Chapter 9 Flashcards
Serrates anterior is innervated by what nerve?
Disc Levels?
What is the job of the serrates anterior?
Long thoracic Nerve, C5 - 7 and maybe C8
Protraction
Mechanism of injury most common to the long thoracic nerve?
All sports - either traction or direct trauma under the arm
Sign for an injured long thoracic nerve?
Winging of the scapula (comes off the scapular thoracic articulation)
Rhomboids are innervated by what nerve?
Disc level?
Function of the rhomboids?
Dorsal Scapular Nerve C5
Pulls the scapula in and up
Injury sign for dorsal scapular nerve
Flaring of the scapula = weak rhomboids
How is the scapula moving when there is a spinal lesion to Dorsal scapular nerve
scapula rotates anterior and drops aka the scapula deviates laterally
Mechanism of injury for a dorsal scapular nerve?
From trauma to neck, shoulder from sports/whiplash etc
Erb palsy is a result of what injury?
Upper trunk of brachial plexus injury
What is the mechanism of injury for erb palsy?
Traction of brachial plexus
What is a common sign you would see in Erb Palsy?
What is a common injury?
Waiter’s tip position - extensors are week, but flexors are okay
- shoulder injury
- Birthing Process (look for hand dominance)
Middle Trunk of brachial plexus Injury would commonly affect what nerve root distribution level?
C7 distribution - very rare
Common lower trunk of brachial plexus injury?
Klumpke Paralysis
Causes of lower trunk injury?
Falling and hanging on
Pan coast tumor
T1 Transverse process or 1st rib fracture
What is a common sign for a lower trunk injury?
Affects to the ulnar nerve (C8-T1)
- Hand and finger flexion weakness, hypothenar atrophy
- Possible Horner syndrome
Define Thoracic outlet syndrome
Compression of the brachial plexus and subclavian/axially artery
Ortho test that is sensitive to thoracic outlet syndrome. Describe the test and the positive and indicator
Roos Test
(+) patient raises hands to 90 degrees and abducts the arms and pumps hands for 3 minutes
Indicates: if the patient can not perform the test or experiences pain, heaviness or parasthesia in the shoulder, arm or hands.
Where is the thoracic outlet located? What structures?
Scalene triangle, clavicle/1st rib (costoclavircular) or pec minor
What three places would we use different tests to differentiate the area of compression on the lower trunk of the brachial plexus that would give us thoracic outlet syndrome type signs?
Scalene triangle
Clavicle first rib
Pectoralis Minor syndrome
Scalene triangle’s cause of compression is where?
anterior scalene mm or cervical ribs
Tests you would use on scalene triangle?
Adson: is the loss of the radial pulse in the arm by rotating head to the ipsilateral side with extended neck following deep inspiration. - TOS
Halstead: head extended and traction arm - TOS
Upon doing adson and halstead tests what would be a sign that the patient may have TOS?
Decrease in pulse, but no puffiness
In the scalene triangle test - the veins will NOT be involved but what artery will be?
Subclavian
What nerve of the brachial plexus will be most affected in compression of the anterior scalene or cervical rib? (scalene triangle)
Ulnar nerve is most effected
Clavicle First rib differentiation for TOS should be determined with what test?
Eden aka Costoclavicular
What is the mechanism of subluxation of a clavicle first rib?
Elevation of first rib, inferior clavicle on that side
Causes of a clavicle first rib?
Large breasts and braw strap
Heavy bags on shoulder straps
Seat Belt injury
Symptoms of clavicle first rib?
Hand swelling - cold and tingling
Pectoralis Minor Syndrome is differentiated by for TOS by what tests?
Wright aka Hyperabduction
Causes of Pectorals minor syndrome?
Overdevelopment of pecs or weakness of rhomboids - dorsal scapular nerve - people who work out only their pecs, without rhomboid support
what artery and vein are being compressed in pectorals minor syndrome?
Compression of axillary artery and vein
Cause of pan coast syndrome
Apical lung tumor
Signs and characteristics of of Pancoast syndrome
Horner Syndrome is a classic sign
- droopy eye, constricted pupil, no facial sweating on that side of the face - due to compression of the sympathetic chain
*eye ptosis, eye mitosis, facial anhydrosis
Pain and tingling in hand
What structures may a apical lung tumor invade
brachial plexus and subclavian artery
What cranial nerve would you check in an exam with someone you would expect a pan coast syndrome?
CN III - oculomotor nerve
The anterior division of the Brachial Plexus innervates the
Flexors
The posterior division of the Brachial Plexus innervates the
Extensors
Brachial plexus medial cord innervates pec ___
Major
Brachial plexus lateral cord innervates pec ____
Minor
Musculocutaneous nerve is the lateral cord and innervates
Forearm flexor muscles (biceps coracobrachials and brachial is mm) and lateral ante brachial cutaneous
Axillary nerve is the posterior cord and innervates
Teres minor and deltoid
What nerve in the brachial plexus do not have individual nerve injury/ lesions?
