AnatomyAnatomy

Part 1

Upper limb Lower limb Thorax

Lesions of the Brachial Plexus Fractures

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Injury to C5-6 at Erb’s point Muscles paralysed – Deltoid, biceps, brachialis, barachioradialis Posture – waiter’s tip

deformity Mechanism of injury : fall on

shoulder or excessive pulling of head of new born during delivery

Erb-Duchenne’s PalsyErb-Duchenne’s Palsy

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Injury to C8-T1 Muscles paralyzed – small muscles of hand Deformity Claw hand Mechanism : Sudden superior pull on upper limb

Symptoms:

Clawed hand due to loss of innervation of Intrinsic muscle of the hand

The characteristic clinical sign of radial nerve injury is wrist-drop.

SATURDAY NIGHT PALSY

WRIST DROP

Radial Nerve Injury in Axilla:

Mechanism:

1.Crutches pressing in axilla

2.Saturday night palsy!

Main Effect:

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Carpal Tunnel syndrome

Common in computer professionals.

Due to constant dorsiflexion of wrist while typing the keyboard

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Clavicle Humerus Radius Scaphoid

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Junction of Medial 2/3rd and Lateral 1/3rd

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Fracture of Surgical Neck of Humerus

Damage to Axillary nerve and Post. Circumflex humoral Artery

Fracture of Mid Shaft Humerus

Damage to Radial Nerve and Deep artery of Arm

Fracture of Fracture of Medial Medial EpicondyleEpicondyle

Damage to Damage to Ulnar Ulnar NerveNerve

Fracture of Supracondylar part:

Damage to median nerve and Brachial artery

A midhumeral fracture may injure the radial nerve in the radial groove in the humeral shaft.

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Fall on Out stretched Fall on Out stretched HandHand

This is more common in older person

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Nerve lesions in lower limb Injuries of hip, knee and ankle joint

Injury to femoral nerve Injury to femoral nerve Injury to obturator nerveInjury to obturator nerve Injury to superior gluteal nerve Injury to superior gluteal nerve Injury to inferior gluteal nerve Injury to inferior gluteal nerve Injury to sciatic nerve Injury to sciatic nerve Injury to tibial nerve Injury to tibial nerve Injury to common fibular nerve Injury to common fibular nerve Injury to deep fibular nerve Injury to deep fibular nerve Injury to superficial fibular nerve Injury to superficial fibular nerve

Weakness of hip flexion Iliopsoas, rectus femoris, and sartorius

Knee extension Quadriceps femoris

Loss of sensation over anterior thigh and medial leg and foot

Difficulty adducting thigh Decreased sensation over upper

medial thigh

Loss of thigh abduction & medial rotationGluteus medius,

gluteus minimus, and tensor fasciae latae

Positive Trendelenburg sign

Weakened hip extension Gluteus maximus

Most noticeable when climbing stairs or standing from a seated position

Weakened hip extension and knee flexion

Inability to dorsiflex, plantar flex, evert, or invert foot

Loss of cutaneous sensation over leg and foot except medial area supplied by saphenous nerve

In Popliteal fossaLoss of plantar flexion of foot (mainly

gastrocnemius and soleus) Weakened inversion (tibialis posterior),

Footdrop and loss of eversion

CausesDirect trauma as

nerve passes superficially around neck of fibula

Hip joint Knee joint Ankle joint

Posterior dislocationPosterior tearing of joint

capsule Dislocated femoral head

lies on posterior surface of ischium

Occurs in head-on collision

Damage to Ischiofemoral ligament

Complications Sciatic nerve may

damage.

Unhappy triad Anterior drawer sign Posterior drawer sign

Anterior drawer sign: This injury causes the free tibia to slide anteriorly under the fixed femur.

PCL ruptures allow the free tibia to slide posteriorly under the fixed femur.

The lateral ligament is injured because it is much weaker than the medial ligament.

The anterior talofibular ligament part of the lateral ligament is most vulnerable and most commonly torn during ankle sprains.

Lungs Heart Mediastinum

1.Pulmonary artery

2. Two pulmonary veins

3. Main bronchus 4. Bronchial

vessels 5. Nerves and

lymphatics.

Has its own Bronchus Has its own Pulmonary

artery (Blue) Drains to multiple

pulmonary veins (Red) between segments

MCL MAL Vertebral Lungs : 6th rib 8th rib 10th vert Pleura : 8th rib 10 th rib 12 th

vert

1. Diaphragmatic (inferior) surface on which the pyramid rests

2. Anterior (sternocostal) surface oriented anteriorly

3.Right pulmonary surface

4.Left pulmonary surface.

Coronary artery circulation

Which wall Which wall infarctioninfarction

Which artery Which artery blockedblocked

DiaphragmatDiaphragmatic or inferior ic or inferior surfacesurface

Proximal RCA or Proximal RCA or Rt. marginalRt. marginal

Posterior Posterior surfacesurface

Distal RCA, PDADistal RCA, PDA

Anterior wallAnterior wall LADLAD

Lateral WallLateral Wall Cx, Lt. marginal Cx, Lt. marginal or diagonal br of or diagonal br of LADLAD

Diaphragmatic or Inferior wall infarct

True Posterior wall infarct

Anterior wall infarct

Antero-lateral infract

1. Right Atrium.2. Left Atrium.3. Right Ventricle.4. Left Ventricle.5. Descending Aorta.6. Transverse Process

of T7.7. Right Bronchus.8. Left Bronchus