Peripheral Nerves Flashcards

1
Q

Radial nerve origins

A

C5-8

Pass through upper, middle and lower trunks then posterior cord of brachial plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Radial nerve anatomy in upper arm

A

As it winds around the humerus or proximal to this it innervates the tricpes.

After course in spiral groove it supplies brachioradialis and ECRL and brevis.

Bifurcates into a superifical (sensory) and deep (motor) branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Muscles supplied by proximal branches of radial nerve

A

Triceps

Brachioradiailis

ECRL

ECRB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Superficial branch of radial nerve

A

In forearm, passes distally into the hand where it supplies skin of the radial aspect of the dorsum of the hand and dorsum of first four fingers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Deep branch of radial nerve

A

Passes deep through the fibrous arch of supinator (arch of Froshe) to enter the posterior compartment of forearm

Continuous in this compartment as the purely motor posterior interosseous branch

Innervates

Supinator

Extensor digitorum

Extensor digit mini

ECU

Abductor pollicis longus

Extensor pollicis longus

Extensor pollicis brevis

Extensor indicies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Forearm muscles dupplied by posterior interosseous nerve

A

Supinator

Extensor digitorum

Extensor digiti minimi

ECU

Abductor pollicis longus

Extensor pollicis longus

Extensor pollicis brevis

Extensor indicis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Supinator function

A

Forearm supinator

Test with resisted supination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Extensor digitorum

A

Extensor of 2nd to 5th metacraophalangeal joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Extensor digiti minimi function

A

Extensor if fifth MCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ECU function

A

Ulnar extenor of the wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

APL function

A

Abductor of carpometacarpal joint of thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

EPL function

A

Extension of thumb interphalangeal joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

EPB function

A

Extensor of the MCPJ of thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Extensor indicies function

A

Extensor of index finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Saturday night palsy

A

AKA radial nerve palsy

Classically associated with a drunkard who falls asleep with arm hyper abducted across a park bench

Site of compression is in the region of the spiral groove

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is the triceps preserved in radial nerve palsy (Saturday night palsy)

A

Because branches of the tricpes originate proximal to spiral groove

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Wrist drop

Inability to extend fingers at MCPJ

Supinator weakness

Triceps spared

Absent sensation first dorsal interosseuous

A

Radial nerve palsy

Compression in the spira groove of humerus/humeral fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why is weakness of supination only partial in Radial nerve palsy

A

Because it may be accomplished with either biceps or supinator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Posterior interosseous nerve syndrome

A

Most common syndrome caused by compression at the arcade of Frohse (fibrous arch at the origin of supinator) which may pathologically constrict nerve

Inability to extend fingers at MCPJ, absence of wrist drop and normal sensation

Supintaor spared as branches are given off proximal to PIN entering the arcade of Frohse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why is wrist drop absent in PIN palsy

A

The ECR is presreved

The ECU is innervated by PIN so there may be radial deviation of the hand on extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why is there no senosry deficit in PIN syndrome

A

It is purely motor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Inability to extend fingers at MCPJ

No wrist drop but radial deviation on extension of wrist

Presrved sensation

Preserved supinator and triceps

A

Posterior interosseus nerve syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
A

Arcade of Frohse associated with PIN syndrome/supinator syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Roots of median nerve

A

C6 to T1

Pasing through upper middle and lower trunks and the lateral and medial cords of the brachial plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Median nerve branches proximal to the elbow

A

None

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Median nerve at elbow

Muscles supplied

A

Pronator teres

Flexor carpi radialis

Palmaris longue

FDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Prontaor teres function

A

Forearm pronator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

FCR function

A

Radial wrist flexor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

PL

A

Wrist flexor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

FDS

A

Flexor at the IPJ for 2nd-5th fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Contents of the cubital fossa

Really Need Beer To Be At My Nicest

A

L->M

Radial nerve

Biceps tendon

Brachial artery

Median nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Under what is the median nerve found at the elbow?

A

Behind the biccipital aponeurous (lacertus fibrosus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How does the median nerve enter the forearm

A

Between the two heads of pronator teres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Where is the AIN given off?

A

As it the median nerve passes deep to pronator teres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Anterior interosseous nerve function

A

Purely motor

Supplies FPL, Pronator quadratus, FDP 1 and 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

FPL function

A

Flexion of thumb at interphalangeal joint, key function for grip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Pronator quadratus

A

Pronation of forearm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Function of FDP

A

Flexion of DIP in 2-4th fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Median nerve in the hand

A

Passes deep to the flexor retinaculum to innervate the LOAF muscle

Lumbricals

Opponens pollicis

Abductor pollicis brevis

Palmar digital nerves-> palmar aspect of thumb, second, third and half of fourth fingers. Raedial aspect of the palm and dorsl aspect of the distal middle phalanges of the sconed, third and half of fourth fingers

Palmar cutaneous bracnh given off proximal to the carpal tunnel and supplies the median eminence and proximal palm on radial aspect of hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Three major median nerve entrapment syndromes

A

Pronator teres syndrome

AIN syndrome

CTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Pronator teres syndrome

A

Results from entrapment of the median nerve as it passes between the two heads of the pronator teres and under the fibrous arch of the FDS

Compression may be caused by thickened lacertus fibrosus, hypertrophied pronator teres, tight fibrous band of the FDS

Pain in forearm with weakness in hand grip and numbness and tingling in the index finger and thumb.

