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GROSS ANATOMY > Nerve Supply Of The Upper Limb > Flashcards

Nerve Supply Of The Upper Limb Flashcards

1
Q

Major nerve network that supplies the upper limb

Begins in the neck and extends into the axilla

A

Brachial Plexus

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2
Q

Brachial Plexus is formed by the union of the:

A 
Anterior rami of the last four cervical (C5-C8)
first thoracic (T1) nerve roots
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3
Q

Where is the brachial plexus located (during dissection)?

A

Posterior Triangle of the Neck

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4
Q

Posterior Triangle of the Neck

Surface Landmarks

A

Anterior: Sternocleidomastoid
Posterior: Trapezius
Inferior: Middle third of the clavicle

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5
Q

Brachial plexus together with the subclavian artery emerges between the anterior and middle __.

A

Scalene muscles

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6
Q

Five Major Segments of the Brachial Plexus

Ro-Tun-Da Cu-Bao
Reach To Drink Cold Beer

A 
Roots
Trunks
Divisions
Cords
Branches
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7
Q

Root anatomy

Dorsal root:

A

Sensation

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8
Q

Root anatomy

Ventral root:

A

Motor

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9
Q

The C5-C7 nerve roots are located __.

A

Above their corresponding vertebral body

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10
Q

Root

C8 is located __.

A

Below the C7 vertebral body

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11
Q

Root

T1 is located below the __.

A

T1 vertebral body

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12
Q

Root

C5 Motor

A 
Shoulder Abduction
Elbow Flexion (palm up)
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13
Q

Root

C5 Sensory

A

Lateral aspect of the arm

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14
Q

Root

C5 Reflex

A

Biceps

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15
Q

Root

C6 Motor

A 
Elbow flexion (thumb up)
Wrist extension
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16
Q

Root

C6 Sensory

A

Lateral forearm and thumb

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17
Q

Root

C6 Reflex

A

Brachioradialis

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18
Q

Root

C7 Motor

A

Elbow extension

Wrist flexion

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19
Q

Root

C7 Sensory

A

Middle and ring finger

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20
Q

Root

C7 Reflex

A

Triceps

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21
Q

Root

C8 Motor

A

Finger flexion, thumb extension

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22
Q

Root

C8 Sensory

A

Medial aspect of forearm and inferior arm

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23
Q

Root

T1 Motor

A

Finger abduction (Interossei)

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24
Q

Root

T1 Sensory

A

Medial aspect of the superior arm and skin of the axilla

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25
Q

Branches that arise at the root level

A
  1. Long Thoracic Nerve (C5-C6-C7)

2. Dorsal Scapular Nerve (C5)

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26
Q

Long Thoracic Nerve (C5-C6-C7)

Innervates the:

A

Serratus anterior

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27
Q

Long Thoracic Nerve (C5-C6-C7)

Abducts the:

A

Scapula

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28
Q

Long Thoracic Nerve (C5-C6-C7)

Injury:

A

Scapular Winging

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29
Q

Dorsal Scapular Nerve (C5)

Innervates the:

A

Major and minor rhomboids

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30
Q

Dorsal Scapular Nerve (C5)

Action:

A

Draws scapula to the spine

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31
Q

Formed by roots after they emerge from the scalenes

A

Trunks [3]

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32
Q

Trunk

C5+C6:

A

Superior Trunk

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33
Q

Trunk

C7:

A

Middle Trunk

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34
Q

Trunk

C8+T1:

A

Inferior Trunk

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35
Q

Nerves that arise at the Trunk level:

A
  1. Suprascapular Nerve

2. Subclavian Nerve

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36
Q

Suprascapular Nerve
Superior trunk (C5-C6)
Innervates:

A
  • Supraspinatus (shoulder abduction)

* Infraspinatus (shoulder external rotation)

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37
Q

Subclavian Nerve
•Superior trunk (C5-C6)
Innervates:

A

The subclavius muscle and sternoclavicular joint

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38
Q

Each trunk (superior, middle and inferior) gives rise to two divisions:

A

Anterior and posterior division

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39
Q

Divisions Occur at the level of the:

A

Clavicle

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40
Q

Anterior divisions supply the __ of the upper limb

A

Anterior (flexor) compartments

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41
Q

Posterior divisions supply the:

A

Posterior (extensor) compartments

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42
Q

Three cords labelled according to their position relative to the axillary artery:

A
  1. Lateral cord
  2. Medial cord
  3. Posterior cord
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43
Q

Formed by the 💡anterior divisions of the 💡superior and 💡middle trunks

A

Lateral Cord

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44
Q

Continuation of the 💡anterior division of the 💡inferior trunk

A

Medial Cord

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45
Q

Formed by the union of the 💡posterior divisions of all three trunks

A

Posterior Cord

46
Q

Nerves that arise at the Cord level:

