Exam 2: Nerve Plexi Spring 2024

Question 1

What two nerves are part of the Cervical Plexus?

Answer 1

Supraclavicular nerve
Phrenic Nerve

Question 2

What does the Phrenic nerve control?

Answer 2

Breathing via the diaphragm

Question 3

Where is the Cervical Plexus located in the neck?

Answer 3

Posterior triangle of the neck, halfway up the sternocleidomastoid muscle and within the prevertebral layer of the cervical fascia

Question 4

The Cervical plexus is formed by the _____ ______ (divisions) of cervical spinal nerves _____-_____.

Answer 4

The Cervical plexus is formed by the anterior rami (divisions) of cervical spinal nerves C1-C4.

Question 5

What is a complication if you are off on your block of the supraclavicular nerve?

Answer 5

You can hit the phrenic nerve and cause hemi-diaphragmatic paralysis.

Not good for patients with COPD or breathing issues

Question 6

Where is the Stellate Ganglion located?

Answer 6

C-7 and comes off the front side of the neck, above the FIRST rib.

Question 7

What does the Stellate Ganglion have to do with the Cervical Plexus?

Answer 7

It is not part of the Cervical Plexus, however it comes off of and is adjacent to a cervical vertebrae.

Question 8

What does the Stellate Ganglion do to the body? What are its branches?

Answer 8

It is a collection of sympathetic nerves and increases SNS transmission via multiple branches in the body.

Somatic branches - gray rami communicantes to C7, C8 and T1

Visceral branches - via the inferior cardiac nerve and contributes to cardiac plexus in the thorax

SNS branches to the brachial plexus, subclavian, vertebral arteries and brachiocephalic trunk

Question 9

If you block the Stellate Ganglion what can you end up treating? (5 things he mentioned in class, but there is a long list.)

Answer 9

1. Chest pain
2. Scleroderma
3. Long Covid symptoms (return smell/taste)
4. Chronic pain
5. Craniofacial hyperhidrosis (excessive sweating)

• Refractory angina
• Atypical angina
• Postherpetic neuralgia
• Phantom limb pain
• Chronic post-surgicalpain
• Post-traumatic stress disorder
• Neuropathic pain syndromes in cancer pain
• Vascular headaches including cluster headache and migraine headache
• Raynaud syndrome
• Upper extremity embolism
• Meniere syndrome
• Refractory cardiac arrhythmias including Roman/Ward syndrome and Jervell/Lang/Nielson syndrome
• To diagnosesympathetically mediated pain
• Quinine poisoning
• Sudden loss of hearing accompanied by tinnitus
• Accidental intraarterial injection of intravenous medications

Question 10

What type of syndrome and symptoms do you see when you block the stellate ganglion?

Answer 10

Horners syndrome

Partial ptosis ( eyelid drooping)
Miosis ( constricted pupil)
Facial anhidrosis (absence of sweating)

Question 11

Does blocking the phrenic nerve cause Horner’s syndrome?

Answer 11

No. It is the blockade of the stellate ganglion that causes Horner’s syndrome

*Phrenic nerve blockade can be associated because of how close it is to the stellate ganglion. - this causes respiratory problems

Question 12

Interscalene blocks are associated with which spinal vertebrae nerve roots?

Answer 12

C5-C7

Question 13

When blocking the Interscalene what other structures could you block around it accidentally?

Answer 13

Stellate Ganglion, Phrenic nerve

Question 14

What plexus innervates the upper extremities and what spinal root vertebrae does it come off of it?

Answer 14

The brachial plexus - C5-T1

It exits the cervical spine and traces between the anterior and middle scalene muscles and around the axillary artery.

Question 15

What are the five parts that the Brachial Plexus is divided into?

Answer 15

Roots
Trunks
Divisions
Cords
Branches

There are no functional difference between these divisions, they are simply used to aid explanation of the brachial plexus

Mnemonic - Read That Damn Cadaver Book.

Question 16

What four types of blocks can you do in the brachial plexus area?

