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

Radial nerve

Supplies:

TricepsBrachioradialisSupinatorAll extensors in the forearmAbductor pollicis longusA small patch of skin at the

base of the thumb

Causes of injury:

Crutch palsy

Fracture of humerus

Tourniquet palsy

Causes of injury:Dislocation of elbowFractures around elbowSurgical accidentsBullet or knife

Signs and symptoms

Wasting of the above musclesWrist dropLoss of supination of extended elbow.Weak abduction of thumbSensation loss at the base of thumb.

Treatment

Open wounds: Repair or graftClosed wounds: Spontaneous recovery during 8-12 weeks. If not: Exploration and repairIf repair failed: Tendon transfer

Median nerve

Supplies:All flexors in the forearm except:Flexor carpi ulnarisUlnar ½ of flexor digitorum profundusThe two pronatorsThenar eminence musclesLateral two lumbricalsSkin: lateral ⅔ of palm + lateral 3½ fingers

(palmar surface)

Causes:

Forearm fractures

Elbow dislocation

Gunshot or stab wound

Carpal dislocation

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

Treatment:

Repair or graft

Ulnar nerve

Supplies:

Two flexors in the forearm

Hypothenar eminence muscles

Eight interossei and two lumbricals

Abduction and Adduction of the fingers

Flexion of M.P.J

Extension of I.P.J

Adductor pollicis

Causes

Injuries

Pressure of a deep ganglion in the wrist

Fractures around elbow

Cubitus valgus deformity

Nerve entrapment in the cubital tunnel

Symptoms and signs

Hypothenar wasting

Wasting of the interossei(first dorsal interosseous

Claw hand

Loss of thumb adduction (Froment’s test)

Sensation loss

Treatment

Repair or Graft

Tendon transfer

Femoral nerve

Supplies:

Quadriceps muscle

Iliopsoas muscle

Skin: (1) Anterior of thigh

) 2 (Medial aspect of the leg.

Causes

Gunshot

Bleeding into the thigh

Traction during operation

Symptoms and signs

Loss of knee extension

Hand- knee gait

Numbness of skin

↓Knee jerk.

TreatmentSuturing OR Grafting