NPTE ALL OF IT Flashcards
Rotator Cuff Muscles “SITS”
Supraspinatus, infraspinatus, teres minor and Subscapularis
How much elevation occurs at GH joint?
120 degrees
How much elevation occurs at Scapulothoracic ?
60 degrees
The ratio of scapular to humeral motion for elevation
1 to 2
Upward rotation of Scapula with elevation?
traps and serratus anterior
Downward rotation with purposeful extension
rhomboids, levator scap, pec minor
Scapular protaction
serratus anterior and pec minor
scapular retraction
rhomboids, middle and lower trap
Depression of scapula
pectoralis minor and latissimus dorsi
Long thoracic Nerve
C5, C6, C7
innervates the serratus anterior
injury can cause scap winging
Dorsal scapular Nerve
C5, C6
innervates leavtor scapulae and rhomboids
Injury can affect scapular retraction and downward rotation
What nerve roots pass through the first rib?
C8 and T1
Suprascapular Nerve
C5, C6
innervates the supraspinatus and infraspinatus
if injured it will cause pain/ decreased shoulder abduction and ER limitations.
Carrying angle for men vs women
men: 10-15 deg
women: 20-25 deg
Axillary Nerve off the posterior cord
Supplies: Teres minor whats the action?
Supplies Deloid whats the action?
Nerve Root: C5-C6
Teres: shoulder ER, Extension, abduction and horizontal abduction
Deltoid: anterior: shoulder IR, flexion
Posterior: shoulder ER, extension, horizontal abduction
Axillary nerve sensory
Upper lateral cutaneous nerve of arm supples the skin covering the lower half of deltoid and upper part of long head of triceps
Axillary Nerve injury
Shoulder dislocation, fracture at the surgical neck
Square shoulder from deltoid atrophy
sensory loss over lower half of deltoid
Radial nerve comes off the posterior cord
Supplies triceps tell me action
Supplies anconeus tell me action
Supplies brachioradialis tell me action
Supplies supinator tell me action
Nerve root: C5-T1
Triceps
- Elbow extension
Anconeus
- Weak elbow extensor
Brachioradialis
- Elbow Flexion especially
in mid-prone position
Supinator
- Supination of forearm
Radial nerve Supplies all the extensors tell me actions
Extensor Carpi Radialis Longus
- Action: Wrist EXT, Radial Deviation
Extensor Carpi Radialis Brevis
- Action: Wrist EXT, Radial Deviation
Extensor Carpi Ulnaris
- Action: Wrist EXT, Ulnar Deviation
Extensor Digitorum
- Action: 2-5
th digits EXT a MCP, IP, Wrist
Extensor Digiti Minimi
- Action: 5th digit EXT at MCP, IP
Radial nerve Supplies all the extensors tell me actions
Extensor Pollicis Longus
- Action: 1st digit EXT at CMC, IP
Extensor Pollicis Brevis
- Action: 1st digit EXT at MCP, IP
Extensor Indicis
- Action: 2nd digit EXT, wrist extension
Abductor Pollicis Longus
- Action: 1st digit ABD and extension at
CMC joint
Radial Nerve Sensory supply
Skin of lower half of lateral side of arm
skin of back of arm
skin of back of forearm
skin of lateral half of dorsum of hand, lateral two and half digits including thumb
Radia tunnel syndrome
Radial nerve is compressed at the tunnel. Pain 1/2 down arm under the supinator
Posterior interosseous nerve syndrom
Radial nerve compression at the arcade of frohse
Lateral epicondylitis
Inflammation of the extensors at the lateral epicondyle of the humerus. The main muscle affected is the extensor carpi radialis brevis
What motions provoke pain for lateral epicondylitis?
Repeated extension and supination cause it. The pain will increase with wrist flexion with elbow extension, resisted extension and resisted radial deviation.
Medial epicondylitis affects what muscles?
Affects the flexor carpi radialis, humeral head of pronator teres
Medial epicondylitis increases in pain with what motions?
Pain with resisted wrist flexion and resisted pronation
Ulnar Nerve comes off the medial cord
Supplies the Doral interossei Tell me action
Supplies the Palmar interossei Tell me action
Supplies the adductor pollics Tell me action
Supplies the opponens digiti minimi and abductor digiti minimi
Nerve root: C8-T1
Doral interossei : DAB = abduction
Palmar interossei: PAD = adduction
Adductor pollicis: adduction of thumb
Opponens digiti mimini: opposition of 5th digit
Abductor digiti minimi: abduction of 5th finger
Ulnar nerve supplies
Flexor pollicis brevis
Flexor digitorum profundus
Flexor digiti minimi
Flexor carpi ulnaris
what are their actions?
