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Understand first, then memorize and apply
l Dear students, you can use this presentation like a guide during your
preparing for GA exams.
l It does NOT cover all material of the Gross Anatomy course.
100 must important l To complete GA material you should work with ALL professor’s
GA conceptions presentations.
l Good Luck and All the best!
Dr. Mavrych, MD, PhD, DSc
Dr. Bolgova, MD, PhD
Dr. Mavrych
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
1. Lumbar puncture (tap) and
Epidural anesthesia
l When lumbar puncture is
performed, the needle
enters the subarachnoid
space to extract
cerebrospinal fluid (CSF)
or to inject anesthetic to
epidural space. 3
l The needle is usually adults
1
inserted between L3/L4 or 4 2
5
kids L4/L5. Level of horizontal
line through upper points 6*
of iliac crests.
l Remember, the spinal cord Conus medullaris
may ends as low as L2 in Cauda Equina w/ FT
adults and does end at L3 10* dura matter 7
in children and dural sac subdural spac
subd space 8
extends caudally to level of Arachnoid matter 9
S2.
7
Spinal cord ends L2: Conus Medullaris
End Dura Sac S2: Cauda Equina w/ Filum terminale
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
Lamina= front smooth of arches
8 cervical SN (above) Pedicles= attachment of bodies to arches
12 thoracic SN Processes= protuberances and "attachments" (articular=restricts movement, spinous &
5 lumbar SN (below body) transverse muscle attachment & movement)
5 Sacral SNs facets= attachments of other vertebrae or bones
1 coccygeal SN Body=large part where attachment of intervertebral disc (gelatinous nucleus pulposus,
peripheral anulus fibrosus)
3. Abnormal curvatures of the
2. Herniated IV disc spine
l Patients typically have history l Kyphosis is an exaggeration of
of back pain that may radiate the thoracic curvature that may
down to the lower limb.
l Herniation of disc usually occur in elderly persons as a result
occurs in lumbar ((L4/L5 or of osteoporosis (multiply
L5/S1)) or cervical regions compression fracture of vertebral
(C5/C6 or C6/C7) of bodies) or disk degeneration.
individuals younger than age
50. l Lordosis is an exaggeration of the
l Herniated lumbar disc usually lumbar curvature that may be
compreses the nerve root one temporary and occurs as a result
number below: traversing root of pregnancy, spondylolisthesis
(e.g., the herniation L4/L5 will
PLL compress L5 root). or potbelly.
l Scoliosis is a complex lateral Leg len
l The pain begins soon after
patient lifted some heavy thing. deviation, or torsion, that is short bo
l Lower limb reflexes are caused by poliomyelitis, a leg- Coxa V
ALL decreased on the affected length discrepancy, or hip disease. <100de
side Long bo
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc Coxa V
Anterior longitudinal ligament protects 9-3oclock around vertebral body Degenerative osteoarthritis: >130de
Posterior longitudinal ligament protects 6oclock vertebral arch Spondylosis: immobility or fusion of vertebral joints
herniations are typically posterior laterally (4-5 or 7-8oclock) Spondylolysis: degeneration of articulating part of vertebrae
Spondylolisthesis: forward displacement of vertebrae
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4. Upper limb fractures:
Humerus fractures Fracture of distal radius:
Sites of potential injury to major l Transverse fracture within the distal 2 cm of
nerves in fractures of the humerus: the radius. Most common fracture of the
Quadrangular Space: teres major, teres
minor, long head biceps brachii, humerus 1. Axillary nerve and posterior forearm (after 50).
humeral circumflex artery at the l Smith's fracture results from a fall or a blow
surgical neck. on the dorsal aspect of the flexed wrist
deep and produces a ventral angulation of the
2. Radial nerve and profunda brachii
artery at midshaft. Midshaft wrist. The distal fragment of the radius is
fracture affect origin of brachialis ANTERIORLY displaced.
Posterior between triceps brachii
muscle. l Colles' fracture results from forced
3. Brachial artery and median nerve extension of the hand, usually as a result of
at the supracondylar region. trying to ease a fall by outstretching the
cubital fossa upper limb. Distal fragment is displaced
4. Ulnar nerve at the medial
epicondyle. DORSALLY - “dinner fork deformity”.
