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MD2002 > Nerves of the Upper Limbs > Flashcards

Nerves of the Upper Limbs Flashcards

1
Q

Which nerve roots are responsible for the following movements at the glenohumeral joint:

  • Medial rotation
  • Lateral rotation
  • Abduction
  • Adduction
  • Flexion
  • Extension
A
  • Abduction: C5
  • Adduction: C6-C7-C8
  • Extension: C6-C7-C8
  • Flexion: C5
  • Lateral rotation: C5
  • Medial rotation: C6-C7-C8
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2
Q

Which nerve roots are responsible for the following movements at the wrist joint:

  • Flexion
  • Extension
A
  • Extension: C6 (mainly)-C7

- Flexion: C6-C7 (mainly)

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3
Q

Which nerve roots are responsible for the following movements at the elbow joint:

  • Flexion
  • Extension
A
  • Extension: C6-C7 (mainly)

- Flexion: C5-C6 (mainly)

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4
Q

Which nerve roots are responsible for the following movements at the radio-ulnar joint:

  • Pronation
  • Supination
A
  • Pronation: C7-C8

- Supination: C6

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5
Q

Which nerve roots are responsible for the following movements at the metacarpo-phalangeal and inter-phalangeal joint:

  • Digital Extension
  • Digital Flexion
  • Lateral abduction of 3rd digit
  • Medial abduction of 3rd digit
  • Abduction of other 4 digits
  • Adduction of other 4 digits
A
  • Digital Extension: C7 (mainly)-C8
  • Digital Flexion: C7 -C8 (mainly)
  • Lateral abduction of 3rd digit: T1
  • Medial abduction of 3rd digit: T1
  • Abduction of other 4 digits: T1
  • Adduction of other 4 digits: T1
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6
Q

Describe the location and path of the axillary nerve relative to surrounding structures.

A

Passes posteriorly through the quadrangular space

Lies on the surgical neck of the humerus with the posterior circumflex humeral artery

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7
Q

What are the nerve roots of the axillary nerve ?

A

C5-C6

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8
Q

Which structures does the axillary nerve provide sensory innervation to ? motor innervation ?

A

SENSORY
- skin over the lower part of deltoid by superior lateral cutaneous of the arm

MOTOR

  • Deltoid
  • Teres minor
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9
Q

What are possible causes of axillary nerve injury ?

A
  • Fracture of the surgical neck
  • Subglenoid dislocation of humeral head towards quadrangular space
  • Quadrilateral (quadrangular) space syndrome
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10
Q

What are possible clinical findings following axillary nerve injury ?

A
  • Paresthesia over deltoid
  • Weak abduction (beyond 15°)
  • Muscle atrophy (flattened shoulder) in advanced cases
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11
Q

What are the nerve roots of the radial nerve ?

A

C5-T1

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12
Q

Describe the location and path of the radial nerve relative to surrounding structures.

A
  • Passes posteriorly through the lower triangular space with profunda brachii
  • Descends in the radial groove between the lateral and medial heads of the triceps with radial collateral artery
  • Pierces the lateral intermuscular septum.
  • Passes anterior to the lateral epicondyle and enters the cubital fossa
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13
Q

What are the branches of the radial nerve ?

A

Branches of Radial nerve:

  • Posterior cutaneous nerve of arm
  • Inferior lateral cutaneous nerve of arm
  • Posterior cutaneous nerve of forearm

In the foreaem, Radial nerve divides into:

  • Superficial branch (sensory)
  • Deep branch (motor)
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14
Q

Describe the path of the superficial and deep branches of the radial nerve (including any possible further divisions).

A
  • Superficial branch descends deep to the brachioradialis muscle
  • Deep branch pierces supinator muscle (very close to radius), supplies muscles and descends on interosseous membrane as posterior interosseal nerve with the posterior interosseal artery
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15
Q

Which structures does the radial nerve provide sensory innervation to ? motor innervation ?

A

SENSORY
− Posterior skin of arm
− Posterior skin of forearm
− Dorsal surface of lateral 3.5 fingers except distal phalanges

MOTOR
− Triceps
− Anconeus
− Brachioradialis
− Supinator
− Abductor pollicis longus 
− All extensors in forearm
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16
Q

What are possible causes of radial nerve injury ?

A
  • Fracture of shaft of the humerus

- Maladjusted crutches

17
Q

What are possible clinical findings following radial nerve injury ?

A
  • Sensory loss: Depends on before or after cutaneous nerves
  • Weakness in/Loss of hand extension –> Wrist drop
  • Weakness in/Loss of extension of the thumb
  • Weakness in/Loss of extension of the Metacarpo- phalangeal joints
18
Q

What is the physical exam for the radial nerve ?

A

Asking the patient to extend the MP joints against resistance

19
Q

Describe the path of the musculocutaneous nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Pierces coracobrachialis
  • Terminates as the lateral cutaneous nerve of the forearm
  • Runs with the cephalic vein near the cubital fossa
20
Q

What are the nerve roots of the musculocutaneous nerve ?

A

C5-C7

21
Q

Which structures does the musculocutaneous nerve provide sensory innervation to ? motor innervation ?

A

SENSORY
- Skin on the anterolateral side of the
forearm by Lateral cutaneous nerve of the forearm

MOTOR (All muscles in the anterior compartment of the arm)

  • Biceps
  • Brachialis
  • Coracobrachialis
22
Q

What are possible causes of musculocutaneous nerve injury ?

A

Penetrating injuries to the axilla/proximal medial arm

23
Q

What are possible clinical findings following musculocutaneous nerve injury ?

