#5 hyperextended at MCP and abducted at MCP an flexed at IP #4 hyperextended at MCP and flexed at IPs Hypothenar mm wasting Altered sensation in 5 and half of 4 Loss of lumbricals

Class 3 Flashcards by Nicole Yuen

The ulnar nerve’s relationship to forearm muscles.

Under FCU and over FDP

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Path of ulnar nerve

Inner/medial cord of brachial plexus
Posterior wall of axilla
Under pec minor (as do they all)
Coracobrachialis insertion
Medial triceps, posterior to medial epicondyle and Olecranon
Deep to FCU and above FDP
Over flex Ret and through Tunnel of Guyon (between hook of hamate and pisiform)

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Ulnar claw hand

5 hyperextended at MCP and abducted at MCP an flexed at IP

Hypothenar mm wasting

Altered sensation in 5 and half of 4

Loss of lumbricals

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Froment’s Sign

Results from ulnar nerve lesion

Adductor pollicis doesn’t work so can’t hold paper between thumb and index finger. Has to recruit FPL to flex DIP instead.

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Tardy ulnar palsy

Common complication after elbow fracture.

Associated with callus or valgus deformity at elbow, which produce gradual stretching of nerve in ulnar groove.

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Where can the ulnar nerve become compressed?

Cubital tunnel (ulnar collateral ligament + FCU)
Between heads of FCU

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What increased the chance of ulnar nerve compression?

Elbow Flexion

Valgus elbow

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Thoracic outlet syndrome

Compression of brachial plexus from structures in thoracic outlet.

May also involve arteries and veins.

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Thoracic outlet

Inter scalene triangle to inferior border of axilla.

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Path of brachial plexus

Travels with subclavian artery
Btwn anterior and middle scalene
Then meets up with subclavian vein

Entire neurovascular bundle goes behind clavicle and under pec minor attachment and down arm.

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Symptoms of TOS

Pain, numbness, weakness.
Tingling in arm, across upper thoracic area or over scapula
Trophic changes.

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Causes of TOS

Cervical rib (C7)
Anterior scalene syndrome
Scalene triangle syndrome
Costoclavicular syndrome 
Pec minor syndrome

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Anterior scalene syndrome

TOS caused by brachial plexus being compressed between anterior and middle scalene

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Scalene triangle syndrome

TOS caused by brachial plexus being caught in between anterior scalene (anterior), middle scalene (posterior) and R1 (inferior).

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Costoclavicular syndrome

TOS caused by brachial plexus being compressed between clavicle and R1.

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Pec Minor syndrome

TOS involving compression between the coracoid process and pec minor

Happens with hyperabduction with ER/extension

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Lumbar plexus

Between heads of Psoas major, anterior to QL

Formed by anterior rami of spinal nerves L1-4

Supplies anterolateral abdominal wall, external genitals, part of lower limbs.

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What nerves emerge from the lumbar plexus?

Iliohypogastric
Ilioinguinal 
Genitofemoral
Lateral cutaneous nerve of the thigh 
Femoral
Obturator

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Iliohypogastric nerve

L1
Anterior division of lumbar plexus

Ant-lat abdominal muscles
Skin of inferior abdomen and butt

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Ilioinguinal nerve

L1
Anterior division of lumbar plexus

Ant-lateral muscles and skin of superior and medial thigh

Root of penis and scrotum

Labia majora and mons pubis

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Genitofemoral nerve

L1-2
Anterior division of lumbar plexus

Cremaster muscle
Skin of middle anterior thigh
Scrotum and labia majora

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Lateral cutaneous nerve of the thigh

L2-3
Posterior division of lumbar plexus

Skin of lateral, anterior and posterior thigh

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Femoral nerve

Largest nerve in lumbar plexus

L2-4
Posterior division of lumbar plexus

Hip flexor muscles
Knee extensors
Skin of ant/med thigh and medial leg and foot

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Obturator nerve

L2-4
Anterior division of lumbar plexus

Hip adductor muscles
Skin of medial thigh.

