415-416 - Hands, lower extremities, neuromuscular pairing Flashcards
Is clawing more pronounced with proximal or distal lesions? Which nerves can cause it?
distal lesions of median or ulnar nerves
When do deficits present with proximal lesions?
during voluntary flexion of the digits (i.e. making a fist)
When would you see an ulnar claw?
In patients with a distal ulnar nerve lesion when extending fingers or at rest
When would you see a Pope’s blessing?
In patients with a proximal median nerve injury when they try to make a fist
When would you see a median claw?
In patients with a distal median nerve lesion when extending fingers
When would you see an “OK gesture”?
In patients with a proximal ulnar nerve injury when trying to make a fist
Match these findings according to what they look like: ulnar claw, median claw, OK gesture, Pope’s blessing
Ulnar claw = Pope’s blessing
Median claw = OK gesture
What nerve lesion can lead to atrophy of the thenar eminence?
median
What nerve lesion can lead to atrophy of the hypothenar eminence?
ulnar nerve
What three muscles make up the thenar (median) eminence?
- Opponens pollicis
- Abductor pollicis brevis
- Flexor pollicis brevis
OAF: Oppose, Abduct, Flex
What three muscles make up the hypothenar (ulnar) eminence?
- Opponens digiti minimi
- Abductor digiti minimi
- Flexor digiti minimi brevis
OAF: Oppose, Abduct, Flex
Which muscles abduct the fingers?
Dorsal interosseous muscles
DAB = Dorsals ABduct
Which muscles adduct the fingers?
Palmar interosseous muscles?
PAD = Palmars ADduct
What do the lumbrical muscles do?
Flex at the MCP
Extend PIP and DIP joints
What is a common cause of injury to the obturator nerve?
pelvic surgery
What spinal roots contribute to the obturator nerve?
L2-L4
A patient has ↓ medial thigh sensation and ↓ adduction. Which nerve is implicated?
Obturator (L2-L4)
What are the roots of the femoral nerve?
L2-L4
What injury often causes injury to the femoral nerve? What symptoms would you check for?
pelvic fracture; ↓ thigh flexion and leg extension
What are the roots of the common peroneal nerve?
L4-S2
Which injuries would make you concerned about common peroneal nerve damage?
- Trauma or compression of lateral aspect of leg
2. Fibular neck fracture
What signs would indicate peroneal nerve damage?
- Foot drop - inverted and plantarflexed at rest, loss of eversion and dorsiflexion
- “Steppage gait”
- Loss of sensation on dorsum of foot
What are the roots of the tibial nerve?
L4-S3
What are three injuries/conditions that can injury the tibial nerve?
- Knee trauma
- Baker cyst (proximal lesion)
- Tarsal tunnel syndrome (distal lesion)
How does a tibial nerve injury present?
- Inability to curl toes
- loss of sensation on sole of foot
- Proximal lesions: foot everted at rest with loss of inversion and plantarflexion
What are the roots of the superior gluteal nerve?
L4-S1
What are two injuries/conditions that can lead to superior gluteal nerve damage?
- Posterior hip dislocation
2. Polio
What are the signs of a superior gluteal nerve injury?
Trendelenburg sign/gait – pelvis tilts because weight-bearing leg cannot maintain alignment of pelvis through hip abduction (superior nerve → gluteus medius and minimus)
In the trendelenburg sign/gait, is the lesion ipsilateral or contralateral to the side of the hip that drops? Ipsi- or contralateral to the extremity on which the patient stands?
Lesion is contralateral to the side of the hip that drops; ipsilateral to the extremity on which the patient stands
What are the roots of the inferior gluteal nerve?
L5-S2
What is an injury that often leads to inferior gluteal nerve damage?
Posterior hip dislocation
How does an inferior gluteal nerve lesion present?
- Difficulty climbing stairs, rising from seated position
2. Loss of hip extension (inferior nerve → gluteus maximus)
What does the peroneal nerve do?
Peroneal Everts and Dorsiflexes; if injured, foot dropPED
What does the tibial nerve do?
Tibial Inverts and Plantarflexes; if injured, can’t stand on TIPtoes
What are the roots of the sciatic nerve?
L4-S3
What is the distribution of the sciatic nerve?
posterior thigh, splits into common and peroneal tibial nerves?
What artery runs with the long throracic nerve in the axilla/lateral thorax?
Lateral thoracic artery
What artery runs with the axillary nerve at the surgical neck of the humerus?
Posterior circumflex artery
What artery runs with the radial nerve at the midshaft of the humerus?
Deep brachial artery
What artery runs with the median nerve at the distal humerus/cubital fossa
Brachial artery
What artery runs with the tibial nerve at the popliteal fossa?
Popliteal artery
What artery runs with the tibial nerve posteriorly to the medial malleolus?
Posterior tibial artery
