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AoL > Nerves and vessels of the upper limb > Flashcards

Nerves and vessels of the upper limb Flashcards

1
Q

State the sections of the brachial plexus

A 
ROOTS (from anterior rami) 
TRUNKS 
DIVISIONS 
CORDS 
(TERMINAL) BRANCHES (peripheral nerves)

Read That Damn Cadaver Book!

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2
Q

T/f the roots of the brachial plexus refers to the anterior and posterior roots emerging from the spinal cord

A

F!

Anterior/posterior roots from spinal cord firstly combine to form spinal nerve. There are then anterior and posterior rami which contain mixed motor/sensory function.

The roots of the brachial plexus are separate from these spinal cord roots, and are formed by anterior rami

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3
Q

What are the roots of the brachial plexus

A

C5-T1 from anterior rami

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4
Q

Which nerve(s) emerge(s) from the root.

A

Dorsal scapular nerve (C5)

Long thoracic nerve (C5-C7)

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5
Q

Where do the roots exit to get into the base of the neck

A

These nerves pass between the anterior and medial scalene muscles to enter the base of the neck.

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6
Q

What does the dorsal scapular nerve do

A

levator scapulae (as does cervical nerve (C3,C4), rhomboid major, and rhomboid minor muscles.

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7
Q

What are the names of the trunks? Which innervation do each contain

A

Superior (C5,C6)
Middle (C7)
Inferior (C8, T1)

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8
Q

Which nerve(s) emerge(s) from the trunks. What does it/they do

A

The subclavian nerve (C5, C6) from the superior trunk.

Innervates the subclavius muscle

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9
Q

What are the names of the divisions and how many are there

A

There are anterior and posterior divisions of each trunk, so 6 divisions

NOTE it is A, P, A, P, P, A

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10
Q

Which nerve(s) arise(s) from the divisions

A

Suprascapular nerve (C5, C6), from the anterior division of the superior trunk

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11
Q

What are the names of the cords, how many are there, and what are their contributions

A

Lateral (AS, AM)

Posterior (SP, MP, IP)

Medial (AI)

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12
Q

Which nerve(s) emerge(s) from the cords

A

Lateral: lateral pectoral nerve (C5-C7)

Posterior: Upper subscapular nerve (C5, C6), lower subscapular nerve (C5, C6) and thoracodorsal nerve (C6-C8)

Medial: medial pectoral nerve (C8, T1), medial cutaneous nerve of the arm, medial cutaenous nerve of the forearm

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13
Q

What is the function of the lateral pectoral nerve

A

Innervates pectoralis major (along with the medial pectoral nerve)

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14
Q

What is the function of the upper subscapular nerve

A

Innervates subscapularis

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15
Q

What is the funtion of the lower subscapular nerve

A

Innervates subscapularis, and TERES MAJOR

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16
Q

What is the function of the thoracodorsal nerve

A

Innervates lat. dorsi

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17
Q

What is the function of the medial pectoral nerve

A

Innervates pectoralis major

Innervates pectoralis minor

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18
Q

What are the terminal branches of the brachial plexus?

A

Musculocutaneous (from lateral cord), C5-C7

Axillary (posterior cord)- C5,6

Radial (posterior cord)- C5-T1

Median nerve (lateral root of median nerve from lateral cord=C6,7, medial root from medial cord=C8,T1).

Ulnar (medial cord)- C8,T1, C7

(my auntie ripped my uncle)

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19
Q

What are the CORDS named according to

A

according to their relationship to the axillary artery.

The posterior cord is posterior to the artery etc.

