chapter 21

Question 1

Certain peripheral nerves are at an increased risk of injury due to their ANATOMICAL LOCATION what are they?

Answer 1

1) Superficial positioning of the nerve
2) nerve coursing through an area of trauma
3) Narrow pathways through bony or fibrous tissue canals

Question 2

Damage to this area results in paralysis of the serratus anterior muscle. what area is this?

Answer 2

Long thoracic nerve

Question 3

Without a functional serratus anterior, the scapula is not held against the thoracic wall. This is clinically referred to as?
-this also results in difficulty elevating the upper extremity above the horizontal plane

Answer 3

Winged scapula

Question 4

Compression at the SUPRASCAPULAR NOTCH will affect the following muscles?

Answer 4

1) Supraspinatus
2) infraspinatus

Question 5

Damage occurring at the SPINE OF SCAPULA will affect the following muscles:

Answer 5

Infraspinatus

Question 6

Damage to the supraspinatus results in?

Answer 6

difficulty in abducting the arm at the shoulder

Question 7

Damage to the Infraspinatus due to the SUPRASCAPULAR NOTCH results in?

Answer 7

Weakness with lateral rotation of the arm at the shoulder

Question 8

Damage to the Infraspinatus due to the SPINE OF SCAPULA results in?

Answer 8

Weakness with lateral rotation of the arm at the shoulder

Question 9

Damage to the medial brachial cutaneous nerve (MBC) results in:

Answer 9

there is a lack of sensation to the medial forearm

Question 10

Damage to the axillary nerve results in:

Answer 10

1) Shoulder weakness (except for adduction of the arm at the shoulder)
2) Sensory loss BELOW the LATERAL PART of the shoulder

Question 11

Non-traumatic compression of the medial nerve is predominantly caused by

Answer 11

slowly expanding lesions that are often vascular in nature

Question 12

Traumatic compression of the medial nerve such as __________________ may lead to medial nerve injury

Answer 12

SUPRACONDYLAR fracture

Question 13

Common neuropathies associated with median nerve include:

Answer 13

1) PRONATOR syndrome
2) ANTERIOR interosseous nerve syndrome
3) CARPAL tunnel sundrome

Question 14

What is a compression of the MEDIAL NERVE that occurs PROXIMALLY, near the area of the ELBOW called?

Answer 14

Pronator syndrome

Question 15

Pronator syndrome is commonly mistaken for?

Answer 15

carpal tunnel syndrome

Question 16

In pronator syndrome women are affected _______ times more often than men and it typically presents in the fifth decade of life

Answer 16

4

Question 17

Anatomy:
After souring through the MEDIAL COMPARTMENT of the ARM, the median nerve enters the ________________ and gives off the ANTERIOR INTEROSSEOUS NERVE (AIN). As the median nerve passes into the forearm, it gives supply to the pronator teres muscle and then courses between this muscles _______ heads of origin
-As a result, the pronator teres is usually _______, as it receives its innervation before it is pierced by the nerve
The nerve descends through the forearm, BETWEEN the flexor digitorum superficialis and _________________ muscles. ______________ to the flexor retinaculum, the median nerve gives off a _________________ that courses ANTERIOR to the flexor retinaculum to CUTANEOUS innervate the skin of the __________________. The medial nerve then courses THROUGH the _______________ and enters the hand

Answer 17

1) Cubital fossa
2) 2
3) Spared
4) flexor digitorum profundus
5) Proximal
6) palmer branch
7) Lateral palm
8) Carpal canal

Question 18

(Site of compression of the median nerve)
Sites of compression of the median nerve may be located near or within the ___________, as well as the proximal anterior forearm region.

Answer 18

cubital fossa

Question 19

Potential sites compression of the medial nerve include the :

Answer 19

1) Ligament of struthers
2) Bicipital aponeurosis or lacertus fibrosis
3) Pronator teres muscle
4) Arch of the flexor digitorum superficialis

Question 20

What is the ligament that lies between an anomalous supracondylar tubercle and the medial epicondyle called?

Answer 20

Ligament of struthers

Question 21

What is the part of the insertion of the biceps brachii muscle called?

Answer 21

Bicipital aponeurosis or lacertus fibrosis

Question 22

This is when the median nerve pierces between its two heads of origin?

Answer 22

Pronator teres muscles

Question 23

This is when the median nerve passes deep to the arch of this muscle, which is located between its origins?

