MM innervation + SCI Flashcards
SPINAL ACCESSORY NERVE (CN XI
Upper trapezius CN XI & C(2),3,4
Middle trapezius CN XI & C(2),3,4
Lower trapezius CN XI & C(2),3,4
SCM
SUPRASCAPULAR NERVE
Supraspinatus C(4),5,(6) Infraspinatus C(4),5,6
DORSAL SCAPULAR NERVE
Levator scapulae C4,5
Rhomboideus minor C(4),5
Rhomboideus major C(4),5
AXILLARY NERVE
innervates what two mm?
where is dermatome?
Deltoid (all) C5,6
Teres minor C5,6
MUSCULOCUTANEOUS NERVE
where is dermatome?
Biceps brachii C5,6
Brachialis (& radial) C5,6
Coracobrachialis C6,7
What innervates Teres Major?
What actions?
LOWER SUBSCAPULAR NERVE
Spinal level for (Lateral) Pectoral Nerve?
LATERAL PECTORAL NERVE
Pectoralis major-clavicular fibers C5,6,7
Pectoralis major-sternal fibers C5,6,7
LONG THORACIC NERVE - innervates and injury looks like?
Serratus Anterior Latissimus dorsi - C5,6,7,(8)
WINGED MEDIAL BORDER OF SCAP
RADIAL NERVE innervates what mm group
UE EXTENSOR GROUP (triceps + forearm) +
Brachioradialis C5,6 Supinator C(5),6,(7)
MEDIAL PECTORAL NERVE innervates?
Pectoralis minor C(6*),7*,8, T(1)
MEDIAN NERVE mm groups? Impingement site? parasthesia map area?
Thumb OPPOSITION, pronation, radial deviation + Wrist Flexion
Pronator Teres = impingement site
Parasthesia @ Medial forearm, thumb and first 3 fingers
ULNAR NERVE C? - T?
Damage looks like?
Impingement cites?
Flex. Ulnaris + Thumb ADDuction, pinky opposition
C8-T1
Cubital Tunnel and Tunnel of Guyon
MIXED MEDIAN-ULNAR = what hand actions?
Thumb/finger flex + wrist pronation
Flexor Pollicis Longus C(6),7,8, T1
Flexor Pollicis Brevis C(6),(7),(8), T(1)
Flexor Digitorum Profundus C(7),8, T1
Pronator Quadratus C(7),8, T1
FEMORAL NERVE mm group?
L2,3,(4)
Knee Extensors + :
Rectus FEMORIS*** (remember!)
Vastus Medialis
Vastus Lateralis
Vastus Intermedius
Sartorius =Lat rotation and ABD of hip
Pectineus = adductor
Iliacus = hip flexor (Psoas is direct fed by L1-3 )
What innervates psoas vs illiacus
Psoas major is innervated by direct branches of the anterior rami off the lumbar plexus at the levels of L1-L3, while the iliacus is innervated by the femoral nerve (which is composed of nerves from the anterior rami of L2-L4).
OBTURATOR NERVE –> what mm group
L2,3,4
Adductor Magnus*
Adductor Longus
Adductor Brevis
Gracilis
Namesake: Obturator Externus
SUPERIOR GLUTEAL NERVE
L4,5,S1
Tensor Fascia Lata
Gluteus Medius
Gluteus Minimus
SUPERFICIAL FIBULAR NERVE
Fibularis Longus L(4),5,S1
Fibularis Brevis L(4),5,S1
FIBULAR NERVE/”Deep Peroneal”
L5*** - where is sensation?
FOOT SLAP/DROP may reveal injury
***Tibialis Anterior + Toe extensors
Fibularis Tertius L4,5,S1
Extensor Digitorum Longus L4,5,S1
Extensor Digitorum Brevis L(4),5,S1
Extensor Hallucis Longus L(4),5,S1
Extensor Hallucis Brevis L(4),5,S1
TIBIAL NERVE
Mm groups?
L(4),5,S1,2
Knee flexors, Ankle/Toe flexors
Tibialis Posterior L(4),5,S1
Popliteus L(4),5,S1
Semitendinosus L(4)5,S1,2
Semimembranosus L(4),5,S1,2
Plantaris L(4),5,S1,2
Biceps Femoris-long head L(5),S1,2,(3)
Gastrocnemius-medial head S1,2
Gastrocnemius-lateral head S1,2
Soleus L(5),S1,2
Flexor hallicus Longus L5,S1,2
Flexor digitorum Longus L5,S1,2
INFERIOR GLUTEAL NERVE
Gluteus Maximus L5,S1,2
COMMON PERONEAL (Fibular) to what mm? (1)
Biceps Femoris-short head L5,S1,2
MEDIAL PLANTAR NERVE = aspect of what body part
MEDIAL FOOT FLEXORS
Abductor Hallucis L(4),5,S1
Flexor Digitorum Brevis L(4),5,S1
Lumbricals- I L(4),5,S1
Flexor Hallucis Brevis L(4),5,S1
SPINAL ACCESSORY (CN #11) + C1/C2 innrvates….
