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APA 3 - Wolfe > Peripheral Nerve Anatomy > Flashcards

Peripheral Nerve Anatomy Flashcards

1
Q

What supplies the majority of the sensory information for the face?

A

Trigeminal Nerve (CN V)

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2
Q

What is the anesthetic interest for blocking CN V?

A

Trigeminal Neuralgia

Can be blocked to relieve pain, diagnostic prior to neurolysis

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3
Q

What are the 3 nerve branches from the trigeminal nerve (CN V)?

A

Opthalamic
Maxillary
Mandibular

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4
Q

Innervation of the glossopharyngeal nerve (CN IX)

A 
oropharynx 
soft palate 
posterior 1/3 portion of the tongue 
pharyngeal (anterior) surface of epiglottis
vallecula
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5
Q

What does a glossopharyngeal nerve block block?

A

Blocks gag reflex, and posterior pharynx (nasal intubation)

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6
Q

What is the landmark for the glossopharyngeal nerve block (APEX)

A

palatoglossal arch at the anterior tonsillar pillar

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7
Q

Innervation of the Superior Laryngeal Nerve

A

Base of tongue
Posterior surface of epiglottis
Aryepiglottic fold
Arytenoids

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8
Q

The SLN can be blocked by…

A

mucosal saturation

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9
Q

The SLN divides into internal and external branches.
What does the internal branch innervate?
What does the external branch innervate?

A

Internal: sensory ONLY to larynx and hypopharynx

External: cricothyroid muscle

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10
Q

What is the landmark for the SLN block? (APEX)

A

Greater cornu of hyoid bone

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11
Q

Innervation of Recurrent Laryngeal Nerve

A

Vocal cords (below) and trachea

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12
Q

What should you have the patient say after ENT surgery to ensure no damage to the RLN?

A

eeeee

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13
Q

Innervation of the cervical plexus

A

Muscles, joints, and skin in the anterior neck

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14
Q

Where is the cervical plexus located?

A

Ventral rami C1-C4

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15
Q

Where is the site for skin infiltration for the cervical plexus block?

A

posterior border of the sternocleidomastoid muscle

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16
Q 
How many:
Ventral Rami (Roots)
Trunks
Divisions
Cords
Branches
A 
Ventral Rami (Roots): 5
Trunks: 3
Divisions: 6
Cords: 3
Branches: 5
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17
Q

Where are roots, trunks, divisions found?

A

Found in posterior triangle of the neck

Supraclavicular

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18
Q

Where are cords and branches found?

A

Found in the Axilla

Infraclavicular

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19
Q

What rami (roots) are involved?

A

C5-T1 (can include C4 and T2)

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20
Q

Roots are located from the ____ to the ____

A

from lateral foramina to lateral border of scalene muscles

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21
Q

Which nerve roots connect with the superior, middle and inferior trunks?

A

Superior: C5-C6
Middle: C7
Inferior: C8-T1

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22
Q

Trunks are enveloped in a _____

A

fascial sheath

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23
Q

Injection into the fascial sheath when blocking at the trunks level commonly produces what block?

A

Complete block of the upper ext.

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24
Q

The fascial sheath is in the interscalene space, where is this located?

A

Emerge between anterior and middle scalene muscle

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25
Q

When doing an interscalene block with ultrasound, what are we looking for?

A

“stoplight” that will be dark (hypoechoic)

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26
Q

Divisions divide into 3 Anterior (Ventral) & 3 Posterior (Dorsal), what do each supply?

A 
3 Anterior (Ventral):
Supply flexor portions
3 Posterior (Dorsal):
Supply extensor portions
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27
Q

The posterior (dorsal) divisions form to make the ____ cord

The anterior (ventral) divisions form to make the ___ & ___ cords

A

posterior (dorsal) division –> posterior cord

anterior (ventral) division –> lateral & medial cord

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28
Q

The posterior cords makes up what branches?

A

Axillary and radial

and thoracodorsal nerve

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29
Q

The lateral cord makes up what branches?

A

Musculocutaneous & ½ of the Median Nerve

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30
Q

The medial cord makes up what branches?

A

Ulnar & ½ of the median nerve

and Median Cutaneous Nerve of arm and forearm

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31
Q

Axillary Nerve
Formed from ____
Passes from ____ to ____
Posterior to neck of ____

Innervation of the ____

A

C5-C6
axilla to shoulder
humerus

Shoulder

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32
Q

What is the cutaneous innervation of the axilla nerve?

