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Anatomy > Lec 13 & 14 - peripheral nerve lesions of UE > Flashcards

Lec 13 & 14 - peripheral nerve lesions of UE Flashcards

1
Q

DR CUMBA

A
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2
Q

Dorsal Root
Ventral Root

A

Dorsal root - Sensory
Ventral root - Motor

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3
Q

*Suprascapular Nerve Entrapment

A

Innervates supraspinatus muscles first then infraspinatus

can be entrapped under transvers superior scapular ligament in suprascapular notch (affects supra and infra) or spinoglenoid ligament in spinoglenoid notch (would only affect infra, so no ER)

clavicular fractures may also harm

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4
Q

Know median and lateral head of the median N

A
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5
Q

Scalene Block

A

anesthetizes most of brachial plexus during surgery excpet C8 and T1

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6
Q

Common peripheral nerve injuries

A

pins-and-needles from pressure or awkward position

neuropraxia - type of peripheral nerve injury characterized by a temporary loss of function of the affected nerve without any structural damage. It is often caused by compression, stretching, or ischemia (lack of blood flow) to the nerve

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7
Q

What can neuropraxia progress to?

A

cumulative trauma disorders

more severe nerve injuries may involve interruptions of the axons (axonotmesis) or entire nerve (neurotmesis)

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8
Q

How do clinicians test peripheral nerve muscle function and sensory function?

A

manual muscle tests

close eyes and touch different peripheral innervates regions of arm and hand

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9
Q

Causes of PNI

A

diabetes
traction
neoplastic
direct trauma
compression
motor neuron diseases
autoimmune
inflammation/ischemia

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10
Q

**Thoracic outlet entrapment sites

A

between anterior and middle scalene (brachial plexus)

under pec minor - brachial plexus, axially artery and vein

between clavicle and 1st rib

UE in hyperabduction

cervical rib

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11
Q

Radial tunnel syndrome (entrapment sites)

A

“dont spend too much time on”

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12
Q

Radial nerve affects what movements?

A

wrist extension, wrist radial deviation (half, flexor can do other half), finger extension, thenar extension and abduction (half)

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13
Q

Common Radial nerve injury

A

Wrist Drop

not a contracture just cant move on own

radial nerve MOTOR impairment

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14
Q

If someone has radial nerve injury, can they still abduct thumb?

A

Yes, abductor pollicis brevis is median nerve

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15
Q

Does the deep radial nerve / PIN innervate any hand intrinsics?

A

No

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16
Q

Radial N - deep branch innervation

A

extensor digitorum
extensor carpi ulnaris
extenso digit minmi

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16
Q

Radial N innervation

A

tricpes
anconeus
brachioradialis
extensor carpi radialis longus (and brevis on sheet)

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17
Q

Does the median nerve innervate muscles in the brachium?

A

No

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18
Q

Radial N PIN (Posterior interosseous)

A

Abductor Pollicis Longus
Extensor Pollicis brevis
Extensor Pollicis longus
Supinator
Extensor Indices

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19
Q

List the divisions of the median nerve

A

Median N
AIN - Anterior interosseous Nerve
Recurrent branch
Digital branch

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20
Q

Median N

A

Pronator teres
(PL)
Flecor carpi radialis
Flexor digitorum superficialis

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21
Q

Median AIN

A

FDP
Flexor pollicis longus
Pronator quadratus

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22
Q

Median Recurrent

A

APB
FPB
Opponens Pollicis
Lumbricals (DIGITAL BRANCH)

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23
Q

Median N Digital

A

lateral 2 lumbricals and palm sensation

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24
Q

Where does the median nerve split?

A

travels through cubital fossa and innervates PT, PL, FCR first

sends a branch 1/4th way down forearm - anterior interosseous regions (AIN)

at distal radioulnar joint it splits into recurrent branch (thenar side) and digital branch for lumbricals and palm sensation

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25
Q

Median Nerve entrapment sites

A

Between A/P scalene
Pec minor
Pronator teres region - splits
AIN (degeneration)
Carpal tunnel

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26
Q

Pronator syndrome associated with what nerve

A

median

dont spend time on

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27
Q

Carpel tunnel contents

A

FDS, FDP
FPL
FCR
MEDIAN Nerve

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28
Q

Ape hand

A

Median Nerve
thumb rests in adduction because without median nerve innervating thenar muscles there is no one to counter adductor except APL

posture hand takes at rest

loss of web space

29
Q

Hand of Benediction

A

median nerve injury usually happens with ape hand

bishops hand

inability to flex thumb, index and middle finger when asked to make a fist

(last digits are all the way down in fist)

30
Q

What screening procedure can be used for AIN syndrome?

A

Make an OK sign with hand - not circle or pinch = bad

31
Q

What motion is the median nerve entirely responsible for?

A

Pronation

32
Q

What role does anconeus play in pronation

A

abducts ulna during pronation

carrying angel disapears

33
Q

What nerve continues off the musculocutaneous arm and what area does it supply sensation to?

