Lecture 15: Upper Extremity Neurology Flashcards

1
Q

What innervates the skin of the neck and shoulder?

A

Supraclavicular Nerves

(Nerves of the Cervical Plexus)

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2
Q

What are the three major divisions of the Lateral Cord of the Brachial Plexus?

A

Lateral Pectoral Nerve

Musculocutaneous Nerve

1/2 of the Median Nerve

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3
Q

What are the branches and terminal divisions of the Posterior Cord of the Brachial Plexus?

A

Branches: Inferior Subscapular, Superior Subscapular, and Thoracodorsal

Terminal Branches: Axillary Nerve, Radial Nerve

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4
Q

What are the three branches and two terminal branches of the Medial Cord?

A

Branches: Medial Pectoral, Medial Brachial Cutaneous, Medial Antebrachial Cutaneous.

Terminal Branches: Ulnar Nerve and 1/2 of the Median Nerve

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5
Q

What Nerves come directly off the Root of C5?

A

Dorsal Scapular Nerve

Long Thoracic

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6
Q

Dorsal Scapular Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Rhomboid Muscles and Levator Scapulae Muscle

2. Where does it come off of the brachial plexus?

Root of C5

3. What roots contribute to it?

C5 only

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7
Q

Long Thoracic Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Serratus Anterior Muscle

2. Where does it come off of the brachial plexus?

Root of C5

3. What roots contribute to it?

C5, C6, C7

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8
Q

What two Nerves come directly off of the Superior Trunk?

A

Suprascapular Nerve and Subclavian and Nerve

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9
Q

Suprascapular Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Supraspinatus Muscle and Infraspinatus Muscle

2. Where does it come off of the brachial plexus?

Superior Trunk

3. What roots contribute to it?

C5 and C6

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10
Q

Subclavian Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Subclavius Muscle

2. Where does it come off of the brachial plexus?

Superior Trunk

3. What roots contribute to it?

C5 and C6

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11
Q

Lateral Pectoral Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Pectoralis Major Muscle

2. Where does it come off of the brachial plexus?

Lateral Cord

3. What roots contribute to it?

C5, C6, and C7

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12
Q

Thoracodorsal Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Latissimus Dorsi Muscle

2. Where does it come off of the brachial plexus?

Posterior Cord

3. What roots contribute to it?

C6, C7, and C8

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13
Q

Superior Subscapular Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Subscapularis Muscle

2. Where does it come off of the brachial plexus?

Posterior Chord

3. What roots contribute to it?

C5 and C6

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14
Q

Inferior Subscapular Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Subscapularis Muscle and Teres Major Muscle

2. Where does it come off of the brachial plexus?

Posterior Chord

3. What roots contribute to it?

C5 and C6

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15
Q

Medial Pectoral Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Pectoralis Major and Minor Muscles

2. Where does it come off of the brachial plexus?

Medial Chord

3. What roots contribute to it?

C8 and T1

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16
Q

Medial Brachial Cutaneous Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Skin of the brachium

2. Where does it come off of the brachial plexus?

Medial Chord

3. What roots contribute to it?

Skin of Medial Arm

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17
Q

Medial Antebrachium Cutaneous Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Skin of medial forearm

2. Where does it come off of the brachial plexus?

Medial Chord

3. What roots contribute to it?

C8 and T1

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18
Q

If there is an injury to the Anterior Rami of C5 and C6, what disease can you expect?

A

Erb-Duchenne Palsy (Waiter Tip Position)

  • Adducted Arm
  • Medially Rotated Arm
  • Extended Elbow
19
Q

If there is an injury to lower brachial plexus or injure the ulnar nerve, what disease can you expect?

A

Klumpke Paralysis (Claw Hand)

Will affect the short muscles of the hand when the individual tries to make a fist

20
Q

What might happen if you spend an extended amount of time working with your arm above your head?

A

Compression of the Brachial Plexus

  • Weakness and tingling in the arms
  • Pain radiating down the arm
  • Loss of sensation in the arm
21
Q

Musculocutaneous Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Biceps Brachii Muscles (long and short head)

Coracobrachialis Muscle

Brachialis Muscle

2. Where does it come off of the brachial plexus?

Terminal Branch (anterior)

3. What roots contribute to it?

C5, C6, and C7

22
Q

Musculocutaneous Nerve splits off into another nerve:

What is this nerve and what does it innervate?

A

Lateral Antebrachial Cutaneous Nerve

-innervates lateral skin of the forearm

23
Q

What happens if the Musculocutaneous Nerve is injured?

A

Renders the anterior brachial muscles paralyzed and possible loss to sensation on the skin of the lateral forearm

(Quiet rare and is possible with blunt force trauma)

24
Q

Axillary Nerve

  1. What does it innervate?
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A

1. What does it innervate?

Deltoid Muscle and Teres Minor Muscle

2. Where does it come off of the brachial plexus?

Terminal Branch (posterior)

3. What roots contribute to it?

C5 and C6

25
Q

Axillary Nerve splits off into another nerve:

What is this nerve and what does it innervate?

A

Superior Lateral Brachial Cutaneous Nerve

The name describes the position of the Deltoid, which is where the Axillary nerve innervates both Muscle and Skin.

26
Q

What happens if the Musculocutaneous Nerve is injured?

A

Atrophy of the Deltoid Musle and loss of sensation over the superolateral arm

-Inability to abduct the arm to 90 degrees (the Supraspinatus can get it up about 15 degrees)

27
Q

Median Nerve

  1. What does it innervate? (only median nerve proper)
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
A
    1. What does it innervate?* Mostly forearm flexor muscles
  • Pronator Teres
  • Flexor Carpi Radialis
  • Palmaris Longus
  • Flexor Digitorum Superficialis
    1. Where does it come off of the brachial plexus?*

Terminal Branch (anterior)

3. What roots contribute to it?

C5 - T1 (all of them)

28
Q

What are the branches off of Median Nerve and what do they innervate?

