Exam 1: Lecture 6: Thoracic & Pelvic distal limb blood vessels & nerves. Perineural blocks Flashcards

1
Q

Thoracic limb innervation is through the _____ plexus which is:

A

Brachial plexus C6-T2

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2
Q

What nerves are involved with the brachial plexus?

A

-Suprascapular
-Subscapular
-Axillary
-Musculocutaneous
-Median
-Radial
-Ulnar

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3
Q

What nerve is indicated by the blue arrow?

A

-Suprascapular n.

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4
Q

What does the suprascapular n. supply?

A

-Supraspinatus m.
-Infraspinatus m.

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5
Q

What can occur if the suprascapular n. is injured?

A

-Atrophy of infraspinatus m. and supraspinatus m.
-Instability of the shoulder
-Shoulder “slip”

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6
Q

Why is damage to suprascapular n. not uncommon in horses?

A

-Because in other animals the nerve goes around the acromion of the scapula, but horses do not have an acromion so the nerve is unprotected

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7
Q

What nerve is indicated by the blue arrow?

A

-Subscapular n.

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8
Q

What does the subscapular n. supply?

A

-Subscapular m.

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9
Q

What nerve is indicated by the blue arrow?

A

-Axillary n. (located between teres major m. and subscapular m.)

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10
Q

What does axillary n. supply?

A

-Muscles of the shoulder

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11
Q

What nerve is indicated by the blue arrow?

A

-Musculocutaneous n.

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12
Q

What does musculocutaneous n. supply?

A

-Innervates muscles that will flex the shoulder
-Supplies autonomic in the distal part of the limb

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13
Q

What nerve is indicated by the blue arrow?

A

-Median n.

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14
Q

What does the median n. supply?

A

-Responsible for movement of the flexors
-Main innervation of palmar surface of “hand”
-Runs w/ brachial a.

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15
Q

What is indicated by the blue arrow and what does it do?

A

-Ansa axillaris
-Joins median n. w/ musculocutaneous n.

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16
Q

What nerve is indicated by the blue arrow?

A

-Radial n.

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17
Q

What nerve is indicated by the blue arrow?

A

-Radial n.

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18
Q

What is innervated by radial n.?

A

-Main nerve for extension m. of carpus & digits
-Innervates triceps brachii m.
-Very big n. chunk
-Hides between head of triceps medially

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19
Q

How can you see the lateral branches of the radial n.?

A

-Seen by reflecting the lateral head of triceps brachii m.

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20
Q

What nerve is indicated by the blue arrow?

A

-Ulnar n.

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21
Q

What does the ulnar n. supply?

A

-Supply flexor of carpus & digit
-From same area as median n.

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22
Q

What autonomous zone is shown by the blue arrow?

A

-Ulnar n.

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23
Q

What autonomous zone is shown by the blue arrow?

A

-Musculocutaneous n.

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24
Q

What autonomous zone is shown by the blue arrow?

A

-Median n.

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25
Q

What autonomous zone is shown by the blue arrow?

A

-Ulnar n.

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26
Q

What autonomous zone is shown by the blue arrow?

A

-Radial n.

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27
Q

What autonomous zone is shown by the blue arrow?

A

-Ulnar n.

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28
Q

What nerve is the blue arrow pointing to?

A

-Median n.

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29
Q

What nerve is the blue arrow pointing to?

A

-Median n. communicating branch

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30
Q

What nerve is the blue arrow pointing to?

A

-Median palmar n.

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31
Q

What nerve is the blue arrow pointing to?

A

-Medial digital palmar n.

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32
Q

What nerve is the blue arrow pointing to?

A

-Medial digital palmar n. dorsal branch

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33
Q

What nerve is the blue arrow pointing to?

A

-Communicating branch

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34
Q

What nerve is the blue arrow pointing to?

A

-Ulnar n.

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35
Q

What nerve is the blue arrow pointing to?

A

-Dorsal branch of ulnar n.

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36
Q

What nerve is the blue arrow pointing to?

A

-Lateral palmar n.

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37
Q

What nerve is the blue arrow pointing to?

A

-Lateral palmar n. dorsal branch

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38
Q

What nerve is the blue arrow pointing to?

A

-Lateral palmar n. dorsal branch

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39
Q

What nerve is the blue arrow pointing to?

A

-Median n. dorsal branch

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40
Q

What nerve is the blue arrow pointing to?

A

-Dorsal branch of ulnar n.

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41
Q

What nerve is the blue arrow pointing to?

A

-Medial cutaneous antebrachial n.

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42
Q

What artery is the blue arrow pointing to?

A

-Median a.

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43
Q

What artery is the blue arrow pointing to?

A

-Proximal radial a.

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44
Q

What artery is the blue arrow pointing to?

