Nerves of the Upper Limb Flashcards

1
Q

Origins of the brachial plexus

A

C5-C8 and T1

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2
Q

Dermatome: Upper lateral region of the arm

A

C5

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3
Q

Dermatome: palmar pad of the thumb

A

C6

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4
Q

Dermatome: Pad of the index finger

A

C7

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5
Q

Dermatome: Pad of the little finger

A

C8

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6
Q

Dermatome: Skin on medial aspect of the elbow

A

T1

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7
Q

Myotome: Abduction of arm at glenohumeral joint

A

C5

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8
Q

Myotome: Flexion of the elbow

A

C6

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9
Q

Myotome: Extension of the elbow

A

C7

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10
Q

Myotome: Flexion of the fingers

A

C8

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11
Q

Myotome: Abduction / Adduction of fingers

A

T1

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12
Q

Spinal nerve tested with biceps reflex

A

C6

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13
Q

Spinal nerve tested with triceps reflex

A

C7

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14
Q

Nerve that innervates all of the anterior compartment of the arm

A

Musculocutaenous nerve

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15
Q

Nerve that innervates all the muscles in the anterior compartment of the forearm except flexor carpi ulnas and medical 1/2 of flexor digitorum profundus

A

Median nerve

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16
Q

Innervates intrinsic muscles of hand apart from thenar muscles and lateral two lumbicals

A

Ulnar nerve

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17
Q

Innervates all the muscles in the posterior compartment of the forearm

A

Radial nerve

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18
Q

Nerve that innervates the skin on the anterolateral aspect of the forearm

A

Musculocutaenous nerve

–> Lateral cutaneous nerve of the forearm

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19
Q

Nerve that innervates the palmar surface of the lateral 3 and 1/2 digits

A

Median nerve

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20
Q

Nerve that innervates the palmar surface of the medial one and 1/2 digits

A

Ulnar nerve

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21
Q

Nerve that supplies the skin of the posterior forearm and elbow

A

Radial nerve

–>Posterior cutaneous nerve of the forearm

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22
Q

Nerve that supplies the dorsolateral surface of the hand

A

Radial nerve

–> Superficial branch

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23
Q

Nerve that passes around the surgical neck of the humerus

A

Axillary nerve

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24
Q

Nerve that spirals around the humerus in a groove

A

Radial nerve

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25
Q

Nerve that passes behind the medial epicondyle of the humerus

A

Ulnar nerve

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26
Q

Order of divisions of brachial plexus

A

5 roots

3 trunks

6 divisions

3 cords

4 nerves

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27
Q

Superior trunk of the brachial plexus

A

Formed by C5 and C6 spinal roots

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28
Q

Middle trunk of the brachial plexus

A

Formed by continuation of the C7 spinal root

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29
Q

Inferior trunk of the brachial plexus

A

Formed by C8 and T1 spinal roots

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30
Q

Cords of the brachial plexus

A

Named in relation to their position to the 2nd part of the axillary artery 3 cords

The posterior cord contains all of the posterior divisions and hence goes on to supply the posterior aspect of the UL

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31
Q

Lateral cord of the brachial plexus

A

Formed by the anterior divisions of the superior and middle trunk

Hence received innervation from the C5, C6 and C7 spinal roots

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32
Q

Posterior cord of the brachial plexus

A

Formed by all of the posterior divisions, from superior middle and inferior trunks

Hence contains innervation from C5 - T8

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33
Q

Medial cord of the brachial plexus

A

Formed from the lone anterior division of the inferior trunk

Hence received innervation from C8 and T1

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34
Q

Dorsal scapular nerve

A

Branch of C5 root of the brachial plexus

Passes posteriorly piercing the middle scalene
–> medial border of scapula

Motor:
Rhomboid major
Rhomboid minor

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35
Q

Long thoracic nerve

A

Originates from anterior rami of C5-C7

Passes vertically down the neck through the axillary inlet
–> down medial wall of the axilla

