Lesson2 Flashcards
Cervical Plexus Superficial Branches
- Lesser Occipital
- Great Auricular
- Transverse Cervical
- Supraclavicular
Cervical Plexus Deep branches
- Ansa Cervicalis Sup
- Ansa Cervicalis Inf
- Phrenic
- Segmental Branches
Lesser Occipital O/D
O: C2
D: Posteroinferior head, post to ear
Great Auricular O/D
O: C2-C3
D:Ant/inf to ear, over parotid gland
Transverse Cervical O/D
O: C2-C3
D: Anterior neck
Supraclavicular O/D
O: C3-C4
D: Superior Chest/shoulder
Ansa Cervicalis Sup O/D
O: C1
D: Infrahyoids
Ansa Cervicalis Inf root O/D
O: C2-C3
D: Infrahyoids
Phrenic O/D
O: C3-C5
D: Diaphragm
Segmental Branches O/D
O: C1-C5
D: Prevertebral, lev scap, mid scalenes
What do Compression Syndromes of Peripheral Nerves result in?
- Conduction block in the peripheral nerve, but no structural damage to the axon or tissue distal to the lesion
Compression syndromes of peripheral nerve symptoms
Numbness, tingling, pain, weakness
Compression syndromes of peripheral nerves symptoms due to
- Impaired oxygenation (ishemia) of nerve
- Impaired local neural conduction
Erb-Duchenne Palsy
- Injury to superior roots of Brachial Plexus (C5-C6)
- Traction injury
- Forceful pulling of head away from shoulder
- No senation over lateral arm (Loss of C5-C6 dermatomes
Erb-Duchenne Palsy
Waiter’s Tip Position
- Arm Adducted
- Medial rotation
- Elbow extended
- Forearm pronated
- Wrist and fingers flexed
Klumpke’s Paralysis
- Traction injury to lower brachial plexus
- Poor positioning at birth or pulled with forceps
- Median and ulnar lesions
- Claw hand
- Sensory loss for C8-T1 dermatomes
- Can get Horner’s Syndrome
Horner’s Syndrome
(On affected side)
4 points
- Miosis - constriction of pupil
- Ptosis - Drooping of eyelid
- Anhydrosis - Loss of sweating to face and neck
- Enophthalmos - Recession of eyeball into orbit
TOS
- Compression of brachial plexus from structures in thoracic outlet
- Thoracic outlet runs from Interscalene triangle to inferior border of axilla
- Subclavian artery and vein may also be compressed
TOS Path
- Brachial plexus travels with subclavian artery between anterior and medial scalene
- Subclavian vein joins in after scalenes and then whole bundle goes under clavicle and the pec minor inserstion and down arm
TOS Symptoms
- Pain, numbness, weakness, tingling in arm/upper thoracic area, or scapula
- Trophic changes in tissue with blood vessel compression
TOS Locations
4 points
- Cervical Rib (additional rib at C7)
- Anterior Scalene Syndrome
- Costoclavicular Syndrome
- Pectoralis Minor Syndrome
Cervical Rib syndrome
- Additional Rib at C7
Anterior Scalene Syndrome
- Compression b/w anterior and middle scalene
Interscalene Triangle
- Anterior Scalene
- Middle Scalene
- Rib 1
- Brachial Plexus and subclavian artery pass through. (Subclavian vein is anterior)
Costoclavicular Syndrome
- Compression b/w clavicle and rib 1
Pectoralis Minor Syndrome
- Compression b/w coracoid process and pec minor
Radial nerve branches before?
