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PMR > Brachial Plexus > Flashcards

Brachial Plexus Flashcards

1
Q

List rotator cuff muscles and their nerve supply

A
  1. Supraspinatus - innervated by suprascapular nerve (C5,6)
  2. Infraspinatus - innervated by suprascapular nerve (C5,6)
  3. Teres minor - axillary nerve
  4. subscapularis - subscapular nerve
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2
Q

dorsal scapular nerve innervates

A

C5
Rhomboid major
Rhomboid minor
Levator scapula muscle

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3
Q

Long thoracic nerve of Bell

A

C5- C7

Serrates anterior

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4
Q

suprascapular nerve

A

C5,6

  • supraspinatus
  • infraspinatus
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5
Q

nerve to subclavius

A

C5 ,6

- subclavian muscle

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6
Q

lateral pectoral nerve

A

C5,6,7

- pectorals major

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7
Q

inferior sub scapular nerve

A

subscapularis M
Teresa Major
C5,6,7

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8
Q

superior ubscapular nerve

A

C5,,6,7

- subscapular muscle

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9
Q

thoracic dorsal nerve

A

C5,6,7

- latissimus dorsal muscle

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10
Q

What nerves come off the medial division

A
  1. medial cutaneous nerve of arm
  2. medial cutaneous nerve of forearm
  3. medial pectoral nerve
  4. median nerve
  5. ulner nerve
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11
Q

what nerves come from posterior division

A

(C5, T 1

  1. inferior sub scapular nerve
  2. superior sub scapular nerve
  3. thoracodorsal nerve
  4. axillary nerve
  5. radial nerve
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12
Q

what nerves come from lateral division

A
  1. lateral pectoral nerve
  2. musculocutanous nerve
  3. median nerve
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13
Q

what muscles does the musculocutanous nerve supplies

A

biceps brachii
brachialis
corocobrachialis

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14
Q

what muscle does the axillary muscle supply

A

teres minor

deltoid

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15
Q

median nerve - 5 sites of compression

A
  1. brachial artery aneurysm
  2. Struthers Ligamanet
  3. lacerates fibrosus
  4. Pronator Teres Syndrome
  5. Anterior interosseous nerve
  6. CTS
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16
Q

Struthers Ligamanet

A

Struthers’ ligament is a feature of human anatomy consisting of a band of connective tissue at the medial aspect of the distal humerus. It courses from the supracondylar process of the humerus (also known as avian spur) to the medial humeral epicondyle (compress median nerve) .

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17
Q

lacertus fibrosus

A

bicipital aponeurosis (AKA lacertus fibrosus) is a broad aponeurosis of the biceps brachii which is located in the cubital fossa of the elbow and separates superficial from deep structures in much of the fossa. The bicipital aponeurosis originates from the distal insertion of the biceps brachii.

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18
Q

motor supply of Median Nerve

A 
PT 
FCR 
Palmer's 
FDS 
AIN*  ( unable to make okay sign)

LOAF

Palmar cutaneous branch - before going through carpal tunnel

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19
Q

AIN supplies

A 
AIN branch of median nerve 
Supplies 
- FDP 
- FPL 
- PQ ( Pronator quadratus)
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20
Q

Sensory distribution of Median nerve

A
  1. medial palmar aspect of hand
  2. distal end of 1,2,3 digit and half of 4th
  3. palmar
  4. thenar eminence
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21
Q

Ulnar nerve branches

A 
FCU
FDP ( 3rd ,4th) 
Abductor DMinimi 
Opposes DM
Flexor DM

Lumbricles
Interossei
FPB
abductor pollicus

dorsal ulnar cutaneous
digital branch

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22
Q

Ulnar sensory

A
  1. palmar aspect ( 1/2 4th, 5th)

2. dorsal - 4th and 5th

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23
Q

Ulnar compression sites

A
  1. axillary artery
  2. Arcade of struther
  3. retrocondylar groove (medial epicotyl and olecranon
  4. Cubital tunnel in forarm ( 2 muscles FCU and PDP ) - medial
  5. Guyons Canal (hook of hamate and piriformis )
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24
Q

Arcade of struther

A

in middle of the arm, ulnar nerve pierces medial intermuscular septum and descends in front of the medial head of the triceps;
- in 70-80% of individuals, nerve passes under arcade of Struthers

