415-416 - Hands, lower extremities, neuromuscular pairing

Question 1

Is clawing more pronounced with proximal or distal lesions? Which nerves can cause it?

Answer 1

distal lesions of median or ulnar nerves

Question 2

When do deficits present with proximal lesions?

Answer 2

during voluntary flexion of the digits (i.e. making a fist)

Question 3

When would you see an ulnar claw?

Answer 3

In patients with a distal ulnar nerve lesion when extending fingers or at rest

Question 4

When would you see a Pope’s blessing?

Answer 4

In patients with a proximal median nerve injury when they try to make a fist

Question 5

When would you see a median claw?

Answer 5

In patients with a distal median nerve lesion when extending fingers

Question 6

When would you see an “OK gesture”?

Answer 6

In patients with a proximal ulnar nerve injury when trying to make a fist

Question 7

Match these findings according to what they look like: ulnar claw, median claw, OK gesture, Pope’s blessing

Answer 7

Ulnar claw = Pope’s blessing

Median claw = OK gesture

Question 8

What nerve lesion can lead to atrophy of the thenar eminence?

Answer 8

median

Question 9

What nerve lesion can lead to atrophy of the hypothenar eminence?

Answer 9

ulnar nerve

Question 10

What three muscles make up the thenar (median) eminence?

Answer 10

1. Opponens pollicis
2. Abductor pollicis brevis
3. Flexor pollicis brevis

OAF: Oppose, Abduct, Flex

Question 11

What three muscles make up the hypothenar (ulnar) eminence?

Answer 11

1. Opponens digiti minimi
2. Abductor digiti minimi
3. Flexor digiti minimi brevis

OAF: Oppose, Abduct, Flex

Question 12

Which muscles abduct the fingers?

Answer 12

Dorsal interosseous muscles

DAB = Dorsals ABduct

Question 13

Which muscles adduct the fingers?

Answer 13

Palmar interosseous muscles?

PAD = Palmars ADduct

Question 14

What do the lumbrical muscles do?

Answer 14

Flex at the MCP

Extend PIP and DIP joints

Question 15

What is a common cause of injury to the obturator nerve?

Answer 15

pelvic surgery

Question 16

What spinal roots contribute to the obturator nerve?

Answer 16

L2-L4

Question 17

A patient has ↓ medial thigh sensation and ↓ adduction. Which nerve is implicated?

Answer 17

Obturator (L2-L4)

Question 18

What are the roots of the femoral nerve?

Answer 18

L2-L4

Question 19

What injury often causes injury to the femoral nerve? What symptoms would you check for?

Answer 19

pelvic fracture; ↓ thigh flexion and leg extension

Question 20

What are the roots of the common peroneal nerve?

Answer 20

L4-S2

Question 21

Which injuries would make you concerned about common peroneal nerve damage?

Answer 21

1. Trauma or compression of lateral aspect of leg

2. Fibular neck fracture

Question 22

What signs would indicate peroneal nerve damage?

Answer 22

1. Foot drop - inverted and plantarflexed at rest, loss of eversion and dorsiflexion
2. “Steppage gait”
3. Loss of sensation on dorsum of foot

Question 23

What are the roots of the tibial nerve?

Answer 23

L4-S3

Question 24

What are three injuries/conditions that can injury the tibial nerve?

Answer 24

1. Knee trauma
2. Baker cyst (proximal lesion)
3. Tarsal tunnel syndrome (distal lesion)

Question 25

How does a tibial nerve injury present?

Answer 25

1. Inability to curl toes 2. loss of sensation on sole of foot 3. Proximal lesions: foot everted at rest with loss of inversion and plantarflexion

Question 26

What are the roots of the superior gluteal nerve?

Answer 26

L4-S1

Question 27

What are two injuries/conditions that can lead to superior gluteal nerve damage?

Answer 27

1. Posterior hip dislocation | 2. Polio

Question 28

What are the signs of a superior gluteal nerve injury?

Answer 28

Trendelenburg sign/gait -- pelvis tilts because weight-bearing leg cannot maintain alignment of pelvis through hip abduction (superior nerve → gluteus medius and minimus)

Question 29

In the trendelenburg sign/gait, is the lesion ipsilateral or contralateral to the side of the hip that drops? Ipsi- or contralateral to the extremity on which the patient stands?

Answer 29

Lesion is contralateral to the side of the hip that drops; ipsilateral to the extremity on which the patient stands

Question 30

What are the roots of the inferior gluteal nerve?

Answer 30

L5-S2

Question 31

What is an injury that often leads to inferior gluteal nerve damage?

Answer 31

Posterior hip dislocation

Question 32

How does an inferior gluteal nerve lesion present?

Answer 32

1. Difficulty climbing stairs, rising from seated position | 2. Loss of hip extension (inferior nerve → gluteus maximus)

Question 33

What does the peroneal nerve do?

Answer 33

Peroneal Everts and Dorsiflexes; if injured, foot dropPED

Question 34

What does the tibial nerve do?

Answer 34

Tibial Inverts and Plantarflexes; if injured, can't stand on TIPtoes

Question 35

What are the roots of the sciatic nerve?

Answer 35

L4-S3

Question 36

What is the distribution of the sciatic nerve?

Answer 36

posterior thigh, splits into common and peroneal tibial nerves?

Question 37

What artery runs with the long throracic nerve in the axilla/lateral thorax?

Answer 37

Lateral thoracic artery

Question 38

What artery runs with the axillary nerve at the surgical neck of the humerus?

Answer 38

Posterior circumflex artery

Question 39

What artery runs with the radial nerve at the midshaft of the humerus?

Answer 39

Deep brachial artery

Question 40

What artery runs with the median nerve at the distal humerus/cubital fossa

Answer 40

Brachial artery

Question 41

What artery runs with the tibial nerve at the popliteal fossa?

Answer 41

Popliteal artery

Question 42

What artery runs with the tibial nerve posteriorly to the medial malleolus?

Answer 42

Posterior tibial artery