Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BR 3rd Ed > Ch 5 - EDX: Plexopathies > Flashcards

Ch 5 - EDX: Plexopathies Flashcards

1
Q

What is a plexopathy?

A

Pathologic process occurring distal to the DRG and proximal to the peripheral
nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do plexopathies present?

A

ABN appear diffuse and will not follow any particular dermatomal or myotomal distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are common etiologies of plexopathies?

A

– Trauma (traction, transection, obstetrical injuries, compression, and hemorrhage)
– Cancer (tumor and radiation therapy)
– Idiopathic (neuralgic amyotrophy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do SNAP’s help in EDX of plexopathies?

A

Localize lesion above or below DRG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If a lesion is proximal how will SNAP and CMAP appear?

A

SNAP preserved

CMAP ABN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the main prognostic factor for plexopathy in EDX?

A

Distal CMAP amplitude because it represents axonal loss and should be compared side to side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do F-waves appear in plexopathy?

A

Delayed or absent

Nonspecific and cannot localize lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is H-reflex helpful for in plexopathy?

A

Evaluate the S1 pathway but not pathognomonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do EMG findings appear in plexopathy?

A

ABN activity in peripheral muscles in distribution of plexus injury but with normal paraspinal activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where does the brachial plexus originate?

A

Ventral rami of the C5–T1 nerve roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where do the ventral rami of the brachial plexus emerge?

A

b/w anterior and middle scalenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What happens in the posterior triangle of the neck?

A

C5 and C6 form the upper trunk
C7 forms the middle trunk
C8 and T1 form the lower trunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What happens as the trunks pass under the clavicle?

A

Form anterior and posterior divisions to become cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The cords are named in their relation to the __.

A

Axillary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which muscles are innervated by the musculocutaneous nerve and C5/C6 roots?

A

Biceps

Brachialis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which muscles are innervated by the musculocutaneous nerve and C5/C6/C7 roots?

A

Coracobrachialis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which muscles are innervated by the axillary nerve and C5/C6 roots?

A

Deltoid

Teres minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which muscles are innervated by the radial nerve and C5/C6 roots?

A

Supinator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which muscles are innervated by the radial nerve and C5/C6/C7 roots?

A

Brachioradialis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which muscles are innervated by the radial nerve and C6/C7/C8 roots?

A

ECR longus

Triceps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which muscles are innervated by the radial nerve and C7/C8 roots?

A 
ECR brevis
Ext digitorum
EIP
EDM
ECU
Abd pollicis longus
Ext pollicis brevis
Ext pollicis longus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which muscles are innervated by the radial nerve and C7/C8/T1 roots?

A

Aconeus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which muscles are innervated by the median nerve and C6/C7 roots?

A

Pronator teres

FCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which muscles are innervated by the median nerve and C7/C8 roots?

A

Plamaris longus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which muscles are innervated by the median nerve and C7/C8/T1 roots?

A

FDS: 4 muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which muscles are innervated by the median nerve and C8/T1 roots?

A 
FDP: 2 muscles
FPL
Pronator quadratus
Lumbricals: 2 muscles
Opp pollicis
APB
1/2 Flex pollicis brevis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which muscles are innervated by the ulnar nerve and C7/C8 roots?

A

FCU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which muscles are innervated by the ulnar nerve and C8/T1 roots?

A 
Palmaris brevis
FDP: 2 muscles
Dorsal interossei: 4 muscles
Plamar interossei: 3 muscles
Lumbricals: 2 muscles
1/2 Flex pollicis brevis
Hypothenar muscles
-Opp dig minimi
-Abd dig minimi
-Flex dig minimi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What makes up the posterior cord?

A

Posterior divisions of upper, middle and lower trunks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What makes up the lateral cord?

A

Anterior divisions of the upper and middle trunks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What makes up the medial cord?

A

Anterior divisions of the lower trunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What does the lateral cord split into?

A

Musculocutaneous branch and also fuses with the medial

cord to form the median branch

33
Q

What does the posterior cord split into?

A

Radial and axillary branches

34
Q

What does the medial cord split into?

A

Contribute to the median branch and the ulnar branch

35
Q

What is injured in Erb’s palsy?

A

C5-C6 nerve roots of upper trunk

36
Q

What is the etiology of Erb’s palsy?

A

Traction, compression, obstetrical injury or stinger from sports injury

37
Q

What is the classic arm position in Erb’s pasly?

A 
Waiter's tip 
Abducted (detloid and SS)
IR (teres minor and IS)
Extended (biceps and BR)
Pronated (supinator and BR)
Wrist flexed (ECRL and ECRB)
38
Q

Where is Erb’s point for EDX?

A

Stimulate at the tip of the C6 transverse process over the trunks of the brachial plexus

39
Q

What is the treatment for Erb’s palsy?

A

Rehabilitation, intermittent splinting and activity restriction

40
Q

What is injured in Klumpke’s Palsy?

A

C8–T1 nerve roots or lower trunk

41
Q

What is the etiology of Klumpke’s Palsy?

A

Obstetrical traction injury

Forced adduction seen in an MVA, falls, shoulder dislocations

42
Q

What is the clinical presentation of Klumpke’s Palsy?

A

Wasting of the small hand muscles and
a claw hand deformity (lumbrical weakness).
Shoulder girdle muscle function is preserved

43
Q

What will be seen on NCS in Klumpke’s palsy?

