MSCT Week 2: Upper Limb II Flashcards
All of the major nerves that innervate the upper limb originate from…
The Brachial Plexus
The brachial plexus is a _______ plexus formed by the ________ Rami of ____ to ____ and most the the ________________ of ____.
The brachial plexus is a somatic plexus formed by the anterior rami of C5 to C8 and most the anterior ramus of T1.
Brachial Plexus location
It originates in the neck, passes laterally and inferiorly over rib 1, enters the axilla, and associates with the axillary artery
Brachial plexus parts from proximal to distal
5 listed
- Roots
- Trunks
- Divisions
- Cords
- Terminal branches
Identify
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Identify
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Step 1 of drawing the brachial plexus
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Step 2 of drawing the brachial plexus
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Step 3 of drawing the brachial plexus
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Step 4 of drawing the brachial plexus
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Step 5 of drawing the brachial plexus
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Step 6 of drawing the brachial plexus
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Identify sensory innervation
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If a nerve is severed as a particular location, the function of the nerve proximal to the injury is?
Normal
The musculocutaneous nerve is
a terminal branch of the lateral cord and immediately enters the anterior compartment of the arm and runs between the brachialis and biceps brachii muscles
The median nerve is?
3 listed
- A terminal branch from both the lateral and medial cords in the axilla and runs distally in association with the brachial artery in the medial aspect of the arm
- The nerve crosses anterior to the elbow joint and enters the forearm’In the upper part of the forearm the median nerves gives off a deep branch (anterior interosseous nerve) and continues through the forearm into the hand through the carpal tunnel
Identify
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the Ulnar Nerve is?
- A terminal branch of the medial cord that runs distally in association with the brachial artery and median nerve in the medial aspect of the arm
- The nerve passes posterior to the medial epicondyle of the humerus and enters the forearm
The nerve passes posterior to the medial epicondyle of the humerus and enters the forearm
The ulnar Nerve
The nerve travels down the medial aspect of the forearm close to the ulna and divides into a superficial and deep branch at the wrist
The Ulnar Nerve
Identify
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The Axillary nerve is?
A terminal branch of the posterior cord that exits through the posterior wall of the axilla and passes posterior to the surgical neck of the humerus
A terminal branch of the posterior cord that exits through the posterior wall of the axilla and passes posterior to the surgical neck of the humerus
The axillary nerve
The Radial Nerve is?
- A terminal branch of the posterior cord that passes out of the axilla into the posterior compartment of the arm in close association to the posterior aspect of the shaft of the humerus
- The nerve enters the forearm posterior to the lateral epicondyle of the humerus and travels to the posterior aspect of the hand
- As it travels through the forearm it gives off a deep branch, (posterior interosseous nerve)
A terminal branch of the posterior cord that passes out of the axilla into the posterior compartment of the arm in close association to the posterior aspect of the shaft of the humerus
The Radial Nerve
The nerve enters the forearm posterior to the lateral epicondyle of the humerus and travels to the posterior aspect of the hand
The Radial Nerve
As it travels through the forearm it gives off a deep branch, (posterior interosseous nerve)
The Radial Nerve
Identify
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Loss of a nerve results in?
Atrophy disuse of that muscle
A movement that is accomplished by 2 or more muscles innervated by different nerves when only one of the nerves is damaged will result in?
Weakness of the movement
A movement that is accomplished by muscles that are all innervated by the same nerve when damaged will result in?
Complete loss of movement
Loss of muscle function nearly always results in the opposite function/motion being?
Dominant
In addition to a motor deficit, injury to a nerve is often associated with a…
sensory loss as well
When thinking about lesions of nerves in the upper limb remember these
6 listed
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The 2 most common injuries to the axillary nerve are?
- Anterior dislocation of the humerus
- Fracture of the surgical neck of the humerus
The most common injury to the Radial nerve is?
midshaft fractures of the humerus
Outcomes of damage to the axillary nerve
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Outcomes of damage to the Radial nerve
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Identify
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Common injuries to the Median Nerve?