Answer 16

Interscalene
Supraclavicular
Infraclavicular
Axillary

Question 17

What area do you block when you put local anesthetic in the Axillary Nerve? What spinal root vertebrae is this associated with?

Answer 17

Primarily blocks the sensory functions of the upper lateral cutaneous nerve aka the skin over the lower deltoid (“regimental badge area”)

Blocks the motor functions of the teres minor and deltoid muscles

Spinal roots from C5-C6

Question 18

Why would you block the Axillary Nerve?

Answer 18

Posterior shoulder pain
Tourniquet pain

Question 19

Where are the spinal nerve roots located for the Musculocutaneous Nerve? What areas does this block?

Answer 19

C5-C7

Blocks the motor functions high in the biceps of the anterior compartment of the arm (coracobrachialis, biceps brachii and the brachialis)

Blocks the sensory down low to the lateral cutaneous nerve of the FOREARM.

Question 20

Median nerve is innervated by which spinal nerve roots?

Answer 20

C6 - T1 (also contains fibers from C5 in some individuals)

Question 21

What spinal nerve root innervates the Radial nerve? What areas does this block?

Answer 21

C5-T1

Blocks sensory to most of the skin of the posterior forearm, lateral aspect of the dorsum of the hand, and the dorsal surface of the lateral three and half digits

Blocks motor functions of the triceps brachii and the extensor muscles in the forearm.

Question 22

Where is the Radial Nerve easiest to find?

Answer 22

You can find it easily next to the radial artery. It can also be found in the axilla.

The radial nerve is a spiral Nerve that wraps around the bone several times, not easy to find.

Question 23

What spinal nerve root is associated with the Ulnar nerve? What does it block?

Answer 23

C8 - T1

Block of motor function to the two muscles of the anterior forearm - flexor carpi ulnaris and medial half of flexor digitorum profundus. Intrinsic muscles of the hand.

Blocks sensory functions - Medial one and half fingers and the associate palm area

Question 24

Where do you expect to see the motor response if you stimulated the Ulnar nerve?

Answer 24

Pinky finger!!

Question 25

What spinal nerve roots make up the Lumbar Plexus? What are the six major peripheral nerves of this plexus?

Answer 25

L1-L4

Iliohypogastric - abdomen

Ilioinguinal
Genitofemoral
Lateral cutaneousnerve of the thigh
Obturator
Femoral

Mneumonic
I, I GetLeftoversOnFridays.

Question 26

Which spinal nerve roots innervate the Iliohypogastric nerve? What does blocking this nerve do?

Answer 26

L1 (some T12)

Blocks motor function of the internal oblique and transverse abdominis muscle

Blocks sensory - posterolateral gluteal skin in the pubic region.

Question 27

What surgery did Cornelius mention for blocking the Iliohypogastric nerve?

Answer 27

Inguinal hernia repair

Question 28

What spinal nerve root innervates the Ilioinguinal nerve?

Answer 28

L1

Blocks motorfunctions of the internal oblique and transversus abdominis.

Question 29

Why do you need to warn males and females about when blocking the Ilioinguinal nerve?

Answer 29

In males, it also supplies the skin over the root of the penis and anterior scrotum.

In females, it supplies the skin over mons pubis and labia majora.

Question 30

Which spinal nerve roots innervate the Lateral Femoral Cutaneous nerve?

Answer 30

L2, L3
Lateral thigh

Question 31

What patients would you do a Lateral Femoral Cutaneous nerve block on?

Answer 31

Femoral fractures

Question 32

Which spinal nerve roots innervate the Obturator nerve?

Answer 32

L2, L3, L4
Medial Thigh

Question 33

Which spinal nerve roots innervate the femoral nerve?

Answer 33

L2, L3, L4
Anterior thigh
“Catch-all for the thigh”
Large nerve

Question 34

What spinal nerve roots innervate the Sacral plexus?

Answer 34

L4-S4

Question 35

What spinal nerve roots innervate the Sciatic nerve?

Answer 35

L4-S3