Innervation of the Upper Limb Flashcards

1
Q

glenohumeral joint

A

joint between humerus and scapula

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2
Q

radius vs ulna

A

radial is more lateral (thumb side)

ulna is more medial (pinky side)

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3
Q

joints of the hand

A

CMC: carpometacarpal joint
MCP: metacarpophalangeal joint
PIP: proximal interphalangeal joint
DIP: distal interphalangeal joint

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4
Q

what is the brachial plexus
relations
divisions

A

somatic plexus formed by the ventral rami of C5 to T1
closely related to axillary artery and vein
divided into roots, trunks (neck), divisions (behind clavicle), cords (in axilla), and terminal nerves

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5
Q

terminal branches of the brachial plexus

A

musculocutaneous nerve
axillary nerve
median nerve
ulnar nerve
radial nerve

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6
Q

what is the musculocutaneous nerve is a branch of

A

lateral cord of the brachial plexus (C5-7)

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7
Q

musculocutaneous nerve pathway and motor supply

A

passes through coracobrachialis muscle and descends between biceps brachii and brachialis muscle in the front of the arm

motor supply to flexor compartment of the arm (above muscles), flexion of shoulder and elbow joints

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8
Q

musculocutaneous nerve sensory supply and pathway

A

continues into the forearm anterior to elbow and becomes lateral cutaneous nerve of forearm

sensory supply to the skin on the lateral forearm

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9
Q

result of damage to musculocutaneous nerve

biceps jerk reflex (C5, C6)

A

no contraction of flexor compartment of arm

hitting the distal attachment of the biceps triggers contraction of flexor and relaxation of extensor of arm

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10
Q

what is the axillary nerve a branch of

A

posterior cord of the brachial plexus (C5, C6)

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11
Q

axillary nerve pathway

A

exits the axilla posteriorly and passes posteriorly around the surgical neck of the humerus

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12
Q

axillary nerve motor supply and function

A

deltoid and teres minor muscles

abduction, flexion, extension and external rotation of shoulder

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13
Q

axillary nerve sensory supply

A

skin over the deltoid (regimental patch) via the superior lateral cutaneous nerve

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14
Q

effect of injury to axillary nerve
when is this common

A

paralysis of deltoid and weakness of abduction of arm
sensory loss over deltoid

may occur when surgical neck of humerus is fractured

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15
Q

what is the median nerve a branch of

A

lateral cord and medial cord of the brachial plexus (C5-T1)

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16
Q

median nerve general pathway

A

extend from the terminal branches of the brachial plexus distally to the hand

17
Q

median nerve motor supply and pathway

A

no motor supply to the arm
supplies forearm and hand

descends on the antero-medial aspect of the arm with no branches
at the cubital fossa (elbow region) it is located anterior to the brachialis muscle and medial to the brachial artery
passes into the forearm and supplies all muscles except the 1.5 supplied by ulnar nerve
passes through carpal tunnel and supplies muscles of the hand

18
Q

forearm muscles supplied by median nerve

A

pronator teres
superficial flexor muscles

flexor digitorium superficialis (FDS)

flexor pollicis longus (FPL)
lateral half of flexor digitorium profundus (FDP)

19
Q

carpal tunnel

A

fibrous tunnel formed by the flexor retinaculum and the wrist bones

median nerve passes though inside it
ulnar nerve passes superficially to it

20
Q

hand muscles supplied by the median nerve and their role

A

thenar muscles for thumb abduction and flexion

21
Q

median nerve sensory supply

A

lateral part of palm
palmar surface and nailbeds of the lateral 3 and half digits

22
Q

median nerve effect of injury and common causes

A

motor loss of pronation of forearm, opposition of thumb, flexion of index and middle fingers, hand of Benediction when attempting to make a fist
weakness of abduction and flexion of thumb and sensory loss over lateral three digits palmar surface

causes by fracture of distal humerus or carpal tunnel syndrome

23
Q

what is the ulnar nerve a branch of

A

medial cord of the brachial plexus (C7-T1)

24
Q

ulnar nerve pathway and motor supply

A

descends along the medial aspect of the arm
passes behind medial epicondyle of the humerus
passes into the medial side of the forearm and supplies 1 and a half muscles in forearm
passes superficially to the carpal tunnel and supplies muscles of the hand

25
Q

forearm muscles supplied by ulnar nerve

A

flexor carpi ulnaris (FCU)

medial half of flexor digitorium profundus (FDP)

26
Q

hand muscles supplied by the ulnar nerve and their role

A

three hypothenar muscles
abduct and flex 5th finger allowing opposition of fingers

27
Q

ulnar nerve effect of injury

A

claw hand deformity (flexed at PIP and DIP, extended at MCP)

loss of adduction of thumb and sensory loss over medial 1 and a half fingers and part of the hand

28
Q

why is the radial nerve the most commonly injured

A

largest nerve in the upper limb
long course
proximity to the humeral shaft

29
Q

what is the radial nerve a branch of

A

posterior cord of the brachial plexus (C5-T1)

30
Q

radial nerve pathway and motor supply in arm

A

descends posteriorly between the three heads of the triceps brachii
supplies the triceps brachii

passes behind the spiral (radial) groove on the back of the humerus
enters laterally to the anterior compartment of the arm between the brachialis and brachioradialis muscles
supplies the brachioradialis muscle

31
Q

radial nerve pathway and motor supply in forearm

A

enters the forearm anterior to the lateral epicondyle of humerus
divides into deep (motor) and superficial (sensory) branches

deep branch enters posterior compartment of the forearm

32
Q

radial nerve sensory supply of arm

A

supplies skin of the posterior surface of the arm via posterior cutaneous nerve (arises from axilla)

supplies skin of lower lateral arm and posterior of forearm via interior lateral cutaneous nerve and posterior cutaneous nerve respectively

33
Q

radial nerve sensory supply of forearm

A

superficial branch descends on the anterolateral aspect under brachioradialis muscle

passes dorsally to the back of the hand and supplies the lateral side and back of the hand and back of the lateral 3 and a half digits (excluding nailbeds)

34
Q

radial nerve effects of injury

A

sensory loss posterior of arm, forearm, dorsolateral surface of hand and dorsal or lateral 3 and a half digits

injury at axilla (crutch palsy) - inability to extend elbow
injury at spiral groove (Saturday night palsy) - wrist drop