  • Hint: 4 branches*
  • P.S. Hopefully this is worst card in deck*
A

Anterior Interosseous Nerve:

  • Lateral Part of Flexor Digitorum Profundus
  • Flexor Pollicis Longus
  • Pronator Quadratus

Palmar Cutaneous Branch of the Median Nerve:

Skin of the palm

(Can feel the Palm in Carpal Tunnel)

Recurrent Branch of Median Nerve:

  • Flexor Pollicis Brevis (superificial head)
  • Abductor Pollicis Brevis
  • Opponens Pollicis

Lateral Branch of Median Nerve:

1st Lumbrical

Medial Branch of Median Nerve:

  • 2nd Lumbrical
  • Common Palmar Digital Nerves
  • Proper Palmar Digital Nerves
29
Q

What can damage to the median nerve cause?

A

Hand of Benediction

30
Q

Ulnar Nerve

  1. What does it innervate? (only ulnar nerve proper)
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
  4. What are its two main branches?
A

1. What does it innervate? (only ulnar nerve proper)

Flexor Carpi Ulnaris Muscle

Flexor Digitorum Profundus (medial half)

2. Where does it come off of the brachial plexus?

Terminal branch (anterior)

3. What roots contribute to it?

C8 and T1

4. What are its two main branches?

Deep Ulnar Nerve and Superficial Ulnar Nerve

31
Q

What artery does Ulnar Nerve run with?

A

Superior Ulnar Collateral Artery

32
Q

What does Deep Ulnar Nerve innervate?

Hint: A lot

A
  1. Flexor Pollicis Brevis Muscle (deep head)
  2. Adductor Pollicis Muscle
  3. 3rd and 4th Lumbricals
  4. Dorsal and Palmar Interossei Muscles
  5. Adductor Digiti Minimi Muscle
  6. Flexor Digiti Minimi Muscle
  7. Opponens Digiti Minimi Muscle
33
Q

What nerves does the Superficial Ulnar Nerve give rise to?

A
  1. Common Palmar Digital Nerves
  2. Proper Palmar Digital Nerves
34
Q

Ulnar Nerve splits off into two cutaneous nerves:

What are these nerve and what does they innervate?

A

1. Dorsal Cutaneous Branch of Ulnar Nerve:

Skin on the dorsal side of the hand

2. Palmar Cutaneous Branch of Ulnar Nerve:

Skin on palm

35
Q

What can be the result of damage to the Ulnar Nerve?

A
  1. Claw Hand (same as lower plexus injury)
  2. Handlebar Neuropathy (pulling at Guyon canal)
    - pressure on medial side of the hand
36
Q

Where can Ulnar Nerve Damage Occur?

A

Posterior to the Medial Humeral Epicondyle (funny bone area)

Between the Ulnar and Humeral Heads of the Flexor Carpi Ulnaris (we didn’t learn about these heads)

The Wrist

The Hand

37
Q

Radial Nerve

  1. What does it innervate? (only ulnar nerve proper)
  2. Where does it come off of the brachial plexus?
  3. What roots contribute to it?
  4. What are its two main branches? (that innervates muscles)
A
    1. What does it innervate? (only ulnar nerve proper)*
  • Triceps Brachii Muscle (all heads)
  • Anconeus Muscle
  • Brachioradialis Muscle
  • Extensor Carpi Radialis Longus Muscle
    1. Where does it come off of the brachial plexus?*

Terminal Branch (posterior)

3. What roots contribute to it?

C5-T1 (all of them)

4. What are its two main branches? (that innervates muscles)

Deep and Superficial Radial Nerves

38
Q

What does the Superficial Radial Nerve innervate and branch off into?

A

Mostly cutaneous sensation in lateral half of dorsum of hand

  1. Dorsal Digital Nerves: goes to bases of proximal phalanges
  2. Digital Branches of Dorsal Digital Nerves: Dorsal aspect of thumb and proximal aspect of second, third, and lateral half of fourth digit
39
Q

What muscles do the Deep Radial Nerve innervate?

What happens after it inervates these muscle?

A
  1. Extensor Carpi Radialis Brevis Muscle
  2. Supinator Muscle

Deep Radial Nerve changes its name to Posterior Interosseous Nerve

40
Q

What does the Posterior Interosseous Nerve innervate?

A
  1. Extensor Digitorum Muscle
  2. Extensor Digitorum Minimi Muscle
  3. Extensor Carpi Ulnaris Muscle
  4. Extensor Indicis Muscle
  5. Abductor Pollicis Longus Muscle
  6. Extensor Pollicis Longus Muscle
  7. Extensor Pollicis Brevis Muscle
41
Q

Radial Nerve splits off into two cutaneous nerves:

What are these nerve and what does they innervate?

A

Posterior Brachial Cutaneous Nerve: posterior arm

Posterior Antebrachial Cutaneous Nerve: posterior forearm

42
Q

What can happen if radial nerve is damaged?

A

Wrist Drop

  • Impairment of elbow extension
  • Impairment of thumb abduction and extension
43
Q

The Radial Nerve innervates most of the lateral part of the dorsal hand, but what nerve innervates the most distal, dorsal part of the 2nd, 3rd, and 4th digit?

A

The Proper Palmar Digital Nerves of the Median Nerve

The Median Nerve wraps over the fingertips and gets the dorsal tips of Digits 2, 3, and 4,

44
Q

Where does the Intercostobrachial Nerve come from?

What does it do?

A

A Thoracic Spinal Nerve

Provides Sensory Innervation to the most medial part of the posterior brachium.