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Israel Alfonso, MD

CASE OF THE WEEK. 080909. Israel Alfonso, MD. Jeffrey Horstmyer, MD. Daniel A. Castellanos, PhD. 12 YEARS OLD WITH LEFT ARM WEAKNESS?. 1. Which of the following nerves is affected in this patient?. a. median nerve. b. peroneal nerve. c. radial nerve. d. ulnar nerve. WRONG!.

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Israel Alfonso, MD

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  1. CASE OF THE WEEK 080909 Israel Alfonso, MD Jeffrey Horstmyer, MD Daniel A. Castellanos, PhD

  2. 12 YEARS OLD WITH LEFT ARM WEAKNESS?

  3. 1. Which of the following nerves is affected in this patient? a. median nerve b. peroneal nerve c. radial nerve d. ulnar nerve

  4. WRONG! I WANT TO TRY AGAIN GIVE ME A CLUE JUST GIVE ME THE ANSWER

  5. RIGHT! SHOW ME THE QUESTION AGAIN I WANT TO SEE A CLUE, ANYWAY GO TO THE NEXT QUESTION

  6. C4 C5 Radial nerve C6 C7 C8 T1 Wrist drop S Sites of injury Axillary region Spiral groove of the humerus Supinator canal

  7. 1. Which of the following nerves is affected in this patient? a. median nerve b. peroneal nerve c. radial nerve d. ulnar nerve

  8. 2. On physical examination you determine: (1) no sensory deficit, (2) no weakness flexing elbow, (3) no weakness extending the forearm. Where is the injury? a. Carpal tunnel Supinator canal b. c. Axillary region d. Spiral groove of the humerus

  9. WRONG! I WANT TO TRY AGAIN GIVE ME A CLUE JUST GIVE ME THE ANSWER

  10. RIGHT! SHOW ME THE QUESTION AGAIN I WANT TO SEE A CLUE, ANYWAY GO TO THE NEXT QUESTION

  11. RADIAL NERVE (MOTOR) RADIAL NERVE (SENSORY) POST. CUT. NERVE OF THE ARM LAT. CUT. NERVE OF THE ARM POST. CUT. NERVE OF THE FOREARM SUPERFICIAL RADIAL NERVE DORSAL DIGITAL NERVES Supinator canal RADIAL NERVE SENSORY MAP

  12. C7-T1 C5-7 C5-6 C4 C5 C6-8 C6 C7 C8 T1 S GOOD BAD Supinator canal

  13. 2. On physical examination you determine: (1) no sensory deficit, (2) no weakness flexing elbow, (3) no weakness extending the forearm. Where is the injury? a. Carpal tunnel b. Supinator canal c. Axillary region d. Spiral groove of the humerus

  14. 3. Which of the following conditions can produce wrist drop? a. Lower brachial plexus injury b. Upper brachial plexus injury c. Median nerve injury d. Ulnar nerve injury

  15. WRONG! I WANT TO TRY AGAIN GIVE ME A CLUE JUST GIVE ME THE ANSWER

  16. RIGHT! SHOW ME THE QUESTION AGAIN I WANT TO SEE A CLUE, ANYWAY GO TO THE NEXT QUESTION

  17. C7-T1 C5-7 C5-6 C4 Brachial plexus C5 C6 C6-8 C7 C8 T1 S Supinator canal

  18. 3. Which of the following conditions can produce wrist drop? a. Lower brachial plexus injury b. Upper brachial plexus injury c. Median nerve injury d. Ulnar nerve injury

  19. 4. How can you distinguish a lower brachial plexus injury from a spiral groove radial nerve injury? Lower brachial plexus injury will spare _______ a. Brachioradialis b. Extensor carpi radialis c. All of the above d. None of the above

  20. WRONG! I WANT TO TRY AGAIN GIVE ME A CLUE JUST GIVE ME THE ANSWER

  21. RIGHT! SHOW ME THE QUESTION AGAIN I WANT TO SEE A CLUE, ANYWAY

  22. C7-T1 C5-7 C5-6 C4 Brachial plexus C5 C6-8 C6 C7 C8 T1 S Supinator canal

  23. 4. How can you distinguish a lower brachial plexus injury from a spiral groove radial nerve injury? Lower brachial plexus injury will spare _______ a. Brachioradialis b. Extensor carpi radialis c. All of the above d. None of the above

  24. THANK YOU

  25. EXTENSOR POLLICIS BREVIS O: POSTERIOR RADIUS & INTEROSSEOUS MEMBRANE I: BASE OF PROXIMAL PHALANX OF THUMB EXTENSION OF THE PROXIMAL PHALANX OF THUMB AT MP JOINT & WRIST ABDUCTION A: N: RADIAL NERVE P: TENDON, RADIAL SIDE OF ANATOMICAL SNUFFBOX C7-T1

  26. EXTENSOR CARPI RADIALIS (LONGUS) O: LATERAL SUPRACONDYLAR RIDGE & LATERAL EPICONDYLE I: BASE OF 2nd METACARPAL EXTENSION & ABDUCTION OF THE WRIST A: N: RADIAL NERVE P: PROXIMAL FOREARM, WHILE EXTENDING & ABDUCTING THE WRIST C5-7

  27. BRACHIORADIALIS O: LATERAL SUPRACONDYLAR RIDGE I: STYLOID FLEXION OF THE ELBOW WITH FOREARM IN NEUTRAL POSITION A: N: RADIAL NERVE P: UPPER FOREARM, WHILE FLEXING IT, IN NEUTRAL POSITION C5-6

  28. TRICEPS O: INFRAGLENOID TUBERCLE ABOVE SPIRAL GROOVE BELOW SPIRAL GROOVE C6-8 I: OLECRANON EXTENSION A: ELBOW & HUMERUS N: RADIAL NERVE P: POSTERIOR ARM DURING ELBOW EXTENSION

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