Motor
Serratus anterior

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36
Q

Nerve branches of the superior trunk of the brachial plexus

A

Suprascapular nerve
C5 and C6 (superior trunk)
Motor: supraspinatous, infaspinatous

Subclavius nerve
C5 and C6 (superior trunk)
Motor: subclavius muscle

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37
Q

Suprascapular nerve

A

Branch of the superior trunk of the brachial plexus

C5 and C6 (as it is from the superior trunk)

Passes laterally to the posterior triangle

  • -> supra-scapular foramen
  • ->enters posterior scapular region

Motor
Supraspinatous
Infraspinatous

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38
Q

Nerve to the subclavius muscle

A

Branch of the superior trunk of the brachial plexus

C5 and C6 (as it is from the superior trunk)

Passes anterioinferiorly over subclavian artery and vein

Motor
Subclavius muscle

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39
Q

Branches of the cords of the brachial plexus

A

Lateral Cord x1
-Lateral pectoral nerve

Median Cord x3

  • Medial pectoral nerve
  • Medial cutaneous nerve of the arm
  • Medial cutaneous nerve of the forearm

Posterior Cord x4

  • Superior sub-scapular nerve
  • Thoracodorsal nerve
  • Inferior sub-scapular nerve
  • Axillary nerve
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40
Q

Terminal nerves of the brachial plexus

A

Musculocutaneous nerve
-Upper 1/2 of Lateral cord

Median nerve

  • Bottom 1/2 of lateral cord
  • Upper 1/2 of of medial cord

Radial nerve
-Posterior cord

Ulnar nerve
-Bottom 1/2 of medial cord

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41
Q

Cords that produce the Musculocutaneous nerve

A

Upper 1/2 of lateral cord

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42
Q

Cords that produce the Median nerve

A

Bottom 1/2 of lateral cord

Upper 1/2 of medial cord

43
Q

Cords that produce the Radial nerve

A

Posterior cord

44
Q

Cords that produce the Ulnar nerve

A

Bottom 1/2 of medial cord

45
Q

Lateral pectoral nerve

A

Proximal branch of the lateral cord of the brachial plexus

Passes anteriorly with the thoraco-acromial artery and pierces the clavipectoral fascia

Motor
Pectoralis major muscle

46
Q

Musculocutaneous nerve

A

Large terminal branch of the lateral cord

Passes lateral to penetrate the coracobrachialis muscle and pass between the biceps brachii and brachialis muscle

Innervates all three flexors in anterior compartment of the arm

Terminates as lateral cutaneous nerve of the forearm

47
Q

Medial pectoral nerve

A

Most proximal branch of the medial cord of the brachial plexus

Receives a communicating branch from the lateral pectoral nerve

Passes anteriorly between axillary artery and vein
Passes through pectoralis minor, some fibres make it to pectoralis major

Motor
Pectoralis minor muscle

48
Q

Medial cutaneous nerve of the arm (medial brachial cutaneous nerve)

A

Branch of the medial cord of the brachial plexus

Passes through axilla into the arm where it penetrates deep fascia

–> supplies skin over medial sure of the arm

49
Q

Medial cutaneous nerve of the forearm

A

Branch of the medial cord of the brachial plexus just distal to that of the medial cutaneous nerve of the arm

Passes from axilla into arm

Gives off a branch to the skin overlying biceps brachii

Continues down to penetrate the deep fascia with the basilic vein

Continuing to supply skin over anterior surface of the forearm

50
Q

Ulnar nerve

A

Large terminal branch of the medial cord of the brachial plexus

Often received a communication branch from the lateral cord carrying C7 fibres

Passes through arm and forearm
–> Branch supplies flexor carpi ulnaris
and medial 1/2 of flexor digitorum profundus

Innervates all of the intrinsic muscles of the hand (except thenar muscles and lateral two lumbricals)

