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Neurology > Class 11 > Flashcards

Class 11 Flashcards

1
Q

What is the Brachial Plexus?

A

network of nerves that gives rise to all motor
& sensory nerves of upper extremity. Plexus arises from anterior rami of spinal nerves C5-T1 that undergo several mergers & splits into trunks & divisions, until they finally give rise to their terminal branches. Terminal branches are responsible for motor & sensory innervation of upper limb, include musculocutaneous, axillary, radial, median & ulnar nerves.

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2
Q

What is the Musculocutaneous Nerve?

A

Emerges as terminal branch of lateral cord of brachial plexus, from C5-C7 nerve roots. First muscle it enters is coracobrachialis. From here, it runs in flexor compartment superficial to brachialis but deep to biceps brachii muscle. As it descends, it pierces deep fascia & emerges lateral to biceps brachii.

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3
Q

The musculocutaneus nerve supplies motor innervation for?

A
  • Biceps Brachii
  • Brachialis
  • Coracobrachialis
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4
Q

The musculocutaneus nerve supplies sensory innervation for?

A

The musculocutaneous nerve terminates & supplies anterolateral skin of forearm.

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5
Q

The musculocutaneus nerve supplies Articular Innervation for?

A

The musculocutaneous nerve provides articular innervation for elbow joint capsule.

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6
Q

What is the Axillary Nerve?

A

branches from posterior cord (C5 - T1) descends in
axilla anterior to subscapularis by traversing quadrangular space. Space in posterior scapular region, which is bounded by superior margin of teres major inferiorly, inferior margin of teres minor superiorly, lateral margin of long head of triceps brachii medially & surgical neck of humerus laterally.

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7
Q

Axillary Nerve (motor Innervation)

A

Motor fibres that innervate deltoid muscle, as well as teres minor muscle.

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8
Q

Axillary Nerve (Articular Innervation)

A

Supplies a branch to the glenohumeral joint

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9
Q

Axillary Nerve (Sensory Innervation)

A

Sensory innervation to skin of arm superficial to lower deltoid muscle & superficial to upper part of long head of the triceps.

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10
Q

What is the Radial Nerve?

A

largest terminal branch of brachial plexus. Originates from
posterior cord along with axillary nerve, carrying fibers from ventral roots of spinal nerves C5- C8 & T1.

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11
Q

Radial nerve arises in __________, between coracobrachialis & teres major muscles. Descends obliquely downwards through _______________________________, between bellies of medial & lateral head of triceps, through shallow depression on _______________________________.

A

• axilla
• posterior aspect of arm
• posterior surface of humerus (radial groove)

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12
Q

In distal part of arm, radial nerve wraps around ____________________ & courses anterior to _____________________. Upon crossing cubital fossa, radial nerve terminates by _______________________________.

A

• distal humerus
• lateral condyle of humerus
• dividing into two terminal branches: superficial (sensory) & deep (motor).

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13
Q

Deep motor nerve descends inferiorly through posterior aspect of forearm where it penetrates __________________.

A

• supinator muscle

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14
Q

Superficial branch continues course of radial nerve & enters hand from radial side. This branch is also known as _________________ because of its primary role to _________________ to thenar eminence & dorsal aspect of radial 3 and a half digits of hand.

A

• “sensory branch”
• provide sensation

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15
Q

What are Motor Branches?

A

Innervate triceps brachii, anconeus,
& brachioradialis muscles.

Deep motor branch of posterior
forearm provides motor innervation to posterior compartment of forearm muscles (wrist extensors & long muscles of thumb). These muscles include:

  • Extensor carpi radialis longus
  • Extensor carpi radialis brevis,
  • Extensor carpi ulnaris
  • Extensor digitorum
  • Extensor indicis
  • Extensor digiti minimi
  • Extensor pollicis longus
  • Extensor pollicis brevis
  • Abductor pollicis longus.
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16
Q

What are Sensory Branches? (Radial Nerve)

A

It gives off two sensory branches that innervate skin of posterior aspect of arm, its inferior lateral aspect, & strip of skin down middle of posterior forearm.

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17
Q

Radial Nerve Muscles Supplied (*BEST)

A

• Brachioradialis
• Extensors
• Supinator
• Triceps

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18
Q

What is the Median Nerve?

A

Arises in axillary region. Formed by medial & lateral cords of brachial plexus. Contains fibres from roots of spinal nerves C6-T1, but in some individuals it can also contain fibers from C5.

19
Q

After Median Nerve formation from brachial plexus, median nerve descends down _________________ in ________________.

A

centre of arm in superficial course

20
Q

Just before it enters forearm, median nerve passes between tendons of biceps brachii & brachialis. It passes between deep & superficial heads of ___________________. Once it passes this point, it dives deeper & runs between flexor digitorum profundus & flexor digitorum superficialis.

A

• pronator teres muscle

21
Q

The median nerve then passes through ____________________ beneath flexor retinaculum, & terminates by dividing into two ___________________.

A

• carpal tunnel
• terminal branches

22
Q

The median nerve gives off numerous motor branches in forearm & hand regions & innervates the which muscles?

A
  • Pronator teres
  • palmaris longus
  • flexor digitorum superficialis
  • flexor carpi radialis
  • flexor pollicis longus
  • radial part of flexor digitorum profundus
  • pronator quadratus
  • muscles of the thenar eminence (flexor pollicis brevis, abductor pollicis
    brevis, opponens pollicis, 1st and 2nd lumbricals)
23
Q

There is a motor branch which supplies proximal aspect of palm. This branch _________ enter carpal tunnel & is hence spared in carpal tunnel syndrome. This is why carpal tunnel syndrome only has a _______________________ associated with it, all motor branches do not cross in carpal tunnel.

