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Anatomy 2 > Clinical skills-upper limb nerves and vessels > Flashcards

Clinical skills-upper limb nerves and vessels Flashcards

1
Q

What are myotactic reflexes?

A

stretch reflexes that cause muscle contraction after the muscle is stretched

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2
Q

Describe function of afferent and efferent neurones?

A

afferent(sensory)-ipulses from sensory receptors in the muscle to the spinal cord

efferent(motor)-running fromthe anterior grey columns of the spinal cord to the effector organ

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3
Q

What is a monosynaptic vs multiosynaptic reflex arch?

A

monosynaptic- contains 2 neurons-sensory and motor

Multisynaptic-contains neurones connecting sensory and motor neurons

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4
Q

What is a tendon hammer used for?

Describe how it works?

A

small rubber hammer used to elicit reflex

it is tapped to the tendon muscle =stretching of the muscle spindle. This stimulus travels to the spinal cord ans stimulates the EFFERENT motor neurones in the ANTERIOR GREY COLUMNS(horns) resulting in involuntary contraction of the main muscle attached to that tendon

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5
Q

Of it is difficult to elicit a tendon reflex what can you do?

A

apply REINFORCEMENT- for example you will ask the patient to either clench the teeth or squeeze an object in their hand

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6
Q

What are 3 main myotactic reflexes to test in the upper limb?

which spine segment/nerve root does each test?

A

BICEPS tendon reflex-c5 and c6

TRICEPS tendon reflex- c7 and c8

BRACHIORADIALIS(supinator) reflex-c5 and c6

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7
Q

How do you test the triceps tendon reflex?

A

ask patient to relax their arm completely and bend it at a right angle at the elbow with forearm across the stomach

Then tap the tendon near the elbow with a tendon hammer

compare reflex on both sides

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8
Q

How do test the biceps tendon reflex?

A

ask patient to relax their arm completely and bend it at a right angle at the elbow with forearm across the stomach

Then tap the tendon near the elbow with a tendon hammer

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9
Q

How do you test the supinator reflex?

A

ask patient to relax their arm completely and bend it at a right angle at the elbow with forearm across the stomach

Then tap the tendon near the wrist with a tendon hammer

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10
Q

What are the laws of reciprocal innervation?

A

in the same limb the flexor and extensor muscles cant contract simultaneously

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11
Q

What can abnormally exaggerated myotactic reflexes mean?

A

UPPER MOTOR NEURON LESION in the brain (as higher centres of the brain influence spinal segmental reflex arch)

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12
Q

What does complete absence of reflexes(areflexia) suggest?

A

disorder in a component of the reflex arch-muscle spindles, afferent sensory neurons, efferent motor neurons and the effector organs-muscle itself

due to LOWER MOTOR NEURON LESION

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13
Q

Describe the grading system used to examine the character of reflexes?

A 
0-absent
1+ -decreased, but still preset
2+ - Normal
3+ -hyper reflex
4+ -clonus-repetitive shortening of the muscle after a single stimulation
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14
Q

What is a dermatome and myotome?

A

dermotome-area of the skin supplied by a single spinal nerve (but possibly many peripheral nerves as the fibres from e.g. C5 are distributed between many peripheral nerves in the brachial plexus)

myotome-region of skeletal muscle innervated by a single spinal nervel

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15
Q

Why might the loss of a single spinal nerve root not cause any detectable sensory loss in a dermatome?

A

because on the skin adjacent dermotomes overlap considerably

So to be able to detect a significant sensory loss at least 3 adjacent dermotomes should be affected

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16
Q

Where are their no overaps of the dermotomes?

A

across the AXIAL lines of the limb

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17
Q

What would damage to a peripheral nerve cause?

A

effect large areas of skin(Dermotomes) and several muscles (myotomes) because they carry nerve components from several spinal segments to the skin and muscle area

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18
Q

What are the dermatome region of the upper limb?

A 
C4-shoulder
C5-lateral side of the arm
C6-lateral side of the forearm and thumb
C7-middle and ring finger
C8-medial side of the hand, forearm and little finger
T1-medial side of forearm and arm
T2-Axilla
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19
Q

Name the Peripheral nerves that go to each dermotome of the upper limb?

A

Musculotaneous-C5,6,7
Median-C6-8, T1
Radial-C5-8, T1
Ulnar-C7,8, T1

20
Q

How do you test light touch(sensory innervation) of the upper limb?

A

Use a piece of cotton wool and place on each dermotome region on the upper limb
When you test a dermotome on one side test it straight away on the other side and ask if it feels the same

21
Q

What can cause an upper limb mononeuropathy?

