Israel Alfonso, MD

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
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JUST GIVE ME THE ANSWER
5
RIGHT!
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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
b.
Supinator canal
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
C5-6
C5-7
C7-T1
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
C5-6
C5-7
C7-T1
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
C5-6
C5-7
C7-T1
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
A
EXTENSION OF THE PROXIMAL PHALANX OF THUMB AT MP
JOINT WRIST ABDUCTION
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
A
EXTENSION ABDUCTION OF THE WRIST
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