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Sunday, March 19, 2023

Henry Gray (Biography)

ANATOMY AIIMS, GROSS ANATOMY, EMBRYOLOGY, NEUROANATOMY, MICROANATOMY, APPLIED/ CLINICAL ANATOMY


Henry Gray




Introduction:

Henry Gray (1827-1861) was a British anatomist and surgeon who is best known for his work in creating the original edition of the textbook "Gray's Anatomy." Gray was born on December 4, 1827, in Belgravia, London, and was the youngest of seven children. His father was a dyer and fabric merchant, and his mother was the daughter of a surgeon. From a young age, Gray showed an interest in science and medicine, and he went on to study medicine at St. George's Hospital Medical School in London.

After completing his studies, Gray worked as a surgeon at St. George's Hospital and also conducted research in anatomy. In 1855, he began work on what would become "Gray's Anatomy," collaborating with illustrator Henry Vandyke Carter to create detailed illustrations of the human body. The first edition of "Gray's Anatomy" was published in 1858 and consisted of 750 pages and 363 illustrations. The book was a critical success and became widely used as a reference source for medical students and healthcare professionals around the world.

Sadly, Gray's career was cut short by his untimely death at the age of 34. In 1861, Gray contracted smallpox while caring for his nephew, who had also contracted the disease. Despite his illness, Gray continued to work on a second edition of "Gray's Anatomy" but died on June 13, 1861, before the book was completed.

Despite his short career, Gray's work in anatomy and the impact of his textbook have had a lasting influence on the field of medicine. In recognition of his contributions to the field, Gray was made a Fellow of the Royal Society in 1859, and in 1860 he was awarded the Royal Medal for his work in anatomy. Today, Gray's Anatomy remains a widely used reference source for students and healthcare professionals, and the book has been revised and updated numerous times since its original publication.



Major Contributions:

Sir Henry Gray made several major contributions to the field of anatomy and medicine during his short career. Some of his notable contributions include:


Gray's Anatomy: Gray is best known for his work in creating the original edition of "Gray's Anatomy," a textbook that provides detailed descriptions of the structure and function of the human body. The book was a critical success and has become one of the most widely used reference sources for anatomy and physiology.

Research in Anatomy: Gray conducted extensive research in anatomy during his career, publishing papers on topics such as the structure of the lymphatic system and the anatomy of the spleen. His research helped to advance our understanding of the human body and has had a lasting impact on the field of medicine.

Teaching and Mentoring: Gray was a skilled teacher and mentor, and he worked to inspire and educate the next generation of anatomists and surgeons. He taught anatomy at St. George's Hospital Medical School and was known for his engaging and informative lectures.

Contributions to the Royal Society: In addition to his work in anatomy, Gray was also a member of the Royal Society, a prestigious scientific organization that promotes scientific excellence and advancement. Gray's contributions to the Royal Society helped to promote the importance of scientific research and discovery.



Overall, Sir Henry Gray's contributions to the field of anatomy and medicine have had a lasting impact on our understanding of the human body. His work in creating "Gray's Anatomy" and his research and teaching have helped to inspire and educate generations of healthcare professionals.

Sir Henry Gray was born on December 4, 1827, in Belgravia, London, England. He was the youngest of seven children born to Frederick T. Gray, a dyer and fabric merchant, and his wife, Elizabeth Lucas Gray, the daughter of a surgeon. From a young age, Gray showed a keen interest in science and medicine, and he decided to pursue a career in medicine after completing his secondary education.

In 1845, Gray began his studies at St. George's Hospital Medical School in London. He was an outstanding student and was awarded several scholarships for his academic achievements. He completed his medical degree in 1851 and was appointed a lecturer in anatomy at St. George's Hospital Medical School the following year.

Gray was a skilled teacher and lecturer, and he was known for his ability to make complex anatomical concepts accessible and understandable to his students. He was also a skilled researcher, and he conducted several studies that contributed to our understanding of the human body. His research focused on topics such as the structure of the lymphatic system, the anatomy of the spleen, and the structure and function of the brain.

In 1855, Gray began work on the first edition of "Gray's Anatomy," collaborating with illustrator Henry Vandyke Carter to create detailed illustrations of the human body. The book was published in 1858 and was an immediate success, with its clear descriptions and high-quality illustrations making it a valuable reference source for medical students and healthcare professionals.

Tragically, Gray's life was cut short by his untimely death from smallpox in 1861, at the age of just 34. Despite his short career, Gray's contributions to the field of anatomy and medicine have had a lasting impact, and his legacy continues to be felt to this day.

Family and Personal Life:

There is not much known about Sir Henry Gray's personal and family life, as he was a very private person and did not leave behind much information about his personal life.

Gray was the youngest of seven children born to Frederick T. Gray and his wife, Elizabeth Lucas Gray. His father was a dyer and fabric merchant, and his mother was the daughter of a surgeon. Gray grew up in a well-to-do family in Belgravia, London, and received a good education from a young age.

