What is cervical Spondylosis
Degenerative osteoarthritis of IV joint in cervical spine- puts pressure on nerve roots - leads to radiculopathy….
(Myotomal mu weakness, dermatomal sensory symptoms)
What is importance of surgical neck of humerus in children
- region of epiphyseal growth- if damaged;asymetric growth
- epiphyses solely dependant on supply from epiphyseal arteries- if disrupted- no compensation from metaphysical artery- Ischaemic necrosis
How would you test for peripheral nerve lesions??
Sensation in skin Innervated by peripheral nerve
What is usually injured in conjunction with medial collateral or ACL injuries
Menisci
Where is safest for intramuscular injection
Ventrogluteal site
OA XR shows…
Reduced joint space, osteophytes, calcification, bone cyst
What is malignant. Hyperthermia
Point mutation in ryanodine receptor- susceptible to volatile anesthetic-> RR opens and massive Ca influx- to sequester, SERCA increases rate and ATP use- raises MET dramatically
- raised temp, respiratory acidosis, tachycardia
Antidote- dantrolene- binds RR to prevent Ca release (mu relaxant)
The action of what muscle is also lost in ulnar nerve lesion at the elbow rather than the wrist
Flexor digitorum profundus
What is the sign of Klumpkes palsy and why
Hand has clawed appearance
- MCP joints are hyperextended and IP joints are flexed
And. Wrist extended
Describe RA
Autoantibodies attack synovium –>synovial inflammation -Pannus forms
Pannus erodes cartillage and bone
How would you test for suspected femoral nerve damage ?
Test quadriceps femoris muscle
- pat supine with knee slightly flexed
- ask to extend leg- resist movement - contraction of QF should be visible
What digits are affected in ulnar nerve injury and what results
Little and ring
Ulnar claw
What two tests can be done to test for. Carpal tunnel syndrome
1- Tinel’s sign- tap nerve in carpal tunnel to elicit pain in median nerve distribution \
2- phalen’s manoeuvre- hold wrist in Flexion for 60 sec to elicit numbness /pain in median nerve distribution
What is the normal curvature of spine?
2 kyphoses (anterior flexions)- thoracic and sacrococcygeal 2 Lordoses (posterior flexions) - cervical and lumbar
What can you fracture if you fall onto the shoulder or outstretched hand?
Clavicle
What is the common cause and presentation of thoracic outlet syndrome
Cause- trauma ( fractured clavicle), repetative Adduction
Presentation - pain in shouder, neck arm , may be tingling , muscle weakness, discolouration
How may collateral ligaments be torn and how would damage be assessed
Cause- force being applied to side of knee when foot placed on ground
Ask pat to rotate leg
- pain on medial rotation - damage to medial ligament
- pain on lateral - damage to lateral ligament
Explain the presentation of hip fracture
Shortened limb- flexors/ adductors / extensors pulling distal fragment up
Externally rotated- Iliopsoas attached to lesser trochanter- externally rotate distal fragment
Abducted - Gluteus Medius/ minimus attached to greater trochanter - abduct distal fragment
What does injury to the radial nerve in the AXILLA result in
Triceps and muscles in posterior compartment PARALYSED- unable to extend forearm, wrist, fingers–> wrist drop
Sensory loss- lateral and posterior upper arm, posterior forearm,
Dorsal surface of lateral 3 and half digits
What can cervical Spondylosis lead to
Pressure on spinal cord and myelopathy- global weakness, gait dysfunction, loss of balance, loss of bladder/bowel control
What is spinal bifida?
NTD- NT fails to develop or close properly - defects in s.cord and bones of spine
Most severe- myelomeningocele- babies spinal canal remains open along several vertebrae in lower/middle back
What are the symptoms of carpal tunnel syndrome
Paresthesia in distribution of median nerve . Pain radiate to forearm (worse in am)
What commonly causes elbow dislocation
Young child falls on hand with the elbow flexed
What is IT band syndrome ?
Continual rubbing of the iliotibial tract band over the lateral femoral epipcondyl + repeated Flexion and extension of knee
-> area inflammed
What may cause swollen forearm, arm and shoulder with superficial venous distension, numbness and skin cyanosis
Axillary vein thrombosis- occlusion of Axillary /subclavian vein
What is a boxers fracture
Fracture in 5th metacarpal neck
Distal part of fracture displaced posteriorly - shortening
What is osteoporosis ?