Flexor Pollicis Brevis
- Action: Flexion of thumb
Flexor Digitorum Profundus (Medial half)
- Action: Flexion of DIP, Secondary –Flexion
of joints of digits, finger, wrist
Flexor Digiti Minimi
- Action: Flexion of little finger
Flexor Carpi Ulnaris
- Action: Wrist flexion, Ulnar Deviation
What is the sensory supply for the ulnar nerve?
- Supplies medial 1⁄2 of palm
Supplies skin of dorsal aspect of medial
two and half fingers
Supplies 1⁄2 of 4th, 5th digit
Cubital tunnel syndrome
Compression at cubital tunnel at elbow
- Paralysis of Flexor Carpi Ulnaris, Flexor
Digitorum Profundus (Ulnar half), hypothenar eminence, interossei, and the
third and fourth lumbrical muscles
- All sensations affected
- Inability to grip paper
Guyon’s canal syndrome
Sensory changes and progressive
weakness of muscles innervated distal to
the site
Ulnar Claw hand
- Hyperextension at 4th,5th MCP, Flexion at 4th, 5th IP due to Flexor Digitorum Profundus
Median Nerve comes from the medial and lateral cord
supplies the abductor pollicis brevis tell me action
supplies the opponens pollicis tell me action
supplies the lumbricals 1,2
Nerve roots: C5-T1
Abductor Pollicis Brevis
- Action: Abduction of thumb at MCP, CMC joint
Opponens Pollicis
- Action: Opposition of thumb
Lumbricals 1,2
- Action: Flexion of MCP and extension of IP
Median nerve supplies almost all of the flexors what are their actions?
Flexor digitorum profundus
Flexor pollicis longus
Flexor carpi radialis
Flexor digitorum superficialis
Flexor pollicis brevis
Flexor Digitorum Profundus (Radial half)
- Action: Flexion of DIP, Secondary –Flexion
of joints of digits, finger, wrist
Flexor Pollicis Longus
- Action: Flexion of distal phalanx of thumb
Flexor Carpi Radialis
- Action: Wrist flexion, Radial deviation
Flexor Digitorum Superficialis
- Action: Flexion of PIP joint
Flexor Pollicis Brevis
- Action: Flexion of thumb
Median nerve sensory supply
Palmar Cutaneous Branch
- Skin of lateral two-thirds of palm
Palmar Digital Branches
- Supplies dorsal tips of 1st, 2nd, & 3rd finger,
palmar skin of lateral three and half fingers
Pronator teres syndrome what nerve is affected and what is the issue?
Hypertrophy of pronator teres muscle can compress the median nerve. Pronator teres
remains normal, but the other muscles supplied
by the median nerve are affected, as is its
sensory distribution
Carpal tunnel syndrome
Median nerve is compressed under the flexor
retinaculum at the wrist
Ape Hand deformity
Wasting of the thenar eminence of the hand
occurs as a result of a median nerve palsy
Musculocutaneous Nerve branches off lateral cord
Supplies the biceps, brachialis and coracobrachialis
Nerve Root: C5-C7
Biceps: elbow flexion, forearm supination
Brachialis: elbow flexion
Coracobrachialis: flexion of arm
Musculocutaneous nerve sensory supply?
Lateral cutaneous nerve of forearm: supply
the skin on lateral side of forearm
Suprascapular Nerve comes from superior trunk
Supplies: infraspinatus and supraspinatus
Nerve root: C5-C6
Infraspinatus
- Action: Lateral rotation and abduction of
arm
Supraspinatus
- Action: Shoulder Abduction up to 15
degrees
Subscapular Nerve Comes from posterior cord
Supplies the teres major from lower branch
Supplies subscapularis with both branches
Nerve root C5-C6
Teres Major (Lower Subscapular Nerve)
- Action: Shoulder medial rotation,
extension, adduction
Subscapularis (Both Upper & Lower Subscapular Nerve)
- Action: Shoulder medial rotation(when
arm is by side), adduction
Lateral pectoral nerve comes from lateral cord
supplies the pec major
Nerve root: C5-C7
Pectoralis Major
- Action: Medial rotation, adduction,
horizontal adduction,
Scapular Protraction, Depression
Medial Pectoral Nerve comes from the medial cord
supplies: Pec Minor
Nerve Roots: C8, T1
Pectoralis Minor
- Action: Downward Rotation of scapula,
Scapular Protraction, Depression
Long Thoracic Nerve comes from the roots of brachial plexus
supplies serratus anterior
Nerve Roots: C5,C6,C7
Serratus Anterior
- Action: Upward Rotation of scapula,
Scapular Protraction, Depression,
Injury can cause:
- Winged Scapula
Thoracodorsal nerve comes from the posterior cord
Supplies the latissimus Dorsi
Nerve Roots: C6-C8
Latissimus Dorsi
- Action: Shoulder extension, adduction,
medial rotation.