Often the ulnar styloid process is avulced
ulnar epicondylar groove
(broken off)
posteriorly and medial to
olecranon
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
Scaphoid fracture Boxer’s fracture
proximal carpal fracture
l Occurs as a result of a fall onto Necks of the metacarpal
l
the palm when the hand is bones are frequently
abducted Extension & abduction of wrist fractured during fistfights.
l Pain occurs primarily on the l Typically, fractures of 2d and
lateral side of the wrist, Boxer's Fracture d
especially during wrist extension 3 metacarpals are seen in
and abduction Brawler's Fracture professional boxers, and
l Scaphoid fracture may not show fractures of 5th and sometimes
on X-ray films for 2 to 3 weeks, 4th metacarpals are seen in
but a deep tenderness will be unskilled fighters.
present in the anatomical
snuffbox.
l The proximal fragment may
undergo avascular necrosis
because the blood supply is
interrupted.
deep radial artery could be compromised
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
Mallet or Baseball Finger 5. Rotator cuff muscles – SITS
l This deformity results from the DIP joint suddenly l Support the shoulder joint by
being forced into extreme flexion (hyperflexion) forming a musculotendinous
when, for example, a baseball is miscaught or a rotator cuff around it
finger is jammed into the base pad.
l Reinforces joint on all sides
l These actions avulse the attachment of the
except inferiorly, where
extensor digitorum tendon to the base of the dislocation is most likely
distal phalanx. As a result, the person cannot
extend the DIP joint. The resultant deformity bears Rotator cuff muscles are:
some resemblance to a mallet. l Supraspinatus Initiate Abduction, Suprasacula
Forced Flexion of DIP l Infraspinatus Lat rotation, Suprascapcular n
l Teres minor Lat rotation, Axillary n
Right humerus l Subscapularis Med. rotation, Upper & Lower
Subscapular ns
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
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Subacromial bursitis &
6. Abduction of the upper limb Tearing of supraspinatus tendon
l Subacromial bursitis (inflammation of
l (0°-15°) Abduction of the the subacromial bursa) is often due to
upper extremity is initiated calcific supraspinatus tendinitis,
by the supraspinatus causing a painful arc of abduction.
muscle ((suprascapular
suprascapular l The same symptoms will be in case of
nerve).
inflammation or trauma of the
l (15°-110º) Further abduction supraspinatus tendon (MRI !torn!
to the horizontal position is a
tendon)
function of the deltoid
muscle ((axillary
axillary nerve).
l (110°-180°) Raising the
extremity above the
horizontal position requires
scapular rotation by action
of the trapezius ((accessory
accessory
nerve CNXI) and serratus
anterior ((long
long thoracic
nerve).
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
Supraspinatus tendon is most commonly ruptured.
7. Three Elbows: Student's elbow Tennis elbow
(Subcutaneous olecranon bursitis) (Lateral epicondylitis)
l The olecranon, to which the triceps l Lateral epicondylitis: repeated
tendon attaches distally, is easily forceful flexion and extension of the
palpated. It is separated from the wrist resulting strain attachment of
skin by only the olecranon bursa, common extensor tendon and
which allow the mobility of the inflammation of periosteum of
overlying skin. lateral epicondyle. Pain felt over
l Repeated excessive pressure and lateral epicondyle and radiates
friction may cause this bursa to down posterior aspect of forearm.
