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Anatomy > Lec 13 & 14 - peripheral nerve lesions of UE > Flashcards

Lec 13 & 14 - peripheral nerve lesions of UE Flashcards

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1
Q

DR CUMBA

A
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2
Q

Dorsal Root
Ventral Root

A

Dorsal root - Sensory
Ventral root - Motor

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3
Q

*Suprascapular Nerve Entrapment

A

Innervates supraspinatus muscles first then infraspinatus

can be entrapped under transvers superior scapular ligament in suprascapular notch (affects supra and infra) or spinoglenoid ligament in spinoglenoid notch (would only affect infra, so no ER)

clavicular fractures may also harm

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4
Q

Know median and lateral head of the median N

A
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5
Q

Scalene Block

A

anesthetizes most of brachial plexus during surgery excpet C8 and T1

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6
Q

Common peripheral nerve injuries

A

pins-and-needles from pressure or awkward position

neuropraxia - type of peripheral nerve injury characterized by a temporary loss of function of the affected nerve without any structural damage. It is often caused by compression, stretching, or ischemia (lack of blood flow) to the nerve

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7
Q

What can neuropraxia progress to?

A

cumulative trauma disorders

more severe nerve injuries may involve interruptions of the axons (axonotmesis) or entire nerve (neurotmesis)

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8
Q

How do clinicians test peripheral nerve muscle function and sensory function?

A

manual muscle tests

close eyes and touch different peripheral innervates regions of arm and hand

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9
Q

Causes of PNI

A

diabetes
traction
neoplastic
direct trauma
compression
motor neuron diseases
autoimmune
inflammation/ischemia

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10
Q

**Thoracic outlet entrapment sites

A

between anterior and middle scalene (brachial plexus)

under pec minor - brachial plexus, axially artery and vein

between clavicle and 1st rib

UE in hyperabduction

cervical rib

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11
Q

Radial tunnel syndrome (entrapment sites)

A

“dont spend too much time on”

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12
Q

Radial nerve affects what movements?

A

wrist extension, wrist radial deviation (half, flexor can do other half), finger extension, thenar extension and abduction (half)

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13
Q

Common Radial nerve injury

A

Wrist Drop

not a contracture just cant move on own

radial nerve MOTOR impairment

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14
Q

If someone has radial nerve injury, can they still abduct thumb?

A

Yes, abductor pollicis brevis is median nerve

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15
Q

Does the deep radial nerve / PIN innervate any hand intrinsics?

A

No

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16
Q

Radial N - deep branch innervation

A

extensor digitorum
extensor carpi ulnaris
extenso digit minmi

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16
Q

Radial N innervation

A

tricpes
anconeus
brachioradialis
extensor carpi radialis longus (and brevis on sheet)

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17
Q

Does the median nerve innervate muscles in the brachium?

A

No

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18
Q

Radial N PIN (Posterior interosseous)

A

Abductor Pollicis Longus
Extensor Pollicis brevis
Extensor Pollicis longus
Supinator
Extensor Indices

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19
Q

List the divisions of the median nerve

A

Median N
AIN - Anterior interosseous Nerve
Recurrent branch
Digital branch

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20
Q

Median N

A

Pronator teres
(PL)
Flecor carpi radialis
Flexor digitorum superficialis

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21
Q

Median AIN

A

FDP
Flexor pollicis longus
Pronator quadratus

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22
Q

Median Recurrent

A

APB
FPB
Opponens Pollicis
Lumbricals (DIGITAL BRANCH)

