Injuries

1. Injuries

2. Injuries of brachial plexus • Long thoracic nerve • Damage to serratus anterior • Wining of scapula • http://www.drnathwingingscapula.com/index.php?referrer=overture&headline=Dr_Nath_Winging_Scapula&keywords=winged_scapula&OVRAW=long%20thoracic%20nerve&OVKEY=long%20thoracic%20nerve&OVMTC=standard#

4. Injuries of brachial plexus • Upper brachial plexus damage could be caused by fall from above because of an accident (above) or excessive stretching during delivery.

9. Upper brachial plexus • The most common damaged spinal components are C5 and C6. The spinal nerves may be yanked out of the spinal cord. Muscles that could be affected: Deltoid (abduction, axillary nerve, C5, 6), Infraspinatus (lateral rotation, suprascapular nerve, C(4), 5, 6 ), Teres minor (lateral rotationAxillary nerve, C5, 6), Subscapularis (medial rotation, upper and lower subscapular nerve, C5, 6, 7), Coracobrachialis (musculocutaneous - C6, 7), Biceps Brachii (musculocutaneous nerve - C5, C6), Brachialis (musculocutaneous nerve + a small branch of radial nerve - C5, C6) , supernator (radial nerve C5, C6, C(7)), also extensors are affected more by flexors. Typical position: arm hangs by the sides in medial rotation.

11. Lower brachial plexus • Lower brachial plexus damage can be caused by forceful pull of upper limb during birth, Or by grasping a limb during falling

15. Lower brachial plexus • Lower brachial plexus (inferior trunk, C8, T1) may be affected. Symptoms are mostly related to the injury of ulnar nerve, i.e. impairment of wrist flexion and digital movements

18. Radial nerve damage • Poorly fitted crutches (too long) may injure the posterior cord of the brachial plexus. Often only the radial nerve is affected. As a result, the triceps, anconeus, and the extensor muscles of the wrist are paralyzed (brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, Supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis) -- a condition referred as wrist drop.

20. Median nerve damage • Median nerve damage at hand (as in carpal tunnel syndrome): Abductor pollicis brevis, Flexor pollicis brevis, Opponens pollicis, Lumbricals I, II

23. Median at arm • Median nerve damage at arm • Pronator teres, Flexor carpi radialis, Palmaris longus, Flexor digitorum superficialis, Flexor digitorum profundus, I, II, Flexor pollicis longus, Pronator quadratus

24. Ulnar at hand • Ulnar nerve damage at hand: • Adductor pollicis, Abductor digiti minimi, Flexor digiti minimi brevis, Opponens digiti minimi, Lumbricals III, IV, Dorsal interossei 1-4, Palmar interossei 

25. Ulnar at hand • Ulnar nerve damage at arm: • Palmaris brevis, Flexor carpi ulnaris, Flexor digitorum profundus, III, IV,

26. Other branches • thoracodorsal nerve (C6, 7, 8): Latissimus Dorsi • dorsal scapular, C4, 5: Rhomboids • Long thoracic, C5, 6, 7, 8: Serratus anterior • suprascapular nerve, C(4), 5, 6: Infraspinatus, Supraspinous muscle • axillary nerve, C5, 6: Deltoid, Teres minor

27. Carpal tunnel syndrome • Any lesion that significantly reduce the size of the carpal tunnel formed by flexor retinaculum (e.g., inflammation, arthritis, dislocation) may cause the compression of median nerve. Early symptoms include: tingling (paresthesia), absence of tactile sensation (anesthesia), or diminished sensation (hypoesthesia) in the digits. Since median nerve sends a palmar cutaneous branch superficial to the flexor retinaculum, so the sensory impairment of palm is rarely seen. Most patients are 40-60 years old and more common in women, some caused by pregnancy.

28. Carpal tunnel syndrome • There is often a progressive loss of coordination and strength in the thumb, owing to the weakness of abductor pollicis brevis and opponents pollicis. In severe cases of compression of median nerve, there may be wasting or atrophy of the thenar muscles. Partial or complete division of flexor retinaculum (carpal tunnel release) is the cure. Medical approach includes: split, cortisol shot, resolve after delivery.

29. Elbow tendonitis (tennis elbow, lateral epicondylitis) • Elbow tendonitis is a painful musculoskeletal condition that may follow repetitive forceful pronation-supination of the forearm. Clinical symptoms include pain and point of tenderness at or distal to the lateral epicondyle of the humerus and it is caused by the premature degeneration of the common extensor attachment of the superficial extensor muscles of the forearm. Commonly seen in persons who play tennis because of the repeated strenuous contraction of the extensor muscles, especially during the backhand stroke. These movements strain the common extensor tendon of these muscles and produce inflammation of the lateral epicondyle. Treatment options are: immobilization, anti-inflammatory drugs, and surgical (tendon, bone, removal, de-re-attachment of muscles)

33. Other conditions • Fracture of radius • Radial styloid process fracture

35. Rotator cuff muscles • Four muscles • Supraspinatus • Infrespinatus • Teres minor • Subscapularis

39. Mallet or Baseball Finger • Sudden extreme flexion of interphalangeal joint

42. Subluxation and Dislocation • Preschoolers, especially girls vulnerable • “Pulled elbow”