Pain often felt when opening a
become inflamed, producing a door or lifting a glass
friction subcutaneous olecranon l Origins of following muscles may
bursitis. be affected:
1. Extensor Carpi Radialis Extends and abd
Longus & Brevis the hand
2. Extensor Digitorum Extends fingers and
3. Extensor Digiti Minimi
4. Extensor Carpi Ulnaris Extends and addu
Radial n the hand
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
Golfer’s elbow 8. Arterial anastomoses
(Medial epicondylitis) around the scapula
l Medial epicondylitis is
l Blockage of the
inflammation of the common Subclavian or Axillary
flexor tendon of the wrist artery can be bypassed
where it originates on the by anastomoses
medial epicondyle of the between branches of
humerus. the Thyrocervical and
Subscapular arteries:
l Origins of following muscles l Transverse cervical
may be affected: l Suprascapular
off thyrocervical
1. Pronator Teres Pronates forearm
l Subscapular
2. Flexor Carpi Radialis Flexes and abducts wrist
Palmaris Longus flexes wrist (Median n) l Circumflex scapular
3. off subscapul
4. Flexor Carpi Ulnaris flexes and adducts Wrist
Ulnar n Suprascapular a above the Transverse Superi
Scapular Ligament anastamoses with the
Circumflex Scapular a from the triangular spac
(Teres major/minor and long head biceps brac
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
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9. Cubital fossa Anterior Elbow joint
10. Carpal Tunnel Syndrome
l Contents from lateral to medial:
l Results from a lesion that
1. Biceps brachii tendon reduces the size of the carpal
2. Brachial artery tunnel (fluid retention, infection,
dislocation of lunate bone)
3. Median nerve l Median nerve – most sensitive
LATERAL MEDIAL l Subcutaneos structures from lateral to structure in the carpal tunnel
medial: and is the most affected
l Clinical manifestations:
1. Cephalic vein
l Pins and needles or anesthesia
2. Median cubital vein:: joins cephalic of the lateral 3.5 digits
and basilic veins l palm sensation is not affected
3. Basilic vein because superficial palmar
cutaneous branch passes
superficially to carpal tunnel
l Sites of venipuncture is usually median l Apehand deformity - absent
cubital vein because: of OPPOSITION
l Overlies bicipital aponeurosis, so deep Recurrent Median n to Thenar ms are affected
Biceps Brachii m (flex and supinate forearm) structures protected
O: Longhead supraglenoid tubercle, Shorthead l Not accompanied by nerves
coracoid process)
Dr. Mavrych,
I: to Radial TuberosityMD, PhD, DSc
Venous blood is darker/purpleish and flows passively Dr. Mavrych, MD, PhD, DSc
Arterial blood is cherry red and has a pulse ULNAR TUNNEL SYNDROME: Compression at the wrist between pisiform and hook of hama
carpal bones causes hypoesthesia of medial 1.5 fingers and weakened instrinsic ms (Partial C
Cubital Tunnel Syndrome: Compression of ulnar epicondylar groove via tendon of Flexor hand bc flexors of forearm are unaffected)
Carpi Ulnaris, Ulnar n is compressed: Claw hand and weakened adduction of wrist
11. Test of the proximal and 12. Lesion of UL nerves
distal interphalangeal joints Upper Brachial Palsy
l Injury of upper roots and trunk
l Usually results from excessive
increase in the angle between the
l PIP – FDS neck and the shoulder stretching or
Proximal Interphalangeal joint tearing of the superior parts of the
Flexor Digitorum Superficialis brachial plexus (C5 and C6 roots or
Median n
superior trunk)
l May occur as birth injury from
forceful pulling on infant's head
during difficult delivery
l DIP - FDP
DID
Distal Interphalangeal Joint
DIPS- Flexor Digitorum Profundus
Birth injury or Fall causes
Ulnar and Median ns Superior Trunk Damage:
Erb's Palsy
MCPs- Lumbricals
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
Metacarpal phalangeal joint
Upper Brachial Palsy Lower Brachial Palsy
(Erb-Duchenne palsy) (Klumpke paralysis)
Inferior Trunk damage C8-T1
· In all cases, paralysis of the muscles of the l Injury of lower roots and
shoulder and arm supplied by C5 and C6 spinal trunk
nerves (roots) of the upper trunk. l May occur when the upper
· Combination lesions of axillary, suprascapular limb is suddenly pulled
and musculocutaneous nerves with loss of the superiorly: stretching or
shoulder mm and anterior arm. tearing of the inferior parts
· As result patient has “waiter’s tip” hand: of the brachial plexus (C8
· adducted shoulder and T1 roots or inferior
trunk)
· medially rotated arm
l E.g., grabbing support
· extended elbow Wrist flexed
during falling from height
· loss of sensation in the lateral aspect of the or as a birth injury, or
upper limb TOS – thoracic outlet
Axillary C5-C6 syndrome
Musculocutaenous C5-7
Median C6-T1
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD,Full
DSc hand paralysis (open extended hand), ulnar and
median n damage, thumb is extended bc radial n still good
Understand first, then memorize and apply
l Dear students, you can use this presentation like a guide during your
preparing for GA exams.
l It does NOT cover all material of the Gross Anatomy course.