4 listed
- Fractures of the elbow
- Fractures of the distal humerus
- fractures of the Carpal tunnel
- Carpal Tunnel Syndrome
Outcomes of damage to the Median Nerve from supraepicondylar fractures of the humerus
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Identify
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Outcomes of damage to the median nerve from Carpal Tunnel Syndrome, fracture or laceration
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Damage outcomes to the deep branch of the median nerve
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Deep branch of the Median Nerve AKA
Anterior Interosseous Nerve
Anterior Interosseous Nerve AKA
Deep Branch of the Median Nerve
Damage outcomes to the anterior Interosseous Nerve
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Identify
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What nerve is injured
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Common injuries to the Ulnar Nerve
2 listed
- Fractures of the medial epicondyle or compression of the nerve against the bone
- Fractures or lacerations to the ventral medial side of the wrist
Identify
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Ulnar Nerve damage outcomes of entrapment at the elbow or epicondyle fracture
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which nerve is indicated by this test
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ulnar nerve test
Ulnar Nerve damage outcomes of wrist fracture or laceration
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Common Lesions of the Musculocutaneous nerve
Lesions of the musculocutaneous nerve are not common but can occur
Outcomes of damage to the musculocutaneous nerve
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Identify
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Most common lesions of the brachial plexus
- Upper brachial plexus injury (birth injury, fall on the shoulder)
- Lower brachial plexus injury (birth injury, severe abduction of the arm)
Upper brachial plexus injury nerves involved
3 listed
- musculocutaneous nerve
- axillary nerve
- suprascapular nerve
Lower brachial plexus injury nerves involved
Primarily involves the Ulnar nerve
Erb’s Palsy AKA
Upper Brachial Plexus Injury
Klumpke’s Palsy AKA
Lower Brachial plexus injury
Klumpke’s Palsy Causes
An undue abduction of the arm or birth injury
Klumpke’s Palsy Nerves
2 listed
- Ulnar Nerve
- Median Nerve (can also be involved)
Klumpke’s Palsy Deformity
2 listed
- Ulnar Claw hand due to the unopposed action of the long flexors and extensors of the fingers
- Hyperextension of the MP joints and flexion at the IP joints
Klumpke’s Palsy Disability
3 listed
- intrinsic muscles of the hand
- ulnar flexors of the wrist and fingers
- Sensations lost over a small area along the ulnar border of the forearm and hand
Erb’s Palsy Causes
Undue separation of the head from the shoulder commonly encountered in birth injury or fall on the shoulder
Erb’s Palsy Nerves
- Musculocutaneous nerve
- axillary nerve
- suprascapular nerve
Erb’s Palsy Deformity
- Arm hangs by the side
- it is abducted and medially rotated
- The forearm is extended and hand pronated
Erb’s Palsy Disability
3 listed
Loss of Function
- Abduction and lateral rotation of the arm
- Flexion and supination of the forearm
- Sensations lost over a small area over the lower part of the shoulder
what is this?
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Erb’s Palsy
What is this?
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Klumpke’s Palsy
The vascular supply to the upper limb originates from the?
Subclavian Artery in the inferior part of the neck
The subclavian continues anterior or posterior to the clavicle?
Posterior
The subclavian enters the axilla where it?
Changes its name to the axillary artery
The subclavian gives off a branch in the neck called?
Thyrocervical Trunk
Thyrocervical Trunk important in?
The collateral circulation of the shoulder
Axillary artery branches
5 Listed
- Superior Thoracic
- Thoracoacromial
- Lateral Thoracic
- Subscapular
- anterior humeral circumflex
After giving off __ branches the axillary artery becomes the?
- 5 branches
- brachial artery in the arm
The brachial artery branches
One major branch the Deep Brachial
The deep brachial supplies…
the posterior compartment
Anterior to the elbow the brachial artery splits into
The radial and ulnar arteries
Identify
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Identify
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The radial and ulnar arteries run to the hand and anastomose with one another as the?
Superficial and deep palmar arches
Collateral circulation around the shoulder: blockages of the axillary artery between the origins of the thyrocervical trunk and subscapular arteries may be bypassed by
anastomoses between the branches of the thyrocervical trunk (suprascapular artery, transverse cervical and dorsal scapular artery)
and
branches of the subscapular artery (circumflex artery)
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Identify
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Identify
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Collateral circulation around the elbow: Blockages of the brachial artery between the origin of the superior and inferior ulnar collaterals and the bifurcation of the brachial artery may be bypassed by?
The collateral branches of the radial and ulnar arteries and the brachial and deep brachial arteries
Identify
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Collateral circulation around the wrist: Blockage of either the radial or ulnar artery in the distal forearm may be bypassed by the?
Anastomoses established between these two arteries through the superficial and deep palmar arches
Identify
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Identify
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Identify
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Identify
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Upper Limb Overview
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Nerve Lesion O verview
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Overview of muscles in the post forearm
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Nerve Lesion Overview
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Anterior forearm muscle overview
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Ant Int Oss syndrome
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Ulnar Lesions
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Muscles of the hand
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deep intrinsic muscles of the hand
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Erb’s Overview
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Klumpke’s Palsy Overview
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Vascularization of the upper limb Over iew
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Collateral Circulation of the Shoulder
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Collateral Circulation of the Elbow
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Collateral Circulation of the Wrist and Hand
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PQ1
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PQ2
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PQ3
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