A
  • Paresthesia over the lateral forearm
  • Weakness in the flexion of GH joint
  • Very weak or loss of flexion of elbow joint
  • Weakness in supination
24
Q

What are the nerve roots of the median nerve ?

A

C6-T1

25
Q

Describe the location and path of the median nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Travels with the ulnar nerve and brachial artery on the medial aspect of arm
  • Passes into cubital fossa, posterior to the bicipital aponeurosis, medial to the brachial artery and the tendon of biceps
  • Passes between the 2 heads of Pronator Teres
  • Travels distally between the flexor digitorum superficialis and profundus
  • Before entering the carpal tunnel, gives off PALMAR CUTANEOUS BRANCH that passes superficial to the Flexor Retinaculum
  • Passes through the carpal tunnel with the tendons of FDS, FDP, FPL
26
Q

Which structures does the median nerve provide sensory innervation to ? motor innervation ?

A

SENSORY

  • Lateral part of the palm
  • Lateral three and a half fingers on the anterior (palmar) surface of the hand (the thumb, the index and middle fingers, and one half of the ring finger)
MOTOR
− Flexor digitorum superficialis
− Lateral part of Flexor digitorum profundus
− Flexor pollicis longus
− Flexor carpi radialis
− Pronator quadratus
− Thenar muscles (except adductor pollicis)
− Lateral 2 lumbricals
27
Q

What are possible causes of median nerve injury ?

A
  • Elbow dislocation
  • Supracondylar fractures of the humerus
  • Anterior dislocation of the lunate
  • Compression in carpal tunnel
28
Q

What are possible clinical findings following median nerve injury ?

A

-Paresthesia on sensory area of median nerve
-Weakness in/Loss of flexion of the thumb, index and
middle fingers (due to injury to the Anterior interosseous nerve causing loss of flexion of the distal interphalangeal joints of the thumb and index) so cannot make the OK sign
-Weakness in pronation
-Ulnar deviation on wrist flexion
-Hand of Benediction while trying to make a fist

29
Q

What are the physical exams for median nerve

A

Asking the patient to oppose thumb

30
Q

What are the nerve roots of the ulnar nerve ?

A

C7-T1

31
Q

Describe the location and path of the ulnar nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Travels with the median nerve and brachial artery on the medial aspect of arm
  • Later accompanied by superior collateral ulnar artery
  • Passes posterior to the medial epicondyle (cubital tunnel, very superficial)
  • Passes between the 2 heads of flexor carpi ulnaris
  • Descends between flexor carpi ulnaris and flexor digitorum profundus
  • Accompanied by the ulnar artery in the distal half of the forearm
  • Passes through Guyon’s canal with ulnar artery (very superficial)
32
Q

Which structures does the ulnar nerve provide sensory innervation to ? motor innervation ?

A

SENSORY
− Palmar and dorsal surfaces of medial 1.5 fingers and hand

MOTOR (nerve of fine movements)
− Flexor carpi ulnaris
− Medial part of Flexor digitorum profundus
− Hypothenar muscles
− Adductor pollicis
− Medial 2 lumbricals
− Dorsal interosseals
− Palmar interosseals
33
Q

What are possible causes of ulnar nerve injury ?

A
  • Medial epicondyle fracture
  • Degenerative changes in cubital tunnel
  • Direct injury at wrist
34
Q

What are possible clinical findings following ulnar nerve injury ?

A
  • Sensory loss, both palmar and dorsal surfaces, of the medial hand and medial 1.5 digits
  • Weakness in adduction of the wrist
  • Loss of flexion of the MCP joints of 4th and 5th fingers -Loss of abduction and adduction of the fingers
  • Weakened and wasted hypothenar muscles
  • Ulnar claw
35
Q

What is the ulnar claw ? Why is the ulnar claw less pronounced if the nerve injury is at the elbow ?

A

− Possible result of ulnar nerve injury
− metacarpophalangeal joints of 4th and 5th fingers are hyperextended
− interphalangeal joints of 4th and 5th fingers are flexed

Because the flexing effect of Flexor digitorum profundus is lost (=ULNAR PARADOX)

36
Q

What is the physical examination for ulnar nerve ?

A
  • Testing for Froment’s sign (=thumb abduction (radial nerve) and flexion of the distal interphalangeal joint (median nerve)): Asking the patient to clasp a sheet of paper between the thumb and the palm (Adduction of thumb)
  • Testing palmar (paper between index and middle finger, try to take it away) and dorsal (push again fingers and ask patient to abduct them) interossei
37
Q

What is Erb-Duchenne Palsy/Erb’s Paralysis ?
What are possible causes of it ?
What are the clinical findings in Erb-Duchenne Palsy/Erb’s Paralysis ?

A

Traction injury to Superior Trunk (C5-6)

CAUSES:
• high energy trauma (motorcycle accidents or falling
from a horse)
• Obstetric injury during birth (shoulder dystocia)

CLINICAL FINDINGS:
• Paralysis of muscles in arm and shoulder (deltoid, biceps, brachialis)
• Loss of sensation to lateral forearm
• Waiter’s tip position, hanging limb (adducted shoulder,
medial rotation of arm, elbow extended)

38
Q

What is Klumpke’s Palsy/paralysis ?
What are possible causes of it ?
What are the clinical findings in Erb-Duchenne Palsy/Erb’s Paralysis ?

A

Traction injury to Inferior Trunk (C8-T1)

CAUSES:
• Obstetric injury during birth (limb is pulled excessively)
• Breaking a fall from a height

CLINICAL FINDINGS:
• Paralysis of intrinsic hand muscles, flexor muscles of
the wrist and fingers, forearm pronator
• Loss of sensation to medial forearm, little finger
• Ulnar claw hand

MD2002 (77 decks)

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