What 2 types exist?
What are the risk factors?
Metabolic Bone disease- reduced mass of mineralised bone- no longer adequate support- fractures
T1- post menopausal women- low oe- increase OC
t2-elderly - attenuated OB function
RF- insuff ca intake./ absorption, insuff vit D absorption, smoking
What is a hangmans fracture ?
Hyperextension of head on neck - axis fracture through pedicles - forward displacement of C1 and body of C2 on C3
Signifignant spinal cord injury - quadriplegic
What is sciatica ?
Pain from compression or irritation of sciatic nerve - pain in buttocks/leg, leg weakness, burning/tingling down leg,
What is golfers elbow
Epicondylitis - overuse strain of common tendon attaching the flexor muscles to the medial epicondyl
What happens in a median nerve injury and what is a patient being asked to do
Hand of benediction
Asked to make fist
How is a gynecoid pelvis adapted for childbirth
Greater pelvis outlet
- oval inlet
- less prominent ischial spine- greater bispinous diameter
- sacrum shorter , more curved, less pronounced sacral promontory
Which muscles are paralysed in median nerve injury ? What is the result?
Lateral two lumbricals and medial half of FDP
Inability to flex at MCP and IP joints in middle and index finger
Where is a lumbar puncture done?
L2/3, L3/4, L4/5 - after conus medullaris- so only mobile spinal nerve roots, not cords
How is the femoral artery palpated?
Inferior to where crosses inguinal ligament- midway between pubic symphysis and anterior superior iliac spine
What may compress the brachial plexus and lead to paresthesia and mu weakness
Axillary artery aneurysm - compress BP
Where is prone to fracture in the fibula and how
At ankle- lateral malleolus of fibula
- forced external rotation of ankle ; spiral fracture
- foot twisted outwards- transverse fracture
What is tennis elbow
Epicondylitis- overuse strain of common tendon attaching extensor muscles to lateral epicondyl
What is an avulsion fracture of the ischial tuberosity
Hamstring tendon tears off a fragment of ischial tuberosity
What artery is at risk in NOF fracture
Lateral circumflex
What muscles are paralysed in Erbs palsy
Supraspinatus , intraspinatus, subclavius, biceps brachii , brachialis, coracobrachialis, deltoid, teres minor
What is the sign of Erbs palsy
Limb hangs limp, medially rotated (unopposed pec major), forearm pronated (loss of biceps brachii) -‘'’waiters. Tip”
What is kyphosis
Excessive thoracic curvature - hunchback
What is Paget’s disease. Of bone
Excessive breakdown and formation of bone–> disorganised bone remodelling-> weakened bone-> pain, misshapen bones, fractures and arthritis
What may be damaged by upward movement of medical part of clavicle fracture ? What would result?
Suprascapular nerve
- Innervates lateral rotators (eg infraspinatus ) and so damage results in unopposed medial rotation of upper limb- waiters tip position .
What movements are lost in Erbs Palsy
Abduction of shoulder, lateral rotation of arm, suprination of forearm, Flexion of shoulder
name 2 common distal humeral fractures
Medial Epicondyle , supracondylar
What it’s the treatment of myelomeningocele
Surgery after birth- place s.cord and tissue inside babies body
What may cause an upper brachial plexus injury
Excessive angle increase between neck and shoulder- stretch nerve roots
Eg- shoulder trauma, difficult birth
Where would you test for sensation in a radial nerve lesion
Posterior surface of forearm and dorsolateral surface of hand (3 1/2 digits)
What is the unhappy triad caused by
Lateral force to extended knee
What can cause scoliosis
Primary (congenital) , idiopathic , secondary (nm disease)
Cosmetic difficulties, severe- decreased lung capacity
How would you test C5 Dermatome?
Sensation of upper lateral region of arm
What is a bakers cyst
Inflammation and swelling of Semimembranous bursa - sign of chronic knee effusion
- usually assoc with arthritis
Describe osteomalacia
During bone remodelling- deficient calcification of formed bones as decreased Ca per bone unit- bones soften
What is a lower brachial plexus injury called ? What is it caused by, which nerves does it affect?
