MSK Flashcards
How do you remember the brachial plexus, root to branch?
Label roots as fingers c5-T1 Three muscateers C5,6,7 musc Assasinated C5,6 axil Five rates C5-t1 radial Five mice c5-T1 median Two unicorns C8-t1 ulnar
What are the roots in the brachial plexus
C5,6,7,8,T1
What are the trunks, what are they formed from?
Where does this occur?
Superior C5,6
Middle C7
Inferior c8, T1
Base of neck moving towards posterior triangle of neck
What are the divisions of the brachial plexus?
Formed from what trunks and therfore what roots?
Where does the formation occur?
Anterior division of superior trunk- from superior C5,6 and middle C7
Posterior- from superior, middle and inferior trunk C5-T1
Anterior division of inferior trunk- inferior- C8-T1
Occurs leaving posterior triangle of neck
What are the cords of the brachial plexus?
From what divisions are they formed and therefore what trunk and therefore what route?
The lateral cord from the anterior superior division, formed from the superior and middle trunk which originate from C5,C6 and C7
The posterior cord which arises from posterior division which takes trunks from superior, middle and inferior C5-T1
The medial cord which arises from the anterior inferior division which is coming from the inferior trunk C8-T1
What are the 5 major branches of the brachial plexus, what are there roots?
Musculocutaneous from the lateral cord only C5,6,7
Axillary from the posterior cord but superior trunk, C5,6
Median from the anterior inferior and anterior superior cords c5-t1
Radial from posterior cord C5-T1
Ulnar from the anterior inferior cord C8-T1
How do you remember the 5 sections of the brachial plexus
rugby teams drink cold beers
Roots trunks division cord branch
What does LOAF stand For?
Lateral 2 lumbricals
Opponens Pollicis
Anbductor pollicis brevis
Flexor pollicis brevis
What 2 words make you think median nerd
Flex
LOAF
What is the nerve root for the MSK nerve?
C5/6/7
What is the sensory distribution for the MSK nerve?
Lateral forearm
What is the motor distribution for the MSK nerve?
Bicep brachii
Brachiallis
Coracobrachialis
When is the MSK nerve injured?
Very rare due to protection from biceps, stab wound to upper arm
What sensory loss, motor deficit and deformity would be seen with a injury to the MSK nerve?
Numb lateral forearm
Weak elbow flexion, supination
Wasting biceps
Also absent biceps reflex
What is the nerve root of the axillary nerve?
C5/6
What course does the MSK nerve take?
Pierces coracobrachialis
Passes down anterior arm under biceps
Becomes lateral cutaneous nerve of forearm
What course does the axillary nerve take
Passes beneath shoulder into posterior arm, wraps around the surgical neck of humerus
What sensory area does the axillary nerve supply
Regimental badge area
What is the motor supply of the axillary nerve?
Deltoid
Teres minor
When can injuries to the axillary nerve be seen?
Fracture of surgical neck
Compression via shoulder dislocation
Stab wound to posterior shoulder
What sensory deficit, motor deficit and deformity is seen in axillary nerve damage?
Sensory- regimental badge
Motor- weak ABDuction 15-90 degrees, weak flexion, shoulder extension and external rotation
Deformity- wasting of deltoid
What nerve root does the radial nerve arise from?
C5-T1
Describe the route of the radial nerve?
Winds around spiral groove of humerus
Passes through anterior cubical fossa
Divides into superficial and deep
What is the sensory distribution of the radial nerve?
Lower posterior arm and posterior forearm, lateral 2/3 of hand dorsum, proximal dorsal aspect of lateral 3 and 1/2 fingers
What motor supply does the radial nerve have3
Triceps brachii Wrist extensor Finger extensor Brachioradiallis Supinator
When can injuries to the radial nerve occur?
Fractures of humerus proximally and at the shaft level
Fractures of proximal radius
Compression from tight plastercast or tourniquet
Stab wounds to cubical fossa, wrist and forearm
What would be the sensory deficit, motor deficit and deformity seen following radial nerve damage?
Sensory- numb posterior arm and forearm, numb radial lateral 2/3 of hand dorsum
Motor- weak elbow extension, wrist extension and MCPJ extension
Deformity- wrist drop
What’s the nerve root for the median nerve?
C5-T1
Describe the route of the median nerve
Down the back of the arm with the brachial artery
Through the cubital fossa
Divides into 3 terminal branches- anterior interosseous, deep and superficial
What does “really need booze to be at my nicest” tell you
Cubital fossa lateral-> medial structures Radial Nerve Bicep Tendon Brachial Artery Median Nerve
What’s the sensory distribution of the median nerve?
