Rotator Cuff tear Shoulder Pain weakness with active shoulder abduction

Tendon insertions: supraspinatus, infraspinatus, teres minor, subscapularis muscle

Shoulder dislocation Most are anteriorly dislocated --> axillary artery/nerve
Tennis elbow Extensor muscle tendons insert near the lateral epicondyle
Golfers elbow Pain is located where the flexor muscle tendons insert near the medial epicondyle
Ulnar nerve
compression
Areas: transverse carpal ligament, elbow (funny bone area)
-> Pain and numbness of the ulnar aspect of the forearm and ring and little finer plus
weakness of the intrinsic muscles of the hand
DeQuervains disease Chronic stenosing tenosynovitis of the first dorsal compartment of the wrist: contains
the abductor pollicis longus (APL) and extensor pollicis brevis (EPB)
- Excess friction causes thickening of the tendon sheath and stenosis of the
osseofibrous tunnel
- Pain occurs at the radial aspect of the wrist and is aggravated by moving the thumb:
pain in region of radial styloid process
Compartment syndrome Pain, parasthesias, pallor, paralysis, pulselessness
-> Causes: fractures, injuries to arteries/soft tissue, prolonged limb compression (cast)
increase in pressure of confined space pressure reduces perfusion.
-> Volkmanns ischemic contracture: complication of the supracondylar fracture of the
humerus --> injury to branchial artery and median nerve
Carpal Tunnel syndrome Median nerve entrapment in transverse carpal ligament.
-> Pain, numbness, paresthesias in the thumb, index finger, second finger, third finger
and the radial side of the fourth finger
-> Thenar atrophy (ape hand appearance). Pain is reproduced by tapping over the
median nerve.
Claw hand Ulnar nerve palsy:
- adduction of the fingers due to innervation of the palmar and dorsal interosseous
muscles
- adduction of the thumb (adductor pollicis muscle)
Wrist drop Radial nerve palsy: extensor muscles of the wrist and digits --> wrist drop is hand that
is flexed at the wrist and cant be extended
- injury due to midshaft fractures of the humerus or Saturday night palsy
Waiter Tip Deformity Brachial plexus lesion involving C5-C6/ Upper trunk injury
-> Erb- Duchennes palsy: birth injury of upper trunk resulting in loss of abduction of
the arm from the shoulder, inability to externally rotate the arm, inability to supinate
the forearm, absent biceps reflex, assymetric Moro reflex
Klumpkes Paralysis Birth injury of brachial plexus at C5-C7 and T1 --> lower trunk injury: paralysis of the
hand; Horners syndrome
Axillary nerve injury
(C5-C6)
Fracture of surgical neck of humerus, dislocation of the shoulder joint (usually
anteriorly)
- Patient cant abduct the arm to the horizontal position or hold the horizontal position
when a downward force is applied to the arm: paralysis of deltoid muscle
- weakening of lateral rotation of arm: paralysis of teres minor muscle
Bone injuries -> Clavicular fracture: ulnar nerve
-> Proximal humerus fracture: axillary nerve
-> Mid shaft/ distal third of humerus: radial nerve -> nerve travels in spiral groove,
wrist drop
Falling on the
outstretched hand:
Colles fracture of distal radius --> dinner fork deformity
Reflex loss -> C4-C5: biceps reflex associated with musculocutaneous nerve (C5-C6)
-> C5-C6: supinator
-> C6-C7: triceps reflex associated with radial nerve C6-C8





L5-S1 herniation Sensory loss: lateral and posterior calf, plantar aspect of foot
Reflex loss: Achilles reflex (Tibial nerve L4-S3)
Motor deficit: loss of plantar flexion, loss of foot eversion (weakness of peroneus
longus/brevis)
L4-L5 disc herniation Sensory loss: dorsum of the foot, webbed space between the great toe
Reflex loss: none
Motor deficit: loss of dorsiflexion of the big (great) toe due to weakness of the
extensor hallucis longus
L3-L4 disc herniation Sensory loss: medial leg to the malleolus
Reflex loss: knee jerk (femoral nerve L2-L4)
Motor deficit: quadriceps weakness due to weakness of knee extension and loss of
dorsiflexion of the foot due to weakness of the tibialis anterior.
Cauda Equina Syndrome Bowel or bladder dysfunction; saddle area anesthesia
Superior gluteal nerve
injury
Causes: surgery, Duchennes, waddling gait
-> SGN supplies GLUTEUS MEDIUS and GLUTEUS MINIMUS muscles = loss of abduction
of the thigh and inability to pull the pelvis down - + Trendelenberg sign
Inferior gluteal nerve
injury
Patient is unable to walk because the IGN supplies the gluteus maximus muscle -->
patient leans backward when the heel strikes the ground
Peroneal nerve injury MC site of entrapment behind the knee: results in pt having slapping gait
Motor deficits: loss of foot eversion due to weakening of peroneus longus/brevis
muscles, loss of foot dorsiflexion due to weakening of the tibialis anterior muscle, loss
of toe extension due to weakening of the extensor digotorum longum and hallucis
longus --> all of this results in Equinovarus deformity: plantar flexion w/ foot drop and
inversion of the foot, loss of ankle jerk reflex
Obturator Nerve Injury
(L2-L4)
Motor deficit: leg swings out when walking since the obturator nerve supplies muscles
that are involved w/ hip adduction
Sensory loss: medial aspect of the thigh, loss of knee reflex
TIbial Nerve injury
(L4-S3)
Motor deficit: loss of plantar flexion (due to weakening of gastronemius, soleus and
plantaris muscles), loss of flexion of the toes (due to weakening of the flexor digitorum
longus and hallucis longus muscle), foot inversion due to weakening of the tibialis
posterior muscle --> results in calcaneovalgocavus: dorsiflexion and inversion of the
foot, loss of ankle jerk reflex
Femoral Nerve injury
(L2-L4)
Motor deficit: pt cant flex the thigh due to weakening of the sartorius and iliacus
muscles, patient cant extend the leg due to weakening of the quadriceps muscle, loss
of knee jerk reflex; kyphosis hump back