100 must important l To complete GA material you should work with ALL professor’s
GA conceptions presentations.
l Good Luck and All the best!
Dr. Mavrych, MD, PhD, DSc
Dr. Bolgova, MD, PhD
Dr. Mavrych
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
1. Lumbar puncture (tap) and
Epidural anesthesia
l When lumbar puncture is
performed, the needle
enters the subarachnoid
space to extract
cerebrospinal fluid (CSF)
or to inject anesthetic to
epidural space. 3
l The needle is usually adults
1
inserted between L3/L4 or 4 2
5
kids L4/L5. Level of horizontal
line through upper points 6*
of iliac crests.
l Remember, the spinal cord Conus medullaris
may ends as low as L2 in Cauda Equina w/ FT
adults and does end at L3 10* dura matter 7
in children and dural sac subdural spac
subd space 8
extends caudally to level of Arachnoid matter 9
S2.
7
Spinal cord ends L2: Conus Medullaris
End Dura Sac S2: Cauda Equina w/ Filum terminale
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
Lamina= front smooth of arches
8 cervical SN (above) Pedicles= attachment of bodies to arches
12 thoracic SN Processes= protuberances and "attachments" (articular=restricts movement, spinous &
5 lumbar SN (below body) transverse muscle attachment & movement)
5 Sacral SNs facets= attachments of other vertebrae or bones
1 coccygeal SN Body=large part where attachment of intervertebral disc (gelatinous nucleus pulposus,
peripheral anulus fibrosus)
3. Abnormal curvatures of the
2. Herniated IV disc spine
l Patients typically have history l Kyphosis is an exaggeration of
of back pain that may radiate the thoracic curvature that may
down to the lower limb.
l Herniation of disc usually occur in elderly persons as a result
occurs in lumbar ((L4/L5 or of osteoporosis (multiply
L5/S1)) or cervical regions compression fracture of vertebral
(C5/C6 or C6/C7) of bodies) or disk degeneration.
individuals younger than age
50. l Lordosis is an exaggeration of the
l Herniated lumbar disc usually lumbar curvature that may be
compreses the nerve root one temporary and occurs as a result
number below: traversing root of pregnancy, spondylolisthesis
(e.g., the herniation L4/L5 will
PLL compress L5 root). or potbelly.
l Scoliosis is a complex lateral Leg len
l The pain begins soon after
patient lifted some heavy thing. deviation, or torsion, that is short bo
l Lower limb reflexes are caused by poliomyelitis, a leg- Coxa V
ALL decreased on the affected length discrepancy, or hip disease. <100de
side Long bo
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc Coxa V
Anterior longitudinal ligament protects 9-3oclock around vertebral body Degenerative osteoarthritis: >130de
Posterior longitudinal ligament protects 6oclock vertebral arch Spondylosis: immobility or fusion of vertebral joints
herniations are typically posterior laterally (4-5 or 7-8oclock) Spondylolysis: degeneration of articulating part of vertebrae
Spondylolisthesis: forward displacement of vertebrae
, L MODE − a valid license will remove this message. See the keywords property of this PDF for more information.
4. Upper limb fractures:
Humerus fractures Fracture of distal radius:
Sites of potential injury to major l Transverse fracture within the distal 2 cm of
nerves in fractures of the humerus: the radius. Most common fracture of the
Quadrangular Space: teres major, teres
minor, long head biceps brachii, humerus 1. Axillary nerve and posterior forearm (after 50).
humeral circumflex artery at the l Smith's fracture results from a fall or a blow
surgical neck. on the dorsal aspect of the flexed wrist
deep and produces a ventral angulation of the
2. Radial nerve and profunda brachii
artery at midshaft. Midshaft wrist. The distal fragment of the radius is
fracture affect origin of brachialis ANTERIORLY displaced.
Posterior between triceps brachii
muscle. l Colles' fracture results from forced
3. Brachial artery and median nerve extension of the hand, usually as a result of
at the supracondylar region. trying to ease a fall by outstretching the
cubital fossa upper limb. Distal fragment is displaced
4. Ulnar nerve at the medial
epicondyle. DORSALLY - “dinner fork deformity”.
