ORTHOPAEDICS - ADULT
UPPER LIMB ANATOMY
PromptRadial nerve - innervation/testing
ResponseMotor - wrist extension, finger extension - MCPJ, thumb IPJ (note PIPJ and DIPJ can still be extended by intrinsic function - Ulnar Nerve)
Sensory - Dorsal first webspace
Sensory - Dorsal first webspace
PromptUlnar nerve - innervation/testing
ResponseMotor - Interossei (Cross fingers or abduct fingers against resistance, paper between thumb and index finger)
Sensory - Distal little finger
Sensory - Distal little finger
PromptCourse of ulnar nerve
ResponseArises from brachial plexus, descendsd down medial side of upper arm, passes posterior to medial epicondyle to enter forearm. Pierces 2 heads of FCU then descends alongside the ulna
PromptInnervation of median nerve
ResponseMuscles of anterior compartment of forearm (FCR, PL, FDS, FDP (lateral/radial aspect), FBP, PQ. (Only flexors it doesn’t innervate are FCU, ulnar ½ FDP)
½ LOAF - Lateral 2 lumbricals, Opponens, adductor and flexor pollicis brevis
Test:
Recurrent motor branch - Palmar abduction of thumb
AIN Flextion of thumb Ip and index DIP (OK sign)
Sensory - finger tip index finger
½ LOAF - Lateral 2 lumbricals, Opponens, adductor and flexor pollicis brevis
Test:
Recurrent motor branch - Palmar abduction of thumb
AIN Flextion of thumb Ip and index DIP (OK sign)
Sensory - finger tip index finger
PromptMedian nerve injury at level of wrist
ResponseSensory loss palm and lateral 3-½ digits (Although palmar cutaneous branch comes off before transverse carpal ligament and palm should be intact?)
Motor loss thumb opposition and abduction
Motor loss thumb opposition and abduction
PromptHow to assess FDP
ResponseAssessed by stabilising the PIPJ and testing ability to flex the distal phalanx (at DIPJ) with and without resistance
PromptHow to assess FDS
ResponseStabilising MCPJ and testing ability to flex finger (PIPJ and DIPJ) with and without resistance
Prompt
ResponseTransverse laceration across entire forearm
Just proximal to wrist crease
Penetrates deep to superficial fascia
Gaping with deep structures on view
Mgmt
ADT, IVABx (Cefazolin), analgesia, spllint/immobilisation, orho/plastics for theatre
(Above summarised. With detail)
Just proximal to wrist crease
Penetrates deep to superficial fascia
Gaping with deep structures on view
Mgmt
ADT, IVABx (Cefazolin), analgesia, spllint/immobilisation, orho/plastics for theatre
(Above summarised. With detail)
PromptTendons of the volar wrist
ResponseSuperficial - FCR, PL, FCU PT
Middle - FDS
Deep - FDP, FPL, PQ
FCR - wrist flexion + Abduction
FCU - Flexion and adduction
PL - no findings of note
FDS - weakness of flexion at PIPJ
FDP - weakness of flexion at DIPJ
FPL - Wrist flexion and thumb IPJ flexion
Middle - FDS
Deep - FDP, FPL, PQ
FCR - wrist flexion + Abduction
FCU - Flexion and adduction
PL - no findings of note
FDS - weakness of flexion at PIPJ
FDP - weakness of flexion at DIPJ
FPL - Wrist flexion and thumb IPJ flexion