Gray never married and had no children. It is not known if he had any romantic relationships or close friendships outside of his professional life. Gray was described as a reserved and private person, who was dedicated to his work in anatomy and medicine.

Gray's untimely death from smallpox in 1861 was a great loss to the medical community, and his colleagues and students mourned his passing. His contributions to the field of anatomy and medicine continue to be celebrated to this day, and his legacy lives on through the enduring popularity of "Gray's Anatomy."

Mentors:



Sir Henry Gray had several mentors throughout his career, but one of the most significant was Dr. John Goodsir. Goodsir was a renowned Scottish anatomist who was known for his pioneering work on the structure and function of cells and tissues. He was a professor of anatomy at the University of Edinburgh, and Gray studied under him during his time at the university.

Goodsir had a profound influence on Gray's thinking about anatomy and physiology, and Gray credited him with helping to shape his approach to research and teaching. Goodsir was known for his innovative teaching methods, which emphasized hands-on learning and encouraged students to think critically and creatively about the human body.

Gray's work on "Gray's Anatomy" was also influenced by the work of his contemporary, Dr. Henry Vandyke Carter. Carter was an anatomist and illustrator who worked closely with Gray on the first edition of "Gray's Anatomy." Carter's detailed illustrations helped to bring Gray's descriptions of the human body to life, and the two men worked closely together to create a comprehensive and accessible textbook on human anatomy.

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Thursday, March 9, 2023

NEET-PG MCQs - Upper Limb Anatomy

ANATOMY AIIMS, GROSS ANATOMY, EMBRYOLOGY, NEUROANATOMY, MICROANATOMY, APPLIED/ CLINICAL ANATOMY

NEET-PG MCQs - Upper Limb Anatomy

Question 1: Which of the following muscles is NOT a part of the rotator cuff muscles?
A) Infraspinatus
B) Teres minor
C) Subscapularis
D) Teres major

Answer: D) Teres major is not a part of the rotator cuff muscles.

Question 2: Which of the following nerves innervates the flexor carpi ulnaris muscle?
A) Median nerve
B) Ulnar nerve
C) Radial nerve
D) Musculocutaneous nerve

Answer: B) Ulnar nerve innervates the flexor carpi ulnaris muscle.

Question 3: Which of the following muscles is NOT involved in elbow flexion?
A) Biceps brachii
B) Brachialis
C) Brachioradialis
D) Triceps brachii

Answer: D) Triceps brachii is not involved in elbow flexion.

Question 4: The axillary nerve supplies which of the following muscles?
A) Deltoid and teres minor
B) Supraspinatus and infraspinatus
C) Subscapularis and teres major
D) Brachialis and brachioradialis

Answer: A) Deltoid and teres minor muscles are supplied by the axillary nerve.

Question 5: Which of the following nerves is responsible for supplying the extensor carpi radialis longus muscle?
A) Radial nerve
B) Median nerve
C) Ulnar nerve
D) Musculocutaneous nerve

Answer: A) Radial nerve supplies the extensor carpi radialis longus muscle.

Question 6: Which of the following bones is NOT part of the wrist joint?
A) Scaphoid
B) Lunate
C) Triquetrum
D) Humerus

Answer: D) Humerus is not part of the wrist joint.

Question 7: Which muscle is responsible for supination of the forearm?
A) Pronator teres
B) Supinator
C) Brachioradialis
D) Flexor carpi radialis

Answer: B) Supinator muscle is responsible for supination of the forearm.

Question 8: Which of the following muscles is NOT part of the intrinsic muscles of the hand?
A) Abductor pollicis brevis
B) Adductor pollicis
C) Flexor pollicis longus
D) Flexor digiti minimi brevis

Answer: C) Flexor pollicis longus muscle is not part of the intrinsic muscles of the hand.

Question 9: The radial nerve passes through which muscle?
A) Brachioradialis
B) Extensor carpi radialis longus
C) Supinator
D) Pronator teres

Answer: C) The radial nerve passes through the supinator muscle.

Question 10: The anterior interosseous nerve supplies which of the following muscles?
A) Flexor carpi ulnaris
B) Pronator teres
C) Flexor digitorum superficialis
D) Flexor pollicis longus

Answer: D) The anterior interosseous nerve supplies the flexor pollicis longus muscle.

Question 11: Which nerve is responsible for the sensation of the lateral aspect of the forearm?
A) Median nerve
B) Ulnar nerve
C) Radial nerve
D) Musculocutaneous nerve

Answer: D) The Musculocutaneous nerve is responsible for the sensation of the lateral aspect of the forearm.


Question 12: Which muscle is responsible for abduction of the arm at the shoulder joint?
A) Infraspinatus
B) Supraspinatus
C) Teres minor
D) Subscapularis

Answer: B) The supraspinatus muscle is responsible for abduction of the arm at the shoulder joint.


Question 13: Which nerve is responsible for the motor innervation of the triceps brachii muscle?
A) Radial nerve
B) Ulnar nerve
C) Musculocutaneous nerve
D) Median nerve

Answer: A) The radial nerve is responsible for the motor innervation of the triceps brachii muscle.