Often the ulnar styloid process is avulced
ulnar epicondylar groove
(broken off)
posteriorly and medial to
olecranon
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
Scaphoid fracture Boxer’s fracture
proximal carpal fracture
l Occurs as a result of a fall onto Necks of the metacarpal
l
the palm when the hand is bones are frequently
abducted Extension & abduction of wrist fractured during fistfights.
l Pain occurs primarily on the l Typically, fractures of 2d and
lateral side of the wrist, Boxer's Fracture d
especially during wrist extension 3 metacarpals are seen in
and abduction Brawler's Fracture professional boxers, and
l Scaphoid fracture may not show fractures of 5th and sometimes
on X-ray films for 2 to 3 weeks, 4th metacarpals are seen in
but a deep tenderness will be unskilled fighters.
present in the anatomical
snuffbox.
l The proximal fragment may
undergo avascular necrosis
because the blood supply is
interrupted.
deep radial artery could be compromised
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
Mallet or Baseball Finger 5. Rotator cuff muscles – SITS
l This deformity results from the DIP joint suddenly l Support the shoulder joint by
being forced into extreme flexion (hyperflexion) forming a musculotendinous
when, for example, a baseball is miscaught or a rotator cuff around it
finger is jammed into the base pad.
l Reinforces joint on all sides
l These actions avulse the attachment of the
except inferiorly, where
extensor digitorum tendon to the base of the dislocation is most likely
distal phalanx. As a result, the person cannot
extend the DIP joint. The resultant deformity bears Rotator cuff muscles are:
some resemblance to a mallet. l Supraspinatus Initiate Abduction, Suprasacula
Forced Flexion of DIP l Infraspinatus Lat rotation, Suprascapcular n
l Teres minor Lat rotation, Axillary n
Right humerus l Subscapularis Med. rotation, Upper & Lower
Subscapular ns
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
, L MODE − a valid license will remove this message. See the keywords property of this PDF for more information.
Subacromial bursitis &
6. Abduction of the upper limb Tearing of supraspinatus tendon
l Subacromial bursitis (inflammation of
l (0°-15°) Abduction of the the subacromial bursa) is often due to
upper extremity is initiated calcific supraspinatus tendinitis,
by the supraspinatus causing a painful arc of abduction.
muscle ((suprascapular
suprascapular l The same symptoms will be in case of
nerve).
inflammation or trauma of the
l (15°-110º) Further abduction supraspinatus tendon (MRI !torn!
to the horizontal position is a
tendon)
function of the deltoid
muscle ((axillary
axillary nerve).
l (110°-180°) Raising the
extremity above the
horizontal position requires
scapular rotation by action
of the trapezius ((accessory
accessory
nerve CNXI) and serratus
anterior ((long
long thoracic
nerve).
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
Supraspinatus tendon is most commonly ruptured.
7. Three Elbows: Student's elbow Tennis elbow
(Subcutaneous olecranon bursitis) (Lateral epicondylitis)
l The olecranon, to which the triceps l Lateral epicondylitis: repeated
tendon attaches distally, is easily forceful flexion and extension of the
palpated. It is separated from the wrist resulting strain attachment of
skin by only the olecranon bursa, common extensor tendon and
which allow the mobility of the inflammation of periosteum of
overlying skin. lateral epicondyle. Pain felt over
l Repeated excessive pressure and lateral epicondyle and radiates
friction may cause this bursa to down posterior aspect of forearm.
Pain often felt when opening a
become inflamed, producing a door or lifting a glass
friction subcutaneous olecranon l Origins of following muscles may
bursitis. be affected:
1. Extensor Carpi Radialis Extends and abd
Longus & Brevis the hand
2. Extensor Digitorum Extends fingers and
3. Extensor Digiti Minimi
4. Extensor Carpi Ulnaris Extends and addu
Radial n the hand
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
Golfer’s elbow 8. Arterial anastomoses
(Medial epicondylitis) around the scapula
l Medial epicondylitis is
l Blockage of the
inflammation of the common Subclavian or Axillary
flexor tendon of the wrist artery can be bypassed
where it originates on the by anastomoses
medial epicondyle of the between branches of
humerus. the Thyrocervical and
Subscapular arteries:
l Origins of following muscles l Transverse cervical
may be affected: l Suprascapular
off thyrocervical
1. Pronator Teres Pronates forearm
l Subscapular
2. Flexor Carpi Radialis Flexes and abducts wrist
Palmaris Longus flexes wrist (Median n) l Circumflex scapular
3. off subscapul
4. Flexor Carpi Ulnaris flexes and adducts Wrist
Ulnar n Suprascapular a above the Transverse Superi
Scapular Ligament anastamoses with the
Circumflex Scapular a from the triangular spac
(Teres major/minor and long head biceps brac
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
, L MODE − a valid license will remove this message. See the keywords property of this PDF for more information.
