Mock1 RTA Neck

[admin]

RTA NECK & SHOULDER INJURYStemPatient involved in an RTA.
Neck and shoulder injury.What injury do you suspect?
Brachial plexus injury

Mechanism of injury?Traction injury

Common trunk to be injured?Upper trunk

C5 nerve will exit in between which 2 vertebra?Between C4 and C5

Where do they exit from? – point at the vertebra (you will be given a vertebra in the exam)Intervertebral Foramen

C5 and C6 cutaneous supply on human body?C5: lateral armC6: lateral forearm and thumb

Describe Erb’s & Klumpke palsy?Erb’sKlumpke’s

ERBS: Damage to the upper nerve roots (C5, C6) Motor affection(waiter’s tip deformity)
Paralysis of arm abductors (supraspinatus + deltoid)
arm adduction
Paralysis of arm external rotators (infraspinatus + teres minor)
arm internal rotation
Paralysis of forearm flexors and supinators (biceps, brachialis, brachioradialis) $\rightarrow$ forearm extension and pronation
Sensory affection loss of sensation of radial side of arm and forearm
KLUMPKE / Injury to lower trunk (C8, T1) (claw hand deformity)
Paralysis of all intrinsic muscles of the hand
Paralysis of wrist flexors (except flexor carpi radialis)
Hyperextension of MCP joints with flexion of IP joints
Sensory: loss of sensation over ulnar border of forearm and hand

[admin]

Identify Rotator cuff muscle? Origin? Insertion? Nerve supply?
MuscleOriginInsertionActionInnervation
SubscapularisVentral scapula (subscapular fossa)Humerus (LT)Internally rotating arm; Providing anterior stabilityUpper and lower subscapular nerves
SupraspinatusSuperior scapula (supraspinatus fossa)Humerus (greater tuberosity)Abducting; Providing stability; Externally rotating armSuprascapular nerve
InfraspinatusDorsal scapula (infraspinatus fossa)Humerus (greater tuberosity)Providing stability; Externally rotating armSuprascapular nerve
Teres minorScapula (dorsolateral)Humerus (greater tuberosity)Providing stability; Externally rotating armAxillary nerve

What is the Deltoid muscle origin and insertion?Origin: lateral clavicle and scapulaInsertion: deltoid tuberosity of humerus

How to test it on actor?Inability to abduct the shoulder $> 15^{\circ}$Loss of sensation over the badge area

What are the flexors of the elbow and their Nerve supply (Value)? Name of the nerve in the forearm?MuscleOriginInsertionActionInnervation
BrachialisAnterior humerusUlnar tuberosity (anterior)Flexing forearmRadial (C5-T1) + Musculocutaneous (C5-C7)
Biceps brachiiCoracoid (short head); Supraglenoid (long head)Radial tuberosity; Relations to bicipital tendon: Medially: Median n. and brachial a.; Lateral: Radial nerveSupination, flexionMusculocutaneous (C5-C7)
Pronator teresMedial epicondyle and coronoidMid-lateral radiusPronating, flexing forearmMedian nerve C5-T1

Name of the sensory nerve in the forearmLateral cutaneous nerve of forearm

Show on actor reflexes of Biceps, triceps & supinator?Demonstrate

What is the sensory distribution of Radial & Median N ulnar nerve?
Radial nerve
Posterior forearm</li><li>The lateral $\frac{2}{3}$ of the dorsum of the hand</li><li>Posterior aspect of lateral $3 \frac{1}{2}$ fingers</li></ul><ul><li>
Median nerve
Lateral $\frac{2}{3}$ of the palm of the hand</li><li>Lateral (radial) $3 \frac{1}{2}$ digits on the palmar side</li><li>Dorsum of the tips of index, middle and thumb</li></ul><ul><li>
Ulnar nerve
Medial $\frac{1}{3}$ of the palmar and dorsal aspects of hands & fingers</li></ul>

[admin]

Rotators of the scapula, origin, insertion & nerve supply?
Upward rotators
-Trapezius
-Serratus anterior
Downward rotators
-Rhomboids minor
-Rhomboids major
Levator scapulae

Muscle Origin Insertion Action Innervation
Trapezius SP C7-T12 Clavicle, scapula (acromion, SP) Rotating scapula Cranial nerve XI
Serratus anterior Ribs 1-9 Scapula (ventral medial) Preventing winging Long thoracic nerve
Latissimus dorsi SP T6-S5, ilium Humerus (ITG) Extending, adducting, internally rotating humerus Thoracodorsal nerve
Rhomboid minor SP C7-T1 Scapula (medial spine) Adducting scapula Dorsal scapular nerve
Rhomboid major SP T2-T5 Scapula (medial border) Adducting scapula Dorsal scapular nerve
Levator scapulae Transverse process C1-C4 Scapula (superior medial) Elevating, rotating scapula C3, C4 nerves

Brachioradialis muscle demonstrate on yourself action & NS:
Action: Flex forearm
Nerve Supply (NS): Radial nerve

Show C5 reflex
Biceps reflex

Name three muscles supplied by musculocutaneous nerve. Nerve root.
Muscles: BBC
Biceps brachii
Brachialis
Coracobrachialis
Nerve root: C5, C6, C7

External rotators of arm
Supraspinatus
Infraspinatus
Teres minor

Axillary nerve cutaneous
Skin to the lower half of deltoid

Axillary nerve muscle supply
Deltoid
Teres minor

Shoulder abductor muscles?
Supraspinatus (0−15 )
Deltoid (middle fibres) (15−90 )
Trapezius and serratus anterior (over 90 ): which will require upward rotation of the scapula with lateral rotation of the humerus.