A

-Medial palmar a.

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45
Q

What artery is the blue arrow pointing to?

A

-Radial a.

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46
Q

What artery is the blue arrow pointing to?

A

-Lateral palmar a.

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47
Q

What artery is the blue arrow pointing to?

A

-Lateral palmar metacarpal a.

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48
Q

What artery is the blue arrow pointing to?

A

-Medial palmar metacarpal a.

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49
Q

What artery is the blue arrow pointing to?

A

-Medial palmar a.

50
Q

What artery is the blue arrow pointing to?

A

-Medial digital palmar a.

51
Q

What artery is the blue arrow pointing to?

A

-Lateral digital palmar a.

52
Q

What artery is the blue arrow pointing to?

A

-Proximal radial a.

53
Q

What artery is the blue arrow pointing to?

A

-Carpal net

54
Q

What is the blood on the dorsal part of the thoracic limb compared to the palmar aspect?

A

-Poor blood supply distally compared to palmar

55
Q

Pelvic limb innervation is through the _____ plexus which is

A

Lumbosacral (LS) plexus L4-S2

56
Q

What nerves are part of the lumbosacral plexus?

A

-Cranial & caudal gluteal n.
-Femoral n.
~Saphenous n. (branch of femoral n.)
-Obturator n.
-Ischiatic (Sciatic) n.
~Tibial n.
~Common fibularis n. (branches into superficial & deep)

57
Q

What do the cranial & caudal gluteal nerves supply?

A

-Supply more proximal muscles of the pelvic limb

58
Q

What does the femoral n. supply?

A

-Supplies quadriceps femoris m.

59
Q

What does the saphenous n. (branch off of femoral n.) supply?

A

-Autonomic zone for medial part of leg & thigh

60
Q

What does the obturator n. supply?

A

-Adductors

61
Q

What happens if the obturator n. is damaged?

A

-Animal is stuck abducting and cannot pull their limbs back in medially

62
Q

Where is sciatic n. located?

A

-Very big n. deep to biceps femoris m.

63
Q

Where does tibial n. go? (branch of sciatic n.)

A

-Stays caudal

64
Q

Where does common fibularis nerve go?

A

-Cranial

65
Q

What nerve is indicated by the big triangle at the top?

A

-Femoral n.

66
Q

What nerve is indicated by the smaller triangle at the bottom?

A

-Saphenous n.

67
Q

What nerve is indicated by the triangle?

A

-Obturator n. (hint: look where it goes through!)

68
Q

What nerve is responsible for the condition indicated in this image?

A

-Damage of obturator n.

69
Q

What nerve is indicated by the large triangle at the top?

A

-Sciatic n.

70
Q

What nerve is indicated by the smaller triangle on the right?

A

-Tibial n. (stays caudal)

71
Q

What nerve is indicated by the smaller triangle on the left?

A

-Common fibularis n. (goes cranial)

72
Q

What autonomic zone is indicated by the blue star?

A

-Saphenous n.

73
Q

What autonomic zone is indicated by the blue star?

A

-Tibial n.

74
Q

What autonomic zone is indicated by the blue star?

A

-Common fibular n. (Aka Peroneal n.)

75
Q

What autonomic zone is indicated by the blue star?

A

-Tibial n.

76
Q

What nerve is indicated by the green line on the left image?

A

-Tibial n.

77
Q

What nerve is indicated by the red line?

A

-Lateral plantar n.

78
Q

What nerve is indicated by the yellow line?

A

-Medial plantar n.

79
Q

What nerve is indicated by the burnt orange line (below the yellow)?

A

-Medial digital plantar n.

80
Q

What nerve is indicated by the purple line?

A

-Lateral digital plantar n.

81
Q

What nerves are indicated by the darker blue lines?

A

-Lateral and medial plantar metatarsal nn.

82
Q

What nerve is indicated by the darker yellow line on the right image?

A

-Saphenous n.

83
Q

What nerve is indicated by the light green line on the right image?

A

-Caudal cutaneous sural n.

84
Q

What nerve is indicated by the light blue line on the right image?

A

-Superficial fibular n.

85
Q

What nerve is indicated by the pink/purple line and what nerves does it split into?

A

-Deep fibular n.
-Splits into lateral & medial dorsal metatarsal nn.

86
Q

What artery is indicated by the blue arrow?

A

-Caudal tibial a.

87
Q

What artery is indicated by the blue arrow?

A

-Saphenous a.

88
Q

What artery is indicated by the blue arrow?

A

-Lateral plantar a.

89
Q

What artery is indicated by the blue arrow?

A

-Medial plantar a.

90
Q

What artery is indicated by the blue arrow?

A

-Deep plantar arch

91
Q

What arteries are indicated by the blue arrow?