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25
Q

radial nerve branches

A
  1. triceps
  2. Anoconeous
  3. Brachioradial
  4. ECRL
  5. ECRB

becomes the posterior interosseous nerve

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26
Q

posterior interosseous nerve branche

A 
Suprascapular 
ECU 
ED comminus 
EDMinimi 
Abductor PL 
EPL 
EPB 
EIP
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27
Q

Radial nerve compression

A
  1. Axillary artery - crutch
  2. long and medial head of triceps
  3. SPIRAL GROOCE
  4. Brachialis and brachioradialis
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28
Q

Saturday night Palsy

A

wrist drop
finger drop
spares elbow extension

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29
Q

Sensation of radial nerve

A

PCNA
PCNF
Inferior lateral Cutaneous N of arm
Superficial branch - dorsal of hand

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30
Q

innervation APL

A

radial C7-C8

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31
Q

APB

A

median C8, T1

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32
Q

Adductor policus

A

ulnar C8, T1

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33
Q

EPB

A

radial C7, C8

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34
Q

EPL

A

radial C7, C8

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35
Q

FPL

A

median C8, T1

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36
Q

FPB

A

median / ulnar C8, T1

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37
Q

Opponeous Polices

A

Median C8,T1

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38
Q

3 shoulder external rotators of the arm

A

infraspinatous
teres minor
posterior deltoid

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39
Q

Martan Guber Anastamosis

A

ulnar and median anastomosis

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40
Q

3 areas of compression in Thoracic outlet syndrome

A
  1. Scalene
  2. Costoclavicular syndrome - 1st rib and clavicle
  3. Cervical rib
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41
Q

Rieche cano anastamosis

A

deep branch of ulnar to recurrent branch of recurrent nerve

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42
Q

Romans ROber anastomosis

A

deep ulnar –> posterior interosseous nerve anastomosis

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43
Q

Ligament of Strutters

A

2 cm bone spur 3-6cm proximal to medial epicondyle

44
Q

Clinical if LOS causes median nerve entrapment

A 
before all muscles are given off 
weak in all muscles 
- weak grip FDS FDP 
- wrist flexion (FCR) 
- dull ache in forearm
45
Q

EMG LOS causes median nerve entrapment

A

SNAP And CMAP - abnormal

46
Q

treatment LOS causes median nerve entrapment

A

Rehab and surgery

47
Q

Clinical if Lacerates Fibrosis causes median nerve entrapment

A
  • all muscles will be affected
48
Q

Pronator Teres Syndrome

A

muscle compresses nerve - either before or after it gives its innervation

49
Q

Anterior Interosseous Syndrome cause

A 
injury to the motor branch of the median nerve 
Supplies (FDS, PQ, FPL) 
- idiopathic 
- fracture of the forearm or humerus 
- laceration 
- compression
50
Q

Clinical appearance of Anterior Interosseous Syndrome

A

The patient may demonstrate a positive “OK” sign (Figure 5–85) or have difficulty forming a fist (Figure 5–86) because of an inability to approximate the thumb and index finger (FPL, FDP weakness). Sensation is spared.

51
Q

.EMG finding of Anterior Interosseous Syndrome

A

Sensory - NORMAL

CMAP - possible abnormal activity to PQ

52
Q

MILD Degrees of CTS

A

Mild

  • numbness, paresthesias, or dysesthesias radiating to the first, second, third, and lateral fourth digits.
  • exacerbated during sleep
  • relieved with wrist shaking.
53
Q

Moderate CT S

A

Moderate

  • continuous sensory deficits in the median nerve distribution- the entire palm and radiating proximally
  • ability to handle fine objects is impaired.
54
Q

Severe CTS

A

complain of severe sensory loss and muscular atrophy of the thenar emi- nence.

55
Q

Severe CTS

A

complain of severe sensory loss and muscular atrophy of the thenar emi- nence.