Klumpke Palsy - due to excessive abduction of arm
damaging nerves from T1 root
- ulna and median nerves
What is the unhappy triad
Damage to medial collateral ligament - resulting (due to attachment) in damage to medial meniscus. ACL also affected
What is the most common direction for shoulder dislocation and how does it occur
Anterior as least support inferiorly
Usually trauma on fully aducted arm
- humeral head forced anteriorly and INFERIORLY (due to adductors) and medially (pec major)
What is the risk with a proximal clavicular fracture?
Pneumothorax
What end of the tibia is more vulnerable to damage? What may happen
Proximal - condyles may be broken up in fracture
- may be injury to ligaments of knee
What is piriformis syndrome
Caused when piriformis muscle compresses sciatic nerve due to hypertrophy or spasm of piriformis muscle
More common if piriformis splits prematurely and pierces piriformis
What neurovascular structures are at risk of damage in a intramuscular injection into the deltoid
Axillary nerve and posterior circumflex artery
During what motion is pain present in painful arch syndrome
Arm abduction 50-130 degrees
What nerves are affected in Erbs palsy
Nerves derived from C5 and C6 roots solely
- MC, Axillary , suprascapular and nerve to subclavius
Where does the humerus move in a elbow dislocation
Distal end driven through joint capsule at anterior side
- ulnar collateral ligament usually torn
Often ulnar collateral ligament torn
(Called ‘posterior dislocation)
How does fracture NOF present
Shorter, laterally rotated
How would you test the C7 (spinal cord level 7) Dermatome?
Sensation on pad of the index finger
How do you test median nerve ? (Motor)
1- test thumb- resisted palmar abduction
2- test opposition
What is the nerve supply that may be damaged in a Shoulder injury
Axillary, suprascapular and lateral pectoral nerves (C5 and C6)- so Erbs palsy will affect shoulder joint function….
How do you test myotome T1?
Abduction and Adduction of index, middle, and ring fingers
How do you treat carpal tunnel pathology ?
Splint, steriods, carpal tunnel releases
How do you test myotome C6?
Flexion of forearm at elbow
What way does the nucleus pulposus usually herniate?
What is the risk
Posteriolaterally- may compress signal nerve roots
If herniates POSTERIORY- may cause spinal cord compression- neurosurgical emergency
What may cause swelling in popliteal fossa? (5)
Bakers cyst Popliteal aneurysm DVT Adventitial cyst of popliteal artery Neoplasm
How would you test the spinal cord level C8 (C8 dermatomes)
Sensation of pad of little finger
What sensation if lost in Erbs palsy
Sensory innervation of MC and Axillary nerves- lateral side of arm
What is congenital hip dislocation ?
Abnormality in either shape of femur, acetabulum or supporting structures
– > acetabulum and femur not in close contact
(Assoc with breech )
How may fracture to the femoral shaft occur and with what consequences
Traumatic injury
- spiral fracture- leg shortening as fragments overriding
- soft tissue damage
- femoral nerve palsy
- comprimise to femoral artery b supply
What 3 nerves may be damaged in relation to humerus fracture and why>
Axillary- around posterior aspect of surgical neck
Radial - passes diagonally around post. Surface of middle of humerus ( radial groove).
Ulnar- posterior to medial epicondyl at distal end f humerus
What is Amelia and meromelia
Amelia- complete absence of limb
Meromelia- partial absence of one/ more limb structures.
What happens with vitamin A deficiency
Affects endochondrial bone growth- reduced growth
Which nerves are at risk in the following humeral fractures?
- surgical neck
- shaft
- medial epicondyl
- supracondylar fracture
Axillary
Radial
Ulnar
Medial
What is myotonia congenita
Mut in Cl channel- Can’t relax muscles at will)-
What is a Bennetts fracture ?
What is it caused by
Fracture of 1st metacarpal base extending into carpometacarpal joint
Caused by hyperabduction of thumb
Describe rickets
Childhood- lack vitamin D- lower Ca uptake- decreased calcification of osteoid - poorly mineralised bones
-bones distort, grow slow, prone to fracture
Which knee menisci is more likely damaged
Medial
What is the treatment for sciatica
NSAIDS, ibuprofen, epidural steroid injection , physiolog, surgery
What neurovascular structures are at risk of damage in a shoulder dislocation or humeral surgical neck fracture?
