UpperExtremity

In this video podcast Mr Alaistair Pace demonstrates an effective technique for examination of the hands. Further video podcasts can be found at www.surgeryandmedicine.com  

This image shows a dislocated shoulder with a fracture through the surgical neck of humerus. The patient is at high risk of axillary nerve injury. The axillary nerve supplies deltoids but this is difficult to test in these conditions - luckily it also supplies an area of skin over the shoulder known as the regimental badge - this must be tested before and after any procedure involving the shoulder.  

In this video Mr Alaistair Pace demonstrates an effective technique for the examination of the elbow joint. Morecontent can be found on www.surgeryandmedicine.com  

In this video Mr Alaistair Pace demonstrates an effective technique for examination of the shoulder joint. More content can be found at www.surgeryandmedicine.com  

Have a look at at these three pages that go with this podcast on the Axilla and Cubital fossa: www.instantanatomy.net/arm/areas/cubitalfossa/superficial.html www.instantanatomy.net/arm/areas/cubitalfossa/deep.html www.instantanatomy.net/arm/areas/axilla/topography.html  

The i-LIMB Hand™ is the world’s first full articulating bionic hand, delivering compliant grip, wraparound fingers, thumb rotation and full hand palmar grip. It brings a new dimension to upper limb prosthetics, with levels of flexibility, durability, aesthetic presentation an overall functionality that have never been seen before. For the first time, a prosthetic hand delivers grip configurations that behave in almost every respect like its natural counterpart, transforming both the capabilitie and the confidence of users.  

hand Incision for infection  

Lobster hand reconstruction  

This is a nice video for explaining the shoulder examination and referencing potential findings to common injuries or complaints. It follows the typical look, feel move, special test structure.  

Tularemia is caused by the bacterium, Francisella tularensis. Symptoms vary depending on how the person was exposed to the disease, and as is shown here, can include skin ulcers.  

 

Topics This afternoon, I’d like to talk about an important complication of delivery, called shoulder dystocia. Shoulder Dystocia… View Text Here Delivery of the Posterior Arm Video… View Free Video Here Commercial Links: Shoulder Dystocia Vide 5-Minute Vaginal Delivery Vide 5-Minute Episiotomy Video Free Links: OBGYN-10 OBGYN-101 Gray Haired Note Shoulder Dystocia in the Global Library of Women’s Medicin Brookside Associates Medical Education Division  

 

 

Orientation, Memor This patient has difficulty with orientation questions. The day of the week is correct but he misses the month and date. He is oriented to place. Orientation mistakes are not localizing but can be due to problems with memory, language, judgement, attention or concentration. The patient has good recent memory (declarative memory) as evidenced by the recall of three objects but has difficulty with long term memory as evidenced by the difficulty recalling the current and past presidents. Attention-working memor The patient has difficulty with digit span backwards, spelling backwards and giving the names of the months in reverse order. This indicates a problem with working memory and maintaining attention, both of which are frontal lobe functions. Judgement-abstract reasoning The patient gives the correct answer for a house on fire and his answers for similarities are also good. He has problems with proverb interpretation. His answers are concrete and consist of rephrasing the proverb or giving a simple consequence of the action in the proverb. Problems with judgement, abstract reasoning, and executive function can be seen in patients with frontal lobe dysfunction. Set generatio Set generation tests word fluency and frontal lobe function. The patient starts well but abruptly stops after only four words. Most individuals can give more then 10 words in one minute. Receptive languag Patients with a receptive aphasia (Wernicke’s) cannot comprehend language. Their speech output is fluent but is devoid of meaning and contains nonsense syllables or words (neologisms). Their sentences are usually lacking nouns and there are paraphasias (one word substituted for another). The patient is usually unaware of their language deficit and prognosis for recovery is poor. This patient’s speech is fluent and some of her sentences even make sense but she also has nonsense sentences, made up of words and parts of words. She can’t name objects (anomia). She doesn’t have a pure or complete receptive aphasia but pure receptive aphasias are rare. Expressive languag This patient with expressive aphasia has normal comprehension but her expression of language is impaired. Her speech output is nonfluent and often limited to just a few words or phases. Grammatical words such as prepositions are left out and her speech is telegraphic. She has trouble saying “no ifs , ands or buts”. Her ability to write is also effected Patients with expressive aphasia are aware of their language deficit and are often frustrated by it. Recovery can occur but is often incomplete with their speech consisting of short phrases or sentences containing mainly nouns and verbs. Praxi The patient does well on most of the tests of praxis. At the very end when he is asked to show how to cut with scissors he uses his fingers as the blades of the scissors instead of acting like he is holding onto the handles of the scissors and cutting. This can be an early finding of inferior parietal lobe dysfunction. Gnosi With his right hand the patient has more difficulty identifying objects then with his left hand. One must be careful in interpreting the results of this test because of the patient’s motor deficits but there does seem to be astereognosis on the right, which would indicate left parietal lobe dysfunction. This is confirmed with graphesthesia where he definitely has more problems identifying numbers written on the right hand then the left (agraphesthesia of the right hand). Dominant parietal lobe functio This patient has right-left confusion and difficulty with simple arithmetic. These are elements of the Gertsmann syndrome, which is seen in lesions of the dominant parietal lobe. The full syndrome consists of right-left confusion, finger agnosia, agraphia and acalculia.  

Sebastian explains how to perform a neurological examination of the upper limbs.  

Margaret attempts to perform an examination of the elbow  

Guide to examining hands during inspection, by the clinical skills tutors at the University of Liverpool  

Teaches the mnemonic CRITOE (also known as CRITOL) used to remember the names and order of the elbow ossification center appearances. Includes two abnormal case examples with annotations.  

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