Innervates skin over palmar surface of little finger and 1/2 of ring finger

51
Q

Median Nerve

A

Formed by union of the bottom 1/2 of lateral cord and upper 1/2 of medial cord of the brachial plexus

This occurs anterior to the third part of the axillary artery

Passes into arm anterior to brachial artery

Branches and supplies most of the anterior compartment of the forearm
-Except flexor carpi ulnaris and medial half of flexor digitrorum profundus

Median nerve continues into the hand and innervates

  • Thenar muscles
  • Lateral two lumbricals

Palmar surface of lateral 3 and 1/2 fingers

52
Q

Superior subscapular nerve

A

Branch of posterior cord of brachial plexus

Supplies subscapularis muscle

53
Q

Thoracodorsal nerve

A

Branch of the posterior cord of the brachial plexus

Passes vertically along posterior axillary wall

Penetrates and innervates latissimus dorsi

54
Q

Inferior subscapular nerve

A

Branch of the posterior cord of the brachial plexus

Passes inferiorly along posterior axillary wall

Innervates subscapularis and teres major

55
Q

Axillary nerve

A

Branch of posterior cord of brachial plexus

Passes inferiorly and laterally along the posterior wall to exit through the quadrangular space

Passes posteriorly around surgical neck of the humerus

Motor
Deltoid
Teres minor

Accompanied by posterior circumflex humeral artery

56
Q

Radial Nerve

A

Major terminal branch of the posterior cord of the brachial plexus

Passes out of the axilla into the posterior compartment lf the arm

Passes through triangular interval composed of the inferior border of trees major, long head of the triceps brachial
Accompanied by profonda brachii artery

Now in the posterior compartment of the arm

Innervates all the muscle in the posterior compartment of the forearm

Skin on posterior surface of elbow and forearm, and dorsolateral surface of the hand

57
Q

Superior lateral cutaneous nerve of the arm

A

Branch of the axillary nerve after passing through the quadrangular space

Loops around posterior deltoid muscle

Innervate skin over deltoid

58
Q

Nerve supplying anterior compartment of the arm

A

Musculocutaenous nerve

  • Coracobrachialis
  • Biceps brachii
  • Brachialis
59
Q

Nerve supplying Coracobrachialis

A

Musculocutaneous nerve

C5, C6, C7

O: Apex of coracoid process
I: Linear roughening on mid shaft of humerus
F: flexion at glenomhumeral

60
Q

Nerve supplying Biceps brachii

A

Musculocutaneous nerve

C5, C6

O: Long head - Supraglenoid tubercle
Short head - apex of coracoid process
I: radial tuberosity

F: Powerful flexor of the forearm at the elbow + supinator of the forearm

61
Q

Nerve supplying brachialis

A

Musculocutaneous nerve

C6

+small radial contribution C7

O: Anterior aspect of humerus, medial and lateral, and adjacent inter muscular septae
I: Tuberosity of ulna
F: Powerful flexor or forearm at elbow

62
Q

Nerve that supplies triceps brachii

A

Radial nerve

C7 (hence when testing triceps reflex one is testing C7)

Origin
Long-head: infraglenoid tubercle
Lateral-head: high up posterior humerus
Medial-head / deep head: posterior humerus lower down
Radial nerve runs in between lateral and medial head

I: olecranon
F: Extension of elbow

63
Q

Course of the musculocutaneous nerve

A

Musculocutaneous nerve is formed by the upper hand of the lateral cord

It passes out of the axilla and enters the arm by passing through the corachobrachialis muscle

It passes diagonally down the arm in between biceps brachii and brachialis

Gives branches to anterior compartment of the arm

Emerges laterally to tendon of biceps brachii and continues as lateral cutaneous nerve of the forerarm

64
Q

Course of the median nerve

A

Formed by lateral and medial cords of brachial plexus

Enters arm from axilla at the inferior margin go tires major muscle

Passes vertically down medial side of the arm in the anterior compartment next to the brachial artery

