Lesson2 Flashcards
1
Q
Cervical Plexus Superficial Branches
A
- Lesser Occipital
- Great Auricular
- Transverse Cervical
- Supraclavicular
2
Q
Cervical Plexus Deep branches
A
- Ansa Cervicalis Sup
- Ansa Cervicalis Inf
- Phrenic
- Segmental Branches
3
Q
Lesser Occipital O/D
A
O: C2
D: Posteroinferior head, post to ear
4
Q
Great Auricular O/D
A
O: C2-C3
D:Ant/inf to ear, over parotid gland
5
Q
Transverse Cervical O/D
A
O: C2-C3
D: Anterior neck
6
Q
Supraclavicular O/D
A
O: C3-C4
D: Superior Chest/shoulder
7
Q
Ansa Cervicalis Sup O/D
A
O: C1
D: Infrahyoids
8
Q
Ansa Cervicalis Inf root O/D
A
O: C2-C3
D: Infrahyoids
9
Q
Phrenic O/D
A
O: C3-C5
D: Diaphragm
10
Q
Segmental Branches O/D
A
O: C1-C5
D: Prevertebral, lev scap, mid scalenes
11
Q
What do Compression Syndromes of Peripheral Nerves result in?
A
- Conduction block in the peripheral nerve, but no structural damage to the axon or tissue distal to the lesion
12
Q
Compression syndromes of peripheral nerve symptoms
A
Numbness, tingling, pain, weakness
13
Q
Compression syndromes of peripheral nerves symptoms due to
A
- Impaired oxygenation (ishemia) of nerve
- Impaired local neural conduction
14
Q
Erb-Duchenne Palsy
A
- Injury to superior roots of Brachial Plexus (C5-C6)
- Traction injury
- Forceful pulling of head away from shoulder
- No senation over lateral arm (Loss of C5-C6 dermatomes
15
Q
Erb-Duchenne Palsy
Waiter’s Tip Position
A
- Arm Adducted
- Medial rotation
- Elbow extended
- Forearm pronated
- Wrist and fingers flexed
16
Q
Klumpke’s Paralysis
A
- Traction injury to lower brachial plexus
- Poor positioning at birth or pulled with forceps
- Median and ulnar lesions
- Claw hand
- Sensory loss for C8-T1 dermatomes
- Can get Horner’s Syndrome
17
Q
Horner’s Syndrome
(On affected side)
4 points
A
- Miosis - constriction of pupil
- Ptosis - Drooping of eyelid
- Anhydrosis - Loss of sweating to face and neck
- Enophthalmos - Recession of eyeball into orbit
18
Q
TOS
A
- Compression of brachial plexus from structures in thoracic outlet
- Thoracic outlet runs from Interscalene triangle to inferior border of axilla
- Subclavian artery and vein may also be compressed
19
Q
TOS Path
A
- Brachial plexus travels with subclavian artery between anterior and medial scalene
- Subclavian vein joins in after scalenes and then whole bundle goes under clavicle and the pec minor inserstion and down arm
20
Q
TOS Symptoms
A
- Pain, numbness, weakness, tingling in arm/upper thoracic area, or scapula
- Trophic changes in tissue with blood vessel compression
21
Q
TOS Locations
4 points
A
- Cervical Rib (additional rib at C7)
- Anterior Scalene Syndrome
- Costoclavicular Syndrome
- Pectoralis Minor Syndrome
22
Q
Cervical Rib syndrome
A
- Additional Rib at C7
23
Q
Anterior Scalene Syndrome
A
- Compression b/w anterior and middle scalene
24
Q
Interscalene Triangle
A
- Anterior Scalene
- Middle Scalene
- Rib 1
- Brachial Plexus and subclavian artery pass through. (Subclavian vein is anterior)
25
Costoclavicular Syndrome
* Compression b/w clavicle and rib 1
26
Pectoralis Minor Syndrome
* Compression b/w coracoid process and pec minor
27
Radial nerve branches before?