A

Skin covering deltoid

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33
Q 
Radial Nerve
Formed from \_\_\_
Passes from \_\_\_ to \_\_\_
Innervation of \_\_\_\_
- Posterior branch of cutaneous muscle
- Innervates skin covering muscle
A

C5 -T1
axilla to arm
long head of triceps

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34
Q

Radial Nerve
Descends along shaft of ____
- Inferior lateral cutaneous branch
–> Innervates _____

  • Posterior antebrachial cutaneous branch
  • -> innervates
A

humerous

posterior arm

posterior surface of arm

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35
Q

Continuing down the arm, the radial nerve crosses the elbow anterior to the _____

A

Lateral epicondyle

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36
Q

Radial nerve divides into deep and superficial
Superficial innervate:
Deep innervates:

A

Superficial: Dorsum of the hand onto the thumb, index, middle, and ring fingers

Deep: Many of the muscles of wrist and hand

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37
Q

Motor response to radial nerve stimulation

A

Wrist extension
Metacarpo-phalangeal extension
Thumb abduction

38
Q

Musculocutaneous Nerve
Formed from ____
Pierces through _____
Descends between ____ & ____

A

C5-C7
coracobrachialis muscle
between brachialis muscle and the biceps brachii muscle (innervates all these muscles)

39
Q

Musculocutansous Nerve
At the elbow, becomes the _____
Runs along the _____ muscle
Innervates _____

A

Lateral antebrachial cutaneous nerve
brachoradialis
innervates skin above muscle

40
Q

Motor response to musculocutaneous stimulation

A

biceps flexion

41
Q 
Median Nerve
Formed from \_\_\_\_
Descends arm with \_\_\_\_
Crosses cubital fossa \_\_\_\_ to the artery
Passes into the forearm through \_\_\_
Innervation to \_\_\_
A 
C5-T1
Brachial artery
Medial
Carpal Tunnel
Palmer side of 1/2 thumb, index finger, middle finger and 1/2 ring finer & dorsal side finger tips of pointer finger, middle finger and 1/2 ring finger
42
Q

Motor response to median nerve stimulation

A

Wrist flexion
Finger flexion
Thumb opposition

43
Q

Medial Cutaneous Branch
Branches of medial cord (T1)
- Skin innervation of

Medial Antebrachial Cutaneous Branch
- Crosses the cubital fossa
Innervates skin on the medial aspect of the forearm

A

skin covering medial surface of arm

44
Q

Ulnar Nerve
Formed from ____
Descends with ____ artery
Crosses the elbow posterior to __ epicondyle

A

C8-T1
Brachial
Medial (and then continuous down forearm)

45
Q

Innervation for ulnar nerve
Motor
Skin

A

Motor: Many muscles in wrist, fingers and thumb

Skin: Dorsal and Medial surface of hand
Dorsam surface of the ring and little fingers

46
Q

Motor response to ulnar nerve stimulation

A

Ulnar deviation of wrist
Finger flexion
Thumb adduction

47
Q

The LumboSacral Plexus is formed from

A

L1-S5

may include T12

48
Q

What is the Iliohypogastric nerve formed from

A

L1 (may include T12)

49
Q

The Iliohypogastric nerve travels in the abd wall to the level of the

A

Symphasis pubis

50
Q

What does is iliohypogastric nerve innervate?

A

Muscle, skin, and parietal peritoneum

Skin over inferior abdomen and buttocks

51
Q

What is the Ilioinguinal nerve formed by?

A

L1 (may include T12)

52
Q 
Ilioinguinal nerve
Travels in \_\_\_\_\_
Pierces posterior wall of the \_\_\_\_\_
Passes through superficial \_\_\_\_\_
Terminates on the anterior \_\_\_\_ or \_\_\_\_
A

abdominal wall
inguinal canal
inguinal ring
scrotum or labia majora

53
Q

What does the Ilioinguinal nerve innervate?

A

Muscle, skin, parietal peritoneum along course

Skin

  • Superior, medial thigh
  • Portions of external genitalia
54
Q

What is the Genitofemoral nerve formed by?

A

L1-L2

55
Q 
Genitofemoral Nerve
Travels in \_\_\_\_\_
Passes through deep \_\_\_\_\_
Passes through superficial \_\_\_\_\_
Terminates on anterior \_\_\_\_ or \_\_\_\_\_
A

abdominal wall
inguinal canal
inguinal ring
scrotum or labia majora

56
Q

What does the Genitofemoral nerve innervate?

A

Skin covering femoral hiatus

Skin on the scrotum or labia majora

57
Q

What is the Pudendal Nerve formed from?

A

Anterior division of S2-S4

Passes from pelvis through greater sciatic foramen into gluteal region.
Passes posterior to ischial spine and into perineum.

58
Q

What does the Pundendal Nerve innervate?

A

Muscle and skin of perineum

59
Q

What is the Lateral Femoral Cutaneous Nerve formed from?

A

L2-L3

60
Q

How does the Lateral Femoral Cutaneous Nerve travel?