A

damage that occurs to a single peripheral nerve distal to the brachial plexus

22
Q

What can an upper limb mononeuropathy cause?

A

deformity, weakness, and sensory loss that are characteristic to the function of the particular nerve

23
Q

How can you detect where on a nerve the lesion/injury is?

A

by testing the nerve

24
Q

What causes mechanical injury?

A

compression or trauma

25
Q

What is the most common cause of mononeuropathies?

A

mechanical injury;median nerve at the wrist, ulnar nerve at the elbow, radial nerve compression at the spiral groove

lesscommon-malignancy and inflammation

26
Q

What is mono-neuritis multiplex?

A

When multiple peripheral nerves are damages and these do not relate to compression sites

-a VASCULITIS or an ANTIBODY MEDIATED RESPONSE against the peripheral nerves should be suspected

27
Q

How do you test the integrity of the nerves of the brachial plexus?

A

test the motor function of the muscles they supply and the sensation in the areas of skin they supply

28
Q

What is the common mode and location of injury to the musculocutaneous nerve?

A

stab round to the upper arm

29
Q

What is the sensory loss and motor deficit when the musculotaneous nerve is damaged?

A

sensory loss:
-lateral forearm

Motor deficit:

  • weak elbow flexion
  • weak wrist supination
  • absent bicep reflex
30
Q

What deformity can be caused by damage to the musculotaneous nerve?

A

wasting of the biceps

31
Q

What is the common mode and location of injury to the axillary nerve?

A

Fracture of surgical head of the humerus

compression injury from shoulder dislocation or crutches in the armpit

32
Q

What sensory loss and motor deficit can come from damage to the Axillary nerve?

A

sensory loss:
-Sergeants patch

Motor deficit:

  • Markedly weak shoulder abduction
  • Weak shoulder flexion, extension and external rotation
33
Q

What deformity can be caused by injury to the axillary nerve?

A

Wasting of the deltoid

34
Q

What is the common mode and location of injury to the Radial nerve?

A

Fracture of the proximal/shaft humerus, proximal radius

Compression from crutches of the armpit, sleeping on the arm or armpit on the cabir

35
Q

What sensory loss and motor deficit can come from damage to the Radial nerve?

A

Sensory loss:

  • Posterior arm and forearm
  • Radial area of hand

Motor deficit:

  • Weak elbow extension
  • Absent triceps reflex
  • Weak wrist extension
  • Weak finger MCP joint extension
36
Q

What deformity can be caused by injury to the axillary nerve?

A
  • Wasting of the triceps and posterior compartments of the forearm
  • Wrist drop on attempted wrist extension
37
Q

What is the common mode and location of injury to the median nerve?

A
  • Supra condylar fracture of the humerus

- compression in carpal tunnel in wrist

38
Q

What sensory loss and motor deficit can come from damage to the Median nerve?

A

Sensory Loss:
-Median distribution of hand and thenar eminence

Motor deficit:

  • Weak forearm pronation
  • Weak wrist flexion
  • weak wrist abduction
  • Weak finger flexion(?DIP joint of the ring and little finger preserved)
  • weak thumb abduction and opposition
39
Q

What deformity can be caused by damage to the Median nerve?

A
  • Wasting of anterior forearm
  • Wasting of thenar eminence
  • Hand of Benediction(on attempted finger flexion
40
Q

What is the common mode and location of injury to the Ulnar nerve?

A
  • Medial epicondylar fracture

- compression at Guyons tunnel in wrist

41
Q

What sensory loss and motor deficit can come from damage to the ulnar nerve?

A

Sensory loss:
-Ulnar distribution of hand and hypothenar eminence

Motor Loss:

  • Weak wrist flexion
  • Weak wrist adduction
  • Weak finger flexion of ring and little finger at the MCP and DIP joint
  • Weak extension a the IP joints in ring and little finger
  • Weak finger abduction, adduction and opposition
42
Q

What deformities can be caused by damage to the ulnar nerve?

A
  • wasting of th hypothenar eminence and intrinsic hand muscle
  • Claw hand(on attempted finger flexion)
43
Q

Where is the cephalic vein located?

A

in the anterior, lateral side of the arm, originating a the lateral dorsal venous arch

44
Q

Where is the Basilic vein located?

A

in the anterior, medial side of the arm, originating from the medial dorsal venous arch

45
Q

What is the medial cubital vein?

A

joins the cephalic and basilic vein in superficial network at the cubital fossa

Anatomy 2 (15 decks)

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