Axillary nerve, circumflex artery
What movement is affected with ulnar nerve lesion
Unopposed extension at MCP joints (from posterior forearm)
Unopposed Flexion at IP joint (unopposed Flexion from flexors of anterior forearm)
Where is commonly fractured in clavicle ? What happens to the fragments
Junction of medial 2/3 and lateral 1/3
Lateral end of clavicle - displaced inferiorly (arm weight),& medially ( pec major)
Medial end - pulled superiorly by sternocleidomastoid muscle
What is syndactyly and polydactyly?
Syndactyly- fusion of digits- cutaneous or osseous
Polydactyly - extra digits
What is the. risk with scaphoid fracture and why
Scaphoid b supply is distal to proximal
Risk of avascular necrosis - > future arthritis
Explain trendelenburgs sign
-pat stand unassisted on each leg- pelvic drop on unsupported leg
- indicates superior gluteal nerve damaged (on other side)
- muscles of G min/Medius paralysed- cannot prevent pelvis drop on other side
What happens with damage to long thoracic nerve
Paralysed serratus anterior (pulls costal face of scapula against throracic cage)-
Winging of scapula when pushing with arm against wall
What are some causes of carpal tunnel syndrome
Diabetes, pregnancy, trauma, RA, idiopathic, neoplasm (MEDIAN TRAP)
What 3 structures are damages in the unhappy triad
ACL, medial collateral ligament, medial meniscus
What is a Colles fracture
Fracture of distal radius- dorsal displacement of distal fragment
Dinner fork deformity
How do you test the ulnar nerve (motor)
1- test Adduction (. Against your index and middle finger )
2- Froment’s test
-> pat grip paper with thumb and index finger- ask them to resist you pulling paper away- LESION: can stop but will flex thumb to compensate)
What is ‘groin strain’ due to
Strain of the adductor muscles - mostly proximal part
Treat- RICE (rest, ice compression elevation)
What is a femoral hernia, what are the risks?
Bowel pushes through into femoral canal , underneath the inguinal ligament
- borders of F Canal are tough - risk strangulation
What causes muscle strain of the hamstrings …
Excessive stretching or tearing of the mu fibres
Grade 1- Overstretching wo tear
Grade 2- partial tear
Grade 3- severe/ complete rupture
How can the lunate bone be dislocated
What is the risk
Falling on dorsiflexed wrist
Lunate forced anteriorly - can compress carpal tunnel- CP syndrome symptoms (paresthesia, weakness)
Also lunate can undergo avascular necrosis
Where would you test for sensation in a median nerve lesion
Palmar surface of lateral 3 and a half digits
and also over nail beds on anterior side
What would damage to radial nerve in midshaft fracture result in
Triceps WEAKENED, not paralysed,
Muscles in posterior forearm paralysed- can’t extend fingers/wrist - wrist drop
Sensory loss- o Bly on dorsal surface of lateral 3 and half digits and associated Palm area
Where does the medial meniscus of the knee attach
Intercondylar attachment,
+fixed to TIBIAL COLLATERAL LIGAMENT and joint capsule
- so damage to TC ligament–> tearing of medial meniscus
What is common cause of sciatica?
Most due to spinal disc herniation pressing on one of lumbar or sacral nerve roots
(Or lumbar spinal stenosis, pregnancy )
How do you treat extracapsular hip fracture
Dynamic screw- no disrupted blood supply- no avascular necrosis
What is posterior draw test
Hold knee in flexed position and push shin posteriorly - If movement- ligament is torn
where will pain be felt in scaphoid fracture
Anatomical snuffbox
What happens with a atlas fracture
‘Jefferson’s fracture’- fracture of anterior and posterior arches of atlas- no neuro symptoms, but PAIN
How can. ACL be torn
- hyperextension of knee
- large force to back of knee with joint partly flexed
What is pulled elbow?
Common in children- head of radius subluxates from annular ligament- head of radius move from articulation with humerus and ulna
- children as bones continuing to ossify from cartillage
How do you test myotome C8?
Flexion of fingers
How would an anterior dislocation of shoulder present clinically?
Shoulder appears square, head of humerus lies below corocoid process, arm supported by other hand
Which digits are affected in median nerve injury
Medial and index finger
What can be damages in mid shaft humeral fracture. What will result?
*check
- profunda brachii artery
- radial nerve- Innervated extensors of wrist- paralysed- unopposed Flexion of wrist- wrist drop
- sensory loss- dorsal aspect thumb, middle finger and index finger, and associated Palm
How may surgical neck of humerus occur
Fall outstretch hand/ direct blow
What are symptoms of congenital dislocation of femoral head
- inability to abduct at hip joint
- affected limb is shorter
- +ve trendelenburg sign
What is associated with dislocation of acromioclavicular joint?
