Treatment Choices for Slip Disc at Gokuldas Hospital
Ulnar, Accessory, Axillar, Long thoracic nerve.pptx
1. Ulnar Nerve
•C8, T1. Arises from medial cord of the brachial
plexus
COURSE:
• In Arm: Lies medial to axillary artery. Becomes
more superficial as it approaches elbow
• In forearm: Enters through two heads of flexor
carpi ulnaris. Lies anterior to the FDP along with
ulnar vessels
• In Wrist: Passes in front of flexor retinaculum
just lateral to pisiform bone. Divides into
superficial and deep terminal branches
2.
3. • HIGH ULNAR NERVE PALSY: Injury proximal to
elbow. Causes paralysis of all the muscles
supplied by the ulnar nerve in the forearm and
hand (less clawed hand;High ulnar paradox).
Sensory deficit in the skin of the hand
• LOW ULNAR NERVE PALSY: Injury in distal third
of forearm. Sparing of forearm muscle but
paralysis of muscles of hand (Claw hand).
Sensory deficit same as that of high ulnar nerve
palsy
4. INDIVIDUAL MUSCLE EXAMINATION
• FLEXOR CARPI ULNARIS:
A) Palmar flexion at wrist against gravity- hand
deviates towards the radial side and tendon of
FCU just above pisiform does not stand out.
B) Same test against resistance- Tendon cannot be
felt
• ABDUCTOR DIGITI MINIMI:
Patient is asked to abduct the little finger against
resistance while keeping the hand flat on the
table
5. • INTEROSSEI:
Palmar interossei- Abduction (PAD)
Dorsal interossei- Abduction (DAP)
1) Egawa’s Test: For dorsal interossei of midle
finger. With the hand kept flat on the table
palmar surface down, asked to move his middle
finger sideways
2) Card Test: For palmar interossei of the fingers.
Patient is asked to hold the card between two
extended fingers tightly. Examiner will pull the
card and thus assess the power.
6.
7. • ADDUCTOR POLLICIS:
Book Test( Froment’s Sign)-
Patient is asked to grasp a book between the
thumb extended and index finger. In ulnar
nerve palsy thumb will flex at inter-phalangeal
joint due to the action of flexor pollicis longus
(supplied by median nerve). Flexion becomes
more pronounced if the examiner tries to pull
the book out while patient tries to hold it
9. Accessory Nerve
• Supplies Trapezius Muscle
• TEST: Ask the patient to elevate his shoulder
against resistance. One can see and feel the
trapezius belly stand out
Long Thoracic Nerve
• Arises from ventral rami of C5, C6, C7 and
supplies serratus anterior
• TEST: Ask the patient to push against wall with
both hands. The medial border of the scapula on
the affected side will become prominent.
10. Axillary Nerve
• C5, C6. Arises from posterior cord of the brachia
plexus. Comes to lie on the medial side of the
surgical neck of the humerus and divides into
anterior and posterior branches.
• Posterior Branch: Teres Minor, Post. Part of deltoid,
Skin over the lower half of the deltoid
• Anterior Branch: Rest of the deltoid
• TEST: Stablise the scapula with one hand and with
feel the contractions of the deltoid with other hand.
Patient is asked to abduct his shoulder. Unable to
abduct his shoulder and there is absence of deltoid
becoming taut