Proximally: lies lateral to brachial artery
Distally: lies medial to brachial artery

Lies anterior to elbow joint

Branches to pronator teres muscle
-Only branch in the arm

65
Q

Course of the ulnar nerve

A

Enters arm with median nerve and axillary artery

Middle of arm it pierces the medial inter muscular septum and enters the posterior compartment

Lies anterior to the medial head of the triceps brachii muscle

Passes posteriorly to medial epicondyle at elbow

66
Q

Course of the radial nerve

A

Formed by the posterior cord of the brachial plexus

Enters arm by crossing inferior margin of trees major muscle

Accompanied by the profunda brachii artery, the radial nerve enters the posterior compartment of the arm passing through the triangular interval

As the radial nerve passes diagonally from medial to lateral in the posterior compartment it lies in the radial groove

On the lateral side it passes anteriorly to pierce the lateral inter muscular septum and enter the anterior compartment

Enters forearm anterior to lateral epicondyle just beneath brachioradialis

67
Q

Innervation of flexor carpi ulnaris

A

Innervated by the ulnar nerve
C8

O:
Medial head: Medial epicondyle of humerus
Ulnar head: Olecranon and posterior ulna

I: Pisiform bone
Extends to the hamate and metacarpal via the pisohamate and pisometacarpal ligament

F: Flexes wrist and ADDucts wrist

68
Q

Innervation of flexor carpi radialis

A

Innervated by median nerve
C6 C7

O: Medial epicondyle of humerus

I: Base of II and III metacarpals

F: Flexes and ABducts wrist

69
Q

Innervation of palmaris longus

A

Innervated by median nerve
C7 C8

O: medial epicondyle of humerus

I: Palmar aponeurosis

F: Flexes wrist

70
Q

Innervation of pronator teres

A

Innervated by median nerve
C6 C7

O:
Humeral head: Medial epicondyle and adjacent supracondylar ridge
Ulnar head: Medial side of coronoid process

I: Lateral mid shaft of radius

F: Pronates forearm

71
Q

Innervation of flexor digitorum superficialis

A

Innervated by median nerve
C8

Two heads:
Humeri-Ulna head: Medial epicondyle of humerus and coronoid process of ulna
Radial head: Oblique line of radius

Ulnar artery and median nerve pass between the two heads and run under FDS

I: Four tendons pass through carpal tunnel and split over base of proximal phalanx, insert on middle phalanx

F: flexion of metacarpal and PIP

72
Q

Innervation of flexor digitorum profundus

A

Innervated in two halves
Ulna/medial side: Ulna nerve
Interosseus side: Anterior interosseous nerve (Median nerve) C8

O: Anterior and medial surface of ulna + interosseous membrane

I: Distal phalanx, passing through split of FDS

F: Flexion of DIP, PIP and metacarpal

73
Q

Innervation of flexor pollicis longus

A

Innervated by the anterior interosseous nerve (Median nerve C8)

O: Anterior surface of radius and radial 1/2 of interosseous membrane

I: Distal phalanx of thumb

F: flexion of metacarpal and interphalangeal joint of thumb

74
Q

Innervation of pronator quadratus

A

Innervated by anterior interosseous nerve (Median nerve) C8

O: Distal anterior surface ulna

I: Distal anterior surface of radius

F: Pronation

75
Q

How to tell if carpal tunnel or proximal median nerve pathology?

