Nerves in the Forearm

This presentation describes Nerves in the Forearm

Transcript

1. Nerves in the Forearm
2. Median Nerve (C5,6,7,8,T1)
3. Course & Relations of Median Nerve
4. Median nerve in cubital fossa Bicipital aponeurosis Lateral Medial Brachial artery
5. Median nerve Humero-ulnar head of flexor digitorum superficialis Radial head of flexor digitorum superficialis Superficial head of pronator teres m. Median nerve Deep head of pronator teres m. Flexor retinaculum Lateral Medial
6. Median nerve Flexor retinaculum Lateral division Medial division
7. Branches of Median N. At cubital fossa: -To pronator teres, flexor carpi radialis, palmaris longus and flexor digitorum superficialis. Between 2 heads of pronator teres m.: Anterior interosseous branch which supplies flexor pollicis longus, pronator quadratus and lateral ½ of flexor digitorum profundus.
8. Median nerve Anterior interosseous br.
10. One inch Proximal to flexor retinaculum: -Palmar cutaneous branch. In the palm: -Thenar muscles. -First 2 lumbricals. -Cutaneous to palmar surfaces of lateral 3&1/2 fingers with back of distal parts.
11. Median nerve Palmar cutaneous branch of median nerve Flexor retinaculum Lateral division of median nerve Recurrent branch Medial division
12. Ulnar Nerve (C7,8,T1)
13. Medial intermuscular septum superior ulnar collateral art. Ulnar nerve Medial epicondyle Medial Lateral
14. Flexor carpi ulnaris m. Ulnar nerve Medial epicondyle
15. Ulnar nerve Flexor retinaculum Medial Lateral Flexor carpi ulnaris Ulnar nerve
16. Flexor carpi ulnaris m. Flexor digitorum profundus m. Ulnar nerve Ulnar artery Flexor retinaculum Medial Lateral
17. Ulnar nerve Superficial terminal branch Deep terminal branch Palmaris brevis Pisiform bone Flexor retinaculum Deep branch of ulnar nerve
18. Branches of Ulnar Nerve In the forearm: Articular: to elbow joint. Muscular: to flexor carpi ulnaris and medial ½ of flexor digitorum profundus m. Cutaneous: Palmar & dorsal cutaneous branches.
19. Flexor carpi ulnaris m. Flexor digitorum profundus m. Ulnar nerve Medial Lateral
20. Branches of ulnar n. in the palm: Superficial branch: ➢Muscular supply to palmaris brevis muscle. ➢Palmar cutaneous branches to medial 1&1/2 fingers. Deep branch: ➢All muscles of the hand except thenar and 1st 2 lumbricals. ➢Articular to joints of the hand.
21. Ulnar nerve Palmar cutaneous br. of ulnar nerve Superficial terminal branch Deep terminal branch Palmaris brevis Digital branches of superficial division Deep branch of ulnar nerve
22. Radial Nerve (C5,6,7,8 & T1)
23. Brachialis m. Brachio-radialis m. Radial nerve Superficial radial n. Deep radial n.
24. 1-Supinator muscle Supinator muscle in the deep muscles of the back of forearm
25. Radial nerve Deep radial nerve (posterior interosseous nerve) Dr. Sherif Fahmy Supinator muscle
26. Superficial fibers of supinator m. Deep fibers of supinator m. Posterior interosseous nerve Posterior interosseous artery Extensor pollicis longus m. Interosseous recurrent artery
27. Radial artery Superficial radial nerve Brachio-radialis m.(cut) Medial Lateral
28. Deep radial nerve (posterior interosseous): It supplies most of the muscles of the back of forearm (extensors of the hand and fingers) except brachioradialis, extensor carpi radialis longus and anconeus ms. Superficial radial nerve: It supplies the skin of -Lateral 2/3 of the dorsum of the hand. -Back of lateral 3 and half fingers except terminal parts (from median nerve).
29. Radial nerve injury Causes: A- In axilla: by badly adjusted crutch in armpit. B- in upper part of arm: Saturday night palsy. C- In spiral groove: by fracture shaft of humerus. D- At elbow: by supracondylar fracture of humerus. N.B. Main deformity of radial nerve injury is wrist & finger drop (bad hand grip)
30. Dr. Sherif Fahmy