Question 14: The flexor carpi ulnaris muscle inserts on which of the following bones?
A) Scaphoid
B) Lunate
C) Triquetrum
D) Pisiform

Answer: D) The flexor carpi ulnaris muscle inserts on the pisiform bone.

Question 15: Which nerve is responsible for the motor innervation of the flexor carpi ulnaris muscle?
A) Ulnar nerve
B) Median nerve
C) Radial nerve
D) Musculocutaneous nerve

Answer: A) The ulnar nerve is responsible for the motor innervation of the flexor carpi ulnaris muscle.


Question 16: Which nerve is responsible for the sensory innervation of the medial aspect of the hand?
A) Radial nerve
B) Ulnar nerve
C) Median nerve
D) Musculocutaneous nerve

Answer: B) The ulnar nerve is responsible for the sensory innervation of the medial aspect of the hand.


Question 17: The axillary nerve is responsible for the motor innervation of which muscle?
A) Supraspinatus
B) Infraspinatus
C) Teres minor
D) Subscapularis

Answer: C) The axillary nerve is responsible for the motor innervation of the Teres minor muscle.


Question 18: Which ligament stabilizes the acromioclavicular joint?
A) Coracoacromial ligament
B) Acromioclavicular ligament
C) Coracoclavicular ligament
D) Glenohumeral ligament

Answer: B) The acromioclavicular ligament stabilizes the acromioclavicular joint.

Question 19: Which nerve innervates the flexor carpi radialis muscle?
A) Radial nerve
B) Ulnar nerve
C) Median nerve
D) Musculocutaneous nerve

Answer: C) The median nerve innervates the flexor carpi radialis muscle.

Question 20: The ulnar nerve runs posterior to which bony landmark of the elbow joint?
A) Medial epicondyle
B) Lateral epicondyle
C) Olecranon process
D) Coronoid process

Answer: A) The ulnar nerve runs posterior to the medial epicondyle of the elbow joint.

Question 21: Which of the following is NOT a muscle of the rotator cuff?
A) Subscapularis
B) Supraspinatus
C) Teres major
D) Infraspinatus

Answer: C) Teres major is not a muscle of the rotator cuff.


Question 22: The radial nerve runs in the spiral groove of which bone?
A) Humerus
B) Ulna
C) Radius
D) Scapula

Answer: A) The radial nerve runs in the spiral groove of the humerus bone.


Question 23: Which nerve innervates the muscles of the thenar eminence?
A) Median nerve
B) Ulnar nerve
C) Radial nerve
D) Musculocutaneous nerve

Answer: A) The median nerve innervates the muscles of the thenar eminence.


Question 24: Which muscle forms the anterior border of the axilla?
A) Pectoralis minor
B) Serratus anterior
C) Teres major
D) Latissimus dorsi

Answer: A) Pectoralis minor forms the anterior border of the axilla.


Question 25: Which nerve is most commonly injured in a midshaft humeral fracture?
A) Median nerve
B) Ulnar nerve
C) Radial nerve
D) Axillary nerve

Answer: C) The radial nerve is most commonly injured in a midshaft humeral fracture.



Sunday, March 5, 2023

Acromial Angle and its Significance

ANATOMY AIIMS, GROSS ANATOMY, EMBRYOLOGY, NEUROANATOMY, MICROANATOMY, APPLIED/ CLINICAL ANATOMY

Acromial Angle and its Significance

The acromial angle is the angle formed by the lateral border of the acromion and the horizontal plane. It is an important anatomical landmark in the study of shoulder anatomy and is used to diagnose various shoulder pathologies.

A larger acromial angle is associated with an increased risk of developing subacromial impingement syndrome, rotator cuff tears, and other shoulder disorders. It has been suggested that the shape of the acromion and the size of the acromial angle may contribute to the development of these conditions.

The normal range for the acromial angle is between 70-135 degrees, with an average of 90 degrees. However, there is some variation in the normal range depending on factors such as age, gender, and ethnicity.

The acromial angle can be measured using various imaging modalities such as X-ray, MRI, and ultrasound. It is also commonly assessed during a physical examination of the shoulder.

The acromial angle is an important anatomical landmark in the study of shoulder anatomy. It is the angle formed by the lateral border of the acromion and the horizontal plane. The acromion is a bony process that extends from the scapula (shoulder blade) and articulates with the clavicle (collarbone) to form the acromioclavicular joint. The acromion plays an important role in shoulder function as it serves as a site of attachment for several muscles and ligaments.

The acromial angle has been shown to be an important factor in the development of various shoulder pathologies. A larger acromial angle has been associated with an increased risk of developing subacromial impingement syndrome, rotator cuff tears, and other shoulder disorders. This is thought to be due to the fact that a larger acromial angle can cause compression of the subacromial space, which can lead to impingement of the rotator cuff tendons.