Soft tissue damage
Blow to joint , fall outstretched hand
How can the PCL be torn ?
‘Dashboard injury’- knee flexed and large force to shins- push tibia posteriorly
-hyperextension of knee joint
Why may axilla lymph nodes be biopsied if suspected Br Ca?
What is risk of Axillary clearance
75% lymph drain s into axilla lymph nodes
Long thoracic nerve damage- winged scapula
What are XR features of RA
Narrowing joint space, periarticular osteopenia, juxta-articular bony erosions , subluxation and gross deformity
What is Smiths fracture
Fall onto back of hand
Distal radius fracture- distal fragment placed ANTERIORLY
What is the allens test
Occlude radial artery with fingers and ulnar with thumb- pump hand- release ulnar- pink up- So have PATENT ulnar artery — can do radial a artery puncture
What is the risk with a posterior hip dislocation
Damage to sciatic nerve- paralysis of hamstrings or muscles distal to knee
How would you test accessory nerve?
Test trapezium funciton - ask to shrug shoulders
How is diagonal conjugate of pelvis measured
From inferior border of pubic symphysis to sacral promontory
What is the risk in a medial epicondyl fracture of the humerus ?
Damage to ulnar nerve- ulnar claw
Loss sensation over medial 1 and half fingers (both palmar and dorsal surfaces)
What is marginal osteophytosis
nucleus pulposus dehydrates with age - height IV disc decreases- reactive marginal osteophytosis ajacent to affected end plates =Osteocytes at periphery of vertebra.
What is thoracic outlet syndrome?
Vessels and nerves (Axillary artery/vein and cords of Br.Plexus) become compressed between the bones in the apex of the axilla region
(Clavicle, 1st rib and scapula)
What is at risk of damage in a surgical neck (humerus) fracture
What is the result
Axillary nerve damage
Paralysed deltoid and teres minor- can’t abduct arm
Sensory loss over regimental badge area
(Also risk damage to posterior circumflex artery)
Where is the brachial pulse felt?
Median to biceps tendon in cubital fossa
What prevents anterior/posterior movement of tibia on femur
Anterior dislocation - ACL prevents
Posterior - PCL
What is a Galeazzi’s fracture?
Fracture to radial shaft ( usually distal)
Ulnar head dislocating at distal radio-ulnar joint
Where would you test for sensation in a ulnar nerve lesion
Medial one and half digits
Where is accessed for venepuncture ?
Median cubital vein
What is a ‘slipped disc’?
Herniation of the nucleus pulposus- breaks through annulus fibrosus and lies outside disc space in spinal cord
What are the two types of #NOF
Intracapsular (fracture within capsule of hip joint)
ExtracapsulAr
What type of aquired femoral head dislocation is most common
Posterior dislocations - femoral head forced posteriorly - tear through inferior and posterior part of joint capsule
What is lordosis
Excessive lumbar curvature- swayback deformity
What is lumbosacral plexopathy
Disorder affecting either lumbar or sacral plexus- damage to nerve bundles.
Caused by- diabetic amyotrophy-> high b sugars damage nerves
- idiopathic.
- tumours –> compression
Where would you test for sensation in a Musculocutaneous nerve lesion?
Anterolateral side of forearm
What can occur from falling on a flexed elbow? What is the risk?
Supracondylar fracture (transverse)
Risk
- displaced fragments impinging on /damaging C.fossa contents
- median/radial nerve damage
- VOLKMANNS ISCHAEMIC CONTRACTURE- damage/swelling interfere with b. Flow from brachial artery to forearm- ischemic- flexors become fibrotic and shorten- uncontrolled Flexion of hand
Describe OA
Erosion of articular cartilage- over expr matrix degrading Enz- reduced ability to shock absorb- bones exposed and rub. Tendons/lig stretch giving pain. Bone remodels and forms ostrophytes (limit movement)
How would you test for Axillary nerve damage in a fractured humerus
Test sensation on regimental badge region
Nb Not able to abduct arm as loss sensation of deltoid
What is ulnar paradox
Ulnar nerve lesion at elbow- less deformity, more disability
- as lost FDP so no Flexion at DISTAL IP joints- lesser deformity
What is the motor and sensory loss of klumpkes palsy
Motor- all small mucles of hand - interossei, THENAR and hypothenar
Sensory - along medial side of arm
What is scoliosis
Lateral curvature of the spine
What is clergyman’s knee
Friction between skin and tibia- inflamed infrapatellar bursa
What can be damages in shoulder dislocation ? How would you check?