Answer 23

Arch of the flexor digitorum superficialis

Question 24

1) easy fatigability of the proximal anterior forearm
2) TENDERNESS over the pronator teres muscles
3) Aching pain in the proximal anterior forearm associated with repetitive motions that cause HYPERTONICITY in the pronator teres
—— Repetitive motions include occupational activities such as hammering , shucking oysters, continual manipulation of tools
4) pain on resistance to PRONATION of the pronator teres muscle and resistance to FLEXION of the flexor digitorum superficialis muscle of digits 3 and 4
These symptoms are associated with what disease?

Answer 24

Pronator syndrome

Question 25

1) Numbness or paresthesia (a burning or prickling sensation) in the median nerve distribution
2) Positive TINEL’S test (digital tingling on percussion) over the proximal forearm, which typically takes 4-5 MONTHS to develop
3) These symptoms of this disease are insidious in onset, causing a DELAY in diagnosis that ranges from 9 MONTHS to 2 YEARS
These clinical presentation are associated with what disease?

Answer 25

pronator syndrome

Question 26

(Pronator syndrome) Weakness or lack of function of the:
1) Flexor digitorum superficialis muscle of digits ____ and ____ (flexion of digits ___ and ____)
2) Flexor carpi radialis muscle ( flexion and abduction of the hand and wrist)
3) Palmaris longus muscle (weak flexion of hand at the wrist)
4) Palmar branch of the median nerve ( cutaneous supply of the __________)

Answer 26

1) 3
2) 4
3) 3
4) 4
5) Lateral palm

Question 27

Important (Pronator syndrome) Associated deficits:
1) As a proximal or high lesion, this syndrome will also present with the clinical deficits of a ____________
Thus, in addition to the symptoms of pronator syndrome, the patient will also exhibit the symptoms of ___________________
furthermore, if compression of the median nerve occurs _________ to the location where the AIN branches off of the median nerve- at the pronator teres muscle, the ligament of struthers, or the bicipital aponeurosis- the patient will also present clinical deficits of __________________

Answer 27

1) distal lesion
2) carpal tunnel syndrome
3) proximal
4) Anterior interosseous nerve syndrome

Question 28

AIN syndrome is also called KILOH-NEVIN syndrome. It is a compression of the AIN that occurs along its pathway within the ________________. The AIN is purely ___________ therefore, there is no ____________ disturbance associated with the compression of this nerve. This syndrome can be the result of an injury to the __________ by direct trauma, compression or inflammation of the AIN. AIN accounts for fewer than ____ of all upper extremity neuropathies

Answer 28

1) Anterior forearm
2) motor
3) sensory
4) forearm
5) 1%

Question 29

(Anatomy of AIN syndrome)
After coursing through the _______________ of the ________ the median nerve enters the _____________ and gives off the AIN. The AIN courses distally along the ____________ of the interosseous membrane, BETWEEN the flexor digitorum profundus muscles

Answer 29

1) medial compartment
2) arm
3) cubital fossa
4) anterior surface

Question 30

(site composition of AIN syndrome)
Although uncommon, nearby muscular or neurovascular structures may apply pressure on the anterior interosseous nerve, compressing it against the __________________

Answer 30

anterior interosseous membrane

Question 31

Symptoms of AIN syndrome
1) Vague pain in the proximal forearm and ______ that increases with activity, especially repetitive forearm motion. This pain can be relieved by rest
2) Difficulty with ___________ or picking up small objects
3) An unusual pinch demonstrated by the ____________ interphalangeal (IP) joint of the __________ and the distal interphalangeal (DIP) joint of the _________

Answer 31

1) Wrist
2) writing
3) hyperextended
4) Thumb
5) index finger

Question 32

Clinical presentation of AIN syndrome:
1) the patient has difficulty with producing the ___ sign due to the hyperextened DIP joint of the index finger
2) The ________________ muscle is the FIRST muscle affected
3) Weakness or paralysis more commonly occurs with the ___________________ muscle and ___________________ muscle of the index finger (digit 2)
4) Weakness or paralysis less commonly with the middle finger (digit 3) and the _______________ muscle

Answer 32

1) Ok
2) Flexor pollicis longus muscle
3) flexor pollicis longus
4) flexor digitorum profundus
5) pronator quadratus

Question 33

(AIN syndrome)
Weakness or lack of function of the:
1) flexor pollicis muscle (__________ of the thumb at the IP joint)
2) Flexor digitorum profundus muscle of the digits _____ and _____ ( flexion of the digits ____ and ___ at the DIP
3) ______________ (pronation of forearm at the wrist)

Answer 33

1) flexion
2) 2
3) 3
4) 2
5) 3
6) pronator quadratus muscle

Question 34

Carpal tunnel is a syndrome in which compression of the _____________ occurs DISTALLY at the _________. it is also known as __________ syndrome.