Sternocleidomastoid
Trapezius
CN 8 =?
VIII brings sound and information about one’s position and movement in space into the brain.
Vestibulococlear
CN VII = ???
FACIAL NERVE!!
Stylohoid
F CN VII
Platysma
Orbicularis Oculi
Frontalis
Nasalis
Orbicularis Oris
Zygomaticus Major & Minor
Levator Labii Superioris
Depressor Anguli Oris
Mentalis
Levator Anguli Oris
Depressor Labii Inferioris (with Platysma)
Buccinator
Corrugator Supercilii
What C-sections and nerve innervate diaphragm?
Phrenic nerve - C3-5 keeps diaphragm alive!
List the general order of nerves (Traps - UE) from cervical area (9)
1) Accessory (CN 11)
2) Phrenic (C3-5)
3) Supra/Dorsal scap (C4)
4) Axillary (Delts/Tmjr) C5
5) Musculotaneous/Subscap (C6)
6) Lateral Pectoral/Radial (C5-7/C5-T1)
7) Long thoracic (C7)
8) Medial pectoral (C8)
9) Ulnar (C8-T1)
Innervation of scalenes?
C3 to C8. Scalene muscles involve the cervical plexus and the brachial plexus;
Innervation of Longus Colli
anterior rami of C2-C6 from the cervical plexus.
Nerve roots for Long Thoracic N
DIRECT from C5-6-7 - NOT the brachial plexus!
The middle subscapular nerve or the long subscapular nerve is also known as what?
Supplies what mm?
thoracodorsal nerve
Lats
The _______ nerve from C5 to C6 roots innervates the teres major muscle.
subscapular
What CRUCIAL mm action does C7 control? What name is this nerve?
C7 helps control the triceps + wrist extensor muscles. = TENODESIS
radial nerve*
Generally, those with ___ or ____ spinal cord injuries can benefit most from tenodesis grasp because they can control their wrist movements, but have limited finger control. The biomechanical pulling allows individuals to grab and release items despite having limited or no control over their hands.
C6-C7
C? preserves the ability to flex the elbows. Injuries at this level is likely to have some or total paralysis of wrists, hands, trunk and legs. Can speak and use diaphragm, but breathing will be weakened. No tenodesis grip
C5 - deltoid and biceps preserved
What cord syndrome?
Damage to the___ of the spinal cord, affecting pain, temperature and touch sensation, but leaving some pressure and joint sensation. Often motor function is unaffected.
Anterior cord syndrome
MOST COMMON spinal cord injury; incomplete; characterized by impairment in the arms and hands and, to a lesser extent, in the legs. Sensory loss and loss of bladder control may occur.
Central Cord Syndrome
Contralateral altered sensation/anesthesia to pain and temperature, ipsilateral loss of proprioception + motor paralysis. Tactile sensation spared.
Brown-Sequard Syndrome
The most common type of spinal cord injury. The spinal cord is bruised but not severed. Inflammation and bleeding occurs near the injury as a result of the injury; extended periods of long-term hospitalization and rehabilitation needed for up to six to 12 months.
Spinal Contusion
____ = no motor or sensory function is preserved in the sacral segments S4-S5 below injury
Asia A - COMPLETE
sensory ONLY function is preserved below the neurological level and includes the sacral segments S4-S5. This is typically a transient phase and if the person recovers any motor function below the neurological level, that person essentially becomes a motor incomplete
Asia B - Sensory INCOMPLETE
motor function is preserved below the neurological level, and MORE than half of key muscles below the neurological level of injury have a muscle grade less than 3 (gravity elimitated)
Asia C - motor incomplete
motor function is preserved below the neurological level and at least half of the key muscles have a muscle grade of 3 or more (can move against gravity (3) or with additional resistance (4 & 5)).
Asia D - motor incomplete
Both syndromes are neurosurgical emergencies as they can present with back pain radiating to the legs, motor and sensory dysfunction of the lower extremities, bladder and/or bowel dysfunction, sexual dysfunction and saddle anesthesia.
Cauda Equina + Conus Medularris Syndrome
Decerberate rigidity
Legs/arms straight
result of a midbrain lesion
LE flexion synergy - hip, knee, ankle, toes
hip Flexed. Abducted. Externally rotated
Knee flexed
Ankle DF + Inversion
Toes EXTENDED (opposite of flexion)
UE Flexion synergy - scapula, shoulder, elbow, forearm, wrist/fingers
Scapula retracted/elevated
Shoulder abducted and externally rotated
Elbow flexed
Forearm Supinated
Wrist/fingers flexed
LE extension synergy - hip/knee/ankle/toes
hip - Extension, ADD, IR
Knee extended
Foot PF + Inversion
Toes curled
UE extension synergy - Scapula, Shoulder, Elbow, Forearm, Wrist/hand
Scap protracted
Shoulder ADD/IR
Elbow Extended
Forearm PROnated
Wrist/Finger Flexion
Decortiate rigidity
bent arms, clenched fists, and legs held out straight.