Thenar eminence
Lateral 2/3 palm
Palmar lateral 3.5 fingers
Distal dorsal aspects of lateral 3.5
What is the motor control of the median nerve?
All of the anterior compartment apart from flexor carpi ulnaris and .5 dig profundus
LOAF-lateral 2 lumbricals, opponens pollcis, abductor pollicis brevis, flexor pollicis brevis
What are some common injury mechanisms for the median nerve?
Supracondylar fracture of humerus
Carpal tunnel
Stab wound to cubital fossa, forearm, wrist (eg self harm)
What is the resultant sensory deficit, motor deficit and deformity seen in median nerve injury
Sensory- numb thenar eminence, lateral 2/3 palm and distal dorsal 3.5 lateral
Motor- weak pronation, weak wrist flexion, weak finger flexion, *flexion of ring and little finger DIPJ preserved @ ulnar nerve
Deformity- Hand of benediction on attempted finger flexion
What’s the nerve root for ulnar nerve?
C8/T1
What is the route of ulnar nerve
Down arm with brachial artery, behind medial epicondylitis, into anterior compartment with ulnar artery, enter palm via guyons canal
What’s the sensory area of ulnar nerve?
Hypothenar eminence, medial 1/3 palm, palmar aspect of medial 1.5 fingers. Dorsal aspec of medial 1.5 fingers
What are the motor components of the ulnar nerve?
Flexor carpi ulnaris and .5 FDP HILA Hypothenar eminence Interossei Lumbricals (medial 2) Adductor Pollicis
How can the ulnar nerve become damaged?
Supracondylar fracture of humerus or medial epicondylar fracture
Compression at cubital tanner or guyons canal
Stab wound to wrist/forearm
What sensory deficit, motor deficit and deformity is seen with ulnar nerve damage
Sensory- hypothenar eminence and medial side of hand numb (1.5)
Motor- weak wrist flexion, weak wrist adduction, weak flexion of ring and little finger MCPJ, DIP and weak extension of the IPJ
Weak finger abduction, adduction and opposition
Clincal- claw hand on attempted finger flexion
What is the difference between hand of benediction and claw hand?
- Hand of benediction is a median nerve issue and is seen on finger flexion
- Claw hand is an ulnar nerve issue seen on finger extension
Damage to nerves supplying the illiopsoas would present with what?
No pelvic swing on walking
Damage to the femoral nerve would result in what?
Loss of hip flexion and knee extension
Loss of sensation to anterior thigh and medial leg
Damage to the obturator nerve would result in what
Loss of adduction of thigh, loss of sensation to inner thigh
Damage to the superior gluteal nerve would result in what?
Loss of abduction- pelvic dip when walking
Loss of the inferior gluteal nerve would result in what?
Loss of extension at hip- buttock wasting
Damage to the sciatic nerve would result in what?
Loss of all motor except adduction + flexion of thigh, extension of knee.
Loss of sensation to the lower leg and foot
A high tibial nerve injury would result in what?
Loss of flexion of toes and inversion of foot
Loss of sensation to sole of foot and inferior aspect of toes and nail bed
A high injury t the common fibulae nerve would result in what?
Foot drop- loss of extension of toes and foot
Loss of sensation of lateral liver leg and upper foot
A prolapsed intervertebral disk in the lumbar region affects what nerve root?
The nerve that emerges from the next intervertebral foramen e.g l4/5 catches L5 nerve root.
L4/5 disk prolapse will affect what nerve and give symptoms where?
L5 nerve
Sensation to mid shin and big toe and loss of big toe extension
L5/S1 prolapse will affect what nerve and give symptoms where
S1 nerve
Sensation to little toe
Motor to plantarflexion
An l3/l4 disk prolapse will affect what nerve giving symptoms where?
L4
Ankle Doris flexion
Medial lower leg sensation
What is the nerve root for the MSK nerve?
C5/6/7
What is the sensory distribution for the MSK nerve?
Lateral forearm
What is the motor distribution for the MSK nerve?
Bicep brachii
Brachiallis
Coracobrachialis
When is the MSK nerve injured?
Very rare due to protection from biceps, stab wound to upper arm
What sensory loss, motor deficit and deformity would be seen with a injury to the MSK nerve?
Numb lateral forearm
Weak elbow flexion, supination
Wasting biceps
Also absent biceps reflex
What is the nerve root of the axillary nerve?