Answer 34

1) medial nerve
2) wrist
3) carpal canal syndrome

Question 35

What is the most common nerve entrapment?

Answer 35

carpal tunnel syndrome

Question 36

carpal tunnel affects ______ of the ________ population and ________ of individuals in __________ settings

Answer 36

1) 1-3%
2) general
3) 5-15%
4) industrial

Question 37

What syndrome is more commonly occurs in patients who are middle age, female, diabetic, smokers and obese?

Answer 37

carpal tunnel

Question 38

(Carpal tunnel anatomy)
The median nerve courses THROUGH the ___________ and enters the hand. The ______________ is also known as the transverse carpal ligament. it covers the arch of the carpal bones into a canal through which the __________ courses. this is known as the ___________________.
-the lateral attachment of the flexor retinaculum consists of the ___________ and the __________.
- the medial attachment of the flexor retinaculum consists of the ________, the __________ and the __________

Answer 38

1) carpal canal
2) flexor retinaculum
3) median nerve
4) carpal tunnel or carpal canal
5) Scaphoid
6) trapezium
7) Pisiform
8) triwuetrum
9) hook of hamate

Question 39

The contents of the carpal canal include:
1)
2)
3)

Answer 39

1) 9 muscle tendons (4 tendons of flexor digitorum superficialis, 4 tendons of flexor digitorum profundus, and 1 tendon of flexor pollicis longus)
2) 2 bursae ( the radial and ulnar bursae)
3) 1 nerve ( medial nerve)

Question 40

(Site of composition)
Carpal tunnel syndrome occurs due toa compression of the ___________ the flexor retinaculum in the carpal canal

Answer 40

medial nerve under

Question 41

What are the symptoms of mild carpal tunnel syndrome?

Answer 41

1) OCCASIONAL tingling and numbness
2) awakening at night, usually intermittent
3) symptoms increase with activity
4) function is not significantly impaired
5) little or no decrease in GRIP and pinch strength

Question 42

What are the symptoms of moderate carpal tunnel syndrome?

Answer 42

1) regularly occurring tingling and numbness
2) decreased ability to distinguish between hot and cold
3) awakening at night with activity
4) NUMBNESS or pain when driving or reading
5) Some impairment: decreased sweat
6) DECREASE grip and pinch strength

Question 43

What are the symptoms of severe carpal tunnel syndrome?

Answer 43

1) CONSTANT numbness during the day and night
2) sensory symptoms are persistent
3) Function is significantly impaired
4) nerve is TENDER to deep pressure
5) significant and often debilitating decrease in grip and pinch strength
6) dropping things
7) inability to perform certain ADL’s (activities of daily living)

Question 44

Clinical presentation of mild carpal tunnel syndrome:

Answer 44

1) POSITIVE provocative (PINEL’S and PHALENS)
2) NO muscle atrophy
3) Middle finger most commonly involved

Question 45

Clinical presentation of MODERATE carpal tunnel syndrome:

Answer 45

1) POSITIVE provocative (PINEL’S and PHALENS)
2) Weakness of the thenar muscle, but not atrophy
3) middle finger and other areas of median nerve distribution may be involved

Question 46

Clinical presentation of SEVERE carpal tunnel syndrome:

Answer 46

1) TINEL’S and PHALENS may be NEGATIVE
2) Thenar ATROPHY
3) entire distribution of the median nerve is impacted

Question 47

Carpal tunnel causes weakness or lack of function of the:

Answer 47

1) Abductor pollicis brevis muscle (abduction of the thumb)
2) Flexor pollicis brevis muscle (superficial head and flexion o the thumb)
3) Opponens pollicis muscle (opposite of the THUMB)
4) Lumbricals (Digits 2 and 3) (Z-POSITION)
5) Digital branches of the median nerve (cutaneous supply of the LATERAL 3.5 DIGITS ANTERIORLY AND THEIR TIPS POSTERIORLY)

Question 48

Compression neuropathies of the ulnar nerve:
1) the pathway of the ulnar nerve makes it especially vulnerable to compression
2) common neuropathies associated with the ulnar nerve include:

Answer 48

1) CUBITAL tunnel syndrome
2) Guyon’s canal syndrome

Question 49

Cubital tunnel syndrome most often occurs in the?