A

-Lateral & medial plantar metatarsal aa.

92
Q

What artery is indicated by the blue arrow?

A

-Lateral digital plantar a.

93
Q

What artery is indicated by the blue arrow?

A

-Medial digital plantar a.

94
Q

What artery is indicated by the blue arrow?

A

-Cranial tibial a.

95
Q

What artery is indicated by the blue arrow?

A

-Dorsal pedal a.

96
Q

What artery is indicated by the blue arrow?

A

-Dorsal metatarsal a.

97
Q

What nerve block is indicated by this image?

A

-Palmar digital nerve block

98
Q

What technique is used to perform a palmar digital nerve block?

A

-Insert the needle over the neurovascular bundle at the proximal border of the collateral cartilage

99
Q

How much volume is used during a palmar digital nerve block?

A

-1.5 mL per site

100
Q

What nerves are affected during a palmar digital nerve block?

A

-Palmar digital nerves (both medial & lateral)

101
Q

What is anesthetized during a palmar digital nerve block?

A

-Sole
-Navicular apparatus
-Coffin joint
-Distal flexor tendon sheath
-Distal sesamoidean ligaments
-Loss of skin sensation at the heel

102
Q

What nerve block is indicated by this image?

A

-Abaxial sesamoid nerve block

103
Q

What technique is used in an abaxial sesamoid nerve block?

A

-Insert the needle at the abaxial surface of the sesamoid, point needle distally

104
Q

What volume is used during an abaxial sesamoid nerve block?

A

-2ml per site

105
Q

What nerves are affected during an abaxial sesamoid nerve block?

A

-Palmar digital nerves

106
Q

What is anesthetized during an abaxial sesamoid nerve block?

A

-Foot
-Middle phalanx
-Pastern joint
-Distal P1
-Distal SDF & DDF
-Distal sesamoidian ligaments
-Distal annular ligament
-+/- fetlock joint

107
Q

What nerve block is indicated by the image?

A

-Low 4-point block

108
Q

What is the technique for a Low 4-point nerve block?

A

-Insert the needle distal to the button of the splint medially & laterally
-Insert the needle SQ between the suspensory ligament & the DDF tendon

109
Q

What volume is used in a Low 4-point nerve block?

A

-1-2ml per site

110
Q

What nerves are affected during a Low 4-point nerve block?

A

-Palmar metacarpal/metatarsal nerves (adjacent to splint)
-Palmar nerves (between suspensory & DDFT)

111
Q

What is anesthetized during a Low 4-point nerve block?

A

-All structures previously mentioned in the more distal nerve blocks
-Fetlock joint
-Suspensory branches
-More proximal SDF/DDF tendons

112
Q

How does a Low 4-point block work in the hind limb?

A

-Performed the same as the forelimb
-Will not reliably anesthetize the skin dorsally
~IMPORTANT for suturing a laceration
~Less important for lameness workup
-Can do a dorsal ring block to anesthetize the skin

113
Q

What block is shown in the image?

A

-High 4 Point Block front limb

114
Q

What is the technique for a high 4 point nerve block in the front limb?

A

-Inject SQ on dorsal surface of DDFT through the fascia (carpal retinaculum flexorum) just distal to the CMC joint

-Flex the limb & insert the needle along the splint bones pointed at palmar MC3

115
Q

What volume is used in a high 4 point nerve block in the front limb?

A

-2-5ml per site

116
Q

What nerves are affected in a high 4 point nerve block in the front limb?

A

-Medial & lateral palmar nerves
-Medial & lateral palmar metacarpal nerves

117
Q

What does the high 4 point nerve block in the front limb anesthetize?

A

-Flexor tendons
-Splint bones
-Interosseous ligaments (between MC2/4 and MC3)
-Proximal suspensory ligament
-Inferior check ligament

118
Q

What nerve block is shown in the image?

A

High 4 (6) Point block hind end

119
Q

What is the technique for a high 4 (6) point block hind limb?

A

-1.5 in needle inserted 1cm distal to TMT on either side & hit the back of MC3, non-wgt
-25g 5/8in needle - deposit 3-5ml through the fascia over the DDFT on medial & lateral side
-2cm distal to the TMT at 10 & 2 o’clock positions on the dorsal cannon bone

120
Q

What is the volume of a high 4 (6) point block hind limb?

A

-3-5ml per site

121
Q

What nerves are affected during a high 4 (6) point block hind limb?

A

-Medial & lateral plantar nerves
-Medial & lateral plantar metatarsal nerves
-Dorsal metatarsal nerves

122
Q

What is anesthetized during a high 4 (6) point block hind end?

A

-Everything distal to the TMT except the dorsum over the cannon bone
-Dorsal cannon
-Necessary for lacerations, not commonly clinically relevant