stairs or standing from a seated position

INJURY TO COMMON FIBULAR NERVE Footdrop and loss

of eversion May cause sensory

loss over lateral leg and dorsum of foot

CausesDirect trauma as

nerve passes superficially around neck of fibula

JOINTS 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.

DISLOCATION OF HIP JOINT

KNEE JOINT Unhappy triad Anterior drawer sign Posterior drawer sign

UNHAPPY TRIAD(TCL,MEDIAL MENISCUS AND ACL)

KNEE JOINT INJURIES

Anterior drawer sign: This injury causes the free tibia to slide anteriorly under the fixed femur.

POSTERIOR DRAWER SIGN:

PCL ruptures allow the free tibia to slide posteriorly under the fixed femur.

ANKLE JOINT

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.

CASE 1

CASE 2

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