Several studies have investigated the relationship between acromial angle and shoulder pathology. A study by Bigliani et al. (1986) found that patients with rotator cuff tears had a significantly larger acromial angle compared to those without tears. Another study by Itoi et al. (1995) found that the tensile strength of the supraspinatus tendon (one of the rotator cuff tendons) was significantly decreased in specimens with a larger acromial angle.

The normal range for the acromial angle is between 70-135 degrees, with an average of 90 degrees. However, there is some variation in the normal range depending on factors such as age, gender, and ethnicity. The acromial angle can be measured using various imaging modalities such as X-ray, MRI, and ultrasound. It is also commonly assessed during a physical examination of the shoulder.

In clinical practice, the acromial angle is an important consideration in the management of shoulder pathologies. Conservative treatment options such as physical therapy and anti-inflammatory medications may be appropriate for patients with a smaller acromial angle, while surgical intervention may be necessary for those with a larger acromial angle.

References:

Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;10:228.

Itoi E, Berglund LJ, Grabowski JJ, Schultz FM, Growney ES, Morrey BF, An KN. Tensile properties of the supraspinatus tendon. J Orthop Res. 1995;13(4):578-584.

Magee DJ. Orthopedic physical assessment. Elsevier Health Sciences; 2014.



Significance

Description

Reference

Relationship to shoulder pathologies

A larger acromial angle is associated with an increased risk of developing subacromial impingement syndrome, rotator cuff tears, and other shoulder disorders.

Bigliani et al. (1986)

Tensile strength of rotator cuff tendons

The tensile strength of the supraspinatus tendon (one of the rotator cuff tendons) was significantly decreased in specimens with a larger acromial angle.

Itoi et al. (1995)

Normal range

The normal range for the acromial angle is between 70-135 degrees, with an average of 90 degrees.

Magee (2014)

Measurement

The acromial angle can be measured using various imaging modalities such as X-ray, MRI, and ultrasound. It is also commonly assessed during a physical examination of the shoulder.

Magee (2014)

Management of shoulder pathologies

Conservative treatment options may be appropriate for patients with a smaller acromial angle, while surgical intervention may be necessary for those with a larger acromial angle.

N/A


References:

Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;10:228.

Itoi E, Berglund LJ, Grabowski JJ, Schultz FM, Growney ES, Morrey BF, An KN. Tensile properties of the supraspinatus tendon. J Orthop Res. 1995;13(4):578-584.

Magee DJ. Orthopedic physical assessment. Elsevier Health Sciences; 2014.

Friday, March 3, 2023

Winging of Scapula / Winging of shoulder blade / Long thoracic Nerve Injury / Serratus anterior paralysis

ANATOMY AIIMS, GROSS ANATOMY, EMBRYOLOGY, NEUROANATOMY, MICROANATOMY, APPLIED/ CLINICAL ANATOMY

Winging of Scapula / Winging of shoulder blade / Long thoracic Nerve Injury / Serratus anterior paralysis

Winging of the scapula refers to a condition in which the medial border of the scapula protrudes outward from the ribcage. This can be caused by a variety of factors, including nerve damage, muscular weakness, and skeletal abnormalities. Here are some anatomical aspects of winging of the scapula:

Anatomy of the scapula: The scapula is a flat, triangular bone that lies on the back of the ribcage. It has several bony prominences, including the spine, acromion process, and coracoid process, which serve as attachment sites for muscles and ligaments.

Serratus anterior muscle: The serratus anterior muscle originates from the upper eight or nine ribs and inserts on the medial border of the scapula. This muscle is responsible for protracting and stabilizing the scapula against the ribcage.

Long thoracic nerve: The long thoracic nerve arises from the brachial plexus and innervates the serratus anterior muscle. Damage to this nerve can result in weakness or paralysis of the serratus anterior, leading to winging of the scapula.

Scapular dyskinesis: Scapular dyskinesis is a term used to describe abnormal movement of the scapula during shoulder motion. This can result from muscular imbalances or weakness, skeletal abnormalities, or neurological disorders.

Winging of the scapula can result in several deformities that affect the appearance and function of the shoulder and upper back. Some common deformities associated with winging of the scapula include:

Medial border prominence: The most obvious deformity associated with winging of the scapula is the protrusion of the medial border of the scapula away from the ribcage. This can create a visible bulge or hump on the back, especially when the arm is raised.

Abnormal scapular position: Winging of the scapula can also cause the scapula to tilt or rotate abnormally, which can affect the alignment of the shoulder joint and limit its range of motion.

Poor posture: Individuals with winging of the scapula may compensate for the deformity by assuming a rounded or slouched posture, which can contribute to neck and shoulder pain.

Weakness or atrophy of the serratus anterior muscle: Damage to the long thoracic nerve can result in weakness or atrophy of the serratus anterior muscle, which can lead to a visibly smaller muscle in the affected area.

Shoulder instability: In some cases, winging of the scapula can lead to shoulder instability or dislocation, as the abnormal scapular position can affect the stability of the shoulder joint.

It's important to note that the specific deformities associated with winging of the scapula can vary depending on the underlying cause and severity of the condition. A comprehensive evaluation by a healthcare professional is typically necessary to accurately diagnose and treat winging of the scapula.