A

SNAP perserved if nerve root avulsed
Medial antebrachial cutaneous sensory response will be
absent or reduced

44
Q

Why is nerve root avulsion associated with C8 and T1 injury?

A

Lack of protective support at C8/T1

45
Q

What is injured in Thoracic outlet syndrome?

A

Injury involves the subclavian artery, subclavian vein, or axillary vein

46
Q

What is the clinical presentation of arterial involvement in Thoracic outlet syndrome?

A 
Limb ischemia
Necrosis
Vague pain
Fatigue
Decreased color and temperature
47
Q

What is the clinical presentation of venous involvement in Thoracic outlet syndrome?

A

Bluish, swollen, achy limb

48
Q

What is the etiology of neurologic thoracic outlet syndrome?

A

Compression of the lower trunk of the brachial plexus b/w a fibrous band, b/w the first cervical rib and clavicle (costoclavicular syndrome)
Muscular entrapment by the scalenes
or Pectoralis minor muscle

49
Q

What is the clinical presentation of TOS?

A

aiPn and numbness along the medial aspect of the forearm and hand, which
increases with overhead activity. Discomfort can in the neck, clavicle, and axilla

50
Q

What is seen on NCS in TOS?

A

Dec amp for the median CMAP, ulnar SNAP/CMAP, and medial antebrachial cutaneous studies Median SNAP is
spared

51
Q

What is seen on EMG in TOS?

A

ABN spontaneous activity median and ulnar hand muscles

52
Q

What are different names for Neuralgic Amyotrophy?

A 
Parsonage–Turner syndrome
Brachial neuritis
Brachial neuropathy
Idiopathic brachial plexopathy
Shoulder-girdle neuritis
Paralytic brachial neuritis
53
Q

What is the clinical presentation of Neuralgic Amyotrophy?

A

Abrupt onset severe pain in periscapular region
Exacerbated by rotation and abduction
Pain resolves in hours to 2-3 weeks
Develops weakness in patchy fashion

54
Q

How many presentations of Neuralgic Amyotrophy are bilateral?

A

1/3 of cases

55
Q

What are primary plexus tumors?

A

Schwannomas
Neuromas
Neurofibromas

56
Q

Which tumors can cause secondary plexus involvement?

A

Breast and lung

57
Q

What can radiation therapy cause?

A

Neural fibrosis and constriction of the vasa nervorum, leading
to destruction of the axon and Schwann cell

58
Q

Describe location and characteristics of radiation plexopathy.

A

Located Upper trunk
Painless sensation
Myokymia on EDX

59
Q

Describe location and characteristics of tumor plexopathy.

A

Located Lower trunk
Painful sensation
Horner’s syndrome

60
Q

What is the MC site of nerve root avulstion?

A

C8 and T1 roots

61
Q

What can determine the difference between a nerve root stretch and avulsion?

A

MRI

62
Q

What is seen on NCS in nerve root avulsion?

A

Absent CMAPs with normal SNAPs

63
Q

What is seen on EMG in nerve root avulsion?

A

Absent recruitment and

ABN spontaneous activity in a myotomal distribution, including the paraspinals

64
Q

What is the origin of the lumbar plexus?

A

Ventral rami of L1, L2, L3, and L4 roots

65
Q

What is the origin of the sacral plexus?

A

Ventral rami of L4, L5, S1, S2, S3, and S4 roots

66
Q

What do the ventral rami divide to form?

A

Anterior and posterior divisions in each plexus

67
Q

What does the anterior division of the lumbar plexus form?

A

Obturator nerve

68
Q

What does the posterior division of the lumbar plexus form?

A

Femoral nerve and the lateral femoral cutaneous nerve

69
Q

What are terminal branches directly off the lumbar plexus?

A

Iliohypogastric nerve
Ilioinguinal nerve
Genitofemoral nerve

70
Q

What does the anterior division of the sacral plexus form?

A

Tibial portion

71
Q

What does the posterior division of the sacral plexus form?

A

Common peroneal nerve

72
Q

Where does the lumosacral trunk connect?

A

L4 and L5 nerve fibers connect lumbar to sacral plexus and travel over the pelvic brim

73
Q

What are terminal branches directly off the sacral plexus?

A

Superior gluteal nerve

Inferior gluteal nerve

74
Q

What are common etiologies of lumbar plexopathies?

A 
Neuralgic amyotrophy
Neoplastic versus radiation plexopathy
Retroperitoneal bleed
Hip dislocation
Obstetric injuries/cephalopelvic disproportion: Presents as a postpartum foot drop
75
Q

What should be evaluated on NCS for lumbar plexopathy evaluation?

A

SNAP: Lateral femoral cutaneous nerve (L2–L3), saphenous nerve (L4)
CMAP: Femoral nerve (L2–L4)

76
Q

What should be evaluated on EMG for lumbar plexopathy evaluation?

A

Muscles innervated by the femoral nerve, obturator nerve, and the iliopsoas muscle.
Normal paraspinals

77
Q

What should be evaluated on NCS for sacral plexopathy evaluation?

A

SNAP: Superficial peroneal (fibular) nerve (L5), sural nerve (S1)
CMAP: Deep peroneal (fibular) nerve (L4–S1), tibial nerve (L5–S2)

78
Q

What should be evaluated on EMG for sacral plexopathy evaluation?

A

Muscles innervated by the tibial nerve, peroneal (fibular) nerve, and superior and inferior gluteal nerves.
Normal paraspinals

BR 3rd Ed (92 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions