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Flashcards in Upper Limb Deck (44)
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1

At the superior surface of the shoulder, skin is innervated by what nerves?

Supraclavicular nn. (C4) that are branches of the cervical plexus

2

From the proximal to distal surfaces of the lateral side of the arm, skin is innervated by what nerves?

C5 of the brachial plexus

3

On the anterior side of the forearm from the proximal to distal surfaces of the lateral side, and on the posterior side, from the proximal end of the arm to the distal end of the forearm, including the pollex and index finger, skin is innervated by what nerve?

C6 of the brachial plexus

4

From the proximal to distal surfaces of the middle forearm, including index, middle, and ring fingers, skin is innervated by what nerve?

C7 of the brachial plexus

5

From the proximal to distal surfaces of the medial side of the forearm, skin is innervated by what nerve?

C8 of the brachial plexus

6

From the proximal to distal surfaces of the medial side of the arm, skin is innervated by what nerve?

T1 of the brachial plexus

7

At the upper medial surface of the arm (armpit), the skin is innervated by what nerve?

Iintercostobrachial nn. (T2,T3) that arrive from the intercostal segmental nn.

8

The biceps reflex test tests what nerve?

C5

9

The brachioradialis reflex test tests what nerve?

C6 mainly

10

The triceps reflex test tests what nerve?

C7 mainly

11

Extension of wrist associated with what nerve?

C6

12

Flexion of wrist associated with what nerve?

C7

13

Extension of fingers associated with what nerve?

C7

14

Flexion of fingers associated with what nerve?

C8

15

Adduction/Abduction of fingers associated with what nerve

T1

16

A herniated disc between vertebrae C4 and C5 involves what nerve root? What motor, reflex, and sensory abilities will be affected?

Impinges C5 nerve root.
Motor of deltoid and biceps affected.
Reflex of biceps affected.
Sensation of dermatome lateral border of arm affected.

17

When would you see Klumpke paralysis? What exercise would you ask patient to perform to determine this?

If ulnar nerve (C8,T1) was cut/had lesion as it runs over medial epicondyle, ulnar flexors would be lost, rendering patient unable to flex the metacarpophalangeal joints due to paralysis of interosseous and lumbricals mm.

Radial interphalangeal joints can still be flexed (innervated by median n.).
Ulnar digits cannot be flexed at all if the injury is at the forearm.
Muscles of mesothenar paralyzed if injury is at wrist/hand.
Ulnar digits can be flexed at PIP and DIP joints.

You would ask the patient to make a fist --claw hand

18

Besides the characteristic claw hand, what else might you see in Klumpke paralysis?

Atrophy of the interossei would lead to hollowing of the interosseous spaces between digits 2,3,4,5 in the metacarpus.

Sensory abnormalities confined to the little finger.

19

When would you see Froment's sign? What exercise would you ask patient to perform to determine this?

Froment's sign is a special test of the wrist. It tests for palsy of the ulnar nerve, specifically, the action of adductor pollicis.

To perform the test, you would ask patient to hold piece of paper in a pinch grip b/t thumb and forefinger. Thumb will not lay flat and when the examiner attempts to pull paper from grip, patient will have difficulty holding on to it.

20

What postures does Klumpke palsy produce?

How does it manifest in the newborn period?

1. flexion and supination of the elbow, extension of the wrist, hyperextension of the metacarpophlangeal joints, and flexion of the interphalangeal joints with the "claw hand" posture.

2. Manifests in the newborn period as weakness restricted to or mainly involving the hand. Usually there is no reflex or spontaneous movements of the intrinsic hand muscles.

21

Which nerves have been damaged in Erb-Duchenne palsy?

C5, C6
Usually suprascapular, musculocutaneous, and axillary nn.
This is a superior brachial plexus injury

22

What symptoms would you expect to see in Erb-Duchenne palsy?

"Waiter's tip position"
Arm is :
- adducted due to deltoid and supraspinatus weakness
- internally rotated due to teres minor and infraspinatus wakness
- extended due to biceps and brachioradialis weakness
- pronated due to supinator and brachioradialis weakness
And the wrist is flexed due to extensor carpi radialis longus and brevis weakness

23

What may cause Erb-Duchenne palsy in infants?

The most common cause of Erb's palsy is dystocia, an abnormal or difficult childbirth or labor.

- it can occur if the infant's head and neck are pulled toward the side at the same time as the shoulders pass through the birth canal.
- can also be caused by excessive pulling on the shoulders during a cephalic presentation (head first delivery), or by pressure on the raised arms during a breech (feet first) delivery

24

Paralysis of the deep branch of the radial nerve would lead to what symptoms? What exercise would you use to test for this?

In the case of a complete lesion, the hand cannot be extended -- "Wrist drop"

In the case of a partial lesion, you can test for paralysis by extending the metacarpophylangeal joints against resistance. When normal, tendons become prominent on the dorsum of the hand.

25

What nerve has become paralyzed if patient is asked to make a fist and shows "ape hand"?

Where is the nerve damaged if the radial forearm flexors are also paralyzed? Where is it damaged if they are not paralyzed so that digits can still be flexed?

Median nerve

The lesion would be at the forearm (ulnar flexors, which are innervated by the ulnar nerve are unaffected)

The lesion would be at the wrist/hand (as in carpal tunnel syndrome or other wrist injury)

26

If the hand cannot be extended, there is "wrist drop", or the tendons do not become prominent on the dorsum of the hand when patient is attempting to extend against resistance, what nerve is most likely damaged?

Deep branch of the radial n.

27

What symptoms are present with the paralysis of the median nerve?

Hand of benediction

At forearm:
- patient unable to flex the radial digits due to the paralysis of the radial forearm muscles
- Thenar muscles are paralysed, opposition and reposition of the thumb does not work = "ape hand"

At wrist/hand:
- "ape hand" b/c of thenar paralysis
- forearm flexors work, so digits can be flexed

28

What signs are characteristic of the hand of benediction?

When patient tries to make a fist, they can flex only the ulnar fingers. There may be associated sensory disturbances, particularly in the autonomous area of the nerve (tips of digits 1,2,3, and half of 4)

29

If patient is asked to lean against wall with arms outstretched, and scapula shows "winging", what nerve is likely damaged? What muscle is being paralyzed?

Long thoracic nerve (C5,6,7)

Serratus anterior m. is paralyzed

30

What is the cutaneous innervation of half of digit 4 and all of digit 5 including dorsum and palm of hand (ant and post sides of hand)?

Ulnar n.