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20
Q

Which spinal cord segments supply the shoulder girld muscles

A

C3-C7

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21
Q

Which spinal cord segments supply the shoulder joint muscles and elbow flexors

A

C5-C6

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22
Q

Which spinal cord segments supply the elbow joint extensors

A

C7,C8

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23
Q

Which spinal cord segments supply the wrist and coarse hand muscles

A

C6-C8

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24
Q

Which spinal cord segments supply the small muscles of hand

A

C8-T1

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25
Q

Which spinal cord segments abduct the arm from when it is perpendicular to body

A

C5

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26
Q

Which spinal cord segments adduct the arm from when it is perpendicular to body

A

C6,7,(8)

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27
Q

Which spinal cord segments flex the elbow

A

C5,6

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28
Q

Which spinal cord segments extend the elbow

A

C7,8

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29
Q

Which spinal cord segments pronate

A

C7,8

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30
Q

Which spinal cord supinate

A

C6

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31
Q

Which spinal cord segments flex the wrist

A

C6, 7

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32
Q

Which spinal cord segments extend the wrist

A

C6,7

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33
Q

Which spinal cord segments abduct the fingers

A

T1

34
Q

Which spinal cord segments extend the finger

A

C7,8

35
Q

Which spinal cord segments flex the finger

A

C7,8

36
Q

LEARN THE DERMATOMES

A

…

37
Q

T/F the dermatome and cutaneous nerve patterns are similar

A

F: Because of all the fibre recombination that takes place in a plexus, the pattern of cutaneous nerve distribution is very different from the dermatome pattern

WHY

38
Q

Where does the axillary nerve come form

A

Posterior cord

39
Q

How is the axillary nerve damaged

A

Commonly damaged through dislocations of shoulder and fracture of the surgical neck of the humerus.

40
Q

Which muscles are supplied by the axillary nerve

A

Deltoid, teres minor, and glenohumeral

41
Q

What is the course of the axillary nerve

A

Exits axillary fossa posteriorly, passes through quadrangular space with posterior circumflex humeral artery, gives rise to superior lateral brachial cutaneous nerve, then winds around surgical neck of humerus deep to deltoid

42
Q

What would happen if axillary nerve was damaged

A

Wasting of deltoid/analgesia in a spot on the lateral arm due to lack of superior lateral cutaenous nerve of the arm

43
Q

Where is the radial nerve derived from

A

Posterior cord

44
Q

Outline the course of the radial nerve

A

Exits axillary fossa POSTERIOR to axillary artery

Passes posterior to humerus in the radial groove with the deep brachial artery between lateral and medial heads of triceps

Perforates lateral intermusclar septum

Enters cubital fossa

Rivides into superfical (cutaneous) and deep (motor) radial nerves

45
Q

How can the radial nerve be damaged

A

The radial nerve runs closely apposed to the shaft of the humerus, so can be damaged in humeral fractures.

46
Q

What can happen in radial nerve damage

A

Wrist drop and anaesthesia of the dorsal hand
(around the thumb area)

Loss of muscle mass evident in the arm and forearm.

Remember what the guy said in dissection: the radial nerve gives off its branches very high, so the triceps us

47
Q

What loss of function occurs in radial nerve damage

A

Loss of power grip

wrist extension required

48
Q

Where is the musculocutaneous nerve derived from

A

The lateral cord

49
Q

Outline the course of the musculocutaneous nerve

A

Pierces coracobrachialis to exit the axilla.

Descneds between biscpes brachii and brachialis. Supplies both.

Continues as lateral cutaneous nerve of the forearm

50
Q

When is musculocutaenous nerve injured

A

not often injured in trauma as it is well protected by musclesMay be damaged during surgery for breast cancer

51
Q

Where is the ulnar nerve derived from

A

Medial cord

52
Q

Outline the course of the ulnar nerve

A

Descends medial arm, passes posterior to medial epicondyle of hmerus
Descends ulnar aspect of forearm to hand

53
Q

Function of ulnar nerve

A

FCU, ulnar half of flexro digitorum produndus, most intrinsic muscles of hand, skin of hand medial to axial line of digit 4

54
Q

Common sites of ulnar nerve injury

A

Medial epicondyle, near the ulnar stylus

Injuries to medial epicondyle of humerus cause injury to the ulnar nerve at the elbow.

