Concluded Case

Regional nerve injury

Mr.X ,40 years ,Agricultural labour ,C/O progressive painful right elbow on flexion ,over the span of more than 2 years. O/E ,He is not diabetic or hypertension. movements of Right elbow is full on active and passive movements . On flexion of elbow ,biceps brachial is more prominent .Triceps also well in action on extension of elbow from complete flexion. pronation and supination are well preserved.Shoulder joint movement is full. But on flexion of elbow there is hollow ness below the biceps muscle prominence.Humorous bone of anterior surface is easily felt .Flexion of elbow is possible but not as easy as that of his left side. DTR is preserved .No sensory deficit . Examine the hollow ness of elbow on the front or anterior surface of humorous just below the belly of biceps muscle. In arm, there are four muscle 1..Biceps ,2Corocobrachialis, 3brachialis,on the anterior surface . and 4 triceps on the posterior side of humorous. identify the anatomical diagnosis. Diagnosis the condition. No other Neurological deficit is detected. Examine the picture.

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Concluded answer
This is Right side musculocutaneous nerve trunk paralysis .C5,6. Suspected injection prick is suspected . But history is not relevantly obtained . This is complete brachialis muscle wasting ,because the anatomical site. and its absence it is thought to be so.. Faint skin sensation impairment also noticed on its distribution of its dermatome.
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? Muscular dystrophy ? Stiffness ? Elbow dislocation
It may be brachialis muscle wastage .suggests MRI.
Popye sign bicep tendon rupture
Sir the muscle mass below and under the biceps,is under the wastage.Brachialis cover the lower one third of humour bone.Biceps are prominent and hollow ness under the biceps muscle. Power full flexion is brachialis muscle than the biceps.So pain during flexion of elbow.
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Here the hollow ness is more prominent ,below the biceps muscle ,and bone ,humour is easily felt without the muscle mass presence. The muscle ,that is present below the biceps is brachialis ,and innervated by musculocutaneous muscle of C5,6,. This is flexor powerful flexor of elbow ,origin whole anterior surface of humour, just below the deltoid insertion .It inserted into ulnar tuberosity, and biceps muscle into the radial tuberosity. Biceps is more prominent on elbow flexion, but the muscle under the biceps is brachialis muscle which is got wasted out. I suspect may be injection prick might have result in muscle wasting.But deltoid is the casualty but Brachialis muscle wasting is noticed first time in my clinical practise.
This is Right side musculocutaneous nerve trunk paralysis .C5,6. Suspected injection prick is suspected . But history is not relevantly obtained . This is complete brachialis muscle wasting ,because the anatomical site. and its absence it is thought to be so.. Faint skin sensation impairment also noticed on its distribution of its dermatome.
Popey sign is sudden onset. Here it is present for more than two years. No bruise is seen. Flexion of elbow and pronation is possible ,so biceps tendon of lower part is intact .
Partial rupture of distal biceps tendon , near insertion . Suggest MRI
Partial rupture of biceps brachii tendon.
Corocobrachialis muscular dystrophy
Sir corocobrachialis ,gets inserted above the brachialis origin ,that upper 1/3 of humour. Brachialis ,occupy lower 1/3 and inserted into tuberosity of ulna.Here it is brachialis muscle wastage.
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Rupture of muscle go for MRI
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