9. Cubital fossa Anterior Elbow joint
10. Carpal Tunnel Syndrome
l Contents from lateral to medial:
l Results from a lesion that
1. Biceps brachii tendon reduces the size of the carpal
2. Brachial artery tunnel (fluid retention, infection,
dislocation of lunate bone)
3. Median nerve l Median nerve – most sensitive
LATERAL MEDIAL l Subcutaneos structures from lateral to structure in the carpal tunnel
medial: and is the most affected
l Clinical manifestations:
1. Cephalic vein
l Pins and needles or anesthesia
2. Median cubital vein:: joins cephalic of the lateral 3.5 digits
and basilic veins l palm sensation is not affected
3. Basilic vein because superficial palmar
cutaneous branch passes
superficially to carpal tunnel
l Sites of venipuncture is usually median l Apehand deformity - absent
cubital vein because: of OPPOSITION
l Overlies bicipital aponeurosis, so deep Recurrent Median n to Thenar ms are affected
Biceps Brachii m (flex and supinate forearm) structures protected
O: Longhead supraglenoid tubercle, Shorthead l Not accompanied by nerves
coracoid process)
Dr. Mavrych,
I: to Radial TuberosityMD, PhD, DSc
Venous blood is darker/purpleish and flows passively Dr. Mavrych, MD, PhD, DSc
Arterial blood is cherry red and has a pulse ULNAR TUNNEL SYNDROME: Compression at the wrist between pisiform and hook of hama
carpal bones causes hypoesthesia of medial 1.5 fingers and weakened instrinsic ms (Partial C
Cubital Tunnel Syndrome: Compression of ulnar epicondylar groove via tendon of Flexor hand bc flexors of forearm are unaffected)
Carpi Ulnaris, Ulnar n is compressed: Claw hand and weakened adduction of wrist
11. Test of the proximal and 12. Lesion of UL nerves
distal interphalangeal joints Upper Brachial Palsy
l Injury of upper roots and trunk
l Usually results from excessive
increase in the angle between the
l PIP – FDS neck and the shoulder stretching or
Proximal Interphalangeal joint tearing of the superior parts of the
Flexor Digitorum Superficialis brachial plexus (C5 and C6 roots or
Median n
superior trunk)
l May occur as birth injury from
forceful pulling on infant's head
during difficult delivery
l DIP - FDP
DID
Distal Interphalangeal Joint
DIPS- Flexor Digitorum Profundus
Birth injury or Fall causes
Ulnar and Median ns Superior Trunk Damage:
Erb's Palsy
MCPs- Lumbricals
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD, DSc
Metacarpal phalangeal joint
Upper Brachial Palsy Lower Brachial Palsy
(Erb-Duchenne palsy) (Klumpke paralysis)
Inferior Trunk damage C8-T1
· In all cases, paralysis of the muscles of the l Injury of lower roots and
shoulder and arm supplied by C5 and C6 spinal trunk
nerves (roots) of the upper trunk. l May occur when the upper
· Combination lesions of axillary, suprascapular limb is suddenly pulled
and musculocutaneous nerves with loss of the superiorly: stretching or
shoulder mm and anterior arm. tearing of the inferior parts
· As result patient has “waiter’s tip” hand: of the brachial plexus (C8
· adducted shoulder and T1 roots or inferior
trunk)
· medially rotated arm
l E.g., grabbing support
· extended elbow Wrist flexed
during falling from height
· loss of sensation in the lateral aspect of the or as a birth injury, or
upper limb TOS – thoracic outlet
Axillary C5-C6 syndrome
Musculocutaenous C5-7
Median C6-T1
Dr. Mavrych, MD, PhD, DSc Dr. Mavrych, MD, PhD,Full
DSc hand paralysis (open extended hand), ulnar and
median n damage, thumb is extended bc radial n still good