A

Lateral antebrachial cutaneous nerve

lateral forearm

34
Q

What sensory and motor functions could test for musculocutaneous function?

A

elbow flexion

lateral forearm sensory

35
Q

What can cause axillary nerve damage?

A

anterior shoulder dislocation
open shoulder surgeries
improper use of crutches
improper IM injection

36
Q

What branch comes off the axillary nerve and what is its function?

A

The superior lateral cutaneous nerve of arm

innervates sensory area of axillary

37
Q

Ulnar nerve entrapment sites

A

between first rib and clavicle

arcade of Struthers

between heads of flexor carpi ulnaris

cubital tunnel

guyons canal

38
Q

What motor deficits result from ulnar nerve injury

A

lateral key pinch - thumb adduction

39
Q

What is cubital tunnel syndrome?

A

pressure and tension of the ulnar nerve in cubital tunnel with flexed elbow

think texting in bed on stomach

medial, right below elbow joint

causes ulnar neuritis

40
Q

Ulnar transposition

A

surgical relocation of the ulnar nerve in the cubital tunnel to the anterior medial epicondyle

41
Q

Ulnar deep branch innervation

A

PAD
DAB
medial 2 lumbricals
adductor
hypothenars (FDM, ADM, ODM)

42
Q

Guyons canal contents

A

ulnar nerve and artery

43
Q

Ulnar nerve screening

A

thumb adduction
crossing fingers
squeezing paper between fingers

44
Q

Common ulnar nerve injury

A

claw hand at rest

4th and 5th digits cant extend (FDP medial)

hyperextension of MCP, loss of IP extension in 4th and 5th

law of medial lumbricals (and other intrinsic hand muscles)

45
Q

Superior trunk of brachial plexus injury

A

C5 C6
waiters tip or erb-duchenne palsy
neck movements
more important

46
Q

Inferior trunk injury

A

C8 T1
less common (so dont worry)
UE pulled superiorly
claw hand
klumpke palsy

47
Q

Middle trunk injury?

A

C7?

48
Q

*Intrinsic plus position - what condition is associated?

A

MCP flexion with PIP and DIP extension

sandwich or sock puppet

PAD, DAB, lumbricals, flexor digit minimi

tenodesis - passive finger flexion with wrist extension

49
Q

intrinsic minus

A

evil cousin of intrinsic plus

clawing of fingers

MCP hyperextension and IP flexion

50
Q

*Grasp Patterns - cylindrical

A

midrange flexion of digits
tube shaped object
turning steering wheel

51
Q

Grasp patterns - spherical

A

varied flexion of digits
rounded object

52
Q

Grasp patterns - hook (what muscle is crucial)

A

flexion of PIPs and DIPs, extension of MCP

NEED FDP

carrying a bucket

53
Q

Grasp patterns - composite

A

maximal flexion of all joints
wringing out towel

54
Q

Pinch patterns - tip

A

precise movements
distal tips of thumb and index

threading needle

55
Q

Pinch - three jaw chuck

A

tripod pinch

tip of thumb against tips of index and middle fingers

writing with a pencil

56
Q

Pinch - lateral (key)

A

pad of thumb against radial side of index finger

unlock a door with key

57
Q

What is the second strongest muscle

A

adductor pollicis

58
Q

Tinels nerve exam

A

ulnar nerve

tap medial condyle, do they feel it in tips of digits 4&5?

59
Q

scratch collapse test

A

reflextive collapse with external rotation after swiping finger over nerve

suprascapular nerve

60
Q

what position would a wrist brace have the wrist in at night for treatment of carpal tunnel syndrome

A

wrist extension

61
Q

Radial nerve injury treatment - radial nerve palsy orthosis

A

brace to assist with grasping and releasing objects

62
Q

What movements would hurt with de quervains or texting thumb syndrome

A

Thumb extension and abduction

APL EPB

63
Q

Treatment for De Quervains

A

thumb spica orthosis

nerve slides for sensory branch of radial nerve

64
Q

Extensor hood functions

A

extension of IP joints

counterbalances flexor forces of extrinsic muscles

facilitates coordinated finger flexion(?)

65
Q

Extensor hood - sagittal band fxn

A

stabilize volar plates and MCP joints, prevent bowstringing of extensor tendons

66
Q

Extensor hood - central band fxn

A

extended PIP

67
Q

Extensor hood - lateral band fxn

A

extends DIP joint

68
Q

Extensor hood - terminal tendon

assocaited injury

A

extends DIP joint

mallet finger
swans neck

69
Q

Swan neck deformity

A

damage to terminal tendon, direct blow to DIP while extended or progressive weakining (RA)

PIP in hyper extenstion and DIP in flexion

70
Q

Boutonniere deformity

A

opposite of swan neck

injury to the central slip

PIP joint flexion and DIP hyperextension

ORL ligament

Anatomy (23 decks)

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