Clinical outcomes for decerberate v decortiate posturing
decerebrate posturing is usually indicative of a lesion lower in the brainstem;
about 10% of individuals who demonstrate decerebrate posturing survive.
Mild/Moderate/severe coma ratings (high to low indicates what?)
The Glasgow Coma Scale (GCS) classifies Traumatic Brain Injuries (TBI) as Mild (14–15); Moderate (9–13) or Severe (3–8).
Brachial Plexus roots and order of structures (roots to ?)
Robert Taylor Drinks Cold Beer from 5 to 1
Differentiation between ulnar nerve compression at Guyon canal (wrist) vs. cubital tunnel (elbow)
What is ulnar nerve vulnerable to?
guyon = burning pain in the wrist and hand followed by decreased sensation in the ring and little fingers
Cubital Tunnel = Numbness and tingling in the hand when the elbow is bent.
Weak grip and clumsiness due to muscle weakness in the affected arm and hand.
Aching pain on the inside of the elbow.
vulnerability = traction, friction and compression.
The ? tracts are part of the UMN system and are a system of efferent nerve fibers that carry signals from the cerebral cortex to either the brainstem or the spinal cord. It divides into two tracts: the corticospinal tract and the corticobulbar tract.
pyramidal tracts
?? tracts are chiefly found in the reticular formation of the pons and medulla, and target lower motor neurons in the spinal cord
serves an essential function in maintaining posture and regulating involuntary motor functions
These tracts originate in the cerebral cortex, carrying motor fibres to the spinal cord and brain stem. They are responsible for the voluntary control of the musculature of the body and face.
pyramidal
all the neurones within the descending motor system are classed as
upper motor neurones
Their cell bodies are found in the cerebral cortex or the brain stem, with their axons remaining within the CNS
At the termination of the descending tracts, the neurones synapse with a lower motor neurone
- Inhibition of involuntary movements (hyperkinesias), which are particularly evident in ? diseases.
extrapyramidal
Cardinal signs of UMN damage/lesion
- Hypertonia – an increased muscle tone
- Hyperreflexia – increased muscle reflexes
- Clonus – involuntary, rhythmic muscle contractions
- Babinski sign – extension of the hallux in response to blunt stimulation of the sole of the foot Muscle weakness
Conscious proprioception includes what nerve organs
Tactile mechanoreceptors include:
- Meissner’s corpuscles, which are concerned with a fine touch and two-point discrimination
- Free nerve endings on hair follicles, which is concerned with a fine touch, and
- Pacinian corpuscles deal with pressure sense and vibration sense.
The primary function of the dorsal column pathway is to convey
The dorsal column nuclei also transmit
- sensory information regarding fine touch, two-point discrimination, conscious proprioception, and vibration sensations from our skin and joints, excluding the head.
- visceral nociceptive information to the contralateral ventral posterior lateral (VPL) thalamic nucleus, which in turn relays the information to the somatosensory cerebral cortex
- Posterior cord syndrome, also known as posterior spinal artery syndrome- an infraction to posterior spinal artery. This artery supplies the _______
how to test?
DORSAL COLUMN PATHWAYS (SENSORY)
Romberg test is part of a neurological exam used clinically to test for the integrity of the posterior column pathway.
Tested features: fine touch, 2-point discrimination, conscious proprioception, and vibration sensation.
C5 myo + mvmnt Test where? Root of what nerves? Derm where?
Deltoid - Sh ABD Biceps - Elbow Flex TEST @ Biceps tendon Root of musculo + Axillary N (delt) Derm @ lateral shoulder to the elbow
C6 myo + derm Where to test? Root of what nerve?
C6 = WRIST ext, derm @ prox lateral forearm + thumb Where to test: brachioradialis tendon (medial forearm proximal to radial styloid) Root of MUSCULOCUTANEOUS (+C5) and RADIAL (wrist ext)
C7 myo / dermo / test Root of what nerve?
Myo = Elbow ext, wrist FLEX, finger ext Derm = mid finger Test @ triceps Root of ULNAR N
C8 myo, dermo
C8 = finger flexion, sense at Ulnar palm and pinky
T1 myo dermo
T1 = finger ABD Derm @ medial Elbow
L2 myo + movement
Iliopsoas - hip flexion
L4 myo/dermo , where to test?
L4 = knee ext, derm at Med malleolus Test @ patellar tendon
L5 myo/mvmnt, dermo
5 = 5 toes = DORSIFLEX / Tib A Derm @ dorsum
S1 myo/dermo/test site
1 = gastroc = PF = Achilles’ tendon
L5 myo dermo
Myo = Hamstrings - knee flexors + Great toe Ext Derm @ lateral calf and under great toe
S2-S5 dermo and reflex
S2 = back of thigh, buttocks, genitals S3 = buttocks, gentials S4-5 = buttocks and anal ;)
 A fracture of the distal 1/3 of the humerus may cause injury to what nerve with what symptoms
Radio nerve injury, wrist drop, inability to extend fingers, sensory loss at dorsum of hand
What is the most common nerve injury to occur with an anteriorly dislocated shoulder
Axial nerve palsy, inability to ABD shoulder (deltoid loss)
