The median nerve controls movements of the hand and forearm. It arises from the brachial plexus and supplies muscles in the forearm and thenar muscles. Median neuropathy can occur from injuries in the axilla, arm, elbow, forearm, wrist or carpal tunnel. Symptoms include sensory loss and motor deficits. Physical exam may reveal deformities like ape hand. Special tests like Phalen's and Tinel's can help diagnose carpal tunnel syndrome. Electromyography and nerve conduction studies can evaluate the severity of injury and localization. Treatment involves splinting, physiotherapy, or surgery depending on the severity of injury.
1.Anatomy
a.Course
b.Motor distribution
c.Sensory distribution
2.Common sites affected
3.Level of median nerve injury
4.Clinical feature with various test performed
5.Various syndromes related to median nerve
6.Treatment
7.Summary
1.Anatomy
a.Course
b.Motor distribution
c.Sensory distribution
2.Common sites affected
3.Level of median nerve injury
4.Clinical feature with various test performed
5.Various syndromes related to median nerve
6.Treatment
7.Summary
SOUND, TYPES OF SOUND, INTERFERENCE OF SOUND, CALCULATION OF VELOCITY OF SOUND IN AIR, NEWTON'S FORMULA, LAPLACE'S FORMULA, DOPPLER EFFECT, ECHO, RESONANCE, MAGNETO STRICTION & PIEZO ELECTRIC PRODUCTION OF SOUND, APPLICATION OF SOUND
Growth- stages of growth, growth of different tissues & parameters of growth measurements
Developments - Gross motor, fine motor, social & Language development, low birth weight, microcephaly & macrocephaly
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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2 Case Reports of Gastric Ultrasound
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
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AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. ANATOMY
The median nerve controls coarse movements of the
hand, as it supplies most of the long muscles of the front
of the forearm. It is, therefore, called the 'labourer's
nerve'.
ROOT VALUE- C5,C6,C7,C8,T1
Arising from medial and lateral cords of brachial plexus
Motor supply
◦ Pronator teres
◦ Flexor digitorum superficialis
◦ Flexor digitorum profundus (1st & 2nd)
◦ Flexor carpi radialis
◦ Palmaris longus
◦ Flexor pollicis longus
◦ Pronator quadratus
◦ 1st & 2nd lumbricals
◦ Thenar muscles
P/B :- DR NIYATI PATEL 2
5. Forearm
Pronator teres syndrome; A fibrous band that
travels between the deep and superficial head of
the pronator teres can compress the median nerve
due to over use or violent contraction of the
muscle.
A fibrous arch which originates just proximal to the
origin of the flexor digitorum superficialis can
compress the median nerve causing selected
paralysis of FDS and FDP.
P/B :- DR NIYATI PATEL 5
6. Wrist
Glass cut injury can cause isolated involvement of
the median nerve or alongwith the ulnar nerve.
Anterior interosseous nerve can get involved due
to fracture or laceration of the forearm. It can be
compressed by the flexor digitorum superficialis or
pronator teres..
P/B :- DR NIYATI PATEL 6
7. Carpal tunnel syndrome
This is a syndrome characterised by the compression of the
median nerve as it passes beneath the flexor retinaculum
P/B :- DR NIYATI PATEL 7
9. The patient is generally a middle aged woman
complaining of tingling, numbness or discomfort in the
thumb and radial one and a half fingers i.e., in the
median nerve distribution.
Tingling is more prominent during sleep. There is a
feeling of clumsiness in carrying out fine movements.
Nerve conduction studies show delayed or absent
conduction of impulses in the median nerve across the
wrist. Treatment is by dividing the flexor retinaculum,
and thus decompressing the nerve.
P/B :- DR NIYATI PATEL 9
10. SIGN AND SYMPTOMS
Sensory
There will be loss of sensation over the volar
aspect of lateral 3½ fingers up to the distal
phalanx on the dorsal side, skin overlying the
thenar eminence. The autonomous zone for
the median nerve is the pulp of the thumb.
P/B :- DR NIYATI PATEL 10
11. Motor
The muscles supplied by the median nerve
namely the pronator teres, flexor carpi
radialis, flexor digitorum superficialis,
palmaris longus, flexor digitorum profundus(
the lateral half), pronatus quadratus, flexor
pollicis longus, thenar muscles, the first and
second lumbricals
P/B :- DR NIYATI PATEL 11
12. Deformity
The deformity seen in median nerve
palsy are as follows depending upon
the site and extent of lesion.
1. The commonest deformity seen is
ape hand or monkey hand which
occurs due to flattening of the
thenar eminence, lack of opposition
of the thumb because of which the
thumb is held beside the index finger
due to over action of the adductor
pollicis and extensor pollicis longus.