Axillary nerve damage
- loss of sensation in regimental badge area
- NOT test motor function - could cause soft tissue damage and injure Axillary nerve
How would you test Dermatome T1?
Sensation of skin on medial aspect of elbow
How may the radial nerve be damages at the axilla?
Humeral dislocation, fracture of proximal humerus
What is the risk with intracapsular fracture , who is it common in
Elderly - esp women
Risk damage to medial femoral circumflex artery - avascular necrosis - need total hip replacement or hemiarthroplasty
Dislocation of sternoclavicular joint is rare…. But what direction is more common
Anterior (blow to anterior shoulder)
How would you test the C6 Dermatome?
Palmar pad of the thumb
What is olecranon bursitis
bursa at olecranon of elbow- inflamed/ filled with fluid- limit movement and cause pain
Cause- prolonged pressure , trauma, infection
How do you test C7 myotome
Extension of forearm at elbows
What is the anterior draw test?
Attempt to pull tibia forwards- if it moves, the ACL has been torn
What is the risk of an aneurysm in the popliteal artery
Popliteal fascia relatively tough- tibial nerve susceptible to compression- paresthesia/loss motor function
(May see pulsation in popliteal fossa
What is schuermanns disease
Kyphosis of thoracic or lumbar spine due to uneven vertebral growth (wedge shaped) -
How does the patella usually dislocate
Laterally.
Direct trauma/ twisting movement
What is the commonest type of intra capsular fracture of the proximal femur
Subcapital fracture - fracture line extends through the junction of the head and neck of femur
What. Is painful arch syndrome
Pain on abduction of arm from 50-130 degrees due to
-supraspinatus tendon rubbing under the coraco-Acromial arch –> causes irritation and inflammation of SS tendon / subacromial bursa
Leads to - subacromial bursitis, SS tendonitis
How may median nerve be damaged
Supracondylar fracture of humerus
What muscles are paralysed in ulnar claw (from damage at the wrist)
Medial 2 lumbricals
Which 3 bursa can become inflamed in the hip
Trochanteric bursa, iliopsoas bursa, ischiogluteal
What causes whiplash
Hyperextension and hyperflexion- bones move long way and back into place- may be impingement on spinal cord.
Describe a fracture of the tibia at the ankle
Medial malleolus can be fractured when ankle is twisted inwards ( overinversion)
- talus forced against medial malleolus–> spiral fracture
What is housemaids knee?
Friction between skin and patella- prepatella bursa inflamed (anterior knee)
What are the risks with myelomeningocele
- neural tissue exposed- life threatening infection
- neuro impairment - mu weakness, bowel/bladder prob, seizures, ortho prob- scoliosis, deformed feet
What causes cubital tunnel syndrome ? What are symptoms?
Aka ulnar neuropathy…
Compression of ulnar nerve at elbow.
Numbness and tingling in ulnar half of palm and dorsum of hand and ulna 1 and half digits
What is a sign of radial nerve damage
WRIST DROP
Paralysis of triceps and wrist extensors –> unopposed Flexion
Loss of sensation of posterior & lateral upper arm, and posterior forearm
How may a posterior hip dislocation appear and why
Shortened. Limb- extensors/adductors pull femur up external surface of ilium
Internal rotation- gluteus Medius and minimus attached to greater trochanter - anterior fibres pull greater trochanter medially
What causes carpal tunnel syndrom
Compression of median nerve within carpal tunnel
Causes
- tendonitis in carpal tunnel - pressure on nerve
- thickening of flexor retinaculum
How do you test myotome C5
Abduction of arm at glenohumeral joint
What is senile kyphosis
Secondary curvature dissapear- continuous primary curvature re-established.
What is a ‘peg fracture’
Blow to back of head- fracture axis - seen in open mouth XR
What is a Monteggia’s fracture
(Force from behind ulna)
- proximal shaft of ulna is fractured
- head of radius dislocated anteriorly at elbow
How do you test the radial nerve (motor innervation )
Flex wrist and isolate forearm- get pat to push against you with back of hand