Answer 49

right upper extremity

Question 50

Cubital tunnel syndrome
-Middle are men are affected _____ more often than women

Answer 50

3 times

Question 51

Cubital tunnel syndrome
-trauma to this nerve can be?

Answer 51

direct or indirect

Question 52

__________ to the nerve in the cubital tunnel may occur with fractures to the humerus or dislocation of the elbow joint

Answer 52

direct trauma

Question 53

_________ in cubital tunnel syndrome may occur with prolonged resting of the elbow on a hard surface or repetitive flexion motion of the elbow

Answer 53

indirect trauma

Question 54

The ulnar nerve courses through the ____________ of the ____ and pierces the _____________ of the _________________ as it passes from _______ to ______ comaprtment of the ____. The nerve then courses ____________ to the _______ of the humerus. It passes through the ___________ and passes BETWEEN the two heads of origin of the flexor carpi ulnaris muscle. In the distal forearm, the ulnar nerve gives off a ____ that CUTANEOUSLY innervates the ________ of the _____________________________.
_____________ to the flexor retinaculum, the ulnar nerve also gives off a ___________________ that courses _______________ to the flexor retinaculum to CUTANEOUSLY innervate the

Answer 54

1) medial compartment
2) arm
3) posterior lamina
4) medial intermuscular septum
5) medial
6) posterior
7) arm
8) posterior
9) medial epicondyl
10) cubital tunnel
11) dorsal
12) MEDIAL 1.5 digits and hand
13) proximal
14) palmer branch
15) anterior
16) skin of the MEDIAL PALM

Question 55

Sites of compression of the ulnar nerve may be located in the?

Answer 55

elbow region

Question 56

Compression of the ulnar nerve, may result in the?

Answer 56

Cubital tunnel syndrome

Question 57

Potential sites of compression of the ulnar nerve include:

Answer 57

1) medial intermuscular septum
2) medial epicondyle
3) cubital tunnel
4) flexor carpi ulnaris
5) deep flexor pronator aponeurosis

Question 58

The ulnar nerve pierces the ___________ in order to pass from the MEDIAL to POSTERIOR compartment of the ARM

Answer 58

medial intermuscular septum

Question 59

The ulnar nerve courses POSTERIOR to this bony prominence found on the medial side of the distal humerus. What is this?

Answer 59

Medial epicondyle

Question 60

The ulnar nerve passes through the fibro-osseous canal which is formed by the ulnar collateral ligament, trochlea of the humerus, and medial epicondylar groove of the humerus. The roof of this canal is formed by the triangular arcuate ligament, which is also known as Osborne’s ligament. What is this structure?

Answer 60

cubital tunnel

Question 61

The ulnar nerve passes between the two heads of origin of the _________________

Answer 61

Flexor carpi ulnaris muscle

Question 62

The ulnar nerve passes deep to the ____________ about 5cm distal to the medial epicondyle. the _____________ lies on the medial side of the forearm.

Answer 62

Deep flexor pronator aponeurosis

Question 63

Symptoms of cubital tunnel syndrome?

Answer 63

1) pain at the medial elbow
2) decrease ability in FLEXION of the wrist
3) Decrease ability in ADDUCTION of the wrist
4) weak grip and lateral pinch
5) Decrease ability or inability to cross fingers or spread them apart

Question 64

Clinical presentation of cubital tunnel syndrome:
1) Positive _________ at the cubital tunnel
2) Weak intrinsic of the hand
3) Positive ____________ sign in the advance stage
4) The hand to be drawn ___________ while flexing the wrist. This results from an imbalance due to an _________________________________
5) ______________ disturbance (numbness, paresthesia, dysesthesia) over the SKIN of the ________________ (hypothenar eminence), as well as the dorsum of the _________________ and hand

