49 Winged Scapula- Clinical Correlation Damage to Long Thoracic NerveCommon during radical mastectomyLoss of innervation to Serratus AnteriorResults in Winged ScapulaTest by having patient push against wall
50 Erb-Duchenne Palsy Injury to Superior Trunk of brachial plexus Traumatic Birth- Shoulder DystociaLoss of C5 and C6Dorsal Scapular N. (Levator Scapulae, Rhomboids)N. to subclaviusSuprascapular N. (Supraspinatus, Infraspinatus)Upper and Lower Subscapular N. (Subscapularis, Teres Major)Axillary N. (Deltoid, Teres Minor)Loss of abductionDeltoid and supraspinatusLoss of external rotationInfraspinatus and teres minorImbalances cause arm to be held in adduction and medial rotationWaiter’s Tip
51 Claws Median Claw Klumpke’s Total Claw Ulnar Claw Defined by lumbricalsFlex MCP, Extend PIP and DIPLoss of function: MCP hyperextension, PIP and DIP flexionUlnar Nerve: Digits 4 and 5Median Nerve: Digits 2 and 3Klumpke’s: Loss of Inferior Trunk of brachial plexus (C8,T1)All intrinsic hand musclesCan Test by asking patient to make a fistMedian ClawKlumpke’s Total ClawUlnar Claw
52 Radial Nerve Saturday Night Palsy Mid-Shaft Humeral Fracture Pass out with arm over chair, Use of crutches…Injury at axilla: loss of triceps, wrist extension (wrist drop), digit extensionMid-Shaft Humeral FractureRadial nerve injured as passes posteriorly in spiral grooveLoss of wrist extension (wrist drop), digit extensionProximal Radial HeadRadial nerve injured as passes toward posterior compartment of forearmLoss of digit extension
53 Trendelenburg Sign Weakness of thigh abductors Gluteus Medius and Gluteus MinimusSuperior Gluteal Nerve (L5,S1,S2)Test by having patient stand on 1 legPelvis sags on contralateral side when standing on affected leg
54 Foot Drop Be careful with tight bandages and casting Injury to Common Peroneal N. as wraps around head of fibulaBe careful with tight bandages and castingLoss of dorsiflexion (deep peroneal)Compensation with Steppage GaitLoss of sensation on dorsum of foot (superficial peroneal)
55 Club Foot Talipes Equinovarus Associated with spina bifida May require serial casting or orthopaedic surgery
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