Major Plexuses and Peripheral Nerves Arising from Them Flashcards
(99 cards)
1
Q
Composition of a spinal nerve
A
dorsal and ventral roots
2
Q
Each spinal nerve divides into:
A
ventral and dorsal ramus
3
Q
Dorsal ramus
A
innervates strip of skin and muscles along back
4
Q
Ventral Ramus
A
innervates anterolateral parts of trunk and limbs
5
Q
How does the ventral ramus innervate the thoracic region?
A
as intercostal nerves
6
Q
How does the ventral ramus innervate non thoracic region?
A
converge with each other to form network of nerve plexuses
7
Q
Function of brachial plexus
A
provides major sensory and motor innervation to upper limbs
8
Q
Function of lumbosacral plexus
A
provides major sensory and motor innervation to the lower extremities and pelvis
9
Q
Define Plexopathy
A
a type of neuropathy, pathology of plexuses causing motor/sensory dysfunction of extremities, may affet one trunk or all, may have acute or chronic presentation
10
Q
Plexopathy: causes
A
traumatic, mechanical compression by bony abnormalities, radiation, inflammatory lesions, neoplastic infiltration, diabetes
11
Q
C5-C6 plexopathy: alternative name
A
Erb-Duchenne palsy “waiter’s tip”
12
Q
C5-C6 plexopathy: symptoms
A
weakness of should er abduction, elbow flexion, arm supination, numbness of lateral aspect of forearm, arm held at side, internally rotated, with writ flexion
13
Q
C5-C6 plexopathy: main cause
A
accidents and newborns when head is pushed away from shoulder
14
Q
C8-T1 plexopathy: alternative name
A
Klumpke’s Palsy
15
Q
C8-T1 plexopathy: symptoms
A
severe hand weakness, atrophy, claw hand, numbness if medial aspect of hand and forearm
16
Q
C8-T1 plexopathy: when does Horner’s syndrome occur?
A
if the T1 root is damaged proximal to the sympathetic trunk
17
Q
Sypmtoms of Horner’s syndrome
A
ptosis, myosis (pupila pequeña) y anidrosis (no hay sudoracion)
18
Q
C8-T1 plexopathy: common cause
A
ussually occurs when the arm and shoulder are pulled up (upward traction) such as when grabbing a branch during a fall from a tree
19
Q
C8-T1 plexopathy: syndrome that can present this
A
neurogenic thoracic outlet syndrome and Pancoast Syndrome
20
Q
Neurogenic Thoracic Outlet Syndrome: pathology
A
lower brachial plexus is compressed between the clavicle and the first rib
21
Q
Neurogenic Thoracic Outlet Syndrome: symptoms
A
severe hand weakness with numbness/parethesias, increased by raising and external rotation of the arm…pain of hand (ulnar) ad arm usually not prominent but cna also involve the chest and shoulder
22
Q
Neurogenic Thoracic Outlet Syndrome: causes
A
caused by a cervical rib, bony abnormality, postural abnormalities, muscle imbalanca
23
Q
Neurogenic Thoracic Outlet Syndrome: secondary symtpoms
A
swelling of extremity/decreased pulses due to vacular compression
24
Q
Neurogenic Thoracic Outlet Syndrome: common patient
A
common in patients who pratice overhead arm activities
25
Pancoast Syndrome: pathhology
lower brachial plexus injury by an apical lung tumor (usually non-small cell carcinoma)
26
Pancoast Syndrome: symptoms
severe hand weakness, atrophy, numbness of medial aspect of hand and forearm and pain
27
Pancoast Syndrome: other diseases involved
Horner's symdrome sometimes and recurrent laryngeal nerve involvement
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Pancoast Syndrome: long run symptom
may eventually invade the entire plexus-completely weak, insensate arm
29
Idiopathic Brachial Plexitis: alternative name
Parsonage-Turner Syndrome
30
Idiopathic Brachial Plexitis: cause
an immune-mediated inflammatory process
31
Idiopathic Brachial Plexitis: onset characteristics
acute onset shoulde and arm pain (usually intense) followed by weakness and sensory loss
32
Idiopathic Brachial Plexitis: prognosis
usually resolves within days to weeks with some residual motor/sensory loss
33
Idiopathic Brachial Plexitis: patient arm position
arm in an elbow-flexion/should adduction position
34
Diabetic Lumbosacral Plexopathy: onset characteristics
begins rapidly over a few days to a few weeks
35
Diabetic Lumbosacral Plexopathy: definition
rare proximal neuropathy
36
Diabetic Lumbosacral Plexopathy: symptoms
burning, lancinating pain on hips and anterior thigh, followed by weakness and wasting of thigh muscles, causing bukling of knee due to quadriceps weakness
37