Answer 64

1) Positive TINEL’s at the cubital tunnel
2) Weak intrinsic of the hand
3) Positive FROMENT’s sign in the advance stage
4) The hand to be drawn LATERALLY while flexing the wrist. This results from an imbalance due to an INACTIVE FLEXOR CARPI ULNARIS AND AN ACTIVE FLEOR CARPI RADIALIS
5) SENSORY disturbance (numbness, paresthesia, dysesthesia) over the SKIN of the MEDIAL PALM (hypothenar eminence), as well as the dorsum of the MEDIAL 1.5 digits and hand

Question 65

(Cubital tunnel syndrome)
Weakness or lack of function of the:
1. Flexor carpi ulnaris muscle (weakened flexion and adduction of the hand at the wrist)
2. Flexor digitorum profundus muscle of digits __ and ___ (weakened flexion of digits __ and ____)
3. Palmer branch of the ulnar nerve (cutaneous supply of the _______)
4. Dorsal branch of the ulnar nerve (cutaneous supply of the _______ of the _____________)

Answer 65

1. Flexor carpi ulnaris muscle (weakened flexion and adduction of the hand at the wrist)
2. Flexor digitorum profundus muscle of digits 4 and 5 (weakened flexion of digits 4 and 5)
3. Palmer branch of the ulnar nerve (cutaneous supply of the MEDIAL PALM)
4. Dorsal branch of the ulnar nerve (cutaneous supply of the dorsum of the MEDIAL 1.5 DIGITS and HAND)

Question 66

(cubital tunnel syndrome)
Associated deficits
1.As a proximal or high lesion, this syndrome will also present with the clinical deficits of a ________ lesion
a.Thus, in addition to the symptoms of cubital tunnel syndrome, the patient will also exhibit the symptoms of Guyon’s canal syndrome

Answer 66

Associated deficits
1. As a proximal or high lesion, this syndrome will also present with the clinical deficits of a distal lesion
a. Thus, in addition to the symptoms of cubital tunnel syndrome, the patient will also exhibit the symptoms of _______________ syndrome

Question 67

Guyon’s canal syndrome
General information:
i. Guyon’s canal syndrome is also called ______________. It is a compression of the _______ nerve that occurs distally at the region of the _______

Answer 67

Guyon’s canal syndrome
General information:
i. Guyon’s canal syndrome is also called HANDLEBAR PALSY. It is a compression of the _________ nerve that occurs distally at the region of the _________

Question 68

Guyon’s canal syndrome
Anatomy:
i. The ulnar nerve travels distally in the anterior forearm BETWEEN the flexor carpi ulnaris and flexor digitorum profundus muscles
ii. It then courses through the Guyon’s canal in the wrist, ____________ to the ______________
iii. ___________ to the pisiform bone, the ulnar nerve divides into two branches, the superficial and deep branches

Answer 68

Guyon’s canal syndrome
Anatomy:
i. The ulnar nerve travels distally in the anterior forearm BETWEEN the flexor carpi ulnaris and flexor digitorum profundus muscles
ii. It then courses through the Guyon’s canal in the wrist, ANTERIOR to the CARPAL TUNNEL
iii. LATERAL to the pisiform bone, the ulnar nerve divides into two branches, the superficial and deep branches

Question 69

Guyon’s canal syndrome
Site of compression
i. Compression of the ulnar nerve at Guyon’s canal is usually associated with trauma, anomalous muscles or abnormal structures (ganglion cyst or lipoma). Compression can also be due to fractures of the _________ or metacarpal bones of digits __ or ___

Answer 69

c. Site of compression
i. Compression of the ulnar nerve at Guyon’s canal is usually associated with trauma, anomalous muscles or abnormal structures (ganglion cyst or lipoma). Compression can also be due to fractures of the HAMATE or metacarpal bones of digits 4 or 5

Question 70

Symptoms of Guyon’s canal syndrome
i. Weakness or paralysis of the hand intrinsic innervated by the ulnar nerve
ii. Cold intolerance in digits __ and __

Answer 70

Symptoms of Guyon’s canal syndrome
i. Weakness or paralysis of the hand intrinsic innervated by the ulnar nerve
ii. Cold intolerance in digits 4 and 5

Question 71

Clinical presentation of Guyon’s canal syndrome

i. Possible Positive ____________ guyon’s canal
ii. __________ hand deformity due to the atrophy of the interosseous muscles and lumbricals 3 and 4 appears as:
1. _____________ of interphalangeal joints of digits 4 ang 5 resulting from an unopposed flexor digitorum profundus muscle
2. ______________ of the MCP joint of digits 4 and 5 resulting from an unopposed extensor digitorum muscle
iii. Difficulty in making a fist
iv. Motor and sensory deficits are present distal to Guyon’s canal
1. There will be a sensory deficit to the ____________________________