Axillary and musculocutaneous
Radial nerve originates from the posterior cord and innervates
Triceps, brachioradialis, wrist and finger extensor a (posterior mm)
Radial neuropathies
- akas?
- location of injury?
- signs of injury?
Aka crutch arm, Saturday night palsy
- armpit - radial nerve gets entrapped in the axilla
- shoulder/ elbow and wrist extension and numbness and tingling
Honeymoon palsy
- mechanism of injury
- location
- signs
- cuddling with her head on his spiral groove
- spiral groove (not covered by triceps or biceps,radial nerve runs here)
- wrist drop = no or weak extensors
What other subluxation would occur in a wrist drop?
4/5th rib subluxation can also give wrist drop - collapses quadrangle space that the radial nerve goes through
Hairdresser’s wrist drop
Radial nerve effected
Median nerve entrapment may occur at
clavicle and first rib
elbow
Signs of median nerve entrapment
weakness of wrist flexor, abduction, temp opposition, flexion of 2nd and rd fingers
sensory loss of first 3 1/2 fingers
*gives ape hand
Thumb is innervated by RUM
Radial
Ulnar
Median
Carpal Tunnel syndrome Median Neuropathy:
- Location?
- Signs?
- Causes
- Most commonly seen in?
location: entrapment in the carpal tunnel
Signs: sensory loss first 3 1/2 fingers, worse at night better when shaking the hand, may radiate back up the arm **advanced signed would be atrophy of the thenar eminence
Caused by: repetitive stress
- commonly seen in women over 30
Ortho tests for Carpal Tunnel Syndrome?
Whalen, prayers, tines wrist
If the patient has tingling, worse in the hands - this indicates entrapment (adjust?)
under one of the bicep tendons = adj. the elbow
If the patient has pain/tingling upon pronation - this indicates entrapment (adjust?)
at the pronator teres = adj. elbow
If C8 mm. test of the flexor digitorum superficial mm is positive you should adjust
elbow
The ulnar nerve innervates
hypothenar eminence, flexor carpi ulnaris, palmar and dorsal interossi, lumbircles
Ulnar neuropathy:
Causes:
Ortho Tests:
Signs:
Causes: increased carrying angle at elbow; tunnel of guyot at wrist, pisiform/hamate
Ortho tests: Tinel, Froment paper sign
Signs: weakness of wrist flexion, abduction, adduction, sensory loss of fingers 4 & 5
- claw hand: flexion of fingers 4 and 5: extension at MCP with flexion at PIP and DIP
Iliohypogastric nerve is sensory of
pubic symphysis
Ilioinguinal nerve is sensory over what ligament?
inguinal ligament
Genitofemoral nerve innervates sensory to
upper inner thigh and motor to cremaster mm.
Femoral nerve innervates
mm. in the front of the thing (quads) crosses the knee joint and becomes the L4 dermatome - patella reflex is quad reflex
Obturator Nerve innervates mm on
medial thigh and sensory to medial thigh
Lateral femoral cutaneous nerve innervates…
Lateral thigh
Meralgia parenthetic
- Site of entrapment
- causes for entrapment:
entrapment site: entrapment of the lateral femur cutaneous nerve between the ASIS and inguinal ligament
Causes of entrapment: tight waistbands - classic in middle-aged man, worse with hand in pocket - PI ilium also can c0 low rider jeans - cuts right beneath the ASIS
Superior gluteal nerve innervates
Glute medius and minimus and tensor facia lata
Inferior gluteal nerve innervates
Glute maximus
Sciatic nerve innervates
hamstrings
Nerve that constitute sciatic include
Tibial and common fibular
Tibial nerve innervates
posterior leg mm (gatrocneimius, soles) becomes medial plantar nerve - innervates toe flexors
Common fibular
Superficial mm. on the later leg and gives dural nerve
deep mm on the medial leg (sensory is from femoral nerve via saphenous)
Sciatic Neuropathy/radiculopathy
Causes:
Symptoms
Sciatica
Causes: posterior hip dislocation, acetabular fracture (dashboard injury) mm injection in buttocks (like needle shot at hospital) piriformis entrapment
Symptoms: weakness of all foot and ankle mm., knee flexion, achilles reflex
- sensory loss of foot and later leg below the knee
Define Sciatica
Vague term for pareytheisia along the distribution
Most common cause for “sciatica”
lumbosacral nerve root compression by disc or osteophyte
may be caused by distal entrapment aka piriformis syndrome
Peroneal (fibular) nerve palsy
symptoms:
Who?
Symptoms include: changes that look like L5 nerve root such as weakness of foot inversion
Who: seen in people on their knees a lot (monks), falling on knees - gardening
How do you differentiate peroneal (fibular) nerve palsy from L5 radiculopathy
Check flute medium and minibus = trandelenburg test
*if its just foot problems likely entrapped at head of fibula
Morton Neuroma aka Mortan Metatarsalgia
Caused by?
Symptoms?
Tight fitting shoes
Symptoms = pain, numbness, paresthesia between the 3rd and 4th toe