A 
Lateral Pectoral Nerve
Medial Pectoral Nerve
Thoracodorsal Nerve
Upper Subscapular Nerve
Lower Subscapular Nerve
47
Q

Lateral Pectoral Nerve from:

A

Lateral Cord (C5)

48
Q

Lateral Pectoral Nerve Innervates:

A

Clavicular head of pectoralis major

49
Q

Lateral Pectoral Nerve Action:

A

Adducts and Internally Rotates shoulder

50
Q

Medial Pectoral Nerve from:

A

Medial Cord (C8)

51
Q

Medial Pectoral Nerve Innervates:

A

Sternal head of pectoralis major and pectoralis minor

52
Q

Medial Pectoral Nerve Action:

A

Adducts shoulder

53
Q

Thoracodorsal Nerve from:

A

Posterior Cord (C5)

54
Q

Thoracodorsal Nerve Innervates:

A

Latissimus dorsi

55
Q

Thoracodorsal Nerve Action:

A

Adducts and internally rotates the shoulder

56
Q

Upper Subscapular Nerve from:

A

Posterior Cord (C5)

57
Q

Upper Subscapular Nerve Innervates:

A

Subscapularis

58
Q

Upper Subscapular Nerve Action:

A

Internally rotates shoulder

59
Q

Lower Subscapular Nerve from:

A

Posterior Cord (C6)

60
Q

Lower Subscapular Nerve Innervates:

A

Subscapularis, and teres major

61
Q

Lower Subscapular Nerve Action:

A

Internally rotates shoulder

62
Q

Terminal Branches /Peripheral Nerves [5]

A

Axillary Nerve (from posterior cord)
Musculocutaneous Nerve (from lateral cord)
Radial Nerve (from posterior cord)
Median Nerve (from lateral and medial cord)
Ulnar Nerve (from medial cord)

63
Q

Axillary Nerve From:

A

Posterior cord (C5-C6)

64
Q

Axillary Nerve Exits the:

A

Axillary fossa posteriorly

65
Q

Axillary Nerve Passing through the

A

Quadrangular space with the posterior circumflex humeral artery

66
Q

Axillary Nerve Gives rise to

A

Superior lateral brachial cutaneous nerve

67
Q

Axillary Nerve Winds around

A

Surgical neck of the humerus deep to the deltoid

68
Q

Axillary Nerve Structures Innervated:

A

Teres Minor and Deltoid (Flexion, abduction, external rotation of the Shoulder)

Glenohumeral (Shoulder) Joint

69
Q

Axillary Nerve Sensory Innervation:

A

Skin of superolateral arm (over inferior part of deltoid)

70
Q

Spaces of the Posterior Shoulder

Spaces in between muscles through which arteries and nerves pass through

A
  1. Quadrangular Space
  2. Triangular Interval
  3. Triangular Space
71
Q

Quadrangular space Borders:

A

Superior: Teres minor
Lateral: Lateral head of triceps
Medial: Long head of triceps
Inferior: Teres major

72
Q

Quadrangular space Contents:

A

Posterior circumflex artery

Axillary nerve

73
Q

Triangular Interval Borders:

A

Superior: Teres major
Lateral: Lateral head of triceps
Medial: Long head of triceps

74
Q

Triangular Interval Contents:

A

Profunda brachii

Radial nerve

75
Q

Triangular space Borders:

A

Superior: Teres minor
Inferior: Teres major
Lateral: Long head of triceps

76
Q

Triangular space Contents:

A

Circumflex scapular artery

77
Q

Terminal branch of the lateral cord

C5-C7

A

Musculocutaneous Nerve

78
Q

Musculocutaneous Nerve

Exits axilla by piercing the:

A

Coracobrachialis

79
Q

Musculocutaneous Nerve

Descends between:

A

Biceps brachii and brachialis

80
Q

Musculocutaneous Nerve Continuous as the:

A

Lateral antebrachial cutaneous nerve of the forearm

81
Q

Musculocutaneous Nerve Structures innervated:

A

Coracobrachialis, biceps brachii, brachialis (Elbow flexion)

82
Q

Musculocutaneous Nerve Sensory innervation:

A

Skin at lateral aspect of the forearm

83
Q

Arises from the 💡Posterior cord (C5-T1) and the 💡largest branch of the brachial plexus

A

Radial Nerve

84
Q

Radial Nerve Exits:

A

Axillary fossa posterior to axillary artery

85
Q

Radial Nerve

Passes posterior to:

A

Humerus in radial groove with deep brachial artery in the triangular interval between the lateral and medial heads of the triceps

86
Q

Radial Nerve Perforates:

A

Lateral intermuscular septum as it exits the posterior compartment of the arm

87
Q

Radial Nerve Enters:

A

Cubital fossa, dividing into superficial (cutaneous) and deep (motor) radial nerves

88
Q

Radial Nerve

Branches in the forearm and wrist:

A
  1. Posterior interosseous nerve
  2. Superficial branch of the radial nerve
  3. Posterior cutaneous nerve of the forearm
89
Q

Radial Nerve

Structures innervated:

A

All muscles of the posterior compartments of the arm (e.g. triceps) and forearm (e.g. brachialis, extensor carpi radialis longus)

90
Q

Radial Nerve:

Sensory Innervation

A
  • Skin of the posterior and inferolateral arm
  • Posterior forearm
  • Dorsum of the hand lateral to the axial line of the ring finger
91
Q

Arises from the 💡lateral cord (C6, C7) and 💡medial cord (C8, T1)

A

Median Nerve

92
Q

Median Nerve exits the cubital fossa by passing between the heads of the

A

Pronator teres

93
Q

Median Nerve runs deep to palmaris longus tendon as it approaches the flexor retinaculum to traverse the

A

Carpal tunnel

94
Q

Median Nerve

Branches:

A
  1. Anterior interosseous nerve

2. Palmar cutaneous branch of the median nerve

95
Q

Median Nerve

Structures innervated

A

•Muscles of the anterior forearm compartment (except for the flexor carpi ulnaris and the ulnar half of flexor digitorum profundus)

•Five intrinsic muscles in the thenar half of the palm
(OAF+2)
1. 1st and 2nd lumbricals
2. Opponens pollicis
3. Abductor pollicis brevis
4. Flexor pollicis brevis
96
Q

Median Nerve Provides sensation to the:

A

Thenar half (radial 3 ½ digits) of the palmar skin

97
Q

Ulnar nerve Arises from the:

A

Medial cord (C7 –T1)

98
Q

Ulnar nerve

Passes posterior to the

A

Medial epicondyle of the humerus

99
Q

Ulnar nerve

Branches:

A
  1. Palmar cutaneous branch of the ulnar nerve

2. Dorsal cutaneous branch of the ulnar nerve

100
Q

Ulnar nerve

Structures innervated:

A
  • Flexor carpi ulnaris and ulnar half of the flexor digitorum profundus (forearm)
  • Most of the intrinsic muscles of the hand (hypothenar muscles, lumbricals and interossei)
101
Q

Ulnar nerve

Provides sensation:

A

•Skin of the ulnar side of the hand along the ring and small finger

102
Q

Occur during difficult deliveries in infants

A

Obstetric Brachial Plexus Palsy

103
Q

Obstetric Brachial Plexus Palsy Two Types:

A
  1. Erb-Duchenne Palsy

2. Klumpke’s Palsy

104
Q

 Most common type, upper lesion
 Mechanism of injury: lateral flexion of the head
towards the contralateral shoulder with depression of the ipsilateral shoulder causing traction in infants
 PE: Adducted, internally rotated shoulder; pronated forearm, extended elbow (💡Waiter’s Tip)
 Prognosis and Treatment: Observation, best prognosis for spontaneous recovery

A

Erb-Duchenne Palsy

C5,C6

105
Q

 Rare type
 Mechanism of injury: Arm presentation with subsequent traction/abduction from trunk
 PE: deficit of all of the small muscles of the hand (ulnar and median nerves)
 💡“Claw Hand” deformity
• Wrist in 💡extreme extension because of the unopposed wrist extensors
• 💡Hyperextension of the MCP and 💡flexion of the IP joints due to 💡loss of hand intrinsics
 Prognosis: Poor for spontaneous recovery

A

Klumpke’s Palsy

C8, T1

106
Q

 Muscles in the posterior compartment of
the forearm are paralyzed
 💡“Wrist Drop” – inability to extend the wrist and fingers at the metacarpophalangeal joints

A

Radial Nerve Palsy

Humerus Fracture

107
Q

Results from any lesion that significantly reduces the size of the carpal tunnel, increases the size of the structures or their coverings that pass through it
Causes: inflammation of synovial sheaths, fluid retention, infection, tumors

A

Carpal tunnel syndrome

108
Q

Most sensitive structure in carpal tunnel

A

Median nerve

109
Q

Carpal tunnel syndrome

 Signs and symptoms:

A
  1. Paresthesia (tingling), hypoesthesia (diminished sensation), or anesthesia (absence of sensation) may occur in the lateral three and a half digits.
  2. Inability to oppose the thumb
  3. Atrophy of the thenar eminence (thenar muscles)
110
Q

Carpal tunnel syndrome

Treatment:

A

Rest and splint immobilization,

steroid injection or carpal tunnel release

GROSS ANATOMY (8 decks)

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