Nerve Lesions of Upper Limb .Prof. Laila M.Aboul Mahasen Morsy

By

Nerve supply of muscles of upper limb

Ms. of front of armMs. of Back of arm & forearm Ms. of front of forearm

Musculocutaneous N.All the Ms. except medial

11/2 Ms Median Nerve

Ulnar N. Radial N.

Cutaneous innervation of upper limb

ThenareminenceHypothenar

eminence

The muscles of the hand are supplied by ulnar & median nerves

A- All thenar muscles are supplied by median

except “ adductor pollicis” by ulnar N .

B- All hypothenar muscles by ulnar N.

C. Lumbrical muscles :

1 -1st & 2nd by median nerve

2 -3rd & 4th by ulnar nerve

D. Palmar & Dorsal interossei by ulnar nerve

(Fig. 32 ) Lumbrical muscles

Palmar Interossei

(Adductors)

(Abductors)

Ulnar nerve

(Fig.37)Musculocutaneous, median & ulnar nerves in the axilla & arm

Ulnar nerve in forearm & hand

Deep branch of ulnar N. passes with deep palmar arch in front of interossei muscles

Deep branch of ulnar N. supplies the interossei muscles

Injury to the ulnar nerve Cause : a fracture of the medial epicondyle, or wound in the wrist . It results in a claw hand )Fig.43(.

The lesion above the elbow : ) partial claw hand (1 -The ring and little fingers : a- loss of flexion of terminal phalanges ) due

to paralysis of flexor digitorum profundus )

b- hyperextension of the metacarpo-phalangeal joints with flexion of the proximal interphalangeal joints due to paralysis of interossei & the 2 medial lumbrical muscles

2 -loss of abduction and adduction of the fingers .

3 -Wasted hypothenar eminence and loss of adduction of the thumb due to paralysis of the adductor pollicis muscle

The lesion at wrist : leads to paralysis of the muscles of hand

(complete claw)

**The lesion above the elbow leads to less or partial clawing due to paralysis of medial 1\2 of flexor digitorum profundus.

.

(Fig.79)Fracture of medial epicondyle

causing injury of ulnar nerve

Ulnar nerve lesion “ Claw hand”

Dorsal view Palmar view

Ulnar tunnel syndrome

Ulnar Nerve injury

Median nerve

axilla

arm

forearm

hand

(Fig.37)Musculocutaneous, median & ulnar nerves in the axilla & arm

Median nerve in forearm & hand

Ulnar & median nerves

Median nerve lesion“Ape hand “

Colles’fracture. Fracture of the distal end of the radius causing a

“silver fork” deformity.

Flexor retinaculum

Carpal tunnel syndrome

Release of carpal tunnel

Carpal tunnel syndrome ( neglected(

Radial Nerve

(Fig.40) Radial nerve in axilla & arm

In axillaIn posterior arm

N.B. Brachial artery ,Median nerve, radial & ulnar nerves

Radial nerve in axilla , spiral groove , ant. arm

1-In axilla : A- long H. of triceps B-Post. Cut. N. of arm

2-In spiral groove: A-Lat.& Med. Hs. of triceps & anconeusB-Lower lat. Cut. N. of arm

C-Post. Cut. N. of forearm3 -Lower lat. Of front of arm:

A- Lat. Part of brachialisB- Brachioradialis & Ext. carpi radialis longus

C-Articular branch to elbow joint. 4 -In front of lateral epicondyle:

superficial & deep terminal branches

Superficial muscles of posterior forearmThey are arranged from lateral to medial side : 7 Ms.

1 -Brachioradialis 2 -Extensor carpi radialis longus3 -Extensor carpi radialis brevis

1 , 2 & 3 lie in the lateral side of forearm4 -Extensor digitorum

5 -Extensor digiti minimi 6 -Extensor carpi ulnaris

7 -Anconeus All are supplied by radial nerve & its deep branch.

Deep muscles of posterior forearm

They are 5 muscles arranged from above downwards:

1 -Supinator

2 -Abductor pollicis longus

3 -Extensor pollicis brevis

4 -Extensor pollicis longus

5 -Extensor indicis

All are supplied by deep branch of radial nerve ) posterior interosseous nerve (.

Radial nerve in forearm & hand

Front of forearm

Back of forearm

In hand

Radial nerve lesion “ Wrist drop& fingers drop ”

Radial Nerve injury

Fracture of the

shaft of the

humerus may

damage nearby nerves.

Radial Nerve injury

•In the upper part of the arm.

( penetrating injury, stab wound, gun shot injury or traction injury(

•In the mid arm.

( fracture humerus, iatrogenic, stab w(… ,.

•At the elbow.

( fracture or dislocation of the head of the radius(

(Fig.43 )Lesion of ulnar, median & radial nerves

Ulnar nerve lesion“Claw hand“

Median nerve lesion “Ape hand“

Radial nerve lesion “Wrist & finger drop“

Axillary Nerve

Lesion of Axillary Nerve

Musculocutaneous Nerve

Upper trunk lesion “ Erb’s Palsy”

Nerve to serratus anterior Lesion“ Winged scapula“

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Mr. Sayed Mahmoud