Diabetic Lumbosacral Plexopathy: location
mainly, asymmetric involvement of muscles supplied by L3 an L4 (quadriceps, hip adductors, ilepsoas) but can have weakness in any muscle innervated by the lumbosacral plexus
38
Diabetic Lumbosacral Plexopathy: causes
poor glycemic control in adult patientt
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Diabetic Lumbosacral Plexopathy: development
maximum defecit in wks, stable fr weeks to months, improvement over months to yrs
40
What does each peripheral nerve exiing the plexuses have>
axonal fibers from different spinal nerves
41
True or False: damage to a single spinal nerve will completely paralyze a limb
false
42
Region of sensory loss with neuropathy: radial nerve
posterior cutaneous nerve of arm, posterior cutaneous nerve of forearm, dorsal digital nerves
43
Region of sensory loss with neuropathy: median nerve
first three fingers (thumb index and el dedo malo)
44
Region of sensory loss with neuropathy: ulnar nerve
4th and 5th finger
45
Region of sensory loss with neuropathy: axillary nerve
skin where the deltoid muscle goes
46
Region of sensory loss with neuropathy: musculotaneous nerve
lateral forearm
47
Region of sensory loss with neuropathy: femoral nerve
medial thigh and leg
48
Region of sensory loss with neuropathy: obturator nerve
upper inner thigh
49
Region of sensory loss with neuropathy: sciatic nerve
lateral posterior leg, anterior medial leg
50
Region of sensory loss with neuropathy: tibial nerve
sole of foot
51
Region of sensory loss with neuropathy: superficial peroneal nerve
lateral leg and dorsum of foot (with fingers)
52
Region of sensory loss with neuropathy: deep peroneal nerve
la parte entre medio del hallucis and 2nd fingerr
53
Nerve motor function: radial nerve
extension of arm, wrist, and finger joints below the shoulder, forearm supination, thumb abduction
54
Nerve motor function: median nerve
thumb flexion and opposition, flexion of digits 2 nd 3, wrist flexion and abduction, forearm pronation
55
Nerve motor function: axillary nerve
abduction of arm at shoulder beyond first 15 degrees
56
Nerve motor function: musculotaneous nerve
flexion of arm at elbow, supination of forearm
57
Nerve motor function: femoral nerve
leg flexion at the hip, leg extension at the knee
58
Nerve motor function: obturator nerve
adduction of the thigh
59
Nerve motor function: sciatic nerve
leg flexion at the knee
60
Nerve motor function: tibial nerve
foot plantar flexion and inversion, toe flexion
61
Nerve motor function: superficial peroneal nerve
foot eversion
62
Nerve motor function: deep peroneal nerve
foot dorsiflexion, toe extension
63
Neuropathy of Peripheral nerves Arising from the Major Plexus: affecter fibers
sensory, motor, or both
64
Neuropathy of Peripheral nerves Arising from the Major Plexus: symptoms
decreased sensation, abnormal sensation, weakness, atrophy, and muscle twitching (fasciculation)
65
Neuropathy of Peripheral nerves Arising from the Major Plexus: causes
diabetes, infections, mechanical, toxins,
malnutrition, immune disorders, hereditary,
medications
66
Where do the palmar cutaneous branch of the median nerve arise?
prior to carpel tunnel, travels superficial to the flexor retinaculum of the hand
67
Is the palmar cutaneous branch of the median nerve involve in carpel tunnel?
no, it can be spared
68
Phalen’s and Tinel’s Signs: symptoms
increasing pressure in carpal tunnel, compression of median nerve, tapping over median nerve, reproduction of sensory symptoms
69
Carpal Tunnel Syndrome: pathology
Entrapment syndrome by compression of median nerve as passes under flexor retinaculum on flexor surface of wrist
70
Carpal Tunnel Syndrome: cause
Associated with repetitive stress injury of wrist, pregnancy, hypothyroidism…
71
What does the median nerve innervvate after it passes through carpal tunnel?
LOAF: Lumbricals I, II, opponens pollicis brevis, abductor pollicis brevis, flexor brevis pollicis- superficial head
72
Carpal Tunnel Syndrome: symptoms
Sensory loss of 1rst,2nd,3rd digits with abnormal sensation
| paresthesias)...May have Tinel’s sign and Phalen’s sign- provoke abnormal sensation (paresthesias
73
Common Peroneal Nerve Palsy: symptoms
Foot drop, with weakness of foot dorsifexion and eversion, and sensory loss over dorsolateral foot and shin
74
Common peroneal nerve passes around...