Supinator
28
Radial nerve Posterior Motor Branch
"Posterior Interosseous nerve"
* Enters supinator and travels down lateral radius to wrist
29
Radial Nerve Superficial Branch
* Travels down the posterior forearm to hand
30
Radial Nerve Lesion Causes
* Fractures - at spiral/radial groove
* Dislocations - Head of radius, humeroradial, radial ulnar jt
* Post-surgical complications
* Compression
31
Radial Nerve Lesion Symptoms
* Altered sensation at posterior arm and hand (digits 1, 2, 3, lateral 4)
* Wrist drop
* If injury proximal to elbow - motor and sensory affected
* If injury distal to elbow - only sensory OR motor affected
32
Crutch Palsy
* Radial nerve compression at axilla
33
Saturday Night Palsy
* Radial Nerve Lesion at spiral groove
* Direct pressure against firm object
* Deep sleep on arm (passed out on hard surface)
34
Posterior Interosseous Syndrome
* Comes off in front of lateral epicondyle
* Motor nerve
* Wrist drop
* Compression underneath supinator
35
Cheiralgia Parasthetica
* Compression of superficial branch of radial nerve under brachioradialis tendon
* Sensory
* Pain at dorsum wrist, thumb, webspace
* Cause: trauma, tight cast, swelling
36
36
Median Nerve Lesion Causes
* Fractures at elbow, wrist, carpals
* Dislocations at elbow, wrist, carpals
* Compressions
* Trauma
37
Ape Hand
* Median Nerve lesion
* Thumb in same plane as rest of hand due to no opposition
* Wasting of thenar eminence
38
Oath Hand
* Median Nerve Lesion
* Only digits 4 and 5 can flex when trying to make a fist
39
Median nerve lesion symptoms
* Can't grasp objects
* Can't pronate forearm, Flex PIP, DIPS of digits 2,3 (no air quotes)
* Weak wrist flexion, weak thumb movements
* Altered sensation digits 1,2,3, half of 4 (palmar)
40
Median Nerve Lesion Locations
* Ligament of Struthers
* Pronator Teres
* Carpal Tunnel
41
Ligament of Struthers
* From abnormal spur on shaft of humerus to medial epicondyle
* Median nerve compressed as it passes under
* Only in 1% of population
42
Pronator Teres Syndrome
* Median Nerve Lesion
* Compressed at proximal attachment of Pronator Teres
* Aching in anterior forearm
* Numbness in thumb/index finger
* Weakness in thenar eminence
43
Anterior Interosseous Syndrome
* Branch of Median Nerve
* Pinched/entrapped between 2 heads of pronator teres
* Pain and motor loss of Flex pollicis longus, lateral 1/2 FDP, and pronator quadratus
* Paralysis of flexors in index finger and thumb
44
Carpal Tunnel Syndrome
* Most common entrapment condition in arm
45
Carpal Tunnel Formed by
* Carpal bones
* Flexor retinaculum (attaches to scaphoid tubercle and trapezium)
46
Structures that pass through Carpal Tunnel
* Median Nerve
* Flexor Digitorum Superficialis
* Flexor Digitorum Profundus
* Flexor Pollicis Longus
47
Two ways compression can occur at carpal tunnel
1. Size of tunnel decreases
* Bony callus, space occupying lesion, RA bony changes
2. Size of contents passing through increases
* Repetitive actions, edema, fibrosis
* Retinaculum thickening from scar tissue (repeated trauma)
* Systemic conditions causing edema/fluid retention
48
Ulnar Nerve path at the wrist/hand
* Travels over flexor retinaculum b/w pisiform and hook of the hamate (guyon's canal)
49
Ulnar Nerve Lesion Causes
* Fractures (medial epicondyle, midforearm, wrist)
* Dislocations (elbow)
* Compression
* Repetitive actions
* Direct trauma
50
Ulnar Nerve Lesion Symptoms
1. Ulnar Claw Hand
* baby finger hyperextended and abducted at MCP and flexed at IP
* Ring finger hyperextended at MCP and flexed at IP
* Atrophy of interosseous membrane
2. mm wasting of hypothenar
3. Altered sensation of little finger + medial half ring finger
4. Fromont's sign positive
51
Froment's Sign
* Hold paper b/w thumb and index finger
* Adductor pollicis (innervated by ulnar nerve) needed for this
* Patient flexes thumb instead, using flexor pollicis longus
52
Tardy Ulnar Palsy
* Complication of fracture at elbow
* Occurs years after fracture
* Callus formation or valgus deformity of elbow
* Produces gradual stretching of the nerve in the ulnar groove at medial epicondyle