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Iliohypogastric nerve | Ilioinguinal nerve

L1-L2

Genitofemoral nerve

L2-L3

Lateral cutaneous nerve of the thigh

L2-L4

Femoral nerve | Obturator nerve

Injury to femoral nerve

Can't extend knee or flex hip Wasting if quads No sensation over ant/med thigh

Injury of obturator nerve

Paralysis of adductors | No sensation over medial thigh

Meralgia paresthetica

Entrapment of lateral cutaneous nerve near ASIS as nerve passes under inguinal ligament Sensory alteration/burning pain in lateral thigh.

Sacral Plexus

L4-S4 Mostly anterior to sacrum Supplies buttocks, perineum, lower limbs

Nerves of the sacral plexus

``` 1 Superior gluteal 2 Inferior gluteal 3 Nerve to piriformis 4 Nerve to quadrator femoris & inf. gemellis 5 Nerve to obturator internus & sup. gemellis 6 Perforating cutaneous 7 Posterior cutaneous nerve of the thigh 8 Sciatic 9 Tibial 10 Common fibular 11 Pudendal ```

Superior gluteal nerve

L4-S1 Glute min, glute med, TFL

Inferior gluteal nerve

L5-S2 | Glute max

Nerve to piriformis

S1-2 Piriformis

Nerve to quadrator femoris & inferior gemellis

L4-S1 Quadrator femoris Inferior gemellis

Nerve to obturator internus & superior gemellis

L5-S2 Obturator internus Superior gemellis

Perforating cutaneous nerve

S2-3 Skin of inferior and medial buttocks

Sciatic nerve

L4-S3 Largest and longest nerve in the body Hamstrings, adductor Magnus Bundle of tibial and common Fibular which split at knee

Tibial nerve

L4-S3 Branch of sciatic Gastrocnemius, soleus, plantaris, popliteus, tib post, FDL and FHL Branches into medial and lateral plantar at foot.

Medial plantar nerve

Branch of Tibial Adductor hallucis, FDB, FHB, skin of medial plantar foot.

Lateral plantar nerve

Branch of tibial Foot mm not served by medial plantar nerve

Common fibular nerve

L4-S2 Branch of sciatic. Divides into superficial and deep fibular

Superficial fibular nerve

Branch of common fibular Fib long, fib brev, and skin of distal anterior leg and foot dorsum.

Deep fibular nerve

Branch of common fibular Tib ant, EHL, fib tertius, EDL, EDB and skin of toes 1 and 2.

Pudendal Nerve

S2-4 Muscles of perineum Skin of penis, scrotum, clitoris, labia majora and minora, and vagina.

L4-S1

Superior gluteal | N to QF and Inf Gem

L4-S2

Common fibular

L4-S3

Sciatic nerve | Tibial nerve

L5-S2

Inferior gluteal | N to Ob Int and Sup Gem

S1-S2

Piriformis

S1-S3

Post Cut N of the Thigh

S2-S3

Perforating cutaneous nerve

S2-S4

Pudendal

Route of sciatic nerve

Sciatic foramen Under (or through) piriformis Between Ischial tuberosity and greater trochanter Goes deep, follows adductor Magnus Splits at popliteal fossa into tibial and common fibular

Route of tibial nerve

Goes between heads of gastrocs Superficial between medial malleolus and Achilles. Goes around malleolus and travels deep to flexor retinaculum Divides into medial and lateral plantar nerves

Route of common fibular nerve

Travels around and below head of fibula Splits into superficial and deep fibular nerves Deep fib: deep to EDL and down to dorsum of foot Superficial fib: down lateral leg to foot.

Tarsal Tunnel syndrome

Tibial nerve compressed as it passes through tarsal tunnel Pain and paesthesia in sole of foot Worse after long periods of standing or walking. Night waking (like carpal tunnel)

Tarsal tunnel

Formed by medial malleolus, calcaneous, and talus on one side; deltoid ligament on the other.

Symptoms of sciatic nerve compression

Pain from buttocks and down lateral leg and foot Foot drop. Paralysis of dorsiflexors and everters.

Nerve to the Piriformis

S1-S2 Piriformis