Orthopedics 5th year, 10th/part one lecture (Dr. Bakhtyar)

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The lecture has been given on Apr. 2nd, 2011 by Dr. Bakhtyar.

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Orthopedics 5th year, 10th/part one lecture (Dr. Bakhtyar)

  1. 1. Radial nerve
  2. 2. <ul><li>Supplies: </li></ul><ul><li>Triceps </li></ul><ul><li>Brachioradialis </li></ul><ul><li>Supinator </li></ul><ul><li>All extensors in the forearm </li></ul><ul><li>Abductor pollicis longus </li></ul><ul><li>A small patch of skin at the </li></ul><ul><li>base of the thumb </li></ul>
  3. 3. <ul><li>Causes of injury: </li></ul><ul><li>Crutch palsy </li></ul><ul><li>Fracture of humerus </li></ul><ul><li>Tourniquet palsy </li></ul>
  4. 4. <ul><li>Causes of injury: </li></ul><ul><li>Dislocation of elbow </li></ul><ul><li>Fractures around elbow </li></ul><ul><li>Surgical accidents </li></ul><ul><li>Bullet or knife </li></ul>
  5. 5. <ul><li>Signs and symptoms </li></ul><ul><li>Wasting of the above muscles </li></ul><ul><li>Wrist drop </li></ul><ul><li>Loss of supination of extended elbow. </li></ul><ul><li>Weak abduction of thumb </li></ul><ul><li>Sensation loss at the base of thumb. </li></ul>
  6. 6. <ul><li>Treatment </li></ul><ul><li>Open wounds: Repair or graft </li></ul><ul><li>Closed wounds: Spontaneous recovery during 8-12 weeks. If not: </li></ul><ul><li>Exploration and repair </li></ul><ul><li>If repair failed: Tendon transfer </li></ul>
  7. 7. Median nerve
  8. 8. <ul><li>Supplies: </li></ul><ul><li>All flexors in the forearm except: </li></ul><ul><li>Flexor carpi ulnaris </li></ul><ul><li>Ulnar ½ of flexor digitorum profundus </li></ul><ul><li>The two pronators </li></ul><ul><li>Thenar eminence muscles </li></ul><ul><li>Lateral two lumbricals </li></ul><ul><li>Skin: lateral ⅔ of palm + lateral 3½ fingers </li></ul><ul><li>(palmar surface) </li></ul>
  9. 9. Causes: Forearm fractures Elbow dislocation Gunshot or stab wound Carpal dislocation
  10. 11. Symptoms and Signs : All above muscles are wasted Weak wrist flexion Weak pronation Pointing index sign is +ve Thumb abduction is weak Sensation loss and trophic ulcers
  11. 12. Treatment: Repair or graft
  12. 13. Ulnar nerve
  13. 14. <ul><li>Supplies: </li></ul><ul><li>Two flexors in the forearm </li></ul><ul><li>Hypothenar eminence muscles </li></ul><ul><li>Eight interossei and two lumbricals </li></ul><ul><ul><li>Abduction and Adduction of the fingers </li></ul></ul><ul><ul><li>Flexion of M.P.J </li></ul></ul><ul><ul><li>Extension of I.P.J </li></ul></ul><ul><li>Adductor pollicis </li></ul>
  14. 15. <ul><li>Causes </li></ul><ul><li>Injuries </li></ul><ul><li>Pressure of a deep ganglion in the wrist </li></ul><ul><li>Fractures around elbow </li></ul><ul><li>Cubitus valgus deformity </li></ul><ul><li>Nerve entrapment in the cubital tunnel </li></ul>
  15. 16. Symptoms and signs Hypothenar wasting
  16. 17. Wasting of the interossei(first dorsal interosseous
  17. 18. Claw hand
  18. 19. Loss of thumb adduction (Froment’s test)
  19. 20. Sensation loss
  20. 21. Treatment Repair or Graft Tendon transfer
  21. 22. Femoral nerve
  22. 23. Supplies: Quadriceps muscle Iliopsoas muscle Skin: (1) Anterior of thigh (2) Medial aspect of the leg.
  23. 24. Causes Gunshot Bleeding into the thigh Traction during operation
  24. 25. Symptoms and signs Loss of knee extension Hand- knee gait Numbness of skin ↓ Knee jerk.
  25. 27. Treatment Suturing OR Grafting

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