The long thoracic nerve is a nerve that originates from the brachial plexus and innervates the serratus anterior muscle. The anatomy of the long thoracic nerve is as follows:

Origin: The long thoracic nerve arises from the C5, C6, and C7 nerve roots of the brachial plexus.

Course: The nerve descends along the lateral border of the scalenus anterior muscle and continues along the surface of the serratus anterior muscle, giving off branches to the muscle fibers as it goes.

Innervation: The long thoracic nerve innervates the serratus anterior muscle, which is responsible for protracting and stabilizing the scapula against the ribcage.

Vulnerability: The long thoracic nerve is vulnerable to injury from trauma, repetitive motion, or compression, which can result in weakness or paralysis of the serratus anterior muscle and subsequent winging of the scapula.

Breast surgery, particularly mastectomy or breast reconstruction, can result in injury to the long thoracic nerve. Here are some references on the topic:

Rios JL, Tawfik VL, Smith BL, Aft RL, Eberlein TJ. Long thoracic nerve injury during axillary surgery: a prospective analysis of 2,800 consecutive breast cancer operations. Ann Surg Oncol. 2017 Jun;24(6):1500-1504.
This study analyzed the incidence of long thoracic nerve injury in 2,800 consecutive breast cancer operations, including mastectomy and breast reconstruction procedures. The authors found that 0.4% of patients experienced long thoracic nerve injury, with the majority of cases occurring during axillary lymph node dissection.

Pittet-Cuénod B, Laurencet ME, Gisiger M, Alizadeh N, Lüscher NJ. Long thoracic nerve injury in breast cancer patients: a review. J Surg Oncol. 2009 Jun 1;99(7):447-52.

This review article provides an overview of long thoracic nerve injury in breast cancer patients, including its incidence, diagnosis, and management. The authors note that long thoracic nerve injury can result in winging of the scapula, which can lead to shoulder dysfunction and decreased quality of life.

Paolucci T, Danesi C, Forconi F, Cerase A, Sforna L, Paoloni M. Long thoracic nerve injury following breast cancer surgery: a systematic review. Acta Biomed. 2020 Sep 7;91(3-S):e2020015.

This systematic review analyzed the literature on long thoracic nerve injury following breast cancer surgery, including its incidence, risk factors, and outcomes. The authors found that the incidence of long thoracic nerve injury varied widely across studies, ranging from 0.3% to 17%. They also noted that early diagnosis and treatment of long thoracic nerve injury is important for optimizing outcomes and minimizing disability.

These studies highlight the importance of recognizing and addressing long thoracic nerve injury in breast cancer patients undergoing surgery, particularly those undergoing axillary lymph node dissection.

Axillary region surgery can potentially result in injury to the long thoracic nerve. Here are some references on the topic:

Forouzannia SK, Forouzannia BS, Gholami Fesharaki M, Fattahi Mehraban M. Long thoracic nerve injury after axillary lymph node dissection for breast cancer: a systematic review of the literature. Breast Cancer. 2017 May;24(3):295-302.

This systematic review analyzed the literature on long thoracic nerve injury after axillary lymph node dissection for breast cancer. The authors found that the reported incidence of long thoracic nerve injury varied widely across studies, ranging from 0% to 45%. The authors also noted that early recognition and treatment of long thoracic nerve injury is important for optimizing outcomes.

Povlsen B, Eriksen C, Jørgensen LN, Jacobsen GK, Jensen PT. Long-term sensory disturbances after axillary lymph node dissection for breast cancer. Acta Oncol. 2016 Aug;55(8):994-9.

This study evaluated the long-term sensory disturbances in the axilla and upper arm in breast cancer patients who underwent axillary lymph node dissection. The authors found that 9% of patients experienced long-term sensory disturbances in the distribution of the long thoracic nerve.

Eichler C, Stolzenburg T, Viehl CT, Post S. Long-term results of axillary lymph node dissection for breast cancer. Eur J Surg Oncol. 2008 Nov;34(11):1194-9.

This study evaluated the long-term outcomes of axillary lymph node dissection in breast cancer patients. The authors found that 2% of patients experienced winging of the scapula, which is a sign of long thoracic nerve injury.

These studies emphasize the importance of careful dissection and preservation of the long thoracic nerve during axillary region surgery to minimize the risk of injury and optimize outcomes.



Treatment of winging of scapula
The treatment of winging of scapula depends on the underlying cause of the condition. Here are some possible treatments:

Physical therapy: Physical therapy can be helpful in improving scapular stability, strength, and range of motion. A physical therapist can develop an exercise program to target the specific muscles involved in scapular winging.

Nerve mobilization: If the cause of scapular winging is due to nerve compression or entrapment, nerve mobilization techniques can be used to improve nerve gliding and reduce symptoms.

Orthotics: In some cases, a scapular orthotic device, such as a thoracic brace, can be used to support the scapula and improve scapular stability.