Answer 71

Clinical presentation of Guyon’s canal syndrome

i. Possible Positive TINEL’S guyon’s canal
ii. CLAW hand deformity due to the atrophy of the interosseous muscles and lumbricals 3 and 4 appears as:
1. FLEXION of interphalangeal joints of digits 4 ang 5 resulting from an unopposed flexor digitorum profundus muscle
2. EXTENSION of the MCP joint of digits 4 and 5 resulting from an unopposed extensor digitorum muscle
iii. Difficulty in making a fist
iv. Motor and sensory deficits are present DISTAL to Guyon’s canal
1. There will be a sensory deficit to the MEDIAL 1.5 DIGITS of the HAND, ANTERIORLY

Question 72

Classification of Guyon’s canal syndrome
i. Type I: involvement of the __________ muscle and the ________ branch of the ulnar nerve
ii. Type II: involvement of the ________ branch of the ulnar nerve
iii. Type III: involvement of the ____________ sensory branch of the ulnar nerve

Answer 72

Classification of Guyon’s canal syndrome
i. Type I: involvement of the HYPOTHENAR muscle and the DEEP branch of the ulnar nerve
ii. Type II: involvement of the DEEP branch of the ulnar nerve
iii. Type III: involvement of the SUPERFICIAL sensory branch of the ulnar nerve

Question 73

Guyrons canal syndrome causes weakness or lack of function of the:

Answer 73

i. Abductor digiti minimi muscle (abduction of digit 5)
ii. Flexor digiti minimi brevis muscle (flexion of digit 5)
iii. Opponens digiti minimi muscle (drawing digit 5 forward)
iv. Lumbricals (digits 4 and 5 Z-POSITION)
v. Interossei muscles (palmari dorsal)
1. Palmar (ADDUCTION of digits)
2. Dorsal (ABDUCTION of the digits)
vi. Flexor pollicis brevis muscle (adduction of the thumb)
vii. Superficial branch of the ulnar nerve for cutaneous supply of the MEDIAL 1.5 DIGITS, ANTERORLY

Question 74

Compression of the radial nerve
a) The radial nerve and its primary motor branch, the ________________, are less vulnerable to compression compared to the median nerve at the carpal tunnel, or the ulnar nerve at the cubital tunnel

Answer 74

POSTERIOR INTEROSSEOUS (PIN)

Question 75

Common neuropathies of the radial or posterior interosseous nerve include:

Answer 75

a. Axilla-crutch palsy, Saturday night palsy
b. Radial groove compression
c. Posterior interosseous nerve (PIN) syndrome

Question 76

Compression of the radial nerve occurs at the axilla what syndrome is this?

Answer 76

Axilla -cruth palsy. Saturday night palsy

Question 77

occurs from pressure of a crutch pressing against the radial nerve

Answer 77

i. Axilla-crutch palsy

Question 78

commonly occurs when an intoxicated person’s arm is slumped over the back of a chair for an extended amount of time, causing pressure on the radial nerve

Answer 78

ii. Saturday night palsy

Question 79

Anatomy (compression of the radial nerve)
The radial nerve is the continuation of the ________________ of the brachial plexus, beginning after the axillary nerve is given off

Answer 79

Posterior cord

Question 80

a. Compression of the radial nerve in the axilla is caused by pressure on the nerve as it is pushed against the proximal humerus and __________

Answer 80

scapula

Question 81

Symptoms of axilla-crutch palsy and Saturday night palsy include:

Answer 81

a.Symptoms include loss of function of the radial nerve distal to the axilla
b. Difficult with EXTENSION of the forearm at the elbow, wrist, and fingers
c. Sensory deficit to the skin on the arm and forearm, posteriorly

Question 82

Clinical presentation of axilla-crutch palsy and Saturday night palsy

Answer 82

a. Motor deficit includes an inability to perform motor movement
b. Sensory deficit includes numbness and tingling of the posterior upper limb

Question 83

Damage to radial nerve at the proximal arm:

Answer 83

Triceps brachii muscle (extension of the forearm at the elbow)

Question 84

Associated deficits due to damage to radial nerve:
-As a proximal or high lesion, this symptom will also present with the clinical deficits of a ____________
-Thus, in addition to the symptoms of axilla- crutch palsy and Saturday night palsy the patient will also exhibit the symptoms of __________________________ and __________________