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23
Q

Median N Digital

A

lateral 2 lumbricals and palm sensation

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24
Where does the median nerve split?
travels through cubital fossa and innervates PT, PL, FCR first sends a branch 1/4th way down forearm - anterior interosseous regions (AIN) at distal radioulnar joint it splits into recurrent branch (thenar side) and digital branch for lumbricals and palm sensation
25
Median Nerve entrapment sites
Between A/P scalene Pec minor Pronator teres region - splits AIN (degeneration) Carpal tunnel
26
Pronator syndrome associated with what nerve
median dont spend time on
27
Carpel tunnel contents
FDS, FDP FPL FCR MEDIAN Nerve
28
Ape hand
Median Nerve thumb rests in adduction because without median nerve innervating thenar muscles there is no one to counter adductor except APL posture hand takes at rest loss of web space
29
Hand of Benediction
median nerve injury usually happens with ape hand bishops hand inability to flex thumb, index and middle finger when asked to make a fist (last digits are all the way down in fist)
30
What screening procedure can be used for AIN syndrome?
Make an OK sign with hand - not circle or pinch = bad
31
What motion is the median nerve entirely responsible for?
Pronation
32
What role does anconeus play in pronation
abducts ulna during pronation carrying angel disapears
33
What nerve continues off the musculocutaneous arm and what area does it supply sensation to?
Lateral antebrachial cutaneous nerve lateral forearm
34
What sensory and motor functions could test for musculocutaneous function?
elbow flexion lateral forearm sensory
35
What can cause axillary nerve damage?
anterior shoulder dislocation open shoulder surgeries improper use of crutches improper IM injection
36
What branch comes off the axillary nerve and what is its function?
The superior lateral cutaneous nerve of arm innervates sensory area of axillary
37
Ulnar nerve entrapment sites
between first rib and clavicle arcade of Struthers between heads of flexor carpi ulnaris cubital tunnel guyons canal
38
What motor deficits result from ulnar nerve injury
lateral key pinch - thumb adduction
39
What is cubital tunnel syndrome?
pressure and tension of the ulnar nerve in cubital tunnel with flexed elbow think texting in bed on stomach medial, right below elbow joint causes ulnar neuritis
40
Ulnar transposition
surgical relocation of the ulnar nerve in the cubital tunnel to the anterior medial epicondyle
41
Ulnar deep branch innervation
PAD DAB medial 2 lumbricals adductor hypothenars (FDM, ADM, ODM)
42
Guyons canal contents
ulnar nerve and artery
43
Ulnar nerve screening
thumb adduction crossing fingers squeezing paper between fingers
44
Common ulnar nerve injury
claw hand at rest 4th and 5th digits cant extend (FDP medial) hyperextension of MCP, loss of IP extension in 4th and 5th law of medial lumbricals (and other intrinsic hand muscles)
45
Superior trunk of brachial plexus injury
C5 C6 waiters tip or erb-duchenne palsy neck movements more important
46
Inferior trunk injury
C8 T1 less common (so dont worry) UE pulled superiorly claw hand klumpke palsy
47
Middle trunk injury?
C7?
48
*Intrinsic plus position - what condition is associated?
MCP flexion with PIP and DIP extension sandwich or sock puppet PAD, DAB, lumbricals, flexor digit minimi tenodesis - passive finger flexion with wrist extension
49
intrinsic minus
evil cousin of intrinsic plus clawing of fingers MCP hyperextension and IP flexion
50
*Grasp Patterns - cylindrical
midrange flexion of digits tube shaped object turning steering wheel
51
Grasp patterns - spherical
varied flexion of digits rounded object
52
Grasp patterns - hook (what muscle is crucial)
flexion of PIPs and DIPs, extension of MCP NEED FDP carrying a bucket
53
Grasp patterns - composite
maximal flexion of all joints wringing out towel
54
Pinch patterns - tip
precise movements distal tips of thumb and index threading needle
55
Pinch - three jaw chuck
tripod pinch tip of thumb against tips of index and middle fingers writing with a pencil
56
Pinch - lateral (key)
pad of thumb against radial side of index finger unlock a door with key
57
What is the second strongest muscle
adductor pollicis
58
Tinels nerve exam
ulnar nerve tap medial condyle, do they feel it in tips of digits 4&5?
59
scratch collapse test
reflextive collapse with external rotation after swiping finger over nerve suprascapular nerve
60
what position would a wrist brace have the wrist in at night for treatment of carpal tunnel syndrome
wrist extension
61
Radial nerve injury treatment - radial nerve palsy orthosis
brace to assist with grasping and releasing objects
62
What movements would hurt with de quervains or texting thumb syndrome
Thumb extension and abduction APL EPB
63
Treatment for De Quervains
thumb spica orthosis nerve slides for sensory branch of radial nerve
64
Extensor hood functions
extension of IP joints counterbalances flexor forces of extrinsic muscles facilitates coordinated finger flexion(?)
65
Extensor hood - sagittal band fxn
stabilize volar plates and MCP joints, prevent bowstringing of extensor tendons
66
Extensor hood - central band fxn
extended PIP
67
Extensor hood - lateral band fxn
extends DIP joint
68
Extensor hood - terminal tendon assocaited injury
extends DIP joint mallet finger swans neck
69
Swan neck deformity
damage to terminal tendon, direct blow to DIP while extended or progressive weakining (RA) PIP in hyper extenstion and DIP in flexion
70
Boutonniere deformity
opposite of swan neck injury to the central slip PIP joint flexion and DIP hyperextension ORL ligament

Anatomy (23 decks)

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