C5/6
What course does the MSK nerve take?
Pierces coracobrachialis
Passes down anterior arm under biceps
Becomes lateral cutaneous nerve of forearm
What course does the axillary nerve take
Passes beneath shoulder into posterior arm, wraps around the surgical neck of humerus
What sensory area does the axillary nerve supply
Regimental badge area
What is the motor supply of the axillary nerve?
Deltoid
Teres minor
When can injuries to the axillary nerve be seen?
Fracture of surgical neck
Compression via shoulder dislocation
Stab wound to posterior shoulder
What sensory deficit, motor deficit and deformity is seen in axillary nerve damage?
Sensory- regimental badge
Motor- weak ABDuction 15-90 degrees, weak flexion, shoulder extension and external rotation
Deformity- wasting of deltoid
What nerve root does the radial nerve arise from?
C5-T1
Describe the route of the radial nerve?
Winds around spiral groove of humerus
Passes through anterior cubical fossa
Divides into superficial and deep
What is the sensory distribution of the radial nerve?
Lower posterior arm and posterior forearm, lateral 2/3 of hand dorsum, proximal dorsal aspect of lateral 3 and 1/2 fingers
What motor supply does the radial nerve have3
Triceps brachii Wrist extensor Finger extensor Brachioradiallis Supinator
When can injuries to the radial nerve occur?
Fractures of humerus proximally and at the shaft level
Fractures of proximal radius
Compression from tight plastercast or tourniquet
Stab wounds to cubical fossa, wrist and forearm
What would be the sensory deficit, motor deficit and deformity seen following radial nerve damage?
Sensory- numb posterior arm and forearm, numb radial lateral 2/3 of hand dorsum
Motor- weak elbow extension, wrist extension and MCPJ extension
Deformity- wrist drop
What’s the nerve root for the median nerve?
C5-T1
Describe the route of the median nerve
Down the back of the arm with the brachial artery
Through the cubital fossa
Divides into 3 terminal branches- anterior interosseous, deep and superficial
What does “really need booze to be at my nicest” tell you
Cubital fossa lateral-> medial structures Radial Nerve Bicep Tendon Brachial Artery Median Nerve
What’s the sensory distribution of the median nerve?
Thenar eminence
Lateral 2/3 palm
Palmar lateral 3.5 fingers
Distal dorsal aspects of lateral 3.5
What is the motor control of the median nerve?
All of the anterior compartment apart from flexor carpi ulnaris and .5 dig profundus
LOAF-lateral 2 lumbricals, opponens pollcis, abductor pollicis brevis, flexor pollicis brevis
What are some common injury mechanisms for the median nerve?
Supracondylar fracture of humerus
Carpal tunnel
Stab wound to cubital fossa, forearm, wrist (eg self harm)
What is the resultant sensory deficit, motor deficit and deformity seen in median nerve injury
Sensory- numb thenar eminence, lateral 2/3 palm and distal dorsal 3.5 lateral
Motor- weak pronation, weak wrist flexion, weak finger flexion, *flexion of ring and little finger DIPJ preserved @ ulnar nerve
Deformity- Hand of benediction on attempted finger flexion
What’s the nerve root for ulnar nerve?
C8/T1
What is the route of ulnar nerve
Down arm with brachial artery, behind medial epicondylitis, into anterior compartment with ulnar artery, enter palm via guyons canal
What’s the sensory area of ulnar nerve?
Hypothenar eminence, medial 1/3 palm, palmar aspect of medial 1.5 fingers. Dorsal aspec of medial 1.5 fingers
What are the motor components of the ulnar nerve?
Flexor carpi ulnaris and .5 FDP HILA Hypothenar eminence Interossei Lumbricals (medial 2) Adductor Pollicis
How can the ulnar nerve become damaged?
Supracondylar fracture of humerus or medial epicondylar fracture
Compression at cubital tanner or guyons canal
Stab wound to wrist/forearm
What sensory deficit, motor deficit and deformity is seen with ulnar nerve damage
Sensory- hypothenar eminence and medial side of hand numb (1.5)
Motor- weak wrist flexion, weak wrist adduction, weak flexion of ring and little finger MCPJ, DIP and weak extension of the IPJ
Weak finger abduction, adduction and opposition
Clincal- claw hand on attempted finger flexion
What is the difference between hand of benediction and claw hand?
- Hand of benediction is a median nerve issue and is seen on finger flexion
- Claw hand is an ulnar nerve issue seen on finger extension