56
Q

NCS findings for Mild CTS

A

SNAP: Prolonged latency
CMAP: Normal
EMG- normal

57
Q

NCS for moderate CTS

A

SNAP: Plus a decreased amplitude
CMAP: Prolonged latency
EMG - normal

58
Q

NCS for severe CTS

A

SNAP: Absent
CMAP: Plus a decreased amplitude
Emg - abnormal activity

59
Q

Poor outcome with conservative management may occur with:

A
  • Symptoms greater than 10 months in duration
  • Constant paresthesias
  • Positive Phalen’s Test in less than 10 seconds
  • Weakness, atrophy
  • Marked prolonged latency on NCS
  • Abnormal spontaneous activity on EMG
60
Q

indication for surgery

A
  • muscle atrophy
  • severe pain
  • failed conservative measures
61
Q

ulnar course before giving its branches

A

The nerve descends along the medial surface of the medial head of the triceps. It runs within a deep groove of thick fascia, the Arcade of Struthers. It continues posteriorly in a sulcus between the medial epicondyle and olecranon, called the retrocondylar groove.

62
Q

• Arcade of Struthers (AOS)

A

fascial band that connects the brachialis to the triceps brachii.

63
Q

What nerve can be injured with going through AOS

A

ULNAR nerve

64
Q

clinical pictures of AOS entrapment of

A
  • all ulnar nerve muscles will be affected
  • may get radial deviation because weak FCU
  • abnormal sensation in ulnar distribution
65
Q

Ulnar claw hand

A

While the hand is at rest, an unopposed pull of the EDC causes partial finger flexion of the fourth and fifth PIP and DIP joint due to exten- sion of the MCP.

66
Q

froment sign

A

This test demon- strates an inability to hold a piece of paper by the thumb and index finger with pure thumb adduction (adductor pollicis weakness). The patient substi- tutes the median innervated FPL muscle, causing flexion of the interphalangeal joint.

67
Q

Wartenberg’s Sign:

A

nability to adduct the fifth digit. (Interossei weakness). Therefore digiti minimi lies abducted since unopposed

68
Q

NCS for ulnar nerve entrapment at AofS

A

SNAP: Abnormal dorsal ulnar cutaneous (DUC) and ulnar nerve findings
CMAP: Abnormal

69
Q

Tardy Ulnar Palsy

A

ulnar neuropathy that can occur months to years after a distal humerus fracture
- nerve can be injured secondary to a trauma that results in bone overgrowth or scar formation. Nerve traction can occur from an increased carrying angle due to a values deformity at the elbow

70
Q

Cubital Tunnel Syndrome

A

most common site of elbow entrapment. It is bordered by the medial epicondyle and olecranon with an overlying aponeurotic band.
- nerve can be injured from compression beneath the prox- imal edge of the FCU aponeu- rosis or arcuate ligament.

71
Q

What muscles involved in Cubital Tunnel Syndrome

A

ALL ulnar muscles - similar to simp of AOS
FCU may or may not be involve
Tingles sign - positive over cubital tunnel

72
Q

NCS and EMG of Cubital Tunnel Syndrome

A

SNAP: Abnormal findings in
the dorsal ulnar cutaneous and ulnar nerve
CMAP: Approximately 10 ms drop of conduction velocity across the elbow

73
Q

Shea’s System for calcification of ulnar nerve injury at guyots canal

A

Type 1 - hypothenar and deep ulnar branches
Type 1 : deep ulnar branches
Type 3: superficial ulnar sensory branch

74
Q

NCS and EMG finding of Guyon canal ulnar nerve injury

A

NCS
SNAP: DUC nerve is spared, ulnar nerve to the fifth digit is abnormal
CMAP: Abnormal

EMG
Abnormal activity in the ulnar nerve innervates hand muscles

75
Q

clinical finding of Guyon canal ulnar nerve injury

A 
intrinsic muscles 
- 4 dorsal interossei  
- 3 palmar interossei
- 2 lumbricles 
1 adductor polices 
- 1/2 FPB 
PLUS 
- hypothenar muscle, opposes DM, abductor DM, Flexor DM

painless wasting of the FDI.

severe claw hand may occur (lumbrical weak- ness) while the FDP remains intact causing marked finger flexion.