P/B :- DR NIYATI PATEL 12
13. 2. Partial claw hand occurs due
to paralysis of the first and
second lumbricals due to which
there is unopposed action of
the extensor digitorum giving
rise to hyperextension of the
metacarpophalangeal joint of
the index and middle finger
alongwith flexion of the
interphalangeal joint of these
fingers.
P/B :- DR NIYATI PATEL 13
14. 3. Pointing index finger: When
there is a higher lesion involving
even the long flexors of the hand,
on asking to make a fist the index
finger will point forward.
P/B :- DR NIYATI PATEL 14
15. 4. When patient with
anterior interosseous nerve
palsy is asked to make a tip to
tip pinch using the index and
the thumb then due to
paralysis of the flexor
digitorum profundus and
flexor pollicis longus the tip
to tip pinch will show a tear
drop appearance instead of
‘O’.
P/B :- DR NIYATI PATEL 15
16. RECOVERY SIGN
The first sign of recovery of median nerve
following its lesion in the wrist will be the
ability of the thumb to rotate when the
thumb is supported in slight amount of
palmar abduction and flexion.
P/B :- DR NIYATI PATEL 16
17. SPECIAL TESTS
Phalen's test: In carpal tunnel syndrome palmar
flexion of the wrist to 90 degrees for one minute
exacerbates or reproduces the symptoms.
P/B :- DR NIYATI PATEL 17
18. Tinel's sign: Tapping over the dorsum of the wrist
precipitates pain in the median nerve distribution
P/B :- DR NIYATI PATEL 18
19. Carpal Compression Test.:
The examiner holds the supinated
wrist in both hands and applies
direct, even pressure over the
median nerve in the carpal tunnel
for up to 30 seconds .
Production of the patient's
symptoms is considered to be a
positive test for carpal tunnel
syndrome.
P/B :- DR NIYATI PATEL 19
20. Wrinkle (Shrivel) Test
The patient's fingers are, placed in warm
water for approximately 5 to 20 mintues. Then
removes the patient's fingers from the water and
observes whether the skin over the pulp is wrinkled
.
Normal fingers show Tinkling, but denervated
ones do not. The test is valid only within the first
few months after injury.
P/B :- DR NIYATI PATEL 20
22. INVESTIGATION
RADIOGRAPH :- shows whether there is presence of fracture
MRI :- To delineate complete avulsion of nerve roots
SD CURVE:- abnormality in conduction can be verified. Sharp
curve, long chronaxie, low rheobase and the absence of
contraction with repetitive stimuli indicates denervation. If it is
done 2-3 weeks after injury, it shows the sign of denervation and
to find out whether it is moderate or severe injury
NCV:- To find out the severance of nerve fibers with wallerian
degeneration.
EMG:- it will help to find out reversible and irreversible nerve
damage and will help map out whether it pre ganglionic/ post
ganglionic lesion
P/B :- DR NIYATI PATEL 22
24. TYPES OF INJURIES
In Neuropraxia pain, numbness, muscle weakness,
minimal muscle wasting is present. Recovery occurs within
minutes to days
In Axonotmesis there is pain, evident muscle wasting,
complete loss of motor, sensory and sympathetic functions.
Recovery time– months (axon regeneration at 1-1.5
mm/day)
In Neurotmesis no pain, complete loss of motor, sensory
and sympathetic functions. Recovery time – months and
only with surgery
P/B :- DR NIYATI PATEL 24
25. SURGICAL TREATMENT
The basic requirement for hand function in median nerve
injury consist of the following component.
◦ Thumb abduction to perform opposition
◦ Flexion across the metacarpophalangeal joint of the thumb
◦ Flexion of the index and middle finger
◦ Sensation over the thenar eminence and pulp of the thumb.
Tendon transfer surgeries
Transfer of FDS of ring finger to abductor pollicis brevis
Transfer of Brachioradialis to flexor pollicis longus
Transfer of FDP of ring and little finger to middle and index
finger
Following surgery, immobilisation with POP for 3 weeks and
opposition splint can be given for another 6 weeks
P/B :- DR NIYATI PATEL 25
26. PHYSIOTHERAPY TREATMENT
Passive movement to the wrist and fingers to keep the
parts mobile
Gentle stretching of the long flexors to prevent any form of
tightness
IG stimulation to all the muscles supplied by the median
nerve
Care of the anaesthetic hand
Splints: Opposition splints are given to maintain the thumb
in opposition and also to prevent contracture of the first
web space.
The two types of splints which are commonly given are C- bar
and cockup splints.
P/B :- DR NIYATI PATEL 26
27. C-BAR This is used to maintain
the first web space and is held in
place with the help of 3 velcro
straps one over the index finger, one
over the thumb and one at the
deepest part of the first web space
COCK UP SPLINT an opposition
out trigger is also used to maintain
the thumb in opposition
P/B :- DR NIYATI PATEL 27