55
Q

When might clinicians see ulnar nerve damage in the wrist

A

Self harm/assisted suicide

56
Q

What happens in ulnar nerve injury

A

Claw deformity

57
Q

What cuases claw deformity in ulnar nerve injudry

A

lumbrical contraction means loss of flexion of the MPJs and weakened extension of the IPJs.

THEREFORE YOU GET AN EXTENED MPJ and a flexed IPJ

58
Q

What other motor deficits will be evident: in ulnar nerve damage

A

aside from claw like:
Many small muscles of hand affected but thumb, index and middle finger movements largely spared

Adductin and abduction due to interossei muscles

59
Q

Sensory deficits in ulnar nerve

A

skin of hand medial to axial line of digit 4

60
Q

When is claw deformity worse in ulna nerve damage, near the wrist or the elbow and why

A

AT WRIST WORST THAN ELBOW (paradox as you expect to be worse when more proximal)

This is because the ulnar nerve also innervates the ulnar half of FDP, flexion of the IP joints is weakened (there is flexion at IPJ because of loss of the extension usually provided by the lumbicals, but having less flexion from FDP as would occur when the elbow is involved not the wrist reduces the flexion ), therefore less claw-like appearance

61
Q

Where does the medial nerve come from

A

Medial and Lateral Cords

62
Q

What is the path o the median nerve

A

Lateral and medial roots (frm the cords) merge to form median nerve lateral to axillary artery

Descends throiguh arm adjacent to brachial artery, nerve crosses anterior to artery to lie medial to artery in the cubital fossa

Runs through the carpal tunnel

63
Q

Where does the median nerve run within the carpal tunnel

A

Quite laterally

64
Q

T/F ulnar nerve lies LATERAL to the median nerve in the carpal tunnel

A

F! The ulnar nerve doesn’t run within the carpal tunnel!!!

65
Q

When is the median nerve most commonly entrapt

A

Carpal tunnel syndrome

66
Q

Signs in carpal tunnel syndrome

A

Wasting of thenar eminence (adductor pollicis may become prominent as it is NOT supplied by the median nerve)

Sensory deficit lateral to the axial line of the ring finger palmar sid

67
Q

T/F sensory damage in ulnar nerve damage is more signfiicant than in median nerve damage

A

F…. inconvenient in ulnar nerve but severely debitilating in mdian nerve damage

68
Q

What does the long thoracic nerve innervate

A

Serratus anterior muscle

69
Q

Where does the long thoacic nerve lie

A

is relatively superficial, therefore easily damaged

70
Q

What will damage to long thorac nerve resutlt in

A

Pressing against a wall will lead to “winging” of the scapula resulting from the loss of activity of serratus anterior.

71
Q

Injuries to the upper roots of the brachial plexus is ferred to as what

A

Erb-Duchenne Palsy (C5,C6)

72
Q

When can erb dchenne palsy occur

A

During injury (see the image) or during birth

73
Q

What occurs in erb’s palsy to limb position and why

A

“Waiter’s Tip” Position with Upper Root Injury

Many muscles affected (shoulder, anterior arm). Forearm pronated by lack of biceps supination.

74
Q

What is injury to the lower roots called

A

Klumpke’s Palsy

75
Q

What is the common cause of klumpke’s palsy

A

Common cause is over-abduction due to gripping overhead to break a fall.
T1 (and sometimes C8)

or during birth

76
Q

What occurs in lower root injury

A

T1 mainly supplies the small muscles of the hand via the ulnar and median nerves. Loss of their activity results in clawed hand.

77
Q

Why does the claw occur in klumpke’s palsy?

A

/…

78
Q

What does ulnar nerve supply in the arm

A

Nothing

79
Q

The ulnar nerve supplies flexor digitorum profundus to which digits

A

medial, so 4 and 5

80
Q

What can klumke’s result from

A

Klumpke’s monkeys fall from the tree (over abduction)

AoL (9 decks)

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