76
Q

Crutch Palsy

A
  • damage to the radial nerve but can also involved median axillary and supra scapular nerve
77
Q

Clinical Crutch palsy

A
  • weakness in triceps

- sensation decreased over the posterior arm and forearm

78
Q

crutch palsy NCS and EMg

A

SNAP - may or may not be abnormal
CMAP - may or may not be abnormal
EMG - abnormal activity in the radial nerve innervated muscle

79
Q

Spiral Groove injury

A

Radial nerve injury

- also known as Saturday night Palsy or Honeymooner Plays

80
Q

Clinical Spiral Groove injury

A

SPARES - triceps and anconeous (elbow extensors)

All other radial nerves involved - weakness of elbow flexion (BR weakness)

  • supination (supinator weakness)
  • wrist drop (ECRL, ECRB, ECU weakness
  • finger extension (EDC weakness)

Sensory deficits may occur in the dorsal aspect of the hand and posterior arm

81
Q

Differential Dx of Wrist Drop

A
  1. Diffuse polyneuropathy : LEAD
  2. Mononeuropathy - PIN, radial nerve
  3. Plexopathy - posterior cord, upper trunk, middle truck
    Radiculogpthy C6 and C7
    SCI/ TBI / CVA
82
Q

PIN syndrome

A
  • PURE MOTOR Syndrome
83
Q

PIN syndrome cause

A
  1. injury to nerve at Arcade of Frohse

2. Injury by lipoma, cyst, synovitis from RA or a Monteggia fracture

84
Q

Clinical PIN

A
  • normal function of Triceps, ancones, BR, ECRL and ECRB

Abnormal in all muscles supplied by PIN ECU, EDM, EDC, Abductor PL, EPL, EPB, EIP

  • distal extensor weakness
    pseudo claw hand deformity (finger extensor weakness)
85
Q

PIN NcS and EMG

A

SNAP - normal
CMAP - abnormal finding in muscle innervated by PIN

EMG - abnormal activity innervated by PIN including supinator

86
Q

Superficial Radial Neuropathy

A

also known as Cheiralgia Paresthetica or Wristwatch Syndrome

compression at the wrist from a wristwatch, tight hand-
cuffs, etc.

Pure sensory syndrome

87
Q

Clinical Superficial Radial Neuropathy

A
  • plain solely of sensory abnormalities including numbness, burning, or tingling on the dorsal radial aspect of the hand.
  • Discomfort may be exacerbated with palmar and ulnar wrist flexion or forced pronation.
88
Q

Treatment of l Superficial Radial Neuropathy

A

Interventions may include: rehabilitation and removal of the compressive irritant.

89
Q

fucking of EDC

A

extension of MCPs

90
Q

Lumbrical infection

A

Flexion MCP and PIP and DIP extension

91
Q

Dorsal interossei

A

MCP abduction (DAB)

92
Q

Palmar interosse

A

MCP abduction (PAD)

93
Q

heavy backpack with R shoulder weakness no pain, found to have a very weak right shoulder ER

A 
Rotator cuff tear 
C5- C6 nerve root damage 
C6-C7 NR injury 
SUPRASCAPULAR nerve injury (backpackers palsy) 
Impingement syndrome
94
Q

Arcade of Suthers entrapment damages what nerve

A

Ulnar

95
Q

Arcade of Frohse damages what nerve

A

Radial

96
Q

Ligament of strutters damages

A

Median nerve

97
Q

two special signs for ulnar neuropathy

A

Front sign

Waternberg sign

98
Q

Tardy ulnar nerve palsy

A

after a fracture

- entrapment anywhere along elbow

99
Q

Bilateral wrist drop but eaten their fingers

A

THINK: radial nerve damage - wrist drop

Extend fingers : lumbricles and interossi (innervated by ulnar and median nerve

100
Q

Ulnar neuropathy on elbow what not to do

A

external compression of ulnar nerve (leaning on table)

Stop smoking

101
Q

complains of painless wasting of the first dorsal interossei what does it mimic

A

MND
Ulnar neuropathy at Guyon’s canal - more specifically distal deep palmar motor lesion
Preserved strength of APB (C8-T1) muscles. In MND expect all C8 - T1 muscles to be equally

102
Q

Saturday night palsy

A

Radial nerve damage at spiral groove

Sensory loss to back of hand , some supination problems

103
Q

pronator syndrome sensory issue

A

median nerve in hand

104
Q

Pin will always spare

A

ECR
BR
triceps
Ancones

105
Q

neuralgic amyotrophy

A

Supra scapular nerve

106
Q

thumb motor and sensory sensation

A

Motor - all three , PIN, AIN and ulnar

Sensory - medial and radial

107
Q

Rhomboid weakness cause what type of winging

A

lateral winging and retraction

PMR (11 decks)

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