Policeman's tip hand is seen in ?

Ans. is 'a' i.e., Erb's palsy Erb's paralysis One region of upper trunk (C5, C6) of the brachial plexus is called Erb's point where six nerves meet. Injury at this point results in Erb's paralysis.The injury is due to undue separation of the head from the shoulder, which may be seen in : -) Bih injuryFall on the shoulderDuring AnesthesiaClinical features of Erb's palsy1. Muscles paralysed : Mainly biceps brachii, deltoid, branchialis and brachioradialis. Paly supraspinatus, infraspinatus and supinator.2.Deformity (position of the limb)Arm : Hanges by the side; it is adducted and medially rotatedForearm : Extended and pronatedThe deformity is known as 'policeman's tip hand' or 'poer's tip hand'.3.Disability : The following movements are lost.Abduction and lateral rotation of the arm (shoulder).Flexion and supination of the forearm.Biceps and supinator jerks are lost.Sensations are lost over a small area over the lower pa of the deltoid. Klumpke's paralysisSite of injury : Lower trunk of the brachial plexusCause of injury : Undue abduction of the arm, as in clutching something with the hands after a fall from a height, or sometimes in bih injury.Nerve roots involved : - Mainly T 1 and paly C8.Muscles paralysedIntrinsic muscles of the hand (TO.Ulnar flexors of the wrist and fingers (C8).Deformity (position of the hand). Claw hand due to the unopposed action of the long flexors and extensors of the fingers. In a claw hand there is hyperextension at the metacarpophalangeal joints and flexion at the interphalangeal joints.DisabilityClaw handCutaneous anaesthesia and analgesia in a narrow zone along the ulnar border of the forearm and hand. Homer's syndrome if T, is injured proximal to white ramus communicans to first thoracic sympathetic ganglion. There is ptosis, miosis, anhydrosis, enophthalmos, and loss of ciliospinal reflex-may be associated. (This is because of injury to sympathetic fibres to the head and neck that leave the spinal cord through nerve Ti).Vasomotor changes : The skin area with sensory loss is warmer due to aeriolar dilation. It is also drier due to the absence of sweating as there is loss of sympathetic activity.Trophic changes : Long standing case of paralysis leads to dry and scaly skin. The nails crack easily with atrophy of the pulp of fingers.