Lecture 15: Upper Extremity Neurology Flashcards
What is damaged in “Waiter’s Tip Position” or Erb-Duchenne Palsy and what does it look like?
- damaged to Superior Brachial Plexus (C5/C6)
- dramatically inc. angle between neck and shoulder
- spinal roots removed from Spinal Cord
- adducted and medially rotated arm, extended elbow
What is damaged in “Claw Hand” or Klumpke Paralysis and what does it look like?
- damaged Inferior Brachial Plexus (C7/C8/T1)
- dramatically inc. angle between trunk and upper limb
- affects short hand muscles = claw hand
Compression of the CORDS of the Brachial Plexus is a result of what? What are the symptoms?
- from prolonged periods of working with UL extended over head
- pain down arm, loss of sensation, tingling, weakness of Hands
What is the cause of Musculocutaneous N. damage and what is affected?
cause: blunt force trauma
symptoms: paralysis of anterior Brachial muscles
What are the symptoms of damaged Axillary N. and what does it look like?
symptoms: loss of sensation over superolateral arm (Lateral Brachial Cutaneous N.)
appearance: atrophy of the Deltoid M.
What is “Ape’s Hand”?
- injury to Median N. in the wrist
- adducted thumb and thenar eminence atrophy
What is “Hand of Benediction”?
- injury to Median N. at the elbow
- inhibit 2nd/3rd digit flexion
- also has symptoms of Ape Hand
What is “Claw Hand”?
- injury to Ulnar N.
- extensive loss of sensory and motor control in hand (cannot flex 4th/5th digits)
What is “Handlebar Neuropathy”?
- compression of Ulnar N. at Hamulus of Hamate (like when riding a bike)
- sensory loss on medial side, weakness of intrinsic hand muscles
What is “Wrist Drop”?
- injury of Radial N.
- impairment of elbow extension and thumb abduction/extension
What do the Supraclavicular N.’s innervate?
cutaneous innervation of skin over Neck and Shoulder
What two nerves come off of the Roots of the Brachial Plexus and what do they innervate?
- Dorsal Scapular N. (Levator Scapulae/Rhomboids) –> C5
2. Long Thoracic N. (Serratus Anterior) –> C5-C7
What two nerves come off of the Superior Trunk of the Brachial Plexus and what do they innervate?
- Suprascapular N. (Supraspinatous and Infraspinatous)
2. Subclavian N. (Subclavius M.)
What nerve comes off of the Lateral Cord of the Brachial Plexus and what does it innervate?
Lateral Pectoral N. (Pectoralis Major M.)
What three nerves come off of the Posterior Cord of the Brachial Plexus and what do they innervate?
- Superior Subscapular N. (Subscapularis M.) –> C5-C6
- Inferior Subscapular N. (Subscapularis M. & Teres Major M.) –> C5-C6
- Thoracodorsal N. (Latissimus Dorsi) –> C6-C8
What three nerves come off of the Medial Cord of the Brachial Plexus and what do they innervate?
- Medial Pectoral N. (Pectoralis Major and Minor M.)
- Medial Brachial Cutaneous N. (medial upperarm skin)
- Medial Antebrachial Cutaneous N. (medial forearm skin)
What are the levels of innervation for the Branches of the Brachial Plexus?
- Musculocutaneous N. –> C5-C7
- Axillary N. –> C5-C6
- Median N. –> C5-T1
- Radial N. –> C5-T1
- Ulnar N. –> C8-T1
What does the Axillary N. innervate and what is the cutaneous branch that comes off of it?
innervates: Teres Minor and Deltoid M.
branch: Superior Lateral Cutaneous N. (skin upper lateral arm)
What does the Musculocutaneous N. innervate and what is the cutaneous branch that comes off of it?
innervates: Biceps Brachii, Coracobrachialis, Brachialis M.
branch: Lateral Antebrachial Cutaneous N. (skin lateral forearm)
What muscles do the Median N. directly innervate? (4)
- Pronator Teres M.
- Flexor Carpi Radialis M.
- Flexor Digitorum Superficialis M.
- Palmaris Longus M.
What cutaneous branch comes off of the Median N. and what does it innervate?
Palmar Cutaneous Branch
- skin of the palm
What does the Anterior Interosseous N. innervate? (3)
- Lateral 1/2 of Flexor Digitorum Profundus M.
- Flexor Pollicis Longus M.
- Pronator Quadratus M.
What does the Recurrent Branch of the Median N. innervate? (3)
- 1/2 Flexor Pollicis Longus M.
- Abductor Pollicis Brevis M.
- Opponens Pollicis M.
What do the Median and Lateral branches of the Median N. innervate? What are the their nerve branches?
innervate: 1st and 2nd lumbricals
branches: Common Palmar Digital N. –> Proper Palmar Digital N.
What does the Ulnar N. directly innervate? (2)
- Flexor Carpi Ulnaris M.
- Medial 1/2 Flexor Digitorum Profundus M.
What are the two cutaneous nerves that come off of the Ulnar N. and what do they innervate?
- Dorsal Cutaneous Branch of Ulnar N. (Skin dorsal hand)
2. Palmar Cutaneous Branch of Ulnar N. (palm skin)
What does the Superficial Ulnar N. innervate? (3)
- Abductor Digiti Minimi M.
- Flexor Digiti Minimi M.
- Opponens Digiti Minimi M.
What does the Deep Ulnar N. innervate? (4)
- 1/2 Flexor Pollicis Brevis M.
- Adductor Pollicis M.
- Dorsal/Palmar Interossei M.
- 3rd/4th lumbricals
What are the 3 cutaneous nerves of the Radial N. and what do they innervate?
- Posterior Brachial Cutaneous N. (post. arm skin)
- Inferior Lateral Brachial Cutaneous N. (inf. aspect of lateral arm)
- Posterior Antebrachial Cutaneous N. (posterior forearm)
What does the Radial N. directly innervate? (4)
- Triceps Brachii M.
- Anconeus M.
- Brachioradialis M.
- Extensor Carpi Radialis Longus M.
What does the Deep Radial N. innervate? (2)
- Extensor Carpi Radialis Brevis M.
- Supinator M.
What does the Posterior Interossei M. travel under and what does it innervate?
- travels under supinator muscle
- innervates rest of forearm extensors
What nerve travels through the Anatomical Snuff Box and what are its branches?
Superficial Radial N.
branches: Dorsal Digital N. –> Dorsal Branches Dorsal Digital N.