Surgery: In severe cases of scapular winging that do not respond to non-surgical treatments, surgery may be necessary. Surgical options include nerve decompression, tendon transfers, and scapular stabilization procedures.

It is important to note that the success of treatment for scapular winging depends on the underlying cause of the condition, the severity of the symptoms, and the individual's overall health. Therefore, it is recommended to consult with a healthcare professional to determine the most appropriate treatment plan.


Thursday, March 2, 2023

Klumpke's Palsy / Klumpke's Paralysis

ANATOMY AIIMS, GROSS ANATOMY, EMBRYOLOGY, NEUROANATOMY, MICROANATOMY, APPLIED/ CLINICAL ANATOMY

Klumpke's Palsy / Klumpke's Paralysis

Klumpke's palsy is a type of brachial plexus injury that affects the lower nerves of the brachial plexus. The brachial plexus is a network of nerves that originates in the spinal cord and provides motor and sensory innervation to the shoulder, arm, and hand.

Klumpke's palsy is usually caused by a traumatic injury, such as a difficult childbirth, where the infant's arm is forcefully pulled during delivery. This can result in damage to the nerves that control movement and sensation in the hand and forearm.

The symptoms of Klumpke's palsy include weakness or paralysis of the muscles in the hand and forearm, as well as numbness or tingling in the affected area. In severe cases, there may be a loss of sensation in the hand and forearm.

Treatment for Klumpke's palsy typically involves physical therapy to help improve muscle strength and range of motion. In some cases, surgery may be necessary to repair or replace damaged nerves in the brachial plexus.

Klumpke's palsy is a type of brachial plexus injury that affects the lower nerves of the brachial plexus. The brachial plexus is a network of nerves that originates in the spinal cord and provides motor and sensory innervation to the shoulder, arm, and hand.

The lower nerves of the brachial plexus that are affected in Klumpke's palsy are the eighth cervical nerve and first thoracic nerve, also known as C8 and T1. These nerves exit the spinal cord and join together to form the lower trunk of the brachial plexus. The lower trunk then splits into two divisions, the anterior and posterior divisions, which further divide into the cords of the brachial plexus.

Klumpke's palsy typically occurs when the lower trunk of the brachial plexus is stretched or torn. This can happen during childbirth when the infant's head and neck are pulled to one side, causing excessive stretching of the nerves in the lower trunk.

The symptoms of Klumpke's palsy include weakness or paralysis of the muscles in the hand and forearm, as well as numbness or tingling in the affected area. In severe cases, there may be a loss of sensation in the hand and forearm.

Treatment for Klumpke's palsy typically involves physical therapy to help improve muscle strength and range of motion. In some cases, surgery may be necessary to repair or replace damaged nerves in the brachial plexus.

Klumpke's palsy can cause various types of hand deformities depending on the severity of the nerve damage and the specific nerves affected. The most common hand deformities associated with Klumpke's palsy include:

Claw hand: This is a deformity where the fingers and wrist are flexed and the hand appears to be clawed. The muscles that control finger extension are weakened or paralyzed, while the muscles that control finger flexion are relatively stronger.

Loss of grip strength: Klumpke's palsy can weaken the muscles that control grip strength, making it difficult to grasp and hold objects.

Wrist drop: This is a deformity where the wrist is flexed and the hand hangs down. The muscles that control wrist extension are weakened or paralyzed, making it difficult to hold the wrist in a neutral position.

Sensory loss: Klumpke's palsy can also cause numbness or tingling in the hand and forearm due to damage to the sensory nerves.

Treatment for Klumpke's palsy typically involves physical therapy to help improve muscle strength and range of motion. In some cases, surgery may be necessary to repair or replace damaged nerves in the brachial plexus. Hand therapy can also be helpful in improving hand function and reducing the risk of long-term hand deformities.

Reference:
American Society for Surgery of the Hand. (n.d.). Klumpke's Palsy. https://www.assh.org/handcare/hand-arm-conditions/klumpkes-palsy

Horner's syndrome is a rare but possible complication of Klumpke's palsy. Horner's syndrome is a neurological disorder that affects the sympathetic nervous system and can result in a droopy eyelid, constricted pupil, and decreased sweating on one side of the face.

Horner's syndrome occurs when there is damage to the sympathetic nerves that originate in the neck and travel to the face. In Klumpke's palsy, the lower nerves of the brachial plexus (C8 and T1) are affected, and these nerves also give rise to the sympathetic nerves that supply the face.

If the nerve damage in Klumpke's palsy extends to the sympathetic nerves, it can lead to Horner's syndrome. The exact mechanism of how the nerve damage causes Horner's syndrome is not completely understood, but it is thought to involve interruption of the sympathetic nerve fibers that travel through the brachial plexus.

Horner's syndrome in Klumpke's palsy is typically temporary and resolves as the nerve damage heals. However, in some cases, Horner's syndrome can be permanent and may require additional treatment.

Horner's syndrome is a neurological disorder that affects the sympathetic nervous system and can cause several symptoms, which typically occur only on one side of the face. The symptoms of Horner's syndrome may include:

Ptosis: A drooping of the upper eyelid on the affected side of the face.