Answer 84

1) distal lesion
2) radial GROOVE compression
3) Posterior interosseous nerve (PIN) syndrome

Question 85

radial nerve compression at the radial groove is typically due to trauma to the ________

Answer 85

posterior arm

Question 86

Anatomy (radial groove compression)
a. The nerve courses from ________________ in the radial groove of the humerus which is located in the ___________________________
b. It then passes distally toward the elbow region where it is found on the _____________ of the ______________
c. The nerve then pierces the _____________________ as it passes from the ____________ to the ________________________ of the _____
d. BETWEEN the brachialis muscles, the radial nerve divides into its 2 terminal branches
i. Superficial branch of the radial nerve
ii. Deep branch of the radial nerve
e. While the superficial branch of the radial nerve courses distally to the wrist area, the _________ branch of the radial nerve enters the __________________ of the supinator muscle and changes its name to the ___________________________

Answer 86

Anatomy (radial groove compression)
a. The nerve courses from MEDIAL TO LATERAL in the radial groove of the humerus which is located in the POSTERIOR COMPARTMENT of the ARM
b. It then passes distally toward the elbow region where it is found on the LATERAL SIDE of the CUBITAL FOSSA
c. The nerve then pierces the LATERAL INTERMUSCULAR SEPTUM as it passes from the POSTERIOR to the ANTERIOR COMPARTMENT of the ARM
d.Between the brachialis muscles, the radial nerve divides into its 2 terminal branches
i. Superficial branch of the radial nerve
ii. Deep branch of the radial nerve
e. While the superficial branch of the radial nerve courses distally to the wrist area, the DEEP branch of the radial nerve enters the SUPERIOR BORDER of the supinator muscle and changes its name to the POSTERIOR INTEROSSEOUS NERVE (PIN)

Question 87

Compression of the radial nerve in the posterior compartment of the arm may occur as a result of:

Answer 87

i. Entrapment of the nerve due to a broken humerus
ii. Vascular compression of the nerve due to pressure from adjacent arteries

Question 88

4. Symptoms of radial groove compression

Answer 88

a. Pain in the distal arm and the LATERAL elbow
b. Wrist DROP
i. Wrist drop occurs as there is an inability to extend the wrist. Proximal forearm muscles do not receive innervation and thus cannot perform the action of wrist extension

Question 89

Clinical presentation for radial nerve entrapment:

Answer 89

Nerve entrapments occurring PROXIMAL to the branches that innervate muscles acting to extend the hand at the wrist lead to wrist drop

Question 90

Damage to radial nerve at mid arm:

Answer 90

i. Brachioradialis muscle (flexion of the forearm at the elbow)
ii. Extensor carpi radialis longus muscle (EXTENSION AND ABDUCTION of the hand at the wrist)
iii. Anconeus muscle (extension of the forearm at the elbow)

Question 91

Damage to superficial branch of radial nerve:

Answer 91

Sensory deficit to the skin on the LATERAL HALF of the DORSUM of the hand, and the proximal portion of the LATERAL 3.5 DIGITS, POSTERIORLY

Question 92

Damage to deep branch of radial nerve:

Answer 92

Extensor carpi radialis brevis muscle (extension and abduction of the hand at the wrist)

Question 93

As a middle lesion, radial groove compression will also present with the clinical deficits of distal lesion:

Answer 93

Thus, in addition to the symptoms of radial groove compression, the patient will also exhibit the symptoms of Posterior interosseous nerve (PIN) syndrome

Question 94

a. PIN syndrome is also known as ___________________. It is a compression of the __________________________ or its branches that occurs at the _____________________ region
b. The PIN is purely _____________. Since it does not provide sensory innervation, there is no sensory disturbance associated with the compression of this nerve
c. Compression is typically associated with repeated or strenuous efforts involving supination and pronation

Answer 94

a. PIN syndrome is also known as RADIAL TUNNEL SYNDROME. It is a compression of the POSTERIOR INTEROSSEOUS NERVE or its branches that occurs at the PROXIMAL FOREARM region
b. The PIN is purely MOTOR. Since it does not provide sensory innervation, there is no sensory disturbance associated with the compression of this nerve
c. Compression is typically associated with repeated or strenuous efforts involving supination and pronation

