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OS 203 > OS 203 2 Axilla and Brachial Plexus - Sheet1 (1) > Flashcards

OS 203 2 Axilla and Brachial Plexus - Sheet1 (1) Flashcards

1
Q

PE of nerve injury: cooperative patient (2)

A

2-pt discrimination (innervation density), semmes-weinstein test (touch threshold)

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2
Q

PE of nerve injury: unconscious patient (3)

A

Wrinkle test (10 mins; if smooth, nerve injury); tactile adherence (smooth & slipper, nerve injury); sensory testing

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3
Q

sensory testing: tests for median, radial, ulnar nerves

A

median - test for abductor pollicis brevis; radial - extensor digitorium communis or pollicis longus; ulnar - flexor digiti minimi

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4
Q

2 main categories of nerve injuries (which is shorter)

A

Seddon (shorter), Sunderland

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5
Q

Seddon & Sunderland equivalents

A

Neurpraxia = 1st deg; Axonotmesis = 2nd deg; Neurotmesis = 3rd-5th deg

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6
Q

Injury, degeneration, regeneration in 1st degree

A

Myelin sheath, conduction block, complete recovery

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7
Q

Injury, degeneration, regeneration in 2nd degree

A

MA, Wallerian degeneration, complete recovery

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8
Q

Injury, degeneration, regeneration in 3rd degree

A

MAE, Wallerian degeneration, incomplete recovery

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9
Q

When is electromyogram and nerve conduction velocity test done?

A

10-14 days after injury

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10
Q

Motor and sensory axons are excitable up to?

A

motor - 7 days; sensory - 11 days

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11
Q

Wallerian degeneration starts when?

A

10-14 days after injury

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12
Q

Stimulation distal to the site of injury…

A

Normal or slightly abnormal, so you can’t differentiate between neuropraxia and neurotmesis

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13
Q

Stages of nerve regeneration

A

axon fragmented -> macrophage clean distal to injury -> axon sprouts/filaments through regeneration tube formed by Schwann cells -> axon regenerates, new myelin sheath

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14
Q

Posterior triangle borders

A

anterior - sternocleidomastoid, posterior - anterior border of the trapezius, inferior - middle third of the clavicle (M3)

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15
Q

from the posterior triangle, brachial plexus emerges where

A

between the anterior and middle scalene muscles

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16
Q

main supinator of the forearm

A

biceps

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17
Q

musculocutaneous supplies what? (3)

A

coracobrachialis, biceps brachii, brachialis

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18
Q

what supplies the brachialis? it will eventually become a what?

A

musculocutaneous nerve; becomes a sensory nerve called the lateral antebrachial cutaneous nerve

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19
Q

the median nerve distally supplies the? passes through? and supplies recurrent muscle

A

AIN / anterior interosseus nerve, passes through carpal tunnel

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20
Q

supplies intrinsic muscles of the hand

A

ulnar nerve

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21
Q

when the ulnar nerve gets trapped in the cubital tunnel behind the medial epicondyle…

A

cubital nerve syndrome (tardy ulnar palsy)

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22
Q

fracture of the elbow can result to

A

paralysis of the ulnar nerve

23
Q

prolonged ulnar nerve palsy can cause

A

claw hand deformity or ape hand/papal benediction sign (*EH DAPAT MEDIAN NERVE TONG APE/PAPAL EH…)

24
Q

radial nerve goes into the what of the humerus and divides into what?

A

radial groove in distal 1/3 humerus, superficial cutaneous (dorsal web space) and deep motor (extensors of wrist) -> posterior interosseus -> extensors of fingers

25
Q

radial paralysis leads to? and if more proximal?

A

wrist drop, numbness of dorsal web space, if more proximal, loss or weakness of elbow extension

26
Q

(axillary) the posterior cord goes out to the quadrangular space to supply what?

A

motor and sensory function of the deltoid (also, teres minor)

27
Q

how can the axillary nerve be injured? effects?

A

proximal fractures of humerus, surgical neck, dislocation of humerus; lack of abduction, weakness in external rotation, numbness of deltoid patch

28
Q

regions on skin from which sensation is carried by cutaneous branches of a spinal nerve

A

dermatomes

29
Q

long thoracic nerve: innervates what? action? injury?

A

serratus anterior, laterally rotates outwards/protracts scapula, scapular winging

30
Q

dorsal scapular nerve innervates what? action?

A

major & minor rhomboids, medially rotates/retracts scapula

31
Q

the only branch at the trunk level; innervation? action?

A

suprascapular nerve; supraspinatus (shoulder abduction) and infraspinatus (external rotation)

32
Q

lateral pectoral nerve innervates? action?

A

clavicular head of pec major, adducts and internally rotates shoulde

33
Q

medial pectoral nerve innervates? action?

A

sternal head of pec major & minor, adducts shoulder

34
Q

subscapular nerve innervates? action?

A

subscapularis and teres major; internally rotates shoulder

35
Q

thoracodorsal nerve innervates? action?

A

latissimus dorsi; adduction and internal rotation of shoulder

36
Q

innervates thenar muscles (except…)

A

median nerve; except deep head of flexor pollicis brevis and adductur pollicis

37
Q

median nerve: roots and respective innervations and actions

A

C6: forearm pronator; C7: wrist flexor; C8 - long finger flexor; T1: small hand (intrinsic)

38
Q

brachial plexus injuries (3)

A

stretch (neuropraxia), rupture, avulsion

39
Q

pre & post ganglionic injury: what kind of injury? scapular winging? suture?

A

pre: avulsion, present (serratus anterior damage *recall: innervated by long thoracic nerve), can’t be sutured (also: normal in NCV… so normal sensory?);; post: rupture, none, can be sutured

40
Q

causes of upper and lower brachial plex injury

A

upper: extreme lateral flexion; lower: extreme abduction

41
Q

upper & lower: damaged roots

A

upper - C5-C6; lower - C8-T1

42
Q

extreme lateral flexion caused by

A

shoulder dystocia in babies, fall in adults

43
Q

upper brachial plexus injury results to

A

erb-duchenne paralysis

44
Q

extreme abduction caused by

A

babies arms pulled during delivery, adults breaking fall

45
Q

lower brachial plexus injury results to

A

klumpke’s paralysis (claw hand)

46
Q

treatment priority (adult)

A

elbow flexion, shoulder stability/abduction, hand sensation, hand function

47
Q

treatment priority (obstetric)

A

hand function/sensation, elbow function, shoulder stability/abduction, shoulder external rotation

48
Q

for neuromas-in-continuity

A

neurolysis

49
Q

for post-ganglionic/rupture/graftable proximal nerve

A

nerve repair/grafting

50
Q

if pre-ganglionic/not graftable

A

nerve transfer

51
Q

artificial bridges for axons; length limited to? ECM?

A

conduits,

52
Q

late treatment (>12 mos.) (2)

A

muscle transfers, tendon transfers

53
Q

rate of axons regeneration

A

1mm/day or 1 in/month

54
Q

motor end plates degenerate at

A

12-18 months

OS 203 (7 decks)

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