A

Test palmar branch which passes over flexor retinaculum

Innervates skin over base and central palm

76
Q

Seven muscles of the superficial extensor compartment of the forearm

A

Brachioradialis

Extensor carpi radialis longus

Extensor carpi radialis brevis

Extensor digitorum

Extensor digiti minimi

Extensor carpi ulnaris

Anconeus

77
Q

Innervation of the brachioradialis

A

Innervated by the radial nerve C6
Before division into superficial and deep branches

O: Proximal part of lateral supraepichondylar ridge of humerus and adjacent intermuscular septum

I: Lateral surface of distal end of radius

F: Accessory flexor of elbow joint when forearm is mod-pronated

Within posterior compartment

78
Q

Innervation of extensor carpi radialis longus

A

Innervated by radial nerve C6 before division of superficial and deep branches

O: Distal part of lateral supraepichondylar ridge of humerus and adjacent intermuscular septum

I: Dorsal surface of base of metacarpal II

F: Extension and ABduction of wrist

79
Q

Innervation of extensor carpi radialis brevis

A

Innervated by the Deep branch of the radial nerve C7 BEFORE penetrating supinator muscle

O: Lateral epicondyle of humerus and adjacent intermuscular septum

I: Dorsal surface of base of metacarpal II and III

F: Extension and ABduction of wrist

80
Q

Innervation of extensor digitorum

A

Innervated by posterior interosseous nerve C7

O: Lateral epicondyle of humerus and adjacent intermuscular septum and deep fascia

I: Four tendons running through extensor hoods inset on base of middle and distal phalanx

F: Extends fingers and wrist

81
Q

Innervation of extensor digit minimi

A

Innervated by posterior interosseous nerve C7

O: Lateral epicondyle of humerus and adjacent intermuscular septum along with extensor digitorum

I: Extensor hood of little finger

F: Extension of little finger

82
Q

Innervation if extensor carpi ulnaris

A

Innervated by posterior interosseous nerve C7

O: Lateral epicondyle of humerus + posterior border of ulna

I: Tubercle on base and side of metacarpal V

F: Extension and Adduction of wrist

83
Q

Innervation of anconeus

A

Innervated by radial nerve C6 C7 C8 via branch to medial head of triceps brachii

O: Lateral epicondyle of humerus

I: Olecranon and proximal posterior surface off ulna

F: Abduction of ulna in pronation + Accessory extensor at elbow

84
Q

Innervation of the deep extensors of forearm

A

All innervated by posterior interosseous nerve
- branch of radial nerve

Supinator

Abductor pollicis longus

Extensor pollicis brevis

Extensor pollicis longus

Extensor indicis

85
Q

Innervation of supinator

A

Innervated by posterior interosseous nerve
-branch of radial nerve

C6

O: Two heads
Superficial part: Lateral epicondyle of humerus, radila collateral and annular ligaments
Deep part: supinator crest of ulna

I: Lateral surface of radius superior to anterior oblique line

F: Supination

86
Q

Innervation of Abductor pollicis longus

A

Innervated by posterior interosseous nerve
-branch of radial nerve

C7

O: Posterior surfcae of ulna and radius + interosseous membrane (distal to supinator and anconeus)
I: Lateral side of base of metacarpal I
F: Abduction of metacarpal of thumb + accessory extensor

87
Q

Innervation of extensor pollicis brevis

A

Innervated by posterior interosseus nerve
-branch of radial nerve

C7

O: Posterior surface of radius (distal to abductor pollicis longus) and adjacent interosseous membrane
I: Dorsal surface of base of proximal phalanx of the thumb
F: Extends metacarpophalangeal joint of the thumb

88
Q

Innervation of extensor pollicis longus

A

Innervated by posterior interosseous nerve
-branch of radial artery

C7

O: Posterior surface of ulna + adjacent interosseous membrane, distal to the abductor pollicis longus
I: Dorsal surface of base of distal phalanx of thumb
F: Extends metacarpophalangeal and interphalangeal joints of thumb

89
Q

Innervation of extensor indicis

A

Innervated by posterior interosseous nerve
-branch of radial nerve

C7

O: Posterior surface of ulna + adjacent interosseous membrane, distal to extensor pollicis longus
I: Extensor hood of index finger
F: Extension of index finger

