UCF ZOO 3733C - Chapter 6 Clinical Points

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Chapter 6 Clinical PointsAn ulnar (median) collateral ligament injury in a sprain → abnormal abduction of the forearmRadial (lateral) collateral ligament injury in a sprain  abnormal adduction of forearm.Colles’ fracture: Falling on the hand with the arm extended- Foot slides out in front; person goes down slightly sideways and person lands on the heel of the extended hand.- Radius fractured with posterior displacement in its distal inch  dinner fork shape to forearm (known as silverfork deformity)- Fracture of the styloid process of ulna (may or may not be present)- Associated complications: injuries to median and ulnar nerves Fractures of the carpal bones: Upper-extremity fractures are among the most common fractures of the skeletal system.- Carpal bone fractures: 18% of hand fractures- Bones in proximal row are most commonly fractured- Most commonly fractured bone: scaphoid → 70% of fractures in carpal groupand 10% of all hand fractures - Second most common: triquetral fractures → 14% of wrist injuries - Rest of the bones: comparatively low- Carpal injury: result of direct or indirect trauma.- Usually a result of high energy mechanisms- Can result in disability if not treatedCarpal Tunnel Syndrome: pathologic condition of the anterior region of the wrist- Characterized by pain and weakness of the hands- Caused by compression of the median nerve in the carpal tunnel.- Most common cause: repetitive movement of wrist (like typing)- Also due to hypothyroidism, rheumatoid arthritis, pregnancy, and amyloidosis.- Treatment: courses of surgical and nonsurgical treatmentso Early surgery: when there is evidence of median nerve injuryo Typically, local steroid injection or splinting is suggested.o Oral steroids or ultrasounds are other optionso Carpal tunnel releaseo Surgical treatment of carpal tunnel retinaculum is recommended.Describe the rotator cuff injury: Involve supraspinatus, infraspinatus, teres minor,and subscapularis  maintain stability of shoulder joint- Rotator cuff injury: tendinopathy of the supraspinatus (often occurs in athletes), calcification, pain, tendon rupture, and avulsion of the greater tubercle - Many techniques and operative methods introduced.Dupuytren’s contracture: progressive fibrosis- Thickening and shortening of the palmar aponeurosis- Leads to partial flexion of the ring and small fingerWhat are the causes and signs/symptoms of radial nerve injury?- Nerve injury proximal to the origin of the tricps:o Elbow is flexed, extension of the elbow may not be possible, triceps reflex may be absento Wrist drop: all extensor muslces and the supinator are paralyzed and the thumb is flexed and abductedo Forearm might be pronated- Sensory loss may be present: o Dorsolateral lower brachial regiono Posterior surface of the forearmo Dorsum of the hando Radial side of the proximal phalanges- Nerve injury in the radial groove: in fractures of the humeruso Triceps muscle is usually functioningo Wrist drops and sensory loss in the dorsolateral aspect of the forearm may be notice- Nerve injury to the forearm: o Deep radial nerve is injured (wrist drop)o Extension of thumb and metacarpal joints disturbed o Sensation is typically preserved. What are the causes and signs/symptoms of median nerve injury?- Nerve injury above the elbowo Muscles in the arm are NOT affected by nerve injury above the elbow, ONLY the muscles of the forearm and hando ALL flexors of the wrist are paralyzed  flexor carpi ulnaris, and the ulnar part of the flexor digitorium profunduso Thumb flexors and other muscles on the thenar side are paralyzed, but NOT the adductor. (ape hand)o Flexion at the metacarpophalangeal joints may be possible (interossei muscles are intact), but fingers cannot be flexed at the interphalanged joints. o First and second lumbricals lose function altogether, inability to fully flex the index and middle fingers.o Pronation of the forearm may be compromised and sensory loss at themedian nerve area in the hand may be noticed. - Injury at the wrist joint:o May lead to median nerve injury at wrist areao Short muscles of thumb may be paralyzed, but NOT the adductor and the flexor pollicis longuso Thenar muscles atrophy  Ape hando Sensory loss over the median nerve sensory areao Percussion on the nerve in the wrist area may lead to heightened paraesthesia (Tinel’s sign) in carpal tunnel syndrome.What are the causes and signs/symtoms of ulnar nerve injury?- Injury at the elbow:o Paralysis of the flexor carpi ulnaris and the medial portion of the flexor digitorium profundus o Ulnar deviation at the wrist is weakened and hand is abducted and extended- Injury at the wrist:o Fingers are hyperextended at the metacarpophalangeal joints and flexed at the interphalangeal joints Paralysis of the interossei muscles and the two medial lumbrical muscles  claw hando Tendons of flexor digitorium profundus (2 medial muscles) are paralyzed  flexion of ring finger and ring finger not possible at distalphalangeal jointso Flexion at metacarpophalangeal joints is possible due to flexor digitorum superficials being intact. o Small muscles of little finger are paralyzedo Abduction and adduction of the fingers are impaired  paralysis of the interossei muscles  no more writing or piano playingo Sensory loss of the hand in the ulnar nerve territory over the ulnar nerve area.Brachial Plexus Syndromes- Leads to motor, sensory, and automatic deficits- T1 root involvement  Horner’s syndrome- Upper brachial plexus lesion, posterior cord lesion, lower brachial plexus lesion, and total brachial plexus lesion.- Upper brachial plexus lesion (C5-C6)o Due to traction of the arm at birth (Erb-Duchenne paralysis) or trauma to the shoulder  Roots may even be pulled out of the spinal cordo Signs and symptoms: paralysis of the deltoid and supraspinatus (no arm abduction), infraspinatus paralysis (medial rotation of arm), paralysis of the biceps and brachialis (impaired elbow flexion; biceps impaired supination), adductors of shoulder (pectoralis major and latissimus dorsi)  mildly affected- Lower brachial plexus lesion (C8-T1)o Causes: sudden upward pull of the shoulder  Injury to the C8-T1 roots following forced abduction of the shoulder at birth (Klumpke’s paralysis)  leads to paralysis of the intrinsic muscle of the hand and anesthesia o Not as common as uppero Signs/symptoms: atrophic paralysis of the forearm and small muscles of the hand (claw hand)


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UCF ZOO 3733C - Chapter 6 Clinical Points

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