Miosis: Constriction of the pupil on the affected side of the face, causing it to appear smaller than the other pupil.

Anhidrosis: Decreased sweating on the affected side of the face, which may cause the skin to appear dry.

Facial flushing: In some cases, the skin on the affected side of the face may appear redder than the other side due to dilation of the blood vessels.

Eye redness: The affected eye may appear slightly redder than the other eye due to dilation of the blood vessels in the conjunctiva.

Horner's syndrome can be caused by various underlying medical conditions, including injury to the sympathetic nerve fibers, tumors, and neurological disorders. It is important to consult a doctor if you notice any of these symptoms, especially if they appear suddenly or are accompanied by other neurological symptoms.

Treatment for Horner's syndrome depends on the underlying cause and may include medications, surgery, or other interventions to address the underlying condition.

Reference:
National Organization for Rare Disorders. (2021). Horner Syndrome. https://rarediseases.org/rare-diseases/horner-syndrome/




Erb's Palsy / Erb's Paralysis

ANATOMY AIIMS, GROSS ANATOMY, EMBRYOLOGY, NEUROANATOMY, MICROANATOMY, APPLIED/ CLINICAL ANATOMY

Erb's Palsy / Erbs's Paralysis


Erb's paralysis, also known as Erb-Duchenne paralysis, is a condition that affects the brachial plexus, a network of nerves that controls movement and sensation in the shoulder, arm, and hand. The condition is named after Wilhelm Erb and Guillaume Duchenne, who described it in the late 19th century.

Erb's paralysis is typically caused by a traumatic injury to the brachial plexus during childbirth, but it can also result from a fall or other types of trauma. The injury often occurs when the infant's head and neck are pulled to one side during a difficult delivery. The most common symptoms of Erb's paralysis are weakness or paralysis of the shoulder and upper arm, numbness or tingling in the affected area, and a lack of reflexes in the affected arm.

Treatment for Erb's paralysis usually involves physical therapy and, in some cases, surgery. Physical therapy can help improve muscle strength and range of motion, and may include exercises and stretches to help retrain the muscles of the affected arm. In more severe cases, surgery may be necessary to repair or replace damaged nerves.

While the majority of infants with Erb's paralysis will eventually recover some or all of their movement and sensation in the affected arm, some may experience long-term weakness or disability. It is important for parents and caregivers of infants with Erb's paralysis to seek medical attention as soon as possible in order to ensure the best possible outcome.

Erb's paralysis is caused by an injury to the brachial plexus, a network of nerves that originates in the spinal cord and provides motor and sensory innervation to the shoulder, arm, and hand. The brachial plexus is formed by the joining of the nerve roots of the spinal cord that arise from the lower cervical and upper thoracic segments.

The injury to the brachial plexus that causes Erb's paralysis is typically a result of excessive stretching or tearing of the nerve fibers that comprise the plexus. During childbirth, the baby's head and neck may be pulled to one side, causing stretching or tearing of the nerves in the brachial plexus.

The most commonly affected nerves in Erb's paralysis are the fifth and sixth cervical nerves, which form the upper trunk of the brachial plexus. These nerves control movement and sensation in the shoulder and upper arm.

The injury to the brachial plexus in Erb's paralysis can cause a range of symptoms, including weakness or paralysis of the shoulder and upper arm, numbness or tingling in the affected area, and a lack of reflexes in the affected arm.

The severity of the injury to the brachial plexus will determine the extent of the symptoms and the potential for recovery. Mild injuries may result in temporary weakness or discomfort, while more severe injuries may cause long-term disability.

Treatment for Erb's paralysis typically involves physical therapy to help improve muscle strength and range of motion. In some cases, surgery may be necessary to repair or replace damaged nerves in the brachial plexus.

In Erb's paralysis, the position of the affected upper limb may vary depending on the severity and extent of nerve damage. Generally, the affected arm will be adducted (pulled towards the body), internally rotated (turned inwards towards the body), and extended at the elbow, with the forearm pronated (turned downwards) and the wrist flexed (bent downwards). This position is also known as the "waiter's tip" position, as it resembles a waiter holding a tray.

The "waiter's tip" position is a result of the loss of innervation to the muscles that control shoulder abduction, external rotation, and elbow flexion. The affected arm is unable to move away from the body or rotate outwards, resulting in the adducted and internally rotated position. Additionally, the loss of innervation to the muscles that control forearm supination (turning upwards) and wrist extension results in the pronated and flexed position of the forearm and wrist.

The "waiter's tip" position is a common clinical finding in infants with Erb's paralysis, and can be used to help diagnose the condition. However, it is important to note that not all cases of Erb's paralysis will present with this specific positioning, and the extent of nerve damage and resulting symptoms may vary.

References:

American Academy of Orthopaedic Surgeons. (2021). Erb's Palsy (Brachial Plexus Birth Palsy). https://orthoinfo.aaos.org/en/diseases--conditions/erbs-palsy-brachial-plexus-birth-palsy/
Terzis, J.K., & Kokkalis, Z.T. (2017). Nerve Surgery. Thieme Medical Publishers.