Depression and protraction of scapula
Doral scapular nerve comes from the root of the brachial plexus
supplies rhomboids and levator scapulae
Nerve root: C5
Rhomboid Minor
- Action: Scapular Elevation, Retraction, Downward Rotation
Rhomboid Major
- Action: Scapular Elevation, Retraction, Downward Rotation
Levator Scapulae
- Action: Scapular Elevation, Downward Rotation
Nerve to subclavius comes from upper trunk
Subclavius
Nerve root C5-C6
Subclavius
- Action: Depress & stabilize clavicle
What muscles perform scapular elevation?
upper trap, levator scap, rhomboids
What muscles perform scapular protraction?
serratus anterior, pectoralis minor/major, latissimus dorsi
What muscles perform scapular depression?
Serratus anterior, pec minor and major, lower trap, latissimus dorsi
What muscles perform scapular retraction?
Trap and rhomboids
What muscles perform scapular downward rotation?
levator scapular, rhomboids, pec minor
What muscles perform scapular upward rotation?
Serratus anterior, trap upper and lower fibers
Spinal Accessory Nerve
supplies : traps and SCM
Trapezius
- Action: Upper fibers- scapula elevation,
Middle fibers- Retraction, Lower fibers- depression,
Upper and lower fibers-Upward rotation
Sternocleidomastoid
- Action: Cervical lateral flexion and Opposite side
rotation
Superior Gluteal Nerve
supplies gluteus medius, minimus and TFL
Nerve Roots: L4-S1
Gluteus Minimus
- Action: Abduction and medial rotation of hip
Gluteus Medius
- Action: Abduction and medial rotation of hip
Tensor Fascia Latae
- Action: Flexion, abduction, medial rotation of hip
Inferior Gluteal Nerve
Supplies: glute max
Nerve Roots: L5-S2
Gluteus Maximus
- Action: Hip extension
Secondary action: Hip Lateral rotation, abduction
Nerve to piriformis
Supplies piriformis
Ventral rami Nerve Roots: S1-S2
Piriformis
- Action: Abduction and lateral rotation of
hip
Obturator Nerve bifuractes to anterior and posterior the anterior division supplies:
adductor longus, brevis and gracilis
Nerve Roots: L2-L4
Adductor Longus
- Action: Hip adduction, flexion, medial
rotation
Adductor Brevis
- Action: Hip adduction, flexion, medial
rotation
Gracilis
- Action: Hip flexion, medial rotation,
adduction
Obturator Nerve bifuractes to anterior and posterior the posterior division supplies:
obturator externus and adductor magnus
Nerve Roots: L2-L4
Obturator Externus
- Action: Hip lateral rotation, adduction
Adductor Magnus
- Action: Hip adduction, extension,
medial rotation
Obturator sensory supply
obturator nerve
supplies skin of middle part of medial thigh
Nerve to quadratus Femoris
supplies the gemellus inferior and quadratus femoris
Nerve Roots: L4-S1
Gemellus inferior
- Action: Lateral rotation of hip
Quadratus Femoris
- Action: Lateral rotation of hip
Nerve to Obturator Internus supplies the:
Gemellus superior and obturator internus
Nerve Roots: L5-S2
Gemellus superior
- Action: Lateral rotation of hip
Obturator Internus
- Action: Lateral rotation of hip
Sciatic nerve supplies:
Bicep femoris, semitendinosus and semimembranosus and adductor magnus
Nerve Roots: L4-S3
Biceps Femoris
- Action: Knee flexion, hip extension, lateral
rotation of flexed leg in non–weightbearing
Semitendinosus
- Action: Knee flexion, hip extension,
medial rotation of flexed leg in non-weight bearing
Semimembranosus
- Action: Knee flexion, hip extension,
medial rotation of flexed leg in non–
weight-bearing
Adductor Magnus
- Action: Hip adduction, extension,
medial rotation
Femoral Nerve supplies the iliacus, pectineus, sartorius, rectus femoris and vastus medialis/intermedius and lateralis
Nerve Root: L2-L4
Iliacus
- Action: Hip flexion
- Works with Psoas Major & Psoas Minor
Pectineus
- Action: Hip flexion, adduction, medial
rotation
Sartorius
- Action: Hip flexion, abduction, lateral
rotation, Knee flexion
Rectus Femoris
- Action: Hip flexion, Knee extension, Assists
in Hip flexion
Vastus Medialis/Intermedius/Lateralis
- Action: Knee extension
Femoral nerve sensory
medial cutaneous of nerve of thigh
Branch of anterior division of femoral
nerve. Supplies the skin on medial side of
lower two third of thigh
Femoral nerve sensory
intermediate cutaneous of nerve of thigh
Branch of anterior division of femoral
nerve. Supplies the skin on front of thigh
Femoral nerve sensory
Saphenous nerve
Branch of posterior division of femoral
nerve. Supplies the skin on the medial side
of leg
Tibial nerve
Supplies:
