Tony

Tony

1. Loss of Movement Loss of Sensation

   • Nerve Damage
     • Classification
       • Neurapraxia
         • Conduction blocked (compression)
       • Axonotmesis
         • Axon damaged
       • Neurotmesis
         • Axon & CT damaged
         • Recovery highly variable
           • Endoneurium
           • Perineurium
           • Epineurium
     • Degeneration (Wallerian) & regeneration
       • Distal to injury (Injury-dendrites)
       • CT release chemical mediators (e.g. Histamine) attracts macrophages
         • Schwann cells multiply > myelinate regenerating axon
         • Axon sprouts grow from injury. Can follow endoneurial tube if intact
   • Assessing Upper Limb
     • Look & Feel
       • Ulna Claw (hyper-ext Mc-P joint, Hyper-flex 1st & 2nd
         • Interossei
         • Lumbricals 3 & 4
       • Froment's sign
         • Adductor pollicis
     • Move
       • Paper grip test (finger adduction)

2. laceration medial forearm

   • Anatomy of the Upper Limb
     • Muscles
       • Types
         • Skeletal
           • Contraction
             • Muscle AP generated @ NMJ by Motor N Ca pulse from SR Binds tp troponin, moves tropomysin Binding site on actin revealed Cross-Bridge Cycling occurs Relaxation: Ca reuptake at SR
           • Structure
             • Long parallel fibres. myosin-actin in sarcomeres (striated). T-tubules & Scarolemma
         • Cardiac
           • Contraction
             • Myocardial AP via pacemaker cells. Spreads through junctions in ICD Ca pulse via SR & ECF Relaxation: Ca reuptake SR & ECF
           • Structure
             • Branching fibres. Sarcomeres. T-tubules & sarcolemma. Intercalated disks. 1-2 nuclei
         • Smooth
           • Contraction
             • Ca elevation: mechanical, pacemakers, hormones, ANS Ca pulse from SR & ECF Ca binds to Calmodulin > MLCK > myosin. Relaxation: as cardiac + myosin phosphatase
           • Stucture
             • Actin & Myosin in diagonal lattice. No sarcomere. Single nucleus
       • Drugs that alter
         • Muscle relaxants
           • Reduce release of Ach
           • Ach receptors antagonists (blockers)
             • Neuromuscular blockers: nicotinic recept, somatic
             • Ganglion blockers: parasymp & symp
             • Anti-muscarinic agents: parasympathetic
         • Muscle stimulants
           • Increase synaptic Ach by inhibiting breakdown enzymes
     • Nerves
       • Brachial plexus
         • Terminal Nerves
           • Ulna
           • Medial
           • Muscolucutaneous
           • Axillary
           • Radial
         • Roots
         • Trunks
         • Divisions
         • Cords
     • Bones
       • Shoulder
         • Scapula
         • Clavicle
         • Humerus
       • Forearm
         • Ulna
         • radius
       • Hand
         • Carpals
         • Metacarpals
         • Phalanges

3. Surgical repair

   • Anaesthetics (local)
     • Signal Transmission
       • RMP
         • Change in RMP via graded potential
           • Depolarisation summation > threshold to overcome decay
             • AP Generated
               • Open/ closes gated ion channels.
                 • 3. K activation gate opens
                   • Stays open while Na has reset > Hyperpolarisation (relative refractory period)
                   • Repolarisation (absolute refractory period)
                 • 2. Na Inactivation gate closes
                 • 1. Na activation gate opens
                   • Depolarisation > propogates AP
               • Constant amplitude
               • Cannot go backwards
               • All or none
         • Concentraion gradient Maintained by pumps
         • Established by differential leak of Na and K
     • Properties
       • Weak bases Non-ionised in ECF Ionises once across membrane
     • Actions
       • Block Na channels

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