Common peroneal nerve passes around
| fibular head near skin surface
75
Common Peroneal Nerve Palsy: causes
Vulnerable to laceration, stretch injury by forcible foot inversion, or compression by stockings, cast, trauma
76
Common Peroneal Nerve Palsy: diseases to take into consideration in differential diagnosis
L5 radiculopathy
77
Femoral Neurpathy: symptoms
Weakness of thigh flexion, knee extension, loss of patellar reflex, and sensory loss in anterior thigh
78
Femoral Neurpathy: causes
pelvic surgery, diabetes
mellitus, compression by pelvic
mass ,retroperitoneal hematoma,
pelvic fracture
79
Femoral Neurpathy: diseases to take into consideration in differential diagnosis
Consider in the differential
diagnosis an L3 or L4
radiculopathy
80
Meralgia Paresthetica: pathology
Lateral femoral cutaneous nerve entrapped as passes under inguinal ligament and fascia lata
81
Meralgia Paresthetica: symptoms
Abnormal sensation (paresthesias) and loss of sensation in lateral thigh
82
Meralgia Paresthetica: associated conditions
Associated to obesity, pregnancy, weight loss, heavy equipment belts
83
Ulnar Neuropathy: common cause
Associated to trauma as passes in ulnar
| groove of elbow
84
Ulnar Neuropathy: pathology
entrapment due to
degenerative disease, habit of resting
elbows on hard table
85
Ulnar Neuropathy: symptoms
Weakness of wrist flexion and adduction, finger adduction and abduction, and flexion of 4th and 5th digits, together with sensory loss and paresthesias in ulnar
distribution
86
Ulnar Neuropathy: diseases to take into consideration in differential diagnosis
Differential diagnosis includes C8 and T1 radiculopathy, brachial plexus injury
87
Radial Neuropathy: common causes
Associated to sleeping with arm slung over
object, improper crutch use, tight wrist bands or
hand cuffs
88
Radial Neuropathy: symptoms
Weakness of extensors of arm, hand and fingers,
sensory loss in radial nerve distribution, often
with wrist drop
89
Sciatic Neuropathy: common causes
Associated to posterior hip dislocation, acetabular
fracture, intramuscular injection placed too medially and
inferiorly in buttocks
90
Sciatic Neuropathy: symptoms
Weakness of all foot and ankle muscles and of knee
| flexion, loss of Achilles tendon reflex
91
Sciatic Neuropathy: diseases to take into consideration in differential diagnosis
Differential diagnosis includes lesions in foot area of
| motor cortex
92
Case: 3 week-old infant with hx of complicated birth due to shoulder dystocia
(difficulty delivering the shoulder) presents right arm weakness. There was
significant traction on the right neck and shoulder during birth. Has Decreased tone of right arm, internally rotated at infants side with decreased spontaneous movements. No flexion at elbow nor
abduction. Prominent weakness of deltoid, biceps, infraspinatus, wrist
extensors. Right biceps reflex absent.
C5-C6 plexopathy
93
60 yo man with hx of lung cancer (apical) gradually develops severe
pain, with progressive weakness and numbness in his right arm. Pain is described as shooting, with swelling of the arm. Eventually, all strength and sensation is lost on the arm. Right arm and hand 0/5 strength with flaccid tone, absent DTR’s right arm, absent light touch, pinprick, vibration sense in entire arm up to the deltoid
Pancoast's Syndrome
94
Male pt develops pain and tingling in his right thumb, index and middle fingers that is worse at night.On exam
• decreased pinprick sensation as shown
• 4/5 weakness on right opponens pollicis
• Tinel’s and Phalen’s sign positive
Median nerve neuropathy (not C6-C7 radiculopathy because there is no neck pain that radiates)... mild weakness of right opponens pollicis
95
Male pt slipped on wet floor and twisted right foot
toward the left, causing pain and weakness.On exam:
• Decreased sensation to pinprick as shown
• 0/5 strength right tibialis anterior, 3/5
strength strength right foot evertors
Common peroneal nerve palsy (not L5 radiculopathy becausethere is no back pain with radiation, the onset of sensory deficit is rapid and there is specific foot weakness)
96
A diabetic male after weeks in intensive care unit notices weakness and numbness and tingling in left leg, over anterior thigh down to medial calf above foot. On exam
– Decreased pinprick sensation as shown
– 4/5 strength in left ileopsoas and quadriceps femoris, no other weakness, with absent left patellar reflex
peripheral femoral nerve lesion (not L2, L3, L4 radiculopathy because there is no back pain), not obturator nerve because there is no weakness of adduction of thigh
97
After giving birth, a woman develops pain and numbness in the right lateral thigh. On exam:
– Decreased sensation to pinprick as shown
– Motor strength and reflexes normal
Dysfunction of lateral femoral cutaneous nerve (not L2 radiculopathy because there is no back pain, and history of pregnancy)
98
Male patient develops tingling and numbness in his left 5th digit, in the medial aspect of his left fourth digit, and along medial surface of his left hand and forearm, exacerbated by resting elbows on hard surface On exam:
– Decreased sensation to pinprick as shown
– Weakness of left 5th finger abduction
Ulnar Nerve lesion (not C8, T1 radiculopathy because no neck pain, and worsened by resting elbow on hard surface)
99
After a fall, a female patient is unable to move her right
foot and has a tingling sensation on her right lateral lower leg and foot.On exam
– Decreased pinprick sensation as shown
– Strength 0/5 right tibialis anterior, extensor hallicus
longus, foot invertors , foot evertors, and
gastrocnemius
– Strength 3/5 right hamstrings
– Absent right Achilles tendon reflex
Sciatic Nerve Lesion(not L5, S1 radiculopathy because no back pain)