A

Descends posterior abdominal wall

Crosses iliac crest into pelvis and down to inguinal ligament and anterior iliac spine

61
Q

What does the Lateral Femoral Cutaneous Nerve innervate?

A

Sensory: Lateral Thigh
Motor: NONE

62
Q

What is the Posterior Femoral Cutaneous Nerve formed from?

A

Anterior and Posterior Division of S1-S3

APEX says L4-S3

63
Q

How does the Posterior Femoral Cutaneous Nerve travel?

A

Passes from pelvis into gluteal region

To posterior thigh

64
Q

What does the Posterior Femoral Cutaneous Nerve innervate?

A 
Skin
Posterior thigh (Hip to mid calf)
65
Q

What is the Obturator Nerve formed from?

A

L2-L4

66
Q

How does the Obturator Nerve travel?

A

Travels to medial compartment of thigh

67
Q

What does the Obturator Nerve innervate?

A

Sensory: medial thigh (cutaneous branches)
Motor: Controls adduction, flexion and extension of hip (articular branches)

68
Q

What is the Femoral Nerve formed by?

A

Posterior division L2-L4

69
Q

How does the Femoral Nerve travel?

A

Through pelvis
Deep into inguinal ligament
Enters anterior compartment of thigh
Divides into multiple branches

70
Q

Where does the anterior/posterior division of the femoral nerve split?

A

Below inguinal ligament

71
Q

Does the anterior or posterior division of the femoral nerve contain the saphenous nerve?

A

Posterior

72
Q

What is the position of the vein/artery/nerve from
Medial to lateral
&
Lateral to medial

A

Medial to Lateral
VAN (Vein, Artery, Nerve)
remember: venous penis

Lateral to Medial
NAVEL (Nerve, Artery, Vein, Empty space, Ligament)

73
Q

What does the Femoral Nerve innervate?

A 
Sensory: Anterior thigh
Motor: 
Rectus femoris
Vastus lateralis
Vastus Intermedius
Vastus medialis
Sartorious
74
Q

The Saphenous Nerve is from the posterior femoral nerve, how does it travel?

A

Follows deep surface of Sartorius muscle to attachment on tibia
Accompanied by saphenous vein
Passes to skin

75
Q

What does the Saphenous Nerve innervate?

A

Sensory: Medial leg from knee to the arch of the foot
Motor: NONE

76
Q

What does stimulation of the Saphenous nerve cause?

A 
Sartorious muscle contraction (bandlike across thigh)
Patellar twitch (snap)
77
Q

Sciatic Nerve forms which 2 nerves

A

Tibial Nerve (anterior) L4-S3 (largest)

Common Peroneal Nerve (posterior) L4-S2

78
Q

T/F: In the Sciatic Nerve, the common peroneal and tibial nerves are distinct nerves from the beginning in the same sheath

A

True

79
Q

How does the Sciatic Nerve travel?

A 
Passes from pelvis through greater sciatic foramen into gluteal region
Descends between:
- gluteus maximus (posteriorly) 
- obturator internus (anteriorly) 
- lateral to ischial tuberosity 
Enters Posterior thigh
80
Q

When the Sciatic Nerve innervates the muscles, what happens?

A

Hip Extension

Flexion of knee

81
Q

The Sciatic Nerve descends _____ where it splits into Tibial & Common Peroneal

A

popliteal fossa

82
Q

How does the tibial nerve travel

A

Exits popliteal fossa and into superficial posterior compartment of leg

Passes between tibial and fibular heads and enters deep posterior compartment

Passes posterior to medial malleolus into foot and branches

  • Medial plantar nerve
  • Lateral plantar nerve
  • Two branches innervate plantar surface of foot
83
Q

The Common Peroneal Nerve divides into superficial and deep, where does the superficial terminate?

A

Enters lateral compartment of leg and terminates in lateral and dorsal surface of foot

84
Q

The Common Peroneal Nerve divides into superficial and deep, where does the deep terminate?

A

Enters anterior compartment
Crosses anterior surface of ankle into foot
Terminates as cutaneous fibers
- Skin between hallux and second toe

85
Q

What 2 nerves is the Sural Nerve formed from?

A

branches from tibial and common peroneal

86
Q

The Sural Nerve travels with which other nerve?

A

Saphenous Nerve

87
Q

What does the Sural Nerve innervate?

A

Posterior sole of foot
Posterior heel
Achilles tendon above ankle

88
Q

Motor innervation of tibial nerve

A

Inversion and plantar flexion

89
Q

Motor innervation of superficial peroneal nerve

A

Eversion and abduction of foot

90
Q

Motor innervation of deep peroneal nerve

A

Dorsiflexion

APA 3 - Wolfe (11 decks)

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