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The Peripheral Neuropathy Solution

Dr. Labrum Peripheral Neuropathy Solution

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Upper Extremity and Shoulder Girdle

CONTENTS

introduction

247

Section I: Innervation

Brachial Plexus

248, 249

Cutaneous Distribution

250

Spinal Nerve and Motor PointChart

251

Nerves to Muscles: Motor and Sensory,

and Motor Only, and Chart

252, 253

Scapular Muscle Chart

253

Chart ofUpper Extremity Muscles

254, 255

Cutaneous Nerves—Upper Limb

256,257

Section II: Hand, Wrist, Forearm and Elbow

Movements—Thumb and Finger Joints

258

Movements—Wrist, Radioulnar

and Elbow

259

Chart for Analysis ofMuscle Imbalance

260

Strength Tests

Thumb Muscles

261-268

Digiti Minimi

269-271

Dorsal and Palmar Interossei

272, 273

Lumbricales and Interossei

274-276

Palmaris Longus and Brevis

111

Extensor Indicis and Digiti Minimi

278

Extensor Digitorum

279

Flexor Digitorum Superficialis

and Profundus

280, 281

Flexor Carpi Radialis and Ulnaris

282, 283

Extensor Carpi Radialis and Ulnaris

284, 285

Pronator Teres and Quadratus

286, 287

Supinator and Biceps

288, 289

Biceps Brachii and Brachialis

290,291

Triceps Brachii and Anconeus

292, 293

Brachioradialis

294

Range ofMotion Chart

295

Strength Testing of Thumb and Fingers

295

Joint Measurement Chart

296

Section III: Shoulder

Joints and Articulations

297-299

Charts: Shoulder Girdle Articulations

300, 301

Combined Shoulder& Scapular Muscles 302

Movements of Shoulder Girdle & Scapula 303

Movements of Glenohumerai Joint

304, 305

Length Tests

Humeral and Scapular Muscles

306

Pectoralis Minor

Teres Major, Latissimus Dorsi and

Rhomboids Shoulder Rotators Upper Extremity Muscle Chart Strength Tests Coracobrachialis Supraspinatus Deltoid

Pectoralis Major, Upper and Lower Pectoralis Minor Shoulder Lateral Rotators Shoulder Medial Rotators Teres Major & Subscapuiaris Latissimus Dorsi

Rhomboids, Levator Scapulae and

Trapezius Serratus Anterior

Section IV: Painful Conditions of Upper Back

Weakness of Upper Back 338

Short Rhomboids 338

Middle & Lower Trapezius Strain 339

Back Pain from Osteoporosis 340

Painful Conditions of the Arm

Thoracic Outlet Syndrome 341

Coracoid Pressure Syndrome 342,343 Teres Syndrome (Quadrilateral

Space Syndrome) 344

Pain from Shoulder Subluxation 345

Tight Shoulder External Rotators 345

Cervical Rib 345

Section V: Case Studies 346

Case 1: Radial Nerve Lesion 347 Case 2: Radial, Median, & Ulnar Nerve 348,349

Case 3: Probable C5 Lesion 350

Case 4: Lateral and Medial Cord 351

Case 5: Partial Brachial Plexus 352-354 Case 6: Stretch Weakness Superimposed on a Peripheral Nerve Injury 355

Overuse Injuries 356

Exercises 357

References 358

310,311

315-317 318,319

324, 325

326-331 332-337

INTRODUCTION

Differential diagnosis of problems of the shoulder girdle requires that special attention be paid to the innervation of the muscles. The shoulder girdle and upper extremity have many muscles that are supplied by nerves that are motor-only. With no sensory innervation, the result can be a loss of function without symptoms of pain. An example is the extreme weakness of the serratus anterior muscle, illustrated on the bottom of page 336. (In contrast to many in the upper extremity, only four lower extremity muscles have motor-only innervation. See pages 252-253.)

Ordinarily, the terms joint and articulation are used inter-changeably. However, this text provides a distinction between the two. Differentiating them serves a special purpose. With joint referring to a "bone to bone" connection and articulation referring to a "bone to muscle to bone" connection, the role of muscle has been made very clear. Pages 297 through 299 define and illustrate the use of the terms. The charts on pages 300 and 301 provide information regarding the 10 classifications for 25 articulations of the shoulder girdle.

No longer should the shoulder girdle be considered incomplete as commonly described. Recognition of the vertebroscapular and vertebroclavicular articulations posteriorly, and the costoscapular and costoclavicular articulations anteriorly, makes the shoulder girdle complete. Reference to attachments of scapular muscles to the dorsal thorax via the "scapulothoracic joint" should no longer be necessary.

The glenohumeral joint provides freedom of motion in all directions for the upper extremity as a whole. Stability in certain positions is obtained by the coordinated action of muscles. The elbow joint provides free motion in the direction of flexion, and stability in the position of zero extension (180° angle). By virtue of forearm supination and pronation, the extended hand can be moved from the anatomical position facing forward to facing backward. The wrist joints provide for flexion and extension, abduction and adduction, but not for rotation. Text and charts on page 295 are devoted to range of joint motions and to strength testing of the fingers and thumb.

This chapter includes discussions regarding faulty and painful conditions of the upper back and arm. Brief reviews of several cases of nerve injuries show the value of the Spinal Nerve and Muscle Chart as an aid in differential diagnosis.

BRACHIAL PLEXUS

The brachial plexus arises just lateral to the scalenus anterior muscle. The ventral rami of C5, 6,7, and 8, and the greater part of Tl. plus a communicating loop from C4 to CS and one from T2 (sensory) to Tl, form (successively) the roots, trunks, divisions, cords and branches of the plexus.

Ventral rami containing CS and C6 fibers unite to form the superior (upper) trunk. Those containing C7 fibers form the middle trunk. Those containing CS and Tl fibers unite to form the inferior (lower) trunk Next, the trunks separate into anterior and posterior divisions. The anterior divisions from the superior and middle trunks, composed of CS, 6, and 7 fibers, unite to form the lateral cord. The anterior division from the inferior trunk, composed of C8 and Tl fibers, forms the medial cord, and the posterior divisions from all three trunks, composed of C5 through CS (but not Tl) fibers, unite to form the posterior cord.

The cords then divide and reunite into branches that become peripheral nerves. The posterior cord branches into the axillary and radial nerves. The medial cord, after receiving a branch from the lateral cord, terminates as the ulnar nerve. One branch of the lateral cord becomes the musculocutaneous nerve; the other branch unites with one from the medial cord to form the median nerve. Other peripheral nerves exit directly from various components of the plexus, and some exit directly fiom the ventral rami. (See the left column and top of Spinal Nerve and Muscle Chart, p. 27.)

The anterior divisions, the lateral and medial cords, and the peripheral nerves arising from them innervate anterior or flexor muscles of the upper extremity. The posterior division, the posterior cord, and the peripheral nerves arising from them innervate the posterior or extensor muscles of the upper extremity.

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© 2005 Florence P. Kendall. Author grants permission to reproduce for personal use but not for sale-

© 2005 Florence P. Kendall. Author grants permission to reproduce for personal use but not for sale-

Pectoralis minor

Pectoralis minor

250 CUTANEOUS DISTRIBUTION

DERMATOMES + CUTANEOUS DISTRIBUTION

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