Anybody else frustrated at Upper Extremity Nerve injuries in FA?

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kaleerkalut

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I absolutely hate this section of FA. They totally screw up the whole Pope's blessing and Claw hand thing like 10 times. Even their errata from 2011 to 2012 editions say different things and they both still seem off. Sigh... :(
 

shan564

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Ha, yeah, I just found a reliable source and moved on.

Plus, I think what's more important for Step 1 is that you know what each nerve innervates. Based on that, you can figure out what the answer to the question is. They won't say "Pope's blessing" or "claw hand" on the test... they're more likely to explain the presentation.
 
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johndoe3344

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Yeah, we hope. :xf:

Knowing them, they'd try and turn that into an "easy one" by literally saying "Pope's blessing" in the question-stem, which would only make it harder.

They probably won't say "Pope's blessing" but they can definitely say claw hand. Claw hand is about the most unspecific term ever, and they'll probably leave it up to you to figure out based on other symptoms which nerve is damaged.
 

RedSoxSuck

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I absolutely hate this section of FA. They totally screw up the whole Pope's blessing and Claw hand thing like 10 times. Even their errata from 2011 to 2012 editions say different things and they both still seem off. Sigh... :(

Yea, i struggled with it as well. But i simplified it and just used the following:

Median n: Claw of 2nd and 3rd digit, can't aBduct the thumb (un opposable thumb), ulnar deviation of wrist upon flexion, carpal tunnel syndrome, anterior dislocation of lunate.

Ulnar n: Claw of 4th and 5th digit, can't ADduct thumb, radial deviation of wrist upon flexion, fracture of hamate.


Above has always worked for me and have never gotten a question wrong.
 
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mdeast

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Yea, i struggled with it as well. But i simplified it and just used the following:

Median n: Claw of 2nd and 3rd digit, can't abduct the thumb (un opposable thumb), ulnar deviation of wrist upon flexion, carpal tunnel syndrome, anterior dislocation of lunate.

Ulnar n: Claw of 4th and 5th digit, can't ABBduct thumb, radial deviation of wrist upon flexion, fracture of hamate.


Above has always worked for me and have never gotten a question wrong.

Yeah, I don't think the NMBE would use buzz words like that. They'd describe it to you (i.e. 2nd/3rd digit involvement) and expect you to get it from the clinical description. Definitely a high-yield concept to know. Arm and Leg innervations/muscle control seem to be where the majority of MSK questions that deal with movement/sensation outside of things like cranial nerves, etc.
 

CaptainSSO

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Can someone explain the movements of the thumb? I never figured out which is which, since it's out of plane with the fingers.

If you move your thumb "out" from touching your palm to making an "L" with your index finger, would that be extension or abduction? That would be abduction, right?

And if you place your thumb parallel to your index finger, and then form the "L" (so they're parallel and then perpendicular), that would be extension?
 

chet

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If you guys do a search in this forum there is a thread titled "claw hand drama" or something similar, in the thread (its short) there is a great link to a really nice site that explains this whole issue.
 

Morsetlis

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Can someone explain the movements of the thumb? I never figured out which is which, since it's out of plane with the fingers.

If you move your thumb "out" from touching your palm to making an "L" with your index finger, would that be extension or abduction? That would be abduction, right?

And if you place your thumb parallel to your index finger, and then form the "L" (so they're parallel and then perpendicular), that would be extension?

The thumb is out of plane with the fingers, but in plane with itself. Therefore, the movement of the thumb is predicate upon the position of the thumb in relation with the palm, and you don't care about the rest of the fingers.

Put your other hand on the outcropper muscle on the radius bone that is on the same side as your thumb. The "outward" motion that does not involve contraction of the abductor pollicis longur is the motion of extension. The "outward" motion that involves contractor of the abd. pol. longus (on the radius, which you can feel) is abduction. This is because the ext. pol. longus and abd. pol. longus have different origins.
 

CaptainSSO

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The thumb is out of plane with the fingers, but in plane with itself. Therefore, the movement of the thumb is predicate upon the position of the thumb in relation with the palm, and you don't care about the rest of the fingers.

Put your other hand on the outcropper muscle on the radius bone that is on the same side as your thumb. The "outward" motion that does not involve contraction of the abductor pollicis longur is the motion of extension. The "outward" motion that involves contractor of the abd. pol. longus (on the radius, which you can feel) is abduction. This is because the ext. pol. longus and abd. pol. longus have different origins.

Ah, ok, thanks man. That helps a lot.

So I guess I had it exactly backwards, heh.
 
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