Tuesday, February 28, 2023

Muscles of Upper Limb and their Innervation/Nerve Supply

ANATOMY AIIMS, GROSS ANATOMY, EMBRYOLOGY, NEUROANATOMY, MICROANATOMY, APPLIED/ CLINICAL ANATOMY

Muscles of Upper Limb and their Innervation/Nerve Supply
 

Muscle

Nerve Supply

References

Deltoid

Axillary nerve (C5-C6)

Gray's Anatomy, 41st Edition, Chapter 47

Supraspinatus

Suprascapular nerve (C4-C6)

Gray's Anatomy, 41st Edition, Chapter 47

Infraspinatus

Suprascapular nerve (C4-C6)

Gray's Anatomy, 41st Edition, Chapter 47

Teres minor

Axillary nerve (C5-C6)

Gray's Anatomy, 41st Edition, Chapter 47

Subscapularis

Upper and lower subscapular nerves (C5-C6)

Gray's Anatomy, 41st Edition, Chapter 47

Pectoralis major

Lateral and medial pectoral nerves (C5-T1)

Gray's Anatomy, 41st Edition, Chapter 46

Latissimus dorsi

Thoracodorsal nerve (C6-C8)

Gray's Anatomy, 41st Edition, Chapter 46

Teres major

Lower subscapular nerve (C5-C6)

Gray's Anatomy, 41st Edition, Chapter 46

Biceps brachii

Musculocutaneous nerve (C5-C6)

Gray's Anatomy, 41st Edition, Chapter 47

Brachialis

Musculocutaneous nerve (C5-C6);

Radial Nerve

Gray's Anatomy, 41st Edition, Chapter 47

Brachioradialis

Radial nerve (C5-C6)

Gray's Anatomy, 41st Edition, Chapter 47

Triceps brachii

Radial nerve (C6-C8)

Gray's Anatomy, 41st Edition, Chapter 47

Anconeus

Radial nerve (C7-C8)

Gray's Anatomy, 41st Edition, Chapter 47

Pronator teres

Median nerve (C6-C7)

Gray's Anatomy, 41st Edition, Chapter 47

Flexor carpi radialis

Median nerve (C6-C7)

Gray's Anatomy, 41st Edition, Chapter 47

Palmaris longus

Median nerve (C7-T1)

Gray's Anatomy, 41st Edition, Chapter 47

Flexor carpi ulnaris

Ulnar nerve (C7-T1)

Gray's Anatomy, 41st Edition, Chapter 47

Flexor digitorum superficialis

Median nerve (C7-C8)

Gray's Anatomy, 41st Edition, Chapter 47

Flexor digitorum profundus

Median nerve (C8-T1) (index and middle fingers), Ulnar nerve (C8-T1) (ring and little fingers)

Gray's Anatomy, 41st Edition, Chapter 47

Pronator quadratus

Median nerve (C8-T1)

Gray's Anatomy, 41st Edition, Chapter 47

Extensor carpi radialis longus

Radial nerve (C6-C7)

Gray's Anatomy, 41st Edition, Chapter 47

Extensor carpi radialis brevis

Radial nerve (C6-C7)

Gray's Anatomy, 41st Edition, Chapter 47

Extensor carpi ulnaris

Radial nerve (C7-C8)

Gray's Anatomy, 41st Edition, Chapter


Muscles of Hand and their Innervation-

Muscle

Nerve Supply

References

Abductor pollicis brevis

Median nerve (C8-T1)

Gray's Anatomy, 41st Edition, Chapter 48

Flexor pollicis brevis

Median nerve (C8-T1)

Gray's Anatomy, 41st Edition, Chapter 48

Opponens pollicis

Median nerve (C8-T1)

Gray's Anatomy, 41st Edition, Chapter 48

Adductor pollicis

Ulnar nerve (C8-T1)

Gray's Anatomy, 41st Edition, Chapter 48

Flexor digiti minimi brevis

Ulnar nerve (C8-T1)

Gray's Anatomy, 41st Edition, Chapter 48

Abductor digiti minimi

Ulnar nerve (C8-T1)

Gray's Anatomy, 41st Edition, Chapter 48

Opponens digiti minimi

Ulnar nerve (C8-T1)

Gray's Anatomy, 41st Edition, Chapter 48

Lumbricals (1-4)

Median nerve (C8-T1) (1st and 2nd), Ulnar nerve (C8-T1) (3rd and 4th)

Gray's Anatomy, 41st Edition, Chapter 48

Dorsal interossei (1-4)

Ulnar nerve (C8-T1)

Gray's Anatomy, 41st Edition, Chapter 48

Palmar interossei (1-3)

Ulnar nerve (C8-T1)

Gray's Anatomy, 41st Edition, Chapter 48

Adductor pollicis

Ulnar nerve (C8-T1)

Gray's Anatomy, 41st Edition, Chapter 48