1 / 9

Upper Limb Case 3

Upper Limb Case 3. November 27, 2007 Victoria Bradford Steven Gay Richard Smillie Katie Treuhaft. Introduction. A 20 year old male soccer player arrives at the ER using his right hand to hold his left arm close to his body.

calais
Download Presentation

Upper Limb Case 3

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Upper Limb Case 3 November 27, 2007 Victoria Bradford Steven Gay Richard Smillie Katie Treuhaft

  2. Introduction • A 20 year old male soccer player arrives at the ER using his right hand to hold his left arm close to his body. • He said that during practice, he collided with another player and he fell to the ground on his left shoulder.

  3. Physical Examination • Blood Pressure: 120/70 • Pulse: 68 • Rhythm: Regular • Temperature: 98.3˚F • Respiratory Rate: 15 • Height: 6’1” • Weight: 190 lbs • HEENT Examination: Normal • All other systems: Normal

  4. Musculoskeletal Examination • Inspection, movement, and palpation of the upper and lower limbs were normal except for the following findings: • The patient’s left arm hung limply at his side. The forearm was pronated. • Muscle testing revealed a loss of flexion, abduction, and lateral rotation of the arm at the shoulder, and a weakness in flexion of the forearm at the elbow and of supination. • In addition, there was a loss of sensation along the lateral side of the arm.

  5. Questions • What muscles are affected that would produce these symptoms? • Loss of flexion of arm: • deltoid • Loss of flexion of forearm: • biceps brachii, coracobrachialis, brachialis • Loss of abduction of arm: • supraspinatus and deltoid • Loss of lateral rotation of arm: • infraspinatus, teres minor, posterior portion of deltoid • Loss of supination of forearm: • biceps brachii, brachioradialis, supinator

  6. Questions • List the innervation for the affected muscles. • Deltoid • Axillary n. • Biceps brachii, coracobrachialis, brachialis • Musculocutaneous n. • Supraspinatus, infraspinatus • Suprascapular n. • Teres minor • Axillary n. • Brachioradialis, supinator • Radial n.

  7. Questions • What nerve is responsible for sensory innervation of the territory described in the case? • Cutaneous branch of the axillary nerve • Musculocutaneous nerve as it becomes the lateral cutaneous nerve of the forearm

  8. Questions • Is there a single site where a lesion could produce all of the motor and sensory symptoms described in this case? • The upper trunk of the brachial plexus. Injuries to the superior trunk of the plexus is apparent by the characteristic position of the limb in the waiter’s tip position. An injury to the upper trunk of the brachial plexus would affect the musculocutaneous nerve, the radial nerve, and the axillary nerve.

More Related