Question 95

a. As the deep branch of the radial nerve enters the __________________ of the supinator muscle, its name changes to _________________________________
b. PIN courses distally into the forearm innervating ______________________
c. It does not enter the __________________

Answer 95

a. As the deep branch of the radial nerve enters the SUPERIOR BORDER of the supinator muscle, its name changes to POSTERIOR INTEROSSEOUS NERVE
b. PIN courses distally into the forearm innervating 8 MUSCLES
c. It does not enter the HAND

Question 96

(PIN) Posterior interosseous nerve syndrome

The most frequent site of compression is in the _____________________, ____________ to the supinator muscle

Answer 96

The most frequent site of compression is in the PROXIMAL FOREARM, DEEP to the supinator muscle

Question 97

Symptoms of posterior interosseous nerve syndrome are the following:

Answer 97

a. Weakness of wrist extension
i.The action of extension can still occur from the extensor carpi radialis longus muscle, which is supplied by the radial nerve and the extensor carpi radialis brevis muscle, which is supplied by the deep branch of the radial nerve
b. Decreased ability or inability to extend the thumb and digits

Question 98

Clinical presentation for radial nerve entrapment

Answer 98

Patient exhibits weakness or an inability to extend digits against resistance

Question 99

(Weakness or lack of function of:)
Damage to PIN at the proximal forearm:

Answer 99

i. Extensor digitorum muscle (extension of digits 2-5)
ii. Extensor digiti minimi muscle (extension of digit 5)
iii. Extensor carpi ulnaris muscle (extension and ADDUCTION of wrist)
iv. Abductor pollicis longus muscle (ABDUCTION and extension of thumb)
v. Extensor pollicis brevis muscle (extension of the thumb)
vi. Extensor pollicis longus muscle (extension of thumb)
vii. Extensor indicis muscle (extension of digit 2** )
viii. Supinator muscle (supination of the forearm)

Question 100

1) All the following are anatomical risk factors for peripheral nerve injuries EXCEPT?
a. Deep positioning of the nerves
b. Narrow pathways through bony canals
c. Nerves course through areas of trauma

Answer 100

a. Deep positioning of the nerves

Question 101

2) Which of the following is incorrect?
a. Damage to the long thoracic nerve results in difficulty elevating the upper extremity above the horizontal plane
b. Compression at the suprascapular notch will result in difficulty with abduction and lateral rotation of the arm at the shoulder
c. Damage occurring at the spine of the scapula will affect the supraspinatus and infraspinatus muscles
d. Damage to the axillary nerve results in a loss of sensation below the lateral part of the shoulder

Answer 101

c. Damage occurring at the spine of the scapula will affect the supraspinatus and infraspinatus muscles

Question 102

3) Which of the following statements is CORRECT?
a. Carpal tunnel affects 5-15% of the general population and 1-3% of individuals in industrial settings
b. The flexor pollicis brevis is the first muscle affected in anterior interosseous nerve (AIN) syndrome
c. Decreased ability in flexion and adduction of the wrist is associated with pronator syndrome (wrong answer)
d. The anterior interosseous nerve (AIN) is purely motor in nature and causes no sensory disturbances when damaged

Answer 102

d. The anterior interosseous nerve (AIN) is purely motor in nature and causes no sensory disturbances when damaged

Question 103

4) Which of the following statements is INCORRECT?
a. The medial attachment of the flexor retinaculum consists of the pisiform, the trapezium, and the hook of hamate
b. The contents of the carpal canal include 2 bursae and 1 nerve
c. Men are two times more likely than women to suffer from posterior interosseous nerve (PIN) syndrome (Wrong answer)
d. The flexor retinaculum is also known as the transverse carpal ligament

Answer 103

a. The medial attachment of the flexor retinaculum consists of the pisiform, the trapezium, and the hook of hamate

Question 104

5) Which of the following statements is incorrect?
a. The radial nerve and posterior interosseous nerve (PIN) are less vulnerable to compression compared to the median and ulnar nerve
b. Guyon’s canal syndrome type II involved the superficial branch of the ulnar nerve
c. Tinel’s and Phalen’s tests may be negative if a patient has severe carpal tunnel syndrome
d. Kiloh-Nevin syndrome results from compression of the anterior interosseous nerve (AIN) that occurs along its pathway within the anterior forearm

Answer 104

b. Guyon’s canal syndrome type II involved the superficial branch of the ulnar nerve