31. Injury in axilla or upper part of arm: Motor loss: Paralysis of triceps and muscles of the back of forearm. Sensory loss: Loss of sensation in skin of: Back of arm, lower lateral of arm, back of forearm and back of lateral 2/3 of dorsum of hand and lateral 3 and half fingers. Disability: Unable to extends forearm against resistance, extends hand against resistance, extends fingers against resistance and supinate extended forearm. Deformity: Flexed elbow with wrist and finger drop. Late wasting changes: Wasting of back of arm & forearm.
32. Injury in the spiral groove Motor loss: Paralysis of lateral and part of medial head and muscles of the back of forearm. Sensory loss: Loss of sensation in: lower lateral of arm, back of forearm and back of lateral 2/3 of dorsum of hand and back of lateral 3 and half fingers. Disability: Weak extension of forearm. Unable to extends hand against resistance, extends fingers against resistance and supinate extended forearm. Deformity: • Flexed elbow with wrist and finger drop. Late wasting changes: • Partial wasting of back of arm and wasting of back of forearm.
33. Injury in lower part of arm Motor loss: Paralysis of muscles of the back of forearm. Sensory loss: •Loss of sensation in: Back of lateral 2/3 of dorsum of hand and back of lateral 3 and half fingers. Disability: •Unable to extends hand against resistance, extends fingers against resistance and supinate extended forearm. Deformity: Wrist and finger drop. Late wasting changes: Wasting of back of forearm.
34. Injury in axilla or upper part of arm Injury in the spiral groove Injury in lower part of arm Motor loss Paralysis of triceps and muscles of the back of forearm Paralysis of lateral and part of medial head and muscles of the back of forearm Paralysis of muscles of the back of forearm Loss of sensation in skin of: Back of arm. Lower lateral of arm. Back of forearm. Back of lateral 2/3 of dorsum of hand and lateral 3 and half fingers. Loss of sensation in: Lower lateral of arm. Back of forearm. Back of lateral 2/3 of dorsum of hand and back of lateral 3 and half fingers. Loss of sensation in: Back of lateral 2/3 of dorsum of hand and back of lateral 3 and half fingers. Unable to extends forearm against resistance. Unable to extends hand against resistance. Unable to extends fingers against resistance. Unable to supinate extended forearm Weak extension of forearm. Unable to extends hand against resistance. Unable to extends fingers against resistance. Unable to supinate extended forearm Unable to extends hand against resistance. Unable to extends fingers against resistance. Unable to supinate extended forearm Flexed elbow. Wrist and finger drop. Flexed elbow. Wrist and finger drop. Wrist and finger drop. Wasting of back of arm. wasting of back of forearm. Partial wasting of back of arm. Wasting of back of forearm. Wasting of back of forearm. Sensory loss Disability Deformity Late wasting changes
35. Injury of Superficial Radial Nerve
36. Cause: -Stab wound. Result of injury: Sensory loss: -At triangular area between 1st and 2nd metacarpal bones and dorsum of lateral 3 & ½ fingers except distal parts. -Hypoesthesia (decreased sensation) at the rest of area supplied by the nerve due to overlape of surrounding nerves.
37. Injury of Posterior Interosseous Nerve
38. Causes: -Dislocation of superior radio-ulnar joint. -Fracture of neck of radius. Results of injury: Motor loss: -Paralysis of muscles of back of forearm except brachio-radialis, extensor carpi radialis longus and anconeus muscles. Disability & deformity: -Weak extension of wrist with abduction of the hand. -Unable to extends fingers. -Finger drop. -No wrist drop due to action of ext.carpi radialis longus. Late wasting changes: -Wasting of back of forearm with lesser affection to lateral side.