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In order Cuccurullo > Ch 5 - EDX: Plexopathies > Flashcards

Ch 5 - EDX: Plexopathies Flashcards

1
Q

What is a plexopathy?

A

Pathologic process occurring distal to the DRG and proximal to the peripheral nerves

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2
Q

How do plexopathies present?

A

ABN appear diffuse and will not follow any particular dermatomal or myotomal distribution

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3
Q

What are common etiologies of plexopathies?

A

– Trauma (traction, transection, obstetrical injuries, compression, and hemorrhage)
– Cancer (tumor and radiation therapy)
– Idiopathic (neuralgic amyotrophy)

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4
Q

How do SNAP’s help in EDX of plexopathies?

A

Localize lesion above or below DRG

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5
Q

If a lesion is proximal how will SNAP and CMAP appear?

A

SNAP preserved

CMAP ABN

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6
Q

What is the main prognostic factor for plexopathy in EDX?

A

Distal CMAP amplitude because it represents axonal loss and should be compared side to side

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7
Q

How do F-waves appear in plexopathy?

A

Delayed or absent

Nonspecific and cannot localize lesion

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8
Q

What is H-reflex helpful for in plexopathy?

A

Evaluate the S1 pathway but not pathognomonic

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9
Q

How do EMG findings appear in plexopathy?

A

ABN activity in peripheral muscles in distribution of plexus injury but with normal paraspinal activity

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10
Q

Where does the brachial plexus originate?

A

Ventral rami of the C5–T1 nerve roots

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11
Q

Where do the ventral rami of the brachial plexus emerge?

A

b/w anterior and middle scalenes

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12
Q

What happens in the posterior triangle of the neck?

A

C5 and C6 form the upper trunk
C7 forms the middle trunk
C8 and T1 form the lower trunk

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13
Q

What happens as the trunks pass under the clavicle?

A

Form anterior and posterior divisions to become cords

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14
Q

The cords are named in their relation to the __.

A

Axillary artery

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15
Q

Which muscles are innervated by the musculocutaneous nerve and C5/C6 roots?

A

Biceps

Brachialis

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16
Q

Which muscles are innervated by the musculocutaneous nerve and C5/C6/C7 roots?

A

Coracobrachialis

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17
Q

Which muscles are innervated by the axillary nerve and C5/C6 roots?

A

Deltoid

Teres minor

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18
Q

Which muscles are innervated by the radial nerve and C5/C6 roots?

A

Supinator

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19
Q

Which muscles are innervated by the radial nerve and C5/C6/C7 roots?

A

Brachioradialis

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20
Q

Which muscles are innervated by the radial nerve and C6/C7/C8 roots?

A

ECR longus

Triceps

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21
Q

Which muscles are innervated by the radial nerve and C7/C8 roots?

A 
ECR brevis
Ext digitorum
EIP
EDM
ECU
Abd pollicis longus
Ext pollicis brevis
Ext pollicis longus
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22
Q

Which muscles are innervated by the radial nerve and C7/C8/T1 roots?

A

Anconeus

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23
Q

Which muscles are innervated by the median nerve and C6/C7 roots?

A

Pronator teres

FCR

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24
Q

Which muscles are innervated by the median nerve and C7/C8 roots?

A

Palmaris longus

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25
Q

Which muscles are innervated by the median nerve and C7/C8/T1 roots?

A

FDS: 4 muscles

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26
Q

Which muscles are innervated by the median nerve and C8/T1 roots?

A 
FDP: 2 muscles
FPL
Pronator quadratus
Lumbricals: 2 muscles
Opp pollicis
APB
1/2 Flex pollicis brevis
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27
Q

Which muscles are innervated by the ulnar nerve and C7/C8 roots?

A

FCU

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28
Q

Which muscles are innervated by the ulnar nerve and C8/T1 roots?

A 
Palmaris brevis
FDP: 2 muscles
Dorsal interossei: 4 muscles
Plamar interossei: 3 muscles
Lumbricals: 2 muscles
1/2 Flex pollicis brevis
Hypothenar muscles
-Opp dig minimi
-Abd dig minimi
-Flex dig minimi
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29
Q

What makes up the posterior cord?

A

Posterior divisions of upper, middle and lower trunks

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30
Q

What makes up the lateral cord?

A

Anterior divisions of the upper and middle trunks

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31
Q

What makes up the medial cord?

A

Anterior divisions of the lower trunk

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32
Q

What does the lateral cord split into?

A

Musculocutaneous branch and also fuses with the medial

cord to form the median branch

33
Q

What does the posterior cord split into?

A

Radial and axillary branches

34
Q

What does the medial cord split into?

A

Contribute to the median branch and the ulnar branch

35
Q

What is injured in Erb’s palsy?

A

C5-C6 nerve roots of upper trunk

36
Q

What is the etiology of Erb’s palsy?

A

Traction, compression, obstetrical injury or stinger from sports injury

37
Q

What is the classic arm position in Erb’s pasly?

A 
Waiter's tip 
Adducted (deltoid and SS)
IR (teres minor and IS)
Extended (biceps and BR)
Pronated (supinator and BR)
Wrist flexed (ECRL and ECRB)
38
Q

Where is Erb’s point for EDX?

A

Stimulate at the tip of the C6 transverse process over the trunks of the brachial plexus

39
Q

What is the treatment for Erb’s palsy?

A

Rehabilitation, intermittent splinting and activity restriction

40
Q

What is injured in Klumpke’s Palsy?

A

C8–T1 nerve roots or lower trunk

41
Q

What is the etiology of Klumpke’s Palsy?

A

Obstetrical traction injury

Forced adduction seen in an MVA, falls, shoulder dislocations

42
Q

What is the clinical presentation of Klumpke’s Palsy?