Similar symptoms to CTS with hand assuming a “benedicton” attitude in severe cases. Nocturnal exacerbation is absent normally

Weakness is variable but often there is no measurable weakness in median nerve innervated muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How to differentiate between Hand of Benediction and Ulnar Claw

A

Ulnar claw usually seen at rest whereas in Hand of Benediction there is weakness on active flexion in the radial three digirs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Pain in forearm

Weakness in hand attitdue

Numbness in median nerve distribution without nocturnal exacerbation

A

?Pronator teres syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

DDx

A

Ulnar claw or Hand of Benediction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

AIN snyfrome

A

Most commonly due to a constricting band causing entrapment neuropathy near the origin of the nerve

FDP and FPL weakness

Abnormal pinch attitude of the hand

Weakness in pronator quadratus is usually clinically insignificant due to more powerful pronator teres.

No sensory deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Abnormal pinch attitude

A

Extension of hyperextension of the terminal phalanges of the thumb and index finger when the thumb and index finger are opposed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Abnormal pinch attitude of the hand due to weakness in FDP and FPL

Normal sensation

A

AIN syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

CTS

A

Caused by compression of the median nerve as it passes through the carpal tunnel

Pain anad paraesthesia in wrist and hand awakening patient from sleep

Sensory loss in te ditsirubiton of the palmar digital branches Isensory loss easiest to discern along vola tips of index and middle fingers)

Pain may also involve forearm, elbow or shoulder- classically this pain may radiate from distal to proximal and may be associated with shaking the hand to alleviate pain in contrast to cervical radiculopathy in which movement exacerbates pain.

Motor symptoms are usually late- LOAF muscles affected- weakness in abduciton, opposition and flexion of thumb.

Phalen’s positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Function of lumbricals

A

Flex fingers at the MCPJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Function of opponens pollicis

A

Opposition refers to the rather complex movement of the thumb which is a combination of flexion, adduction and medial rotation at the first carpometacarpal joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Function of Abductor pollicis brevis

A

Abduction of thumb at MCPJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Phalen’s test

A

Forcibly dosriflexing affected hand for 60 seconds

Positive test will reproduce symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the most reliable assessment of thenar muscle function?

A

Abductor pollicis brevis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Nocturnal pain and paraesthesia in median distirubtion

Weakness and atrophy in LOAF muscless

Sensory loss

A

Carpal tunnel syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Contents of carpal tunnel

9 tendons, 1 nerve

A

4 tendons of the FDS superifically

Median nerve

1 tendon of FPL

4 tendons of FDP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Roots of the ulnar nerve

A

C7/8/T1

Medial cord of the brachial plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Branches of ulnar nerve in arm

A

None

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Ulnar nerve branches at the elbow

A

Ulnar nerve enters a groove between the medial humeral epicondyle and olecranon process

Groove covered by an aponeurosis formng an osseofibrous canal (cubital tunnel)

Two motor branches- FCU and FDP to fourth and fifth fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Boundaries of the cubital tunnel

A

Roof: Cubital tunnel retinaculum (band of Osbourne)

Laterally: Olecranon

Medially: Medial epicondyle

Floor: elbow joint capsule, posterior band of medial collateral ligament of elbow joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Ulnar nerve in forearm

A

Passes between two heads of FCU to take place superifical to FDP

Two sensory branches- palmar cutaneous branch-> skin over hypothenar eminence

Dorsal cutaneous bramnch-> dorsal ulnar aspect of the hand and dorsal aspect of the fifth finger and half of fourth finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Sensory branches of ulnar nereve in forearm

A

Palmar cutaneous branch

Dorsal cutaneous branch

Superficial sensory branch is given off as the ulnar nerve enters Guyon’s canal at the wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How does the ulnar nerve enter the hand?

