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Sem 2 Anatomy > Week 5 - Nerve injuries + locomotion > Flashcards

Week 5 - Nerve injuries + locomotion Flashcards

1
Q

What is thoracic outlet syndrome?

A

When thoracic outlet is impinged

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2
Q

Where is the thoracic outlet?

A

Between first rib, clavicle and scapula

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3
Q

What is cervical rib?

A

?

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4
Q

What kind of injuries can happen to the brachial plexus?

A
  1. Cervical rib - thoracic outlet syndrome
  2. Stab/bullet injuries
  3. Neoplasms
  4. Upper trunk injuries AKA C5 & C6- violent movement - head and shoulders (birth injury, “motorcyclist’s injury” - stretching head and neck away from the shoulder)
  5. Lower trunk injuries - arresting in a fall by hanging onto something
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5
Q

WHat nerves would be affected by upper trunk injuries?

A

Axillary nerve, musculocutaneous nerve, suprascapular nerve and median nerve

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6
Q

What effects are seen in suprascapular injuries?

A

Arm is medial rotation, slightly flexed wrist, increased flexor tone, deepened protonation to medial rotation

–> Described as Porter’s tip position

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7
Q

What are important nerves of the lower trunk?

A

Ulnar is most important

Some radial

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8
Q

What is one of the main branches of the radial nerve?

A

Posterior interosseous nerve

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9
Q

What is a big muscle innervated by radial nerve?

A

Triceps

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10
Q

What happens to the triceps if radial nerve is cut half-way down arm?

A

Triceps not completely paralysed as only one head of the triceps is innervated from a branch below the mid arm
- An early branch feeds the long head and another head is fed by a nerve from by the scapula

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11
Q

What happens to forearm, wrist and fingers if radial nerve is cut halfway down arm?

A

Extensors of forearm, wrist and fingers are affected

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12
Q

WHat are the two branches of the radial nerve past the elbow?

A

Long superficial

Deep branch - interosseous

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13
Q

What does the deep interosseous branch of radial nerve do in forearm/hand?

A

Supplies all of the muscles

Superficial is cutaneous

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14
Q

What does the annular ligament do?

A

Holds radius in place at the superior radial-ulnar joint

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15
Q

What happens if radias slips out of annular ligament?

A

If slips out, can go posteriorly and press onto the radial nerve. Same situation if fractured

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16
Q

When can wrist not be actively extended?

A

Radial nerve cut

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17
Q

How do you test for radial nerve damage, testing at the wrist?

A

Hold arms out, keep hands in same plane, hand will drop

= Wrist drop

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18
Q

WHat is the clinical use of muscle synergy?

A

Tight grip of the fist requires strong contraction of digital flexors, which cross the wrist joint. This also therefore flexes the wrist joint. Don’t want that so the wrist extensors contract
–> inability to form a tight grip is a functional disadvantage of paralysis of extensors of the wrist joint

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19
Q

What are two methods of testing for forearm/hand extensor paralysis?

A
  • Wrist drop

- Tight grip

20
Q

Where is the median nerve fairly superficial?

A

Upper arm

21
Q

What are some consequences of median arm injury?

A

Brachial artery could be cut –> blood loss

22
Q

Where can the median nerve be commonly injured?

A

At the elbow

23
Q

What would be consequences of median nerve paralysis?

A

Most flexor muscles in the arm paralysed, apart from FCU and 1/2 FDP

24
Q

Which branch/branches of the median nerve are NOT injured at the elbow?

A

anterior interosseous nerve

25
Q

Where is the anterior interosseous nerve?

A

Deep branch of median nerve runs between FCU and FDP, runs almost on the interosseous membrane = anterior interosseous nerve

26
Q

How can you tell at the fingers if whole median nerve is gone?

A

There is no flexor tone to keep index and middle finger slightly flexed because complete ulnar FDP tone has been lost –> they stay straight

27
Q

What change is at the thenar muscles when median nerve is injured?

A

They get paralysed

  • thumb also straightens out into partial extension because of increased extensor tone
  • -> there would be no issue if just thenar was paralysed bc there are other muscles that can do the job as well
28
Q

Which finger lumbricals are innervated by median nerve?

A

Index and middle finger

29
Q

What sensory loss occurs if median nerve is paralysed?

A

Thumb, index, middle and half ring finger would lose sensation
–> variable though

30
Q

Which nerves pass through carpal tunnel?

A

Median and radial

NOT ULNAR

31
Q

Describe carpal tunnel syndrome

A

Compression in the carpal tunnel leads to increased pressure –> paresthesia
Increased compression –> pain, motor effects

32
Q

What happens to nerves compressed for a long time in carpal tunnel?

A

Loss of sensation, scarring, paralysis

33
Q

What’s the progression of carpal tunnel syndrome?

A

Can be temporary or long term

34
Q

What’s the progression of carpal tunnel syndrome?

A

Can be temporary/transient or long term

35
Q

What can cause carpal tunnel syndrome?

A
  • The tendons in there are surrounded by synovial sheets, which can be prone to inflammation –> secretion of fluid, gets bloated = increase in pressure
  • Could just be excess fluid in the body i.e. menopause. Pain would be worse at night
  • Bone problems
36
Q

How can you relieve pressure in CT syndrome?

A

Slice flexor retinaculum

37
Q

What happens if ulnar nerve is paralysed above elbow?

A

FCU is paralysed, as is 1/2 FDP
But, intrinsic muscles of the hand, other than the thenar, are all supplied by ulnar
Interosseous normally flex distal interphalangeal joint and extend interphalangeal joint
–> lose fine movements at the hand

38
Q

What is the physical manifestation of loss of ulnar nerve at forearm/wrist?

A

Ulnar claw hand

39
Q

How do you tell if a lesion in the ulnar nerve is high?

A

Lose FDP

Medial two fingers may be straight

40
Q

What does loose connective tissue do in the wrist?

A

Fills up the space between long flexor tendons, and the metacarpals etc

41
Q

Where is the partition of loose connective tissue in the hand?

A

Walls off thenar muscles and adductor pollicis from the rest of the hand

42
Q

What happens if LCT partition gets inflamed in the hand?

A

Severe inflammation

LCT starts producing more collagen so that infection gets walled off

43
Q

Where is mid palmar space?

A

The side of the hand’s partition containing the hypothenar

44
Q

Where is thenar space?

A

On the thenar side of the LCT partition in the hand

45
Q

Where is thenar space?

A

On the thenar side of the LCT partition in the hand

46
Q

Where is loose connective tissue found in the hand?

A

Between long flexors and interossei/adductor pollicis

47
Q

Where do lumbricals attach distally?

A

To the tendons of the interossei muscles

Sem 2 Anatomy (15 decks)

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