90
Q

Course of the Radial Nerve

A

Radial nerve passes to lateral wall of antecubital fossa deep tp brachioradialis

  • -> supplies brachioradialis
  • -> supplies extensor carpi radialis longus and brevis

Becomes posterior interosseous nerve after emerging from the two heads of supinator muscle

91
Q

Innervation of the intrinsic muscles of the hand

A

Deep branch of the ulnar nerve innervated all the intrinsic muscles of the hand apart from
-Lateral two lumbricals
-Thenar muscles
=Median nerve

This includes:
Palmaris brevis
Interossei
Adductor pollicis brevis
Thenar muscles 
Medial two lumbricals
92
Q

Innervation of the thenar muscles

A

Innervated by recurrent branch of median nerve

T1

Opponens pollicis

Abductor pollicis brevis

Flexor pollicis brevis

93
Q

Innervation of the hypothenar muscles

A

Innervated by the deep branch of the ulnar nerve

T1

Opponens digiti minimi

Abductor digiti minimi

Flexor digiti minimi

94
Q

Innervation of palmaris brevis

A

Innervated by the superficial branch of the ulnar nerve

T1

O: Palmar aponeurosis and flexor retinaculum
I: Dermis of the skin on the medial margin of the hand
F: Improved grip by deepending cup during flexion

95
Q

Innervation of the dorsal interossei

A

Innervated by the deep branch of the ulnar nerve
x4 muscles

T1

O: Adjacent side of metacarpals
I: Extensor hood and base of proximal phalanges of index, middle and ring finger
F: ABduction

96
Q

Innervation of the palmar interossei

A

Innervated by deep branch of the ulnar nerve

T1

O: sides of metacarpals
I: Extensor hood:
F: ADduction of fingers

97
Q

Innervation of the lumbricals

A

Innervated by:
Medial two: Ulnar (deep branch)
Lateral two: Median (digital branch)

O: Tendons of flexor digitorum profundus
I: Extensor hood of index, ring, middle and little finger
F: Flex MCP whilst extending interphalangeals

98
Q

Innervation of opponens pollicis

A

Innervated by recurrent branch of median nerve

T1

O: Tubercle of trapezium and dlexor retinaculum
I: Lateral margin of metacarpal I
F: Medially rotates thumb

99
Q

Innervation of abductor pollicis brevis

A

Innervated by recurrent branch of median nerve

T1

O: Tubercles of scaphoid and trapezium and adjacent flexor retinaculum
I: Proximal phalanx and extensor hood of thumb
F: Abducts thumb at metacarpophalangeal

100
Q

Innervation of flexor pollicis brevis

A

Innervated by the recurrent branch of the median nerve

T1

O: Tubercle of trapezium and adjacent flexor retinaculum
I: Proximal phalanx of thumb
F: Flexes thumb at metacarpophalangeal

101
Q

Innervation of opponens digiti minimi

A

Innervated by deep branch of ulnar nerve

T1

O: Hook of hamate and flexor retinaculum
I: Medial aspect of metacarpal V
F: Laterally rotates metacarpal V

102
Q

Innervation of abductor digiti minimi

A

Innervated by deep branch of ulnar nerve

T1

O:Pisiform, pisohamate ligament, tendon of flexor capri ulnaris
I: Proximal phalanx of little fingers
F: Abducts little finger

103
Q

Innervation of flexor digiti minimi

A

Innervated by deep branch of ulnar nerve

T1

O: Hook of hamate and flexor retinaculum
I:Proximal phalanx of little finger
F: Flexion of little finger at metacarpophalangeal joint

104
Q

Innervation of Adductor pollicis

A

Innervated by Deep branch of ulnar nerve

T1

O: Two heads
Transverse head - metacarpal III
Oblique head - Capitate and bases of metacarpals II and III

I: Base of proximal phalanx and extensor hood of thumb (often contains sesamoid bone)

F: Adducts thumb