neurovascular entrapment Flashcards

(49 cards)

1
Q

brachial plexus nerve roots

A

C5-T1

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2
Q

plexux roots location

A

b/w anterior and middle scalene

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3
Q

primary trunks location

A

lateral to scalenes and superior to clavicle

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4
Q

anterior and posterior divisions location

A

posterior to clavicle

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5
Q

cords location

A

in axilla, posterior to pectoralis minor

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6
Q

radial nerve spinal nerves?

A

C5-T1

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7
Q

radial nerves innervate

A
  1. triceps brachii
  2. brachioradialis
  3. supinator
  4. wrist extensors
  5. hand extensors
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8
Q

median nerve spinal nerves?

A

C6-T1

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9
Q

median nerve innervates

A
  1. pronator teres
  2. wrist flexors
  3. flexor pollicis longus
  4. opponen pollicis
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10
Q

ulnar nerve spinal nerves?

A

C8-T1

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11
Q

ulnar nerve innervates

A
  1. hand flexors

2. intrinsic hand mm

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12
Q

autonomics to the UE: sympathetic

A

inferior cervical (stellate) ganglion: T2-T6

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13
Q

where is inferior cervical ganglion located?

A

adjacent to C7 and 1st rib

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14
Q

mononeuropathy

A

pathology affecting a single periphernal nerve –> sensory symptoms in peripheral cutaneous distribution (ex: carpal tunnel syndrome)

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15
Q

radiculopathy

A

pathology affecting nerve root –> sensory symptoms in corresponding dermatome (ex: herniated disc)

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16
Q

UE reflexes

A

biceps - C5
brachioradialis - C6
triceps - C7

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17
Q

tests the examine UE

A
  1. mm strength
  2. sensation (light and sharp)
  3. DTR
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18
Q

cervical spondylosis

A

degenerative changes (ex: osteophyte formation) of spine that often causes foraminal narrowing and cervical canal stenosis, which comopresses the nerve root

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19
Q

disc herniation

A

nucleus pulposus prolapses through the annulus of an intervertebral disc and compress the nerve root

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20
Q

cervical radiculopathy

A
  1. cervical spondylosis
  2. disc herniation
  3. infection (ex: herpes zoster, lyme)
  4. infiltration by tumor (ex: lymphoma)
21
Q

patient presentation with cervical radiculopathy

A
  • pain in neck, shoulder, upper thoracic, UE
  • paresthesia or numbness in upper limb
  • weakness in upper limb
  • may have precipitating event due to physical exertion or trauma (ex: whiplash)
22
Q

C5 cervical radiculopathy affects?

A
  • deltoid and biceps mm strength

- biceps reflex

23
Q

C6 radiculopathy affects?

A
  • biceps and wrist extensors mm strength

- brachioradialis reflex

24
Q

C7 radiculopathy affects?

A
  • finger extensors mm strength

- triceps reflex

25
which cervical radiculopathy commonly occurs?
C7 radiculopathy commonly affected
26
C8 radiculopathy affects?
- finger flexors mm strength
27
T1 radiculopathy affects?
- interossei mm strength
28
UMN vs LMN is use to?
differentiate b/w CNS and PNS lesions
29
UMN (CNS) lesion
- spastic - increased tone - hyperreflexia
30
LMN (PNS) lesion
- flaccid - decreased tone - hyporeflexia - fasiculation - atrophy
31
special tests for cervical radiculopathy
1. compression test/Spurling Maneuver | 2. Distraction test
32
thoracic outlet syndrome
signs and symptoms that arise from the compression of neurovascular bundle
33
common causes of thoracic outlet syndrome
1. cervical rib 2. scalene syndrome 3. costoclavicular syndrome 4. hyperabduction syndrome (compression by pec minor and coracoid process when arm raised above head)
34
thoracic outlet syndrome - patient presentation
1. neurogenic - will mimic cervical radiculopathy | 2. vascular
35
special tests for thoracic outlet syndrome
1. Spurling Maneuver/Compression test 2. hyperabduction test 3. adson's/costoclavicular test 4. Roo's test 5. eval scalenes and pec minor for hypertonicity 6. eval for cervical rib, upper rib, and clavicular SD
36
ulnar nerve entrapment at elbow
- tardy ulnar palsy | - cubital tunnel syndrome
37
tardy ulnar palsy
entrapment of ulnar nerve (C8-T1) in epicondylar groove
38
cubital tunnel syndrome
compression of ulnar nerve (C8-T1) b/w the 2 heads of the flexor carpi ulnaris
39
common causes of ulnar nerve entrapment at elbow
- repeated flexion at elbow - trauma or chronic inflamm - arthritis - osteophytes
40
ulnar nerve entrapment at wrist
guyon's canal neuropathy - entrapment of ulnar nerve in Guyon's Canal with palmar carpal ligament ant, flexor retinaculum post, b/w hamate and pisiform
41
common causes of ulnar nerve entrapment at wrist
- repeated trauma (common in cyclists) | - fracture of hook of hamate
42
symptoms of ulnar nerve entrapment
- medial elbow pain that may radiate distally - numbness/paresthesia in 4th and 5th digits - motor symptoms - claw hand, weakness of intrinsic hand mm, loss of dexterity - symptoms may increase with flexion of the elbow
43
special tests for ulnar nerve entrapment
1. Tinel's test - tap as nerve passes through both epicondylar groove and Guyon's canal 2. elbow flexion test 3. pressure test
44
carpal tunnel syndrome
- compression of media nerve (C6-T1) as it travels under flexor retinaculum
45
common causes of carpal tunnel syndrome
1. reptitive motions 2. trauma 3. obesity 4. pregnancy 5. diabetes 6. rheumatoid arthritis 7. hypothyroidism 8. CT diseases
46
carpal tunnel syndrome - patient presentation
- pain in the wrist and hand, can radiate proximally - numbness/paresthesia in 1st - 1/2 of 4th digits - motor symptoms - weakness in abduction and opposition of thumb, decreased grip strength, atrophy of thenar eminence, loss of dexterity - symptoms worst at night - provoked by flexion and extension of wrist
47
special tests for ulnar nerve entrapment
1. tinel's test 2. phalen's test 3. prayer sign
48
what do you use to confirm nerve entrapment dx?
1. nerve conduction studies | 2. electromyography (EMG)
49
double crush syndrome
- if nerve is compressed at 2 separate locations along the course of a nerve, even though the degree of indiv compression is insuff to cause symptoms, the cumulative effect is suff enough to cause symptoms - initial injury reduces axoplasmic flow and the 2nd injury further reduces signaling potential below threshold --> symptoms - check the entire length of the nerve and nerve roots when eval for a nerve entrapment syndrome