Supinator
Radial nerve Posterior Motor Branch
“Posterior Interosseous nerve”
- Enters supinator and travels down lateral radius to wrist
Radial Nerve Superficial Branch
- Travels down the posterior forearm to hand
Radial Nerve Lesion Causes
- Fractures - at spiral/radial groove
- Dislocations - Head of radius, humeroradial, radial ulnar jt
- Post-surgical complications
- Compression
Radial Nerve Lesion Symptoms
- Altered sensation at posterior arm and hand (digits 1, 2, 3, lateral 4)
- Wrist drop
- If injury proximal to elbow - motor and sensory affected
- If injury distal to elbow - only sensory OR motor affected
Crutch Palsy
- Radial nerve compression at axilla
Saturday Night Palsy
- Radial Nerve Lesion at spiral groove
- Direct pressure against firm object
- Deep sleep on arm (passed out on hard surface)
Posterior Interosseous Syndrome
- Comes off in front of lateral epicondyle
- Motor nerve
- Wrist drop
- Compression underneath supinator
Cheiralgia Parasthetica
- Compression of superficial branch of radial nerve under brachioradialis tendon
- Sensory
- Pain at dorsum wrist, thumb, webspace
- Cause: trauma, tight cast, swelling
Median Nerve Lesion Causes
- Fractures at elbow, wrist, carpals
- Dislocations at elbow, wrist, carpals
- Compressions
- Trauma
Ape Hand
- Median Nerve lesion
- Thumb in same plane as rest of hand due to no opposition
- Wasting of thenar eminence
Oath Hand
- Median Nerve Lesion
- Only digits 4 and 5 can flex when trying to make a fist
Median nerve lesion symptoms
- Can’t grasp objects
- Can’t pronate forearm, Flex PIP, DIPS of digits 2,3 (no air quotes)
- Weak wrist flexion, weak thumb movements
- Altered sensation digits 1,2,3, half of 4 (palmar)
Median Nerve Lesion Locations
- Ligament of Struthers
- Pronator Teres
- Carpal Tunnel
Ligament of Struthers
- From abnormal spur on shaft of humerus to medial epicondyle
- Median nerve compressed as it passes under
- Only in 1% of population
Pronator Teres Syndrome
- Median Nerve Lesion
- Compressed at proximal attachment of Pronator Teres
- Aching in anterior forearm
- Numbness in thumb/index finger
- Weakness in thenar eminence
Anterior Interosseous Syndrome
- Branch of Median Nerve
- Pinched/entrapped between 2 heads of pronator teres
- Pain and motor loss of Flex pollicis longus, lateral 1/2 FDP, and pronator quadratus
- Paralysis of flexors in index finger and thumb
Carpal Tunnel Syndrome
- Most common entrapment condition in arm
Carpal Tunnel Formed by
- Carpal bones
- Flexor retinaculum (attaches to scaphoid tubercle and trapezium)
Structures that pass through Carpal Tunnel
- Median Nerve
- Flexor Digitorum Superficialis
- Flexor Digitorum Profundus
- Flexor Pollicis Longus
Two ways compression can occur at carpal tunnel
- Size of tunnel decreases
* Bony callus, space occupying lesion, RA bony changes - Size of contents passing through increases
* Repetitive actions, edema, fibrosis
* Retinaculum thickening from scar tissue (repeated trauma)
* Systemic conditions causing edema/fluid retention
Ulnar Nerve path at the wrist/hand
- Travels over flexor retinaculum b/w pisiform and hook of the hamate (guyon’s canal)
Ulnar Nerve Lesion Causes
- Fractures (medial epicondyle, midforearm, wrist)
- Dislocations (elbow)
- Compression
- Repetitive actions
- Direct trauma
Ulnar Nerve Lesion Symptoms
- Ulnar Claw Hand
* baby finger hyperextended and abducted at MCP and flexed at IP
* Ring finger hyperextended at MCP and flexed at IP
* Atrophy of interosseous membrane - mm wasting of hypothenar
- Altered sensation of little finger + medial half ring finger
- Fromont’s sign positive
Froment’s Sign
- Hold paper b/w thumb and index finger
- Adductor pollicis (innervated by ulnar nerve) needed for this
- Patient flexes thumb instead, using flexor pollicis longus
Tardy Ulnar Palsy
- Complication of fracture at elbow
- Occurs years after fracture
- Callus formation or valgus deformity of elbow
- Produces gradual stretching of the nerve in the ulnar groove at medial epicondyle