A

• does not
• sensory dysfunction

24
Q

Median Nerve (Sensory Innervation)?

A

Skin of palmar & distal dorsal aspects of lateral three-and-the-half digits & adjacent palm. Skin of palmar & distal dorsal aspects of thumb & radial half of 2nd digit. Skin of palmar & distal dorsal aspects of adjacent sides of 2nd–4th digits. Skin of central palm.

25
Q

Median Nerve (Articular Innervation)?

A

Terminates by giving articular branches to distal radioulnar, radiocarpal & carpal joints, & very few at elbow.

26
Q

What is the Ulnar Nerve?

A

Terminal branch of medial cord of the brachial plexus. Contains mainly fibres from anterior rami of spinal nerves C8 & T1, may sometimes carry C7 fibers as well.

27
Q

Ulnar nerve can broadly be described as _________________________, as it innervates vast majority of intrinsic hand muscles. It’s one of the most clinically relevant
nerves of upper limb, d/t its ____________________ & ____________________________.

A

• nerve of hand
• superficial course & clinically apparent role in hand function

28
Q

From medial cord, ulnar nerve passes through _________. Descends on medial aspect of arm, medial to _____________________. In mid-portion of arm, nerve enters posterior compartment. Here,
nerve runs anterior to medial head of triceps brachii muscle passes under arcade of ________________. This is a thin, aponeurotic band, extends from medial head of triceps to medial intermuscular septum.

A

• axilla
• biceps brachii muscle
• Struthers

29
Q

What is Struthers?

A

Thin, aponeurotic band, extends from medial head of triceps to medial intermuscular septum.

30
Q

Ulnar nerve then passes through ___________________. Posterior to medial epicondyle, ulnar nerve is _____________ & __________________. Commonly referred to as _______________ in this region. Ulnar nerve typically has no branches in arm.

A

• cubital tunnel
• subcutaneous & easily palpable
• “funny bone”

31
Q

Ulnar nerve continues into anterior compartment of forearm by passing between heads of of ___________________. Ulnar nerve descends on _______________________________.

A

• flexor carpi ulnaris
• medial aspect of forearm to wrist

32
Q

At the wrist, ulnar nerve enters hand by coursing through ______________________, groove between pisiform & hook of hamate. Here, nerve divides into superficial & deep branches to provide both sensory & motor innervation to hand.

A

• Guyon’s canal (ulnar canal)

33
Q

Ulnar Nerve (Motor Innervation)

A
  • Flexor carpi ulnaris
  • Medial half of flexor digitorum profundus
  • Hypothenar muscles (flexor digit minimi brevis, abductor digiti minimi,
    opponens digiti minimi
  • Medial two lumbricals
  • Adductor pollicis
  • Palmar & dorsal interossei of hand

To summarize, ulnar nerve supplies motor innervation to flexor carpi ulnaris, medial half of flexor digitorum profundus & all intrinsic hand muscles with exception of LOAF muscles (lateral two lumbricals, opponens pollicis, abductor pollicis brevis & flexor pollicis brevis).

34
Q

Ulnar Nerve (Sensory Innervation)

A

Ulnar nerve provides sensory supply to following areas of hand: Skin of palmar & dorsal aspects of medial 1½ digits & adjacent palm. Skin on medial side of dorsum of hand.

35
Q

Ulnar Nerve (Articular Innervation)

A

Some branches supply elbow joint.

36
Q

Common Nerve Impairments (Femoral Nerve) (Meralgia paresthetica)

A

Meralgia paresthetica: disorder characterized by tingling, numbness, & burning pain in outer side of thigh. Disorder occurs when femoral nerve is compressed or squeezed as it exits pelvis. Is sensory nerve to skin, so people with disorder often notice a patch of skin that is sensitive to touch & sometimes painful. Meralgia paresthetica should not be associated with weakness or pain that radiates from back.

37
Q

Tarsal Tunnel Syndrome = _____________________

A

• Tibial Nerve Syndrome

38
Q

Common Nerve Impairments (Tibial Nerve) (Tarsal tunnel syndrome)

A

Tarsal tunnel syndrome: Tarsal tunnel includes multiple important structures. Contains tendons of posterior tibialis, flexor digitorum longus (FDL), & flexor hallucis longus (FHL) muscles. Posterior tibial
artery & vein, as well as posterior tibial nerve (L4-S3), also pass through it.

39
Q

Common Nerve Impairments (Peroneal Nerve)

A

At fibular head

40
Q

Common Nerve Impairments (Sciatic Nerve)

A

Sciatica: occurs when one or more nerve roots from L4 to S3 are irritated or compressed d/t conditions such as herniated disc, spinal stenosis, disc degeneration. Radicular pain from sciatic nerve root is typically felt in thigh, calf, &/or foot—away from actual source of problem. Sciatic nerve can also be compressed at site of piriformis, & bicep femoris.

41
Q

Common Nerve Impairments (Axillary Nerve)

A

Quadrangular space

42
Q

Common Nerve Impairments (Radial Nerve)

A

Supinator: entrapment of deep branch of
radial nerve at level of supinator muscle

43
Q

Common Nerve Impairments (Median Nerve)

A

Carpal tunnel (wrist) & pronator teres (forearm)

44
Q

Common Nerve Impairments (Ulnar Nerve)

A

Cubital tunnel (elbow) & ulnar tunnel (Guyon Canal) (wrist).

Neurology (12 decks)

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