neurovascular entrapment Flashcards
brachial plexus nerve roots
C5-T1
plexux roots location
b/w anterior and middle scalene
primary trunks location
lateral to scalenes and superior to clavicle
anterior and posterior divisions location
posterior to clavicle
cords location
in axilla, posterior to pectoralis minor
radial nerve spinal nerves?
C5-T1
radial nerves innervate
- triceps brachii
- brachioradialis
- supinator
- wrist extensors
- hand extensors
median nerve spinal nerves?
C6-T1
median nerve innervates
- pronator teres
- wrist flexors
- flexor pollicis longus
- opponen pollicis
ulnar nerve spinal nerves?
C8-T1
ulnar nerve innervates
- hand flexors
2. intrinsic hand mm
autonomics to the UE: sympathetic
inferior cervical (stellate) ganglion: T2-T6
where is inferior cervical ganglion located?
adjacent to C7 and 1st rib
mononeuropathy
pathology affecting a single periphernal nerve –> sensory symptoms in peripheral cutaneous distribution (ex: carpal tunnel syndrome)
radiculopathy
pathology affecting nerve root –> sensory symptoms in corresponding dermatome (ex: herniated disc)
UE reflexes
biceps - C5
brachioradialis - C6
triceps - C7
tests the examine UE
- mm strength
- sensation (light and sharp)
- DTR
cervical spondylosis
degenerative changes (ex: osteophyte formation) of spine that often causes foraminal narrowing and cervical canal stenosis, which comopresses the nerve root
disc herniation
nucleus pulposus prolapses through the annulus of an intervertebral disc and compress the nerve root
cervical radiculopathy
- cervical spondylosis
- disc herniation
- infection (ex: herpes zoster, lyme)
- infiltration by tumor (ex: lymphoma)
patient presentation with cervical radiculopathy
- 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)
C5 cervical radiculopathy affects?
- deltoid and biceps mm strength
- biceps reflex
C6 radiculopathy affects?
- biceps and wrist extensors mm strength
- brachioradialis reflex
C7 radiculopathy affects?
- finger extensors mm strength
- triceps reflex
which cervical radiculopathy commonly occurs?
C7 radiculopathy commonly affected
C8 radiculopathy affects?
- finger flexors mm strength
T1 radiculopathy affects?
- interossei mm strength
UMN vs LMN is use to?
differentiate b/w CNS and PNS lesions
UMN (CNS) lesion
- spastic
- increased tone
- hyperreflexia
LMN (PNS) lesion
- flaccid
- decreased tone
- hyporeflexia
- fasiculation
- atrophy
special tests for cervical radiculopathy
- compression test/Spurling Maneuver
2. Distraction test
thoracic outlet syndrome
signs and symptoms that arise from the compression of neurovascular bundle
common causes of thoracic outlet syndrome
- cervical rib
- scalene syndrome
- costoclavicular syndrome
- hyperabduction syndrome (compression by pec minor and coracoid process when arm raised above head)
thoracic outlet syndrome - patient presentation
- neurogenic - will mimic cervical radiculopathy
2. vascular
special tests for thoracic outlet syndrome
- Spurling Maneuver/Compression test
- hyperabduction test
- adson’s/costoclavicular test
- Roo’s test
- eval scalenes and pec minor for hypertonicity
- eval for cervical rib, upper rib, and clavicular SD
ulnar nerve entrapment at elbow
- tardy ulnar palsy
- cubital tunnel syndrome
tardy ulnar palsy
entrapment of ulnar nerve (C8-T1) in epicondylar groove
cubital tunnel syndrome
compression of ulnar nerve (C8-T1) b/w the 2 heads of the flexor carpi ulnaris
common causes of ulnar nerve entrapment at elbow
- repeated flexion at elbow
- trauma or chronic inflamm
- arthritis
- osteophytes
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
common causes of ulnar nerve entrapment at wrist
- repeated trauma (common in cyclists)
- fracture of hook of hamate
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
special tests for ulnar nerve entrapment
- Tinel’s test - tap as nerve passes through both epicondylar groove and Guyon’s canal
- elbow flexion test
- pressure test
carpal tunnel syndrome
- compression of media nerve (C6-T1) as it travels under flexor retinaculum
common causes of carpal tunnel syndrome
- reptitive motions
- trauma
- obesity
- pregnancy
- diabetes
- rheumatoid arthritis
- hypothyroidism
- CT diseases
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
special tests for ulnar nerve entrapment
- tinel’s test
- phalen’s test
- prayer sign
what do you use to confirm nerve entrapment dx?
- nerve conduction studies
2. electromyography (EMG)
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