gastroc, soelus, plantaris
Nerve root: L4-S3
Gastrocnemius
- Action: Plantar flexion, Knee flexion
Soleus
- Action: Plantar flexion
Plantaris
- Action: Slight Knee flexion, Plantarflexion
Tibial nerve
Supplies:
poplieus, tibialis posterior, flexor hallucis longus, flexor digitorum longus
Nerve root: L4-S3
Popliteus
- Action: Knee flexion, unlocks the knee
during initial flexion by laterally rotating
femur
Tibialis Posterior
- Action: Plantarflexion, Inversion
Flexor Hallucis Longus
- Action: Flexion of great toe, Plantar
flexion, Inversion
Flexor Digitorum Longus
- Action: 2-5 toes flexion, PF and inversion
Tarsal Tunnel Sydrome
Tom, dick and harry
Tibial artery, nerve and vein compression
Tibialis posterior, flexor hallucis longus and flexor digitorum longus
Tibial nerve sensory
supplies over the heal, medial side of sole from the medial plantar and lateral side of the sole from lateral plantar
Common peroneal nerve
Nerve root: L4-S2
Deep Peroneal nerve supplies the: tibialis anterior, extensor hallucis longus, extensor digitorum longus and extensor digitorum brevis
Nerve Roots: L4-S1
Tibialis Anterior
- Dorsiflexion, inversion
Extensor Hallucis Longus
- Action: 1st toe extension, Ankle
dorsiflexion, inversion
Extensor Digitorum Longus
- Action: Toe extension, ankle DF, eversion
Extensor Digitorum Brevis
- Action: Toes extension
Injury to the deep peroneal nerve can result in what gait deviations?
foot drop and unopposed eversion
Superficial peroneal nerve supplies the peroneus longus and peroneus brevis
Nerve Roots: L4-S2
Peroneus Longus
- Action: Plantarflexion, eversion
Peroneus Brevis
- Action: Plantarflexion, eversion
Deep peroneal sensory supply:
Webbing between 1 and 2 toes on the dorsum of the foot
Superficial peroneal sensory supply:
Dorsum of the foot and anterolateral part of lower leg
General contraindications for electrical stimulation
healing fractures, active bleeding, malignancies, superficial metal implants, pharyneal/laryngeal muscles, pacemaker, cardiac issues
Iontophoresis: what is salicylate used for and what is the charge?
negative, pain relief
Iontophoresis: what is acetate used for and what is the charge?
negative, calcium deposits
Iontophoresis: what is dexamethasone used for and what is the charge?
negative, anti-inflammation
Iontophoresis: what is iodine used for and what is the charge?
negative, softens scars
Iontophoresis: what is hydrocortisone used for and what is the charge?
positive, anti-inflammation
Iontophoresis: what is lidocaine used for and what is the charge?
positive, pain relief
Iontophoresis: what is calcium/magnesium used for and what is the charge?
positive, muscle spasm
Iontophoresis: what is lithium used for and what is the charge?
positive, gout
Iontophoresis: what is zinc used for and what is the charge?
positive, dermal ulcers
Iontophoresis: what is copper used for and what is the charge?
positive, fungal infections
Conventional TENS: frequency, pulse width, intensity, purpose, and duration?
high frequency: 75-120
very short pulse width (50-100 microseconds)
low intensity
Provides temporary relief of pain treatment can last 20-60min
Acupuncture-like TENS: frequency, pulse width, intensity and purpose?
Low frequency: 1-4pps
wide pulse width (150-300 microseconds)
high intensity
Used for more chronic conditions with long lasting pain relief, treatment can take between 30-40 min
Brief intense TENS: frequency, pulse width, intensity and purpose?
High pulse rate: 150pps Long pulse width (300 microseconds) short term pain relief Pain relief with wound debridement, deep friction massage, passive stretching Total time 15 min
High voltage pulsed monophasic stimulation: frequency, pulse width, intensity and purpose?
strong used for denervated muscles
pulse rate: 50-200pps
pulse duration: 20-100 msec
continuous waveform
Muscle contraction: frequency, pulse width, intensity and purpose?
Pulse rate 35-80pps
Pulse duration: 150-200 msec for small 200-350 msec for large
On/ off time: 10-20 reps in about 10-20 min
Muscle strength: frequency, pulse width, intensity and purpose?
Pulse rate 35-50pps
Pulse duration: 150-200 msec for small 200-350 msec for large
On/ off time: 1 to 5 so 6-10 seconds or 50-120 seconds
Muscle spasm/ edema: frequency, pulse width, intensity and purpose?
Pulse rate 35-50pps
Pulse duration: 150-200 msec for small 200-350 msec for large
On/ off time: 1 to 1 ratio