A

Wasting of the small hand muscles and
a claw hand deformity (lumbrical weakness).
Shoulder girdle muscle function is preserved

43
Q

What will be seen on NCS in Klumpke’s palsy?

A

SNAP perserved if nerve root avulsed
Medial antebrachial cutaneous sensory response will be
absent or reduced

44
Q

Why is nerve root avulsion associated with C8 and T1 injury?

A

Lack of protective support at C8/T1

45
Q

What is injured in Thoracic outlet syndrome?

A

Injury involves the subclavian artery, subclavian vein, or axillary vein

46
Q

What is the clinical presentation of arterial involvement in Thoracic outlet syndrome?

A 
Limb ischemia
Necrosis
Vague pain
Fatigue
Decreased color and temperature
47
Q

What is the clinical presentation of venous involvement in Thoracic outlet syndrome?

A

Bluish, swollen, achy limb

48
Q

What is the etiology of neurologic thoracic outlet syndrome?

A

Compression of the lower trunk of the brachial plexus b/w a fibrous band, b/w the first cervical rib and clavicle (costoclavicular syndrome)
Muscular entrapment by the scalenes or Pectoralis minor muscle

49
Q

What is the clinical presentation of TOS?

A

Pain and numbness along the medial aspect of the forearm and hand, which increases with overhead activity. Discomfort can present in the neck, clavicle, and axilla

50
Q

What is seen on NCS in TOS?

A

Dec amp for the median CMAP, ulnar SNAP/CMAP, and medial antebrachial cutaneous studies Median SNAP is
spared

51
Q

What is seen on EMG in TOS?

A

ABN spontaneous activity median and ulnar hand muscles

52
Q

What are different names for Neuralgic Amyotrophy?

A 
Parsonage–Turner syndrome
Brachial neuritis
Brachial neuropathy
Idiopathic brachial plexopathy
Shoulder-girdle neuritis
Paralytic brachial neuritis
53
Q

What is the clinical presentation of Neuralgic Amyotrophy?

A

Abrupt onset severe pain in periscapular region
Exacerbated by rotation and abduction
Pain resolves in hours to 2-3 weeks
Develops weakness in patchy fashion

54
Q

How many presentations of Neuralgic Amyotrophy are bilateral?

A

1/3 of cases

55
Q

What are primary plexus tumors?

A

Schwannomas
Neuromas
Neurofibromas

56
Q

Which tumors can cause secondary plexus involvement?

A

Breast and lung

57
Q

What can radiation therapy cause?

A

Neural fibrosis and constriction of the vasa nervorum, leading to destruction of the axon and Schwann cell

58
Q

Describe location and characteristics of radiation plexopathy.

A

Located Upper trunk
Painless sensation
Myokymia on EDX

59
Q

Describe location and characteristics of tumor plexopathy.

A

Located Lower trunk
Painful sensation
Horner’s syndrome

60
Q

What is the MC site of nerve root avulsion?

A

C8 and T1 roots

61
Q

What can determine the difference between a nerve root stretch and avulsion?

A

MRI

62
Q

What is seen on NCS in nerve root avulsion?

A

Absent CMAPs with normal SNAPs

63
Q

What is seen on EMG in nerve root avulsion?

A

Absent recruitment and ABN spontaneous activity in a myotomal distribution, including the paraspinals

64
Q

What is the origin of the lumbar plexus?

A

Ventral rami of L1, L2, L3, and L4 roots

65
Q

What is the origin of the sacral plexus?

A

Ventral rami of L4, L5, S1, S2, S3, and S4 roots

66
Q

What do the ventral rami of lumbar/sacral levels divide to form?

A

Anterior and posterior divisions in each plexus

67
Q

What does the anterior division of the lumbar plexus form?

A

Obturator nerve

68
Q

What does the posterior division of the lumbar plexus form?

A

Femoral nerve and the lateral femoral cutaneous nerve

69
Q

What are terminal branches directly off the lumbar plexus?

A

Iliohypogastric nerve
Ilioinguinal nerve
Genitofemoral nerve

70
Q

What does the anterior division of the sacral plexus form?

A

Tibial portion

71
Q

What does the posterior division of the sacral plexus form?

A

Common peroneal nerve

72
Q

Where does the lumbosacral trunk connect?

A

L4 and L5 nerve fibers connect lumbar to sacral plexus and travel over the pelvic brim

73
Q

What are terminal branches directly off the sacral plexus?

A

Superior gluteal nerve

Inferior gluteal nerve

74
Q

What are common etiologies of lumbar plexopathies?

A 
Neuralgic amyotrophy
Neoplastic versus radiation plexopathy
Retroperitoneal bleed
Hip dislocation
Obstetric injuries/cephalopelvic disproportion: Presents as a postpartum foot drop
75
Q

What should be evaluated on NCS for lumbar plexopathy evaluation?

A

SNAP: Lateral femoral cutaneous nerve (L2–L3), saphenous nerve (L4)
CMAP: Femoral nerve (L2–L4)

76
Q

What should be evaluated on EMG for lumbar plexopathy evaluation?

A

Muscles innervated by the femoral nerve, obturator nerve, and the iliopsoas muscle.
Normal paraspinals

77
Q

What should be evaluated on NCS for sacral plexopathy evaluation?

A

SNAP: Superficial peroneal (fibular) nerve (L5), sural nerve (S1)
CMAP: Deep peroneal (fibular) nerve (L4–S1), tibial nerve (L5–S2)

78
Q

What should be evaluated on EMG for sacral plexopathy evaluation?

A

Muscles innervated by the tibial nerve, peroneal (fibular) nerve, and superior and inferior gluteal nerves.
Normal paraspinals

In order Cuccurullo (91 decks)

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