Ch 9 - Neuromuscular Flashcards by Guy Greco

Which nerves originate proximal to the brachial plexus?

Dorsal scapular nerve and long thoracic nerve

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Dorsal scapular nerve originates where and supplies what muscles?

C4- C5

Rhomboids and levator scapulae

Rhomboids have 4 sides, C4-5

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Long thoracic nerve originates where and innervates what muscle?

C5-7

Serratus anterior

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(medial) Scapular winging occurs with what?

Damage to serratus anterior (long thoracic nerve)

SALTy WING MEal

SA=serratus anterior, LT= long thoracic, ME=medial

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What causes lateral winging of the scapula?

Damage to trapezius (CN11)

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When is long thoracic nerve commonly injured?

Very superficial and runs supraclavicular, so can be injured by carrying heavy objects on ones shoulder or during mastectomy

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Segments of brachial plexus?

Roots, Trunks, Divisions, Cords, Nerves

Republicans Think Democrats Cant Negotiate

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Roots of brachial plexus?

C5-T1

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Trunks of brachial Plexus?

Upper (C5-6)

Middle (C7)

Lower (C8-T1)

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Divisons of the brachial plexus divide??

Anterior = travels to ventral arm

Posterior = dorsal arm

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Cords of brachial plexus?

Lateral, Medial and posterior cords.

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Lateral Cord of the brachial plexus?

Consists of anterior division of C5-C6 and middle from C7

C5-C7

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Posterior Cord of the brachial plexus?

Consists of all divisions, C5-T1

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Medial Cord of the brachial plexus?

C8-T1

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Branches off the trunks of the BP?

suprascapular and nerve to subclavius

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Suprascapular nerve supplies?

Supraspinatus and infraspinatus

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Function of supraspinatus?Infraspinatus?

First 15 degrees of arm abduction

External rotation of the arm.

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Branches of the lateral cord?

Lateral cutaneous nerve of the forearm

Lateral pectoral nerve

Musculocutaneous

Median Nerve*

*Medial cord also contributes to median nerve

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Lesion of the lateral cord causes?

Sensory loss over the lateral forearm (LCN of forearm), and weakness of elbow and wrist flexion (musculocutaneous)

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Lateral pectoral nerve (C5-7) supplies ? function?

clavicular head of pectoralis major muscle.

Pulls shoulder forward.

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Musculocutaneous Nerve (C5-7) supplies what muscles? Function?

biceps, brachioradialis, coracobrachialis

supination of the forearm, elbow flexion, biceps reflex.

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Median nerve is supplied by what cord (s)?

Lateral and medial cords

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The part of the median nerve supplied by the lateral cord is responsible for sensation to?

Muscles?

Function?

Sensation to thumb, index, middle finger, (lateral ring finger is medial AND lateral cord)

pronator teres and flexor carpi radialis

pronator teres pronates the forearm, FCR flexes and abducts the wrist

Branches of the medial cord?

medial cutaneous nerve of the arm (C8-T1)

medial cutaneous nerve of the forearm (C8-T1)

Median Nerve (C8,T1 from medial cord, C5-T1 total)

Ulnar nerve (C7-T1)

Medial pectoral nerve (C8-T1)

Lesion of the lateral cord causes?

Sensory loss over medial forearm, weakness of long finger flexors, and weakness of intrinsic hand muscles.

Medial Pectoral Nerve innervates? function?

pec minor(lowers scapula and moves shoulder forward) sternal head of pec major (adducts the arm and rotates medially)

Part of median nerve supplied by the medial cord supplies? Function of median nerve?

APB (C8-T1) FDP 1 and 2 (C7-8) FDS (C7-T1) FPB (superficial head) (C8-T1) lumbricals 1 and 2 (C8-T1) Opponens pollicis (C8-T1) Palmaris longus (C7-T1) Pronator quadratus (C7-8) Flexion of thumb, index, middle finger, flexion of wrist, opposition of thumb, pronation of the forearm, abudction of the hand.

APB function

abducts the thumb perpendicular to the hand

FDP 1 and 2 function

flexion of the terminal phalanges

FDS function?

flexes the middle phalanges of the second, third, fourth, fifth fingers.

Superficial FPB function?

flexes the proximal phalanx of the thumb

FPL function?

flexion of the terminal phalanx of the thumb

Lumbricals 1 and 2 function

flex the MCP joint and extend the procimal and distal interphalangeal joints of the 2nd and 3rd digits.

Opponens pollicis fxn

opposition of the thumb

palmaris longus fxn

flexes the wrist

pronator quadratus fxn?

pronates the forearm

Sensory branches of the median nerve supply

thenar emninence, proximal palm, palmar aspect of first 3 digits and half of fourth digit.

Anterior Interosseous Nerve (branch of median nerve) innervates?

FPL (C5-7) FDP 1 and 2 (C5-7) Pronator quadratus (C7-8)

Anterior interosseous nerve injury syndrome?

Pain in the arm/forearm weakness in pronation (PQ) weakness in flexion of the terminal phalanx of the thumb (FPL) weakness in terminal phalanges of 2nd and 3rd digit (FDP 1 and 2) normal sensation (PURE MOTOR NERVE) Cannot make OK sign =\> teardrop sign

Signs of CTS?

weakness in APB, decreased sensation in the median distribution **with sparing of sensation of the thenar area because the palmar cutaneous branch arises proximal to the carpal tunnel.** **Ph**alens - elicited with wrist PHlexion **T**inel - **T**apping over median nerve at the wrist

What is the abnormal NCS finding in CTS?

prolonged distal latency in the median sensory (NCS can be normal in CTS)

Function of the ulnar nerve?

Ulnar flexion at the wrist, flexion of 4th and 5th digits, opposition and abduction of the 5th digit, thumb adduction, finger abduction and adduction

Issues with ulnar nerve causes what deformity?

Claw hand - hyperextension of MCP joints with flexion at interphalangeal joints.

Ulnar nerve supplies sensation to?

Fifth and half of fourth digit

List of muscles supplied by the ulnar nerve?

Abductor digiti minimi (C8-T1) Adductor pollicis (C8-T1) Flexor carpi ulnaris (C7-T1) Flexor digiti minimi (C8-T1) Flexor digitorum profundus 3+4 (C7-C8) Flexor pollicis brevis (deep head) (C8-T1) Interossei (C8-T1) Lumbricals III/IV (C8-T1) Opponens digiti minimi (C8-T1) Palmaris brevis (C8-T1)

Function of ADM?

abducts fifth digit

Function of adductor pollicis

adducts the metacarpal of the thimb

function of FCU

flexes the wrist and adducts the hand

function of flexor digiti minimi

flexes the fifth digit

function of flexor digitorum profundus III and IV

flexes the terminal phalanges of the fourth and fifth digits.

Function of deep head of flexor pollicis brevis

flexes and adducts the thumb

Function of the lumbricals III and IV?

flex the MCP joints and extend the proximal and distal IP joints of the third and fourth digits.

Function of interrosei?

flex the MCP joints and extend the proximal and distal IP joints. Palmar interosei adduct the fingers, dorsal interossei abduct the fingers.

Function of opponens digiti minimi?

opposition of the fifth digit.

Best way to differentiate an ulnar nerve lesion from a T1 radiculopathy?

Test APB (C8-T1) however is innervated by the MEDIAN NERVE