A

Through Guyon’s canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Borders of Guyon’s canal

A

Floor- transverse carpal ligament, hypothenar msucles

Roof- Volar carpal ligament

Ulnar border- Pisiform and pisohamate ligament, abductor minimimuscle belly

Radial border- Hook of hamate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Branches of the ulnar nerve in hand

A

Superficial sensory branch given off proximally in the canal- supplies the distal part of theulnar aspect of th eplam and the palmar aspect of the fifth and half of the fourth finger

Contineus as deep motor branch supplying:

Abductor digiti minimi

Opponens digiti minimi

Flexor digiti minimi

Lumbricals 3 and 4

Interosseous muscles

Addcutor pollicis

Flexor pollicic brevis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Action of abductor digiti minimi

A

Abducts and flexes 5th finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Action of opponens digiti minimi

A

Opposition of the little finger with the tip of the thumb

Deepends hollow of the palm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Action of the flexor digiti minimi

A

Flexes little finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Lumbricals action

A

Flex MCPJ and extend interphalangeals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Interosseous muscle actions function

A

PAD- palmar adduct

DAB- dorsal abduct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Action of adductor pollicis

A

Adducts CMCJ of the thumb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Flexor pollicis brevis function

A

Flexes thumb at MCPJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Two major syndromes assocaited with ulnar nerve

A

Cubital tunnel syndrome

Guyon’s canal syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is a key differentiator between Cubital tunnel and Guyon’s canal syndrome

A

Dorsal cutaneous nerve which is spared in Guyon’s canal but affected in cubital tunnel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Cardinal features of cubital tunnel syndrome

A

Numbness and tingling of the ulnar aspect of hand

Weakness variously described as imapirment of hand grip, clumsiness or difficulty buttoning shirt

Atrophy in hypothenar eminence and first interosseous space.

Sensory loss most easily observed in the distal two phalnges of the little finger

Claw hand deformity

Froment’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Claw hand

A

Results from simultaenous hypextension at the MCPJ and flexion at IPJ

Hyperextension at the MCPJ is due to wekness of rthe lumbricals with unopposed action of the extensor digotorum

Flexion at the IPJ is due to passive tethering pull of the flexor digitorum which occurs when the MCPJ are in extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Froment’s sign

A

Due to weakness in adductor pollicis

On grasping a piece of paper between thumb and index finger and pulling

Positive when the patient attempts to compensate for lack of thumb adduction with extension of the PIPJ and felxion of the distal phalangex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Why are the FCU and FDP often spared in cubital tunnel syndrome?

A

Because they are situated deeply within the nerve and may be spared the more suprifically localted fibres which are compressed first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Differneces between cubital tunnel and CTS

A

Cubital tunnel less frequently associated with pain with weakness and atrophy early rather than late

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q
A

Hypothenar wasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Paraesthesia on medial border of hand

Weakness and clumsiness in hand

Atrophy of the dorsal interossei and hypothenar eminence

Claw hand

Froment’s sign

A

?Cubital tunnel syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Classification of Guyon’s canal syndrome

A

Three types based on the site of the compression

Zone 1 to 3 based on site of compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Guyon’s Canal Syndrome Zone 1

A

Mixed motor and sensory symptoms

Proximal to bifurcation of the nerve

Common causes of compression: Ganglia and hook of hamate fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Guyon’s Canal Syndrome

Zone 2

A

Surrounds deep motor branch

Predominantly motor symptoms

Common causes include ganglia and hok of hamate fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Guyons Canal Syndrome

Zone 3

A

Surrounds superifical sensory branch

Senosry symptoms only

Common caauses include ulnar artery thrombosis or aneursym

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Loss of abductir digiti minimi, abductor pollicis, FDM, dorsal. interossei

Froment’s sign and claw hand

Loss of palmar sensation but not dorsal

A

Zone 1

Guyon’s canal syndrome

Sensory pattern is due to superifical sensory branch being affected but sparing of the dorsal cutaneous branch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Hypothenar muscles spared (abductor digiti minimi and flexor digiti minimi)

Loss of adductor pollicis and dorsal interossei

Froment’s sign and claw hand

Preserved sensation

A

Zone 2 Guyon’s canal syndrome

Hypothenar muscle sparing due to early origin

Sensation spared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

All hand muscles spared

Loss of palmar but not dorsal sensation over ulnar border

Froment’s and Claw hand absent

A

Zone 3 Guyon’s canal syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

LFC

A

Direct branch of the lumbar plexus

Provides sesnosry innervation to the skin of the ventrolateral aspect of the thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Anatomy of the LFC

A

Purely sensory nerve dervied from the second and third lumbar nerves of the lumbar plexus

Emerges from lateral aspect of psoas to run obliquely and forward across iliacus

Passes across the iliac fossa medial to ASIS, enters the thigh beneath the inguinal ligament piercing the fascia lata of te lateral thigh.

Supplis the skin of the ventrolateral aspect of the thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Meralgia paraesthetica

A

Syndrome of the LFC

Usually caused by compression of the nerve in the inguinal region.

Characterised by paraesrthesia involving the ventrolateral of th e thigh.

Common in obese individuals whose abdominal girth causes excessive strain on the inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Fat

No motor signs

Paraesthesia in ventrolateral thigh

A

Meralgia paraesthetica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Saphenous nerve

A

Terminal branch of femoral nerve in lower limb, provides sensory innervation to the ventromedial aspect of the knee leg and foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Anatomy of the saphenous nerve

A

Purely sensory branch of femoral nerve

Originatse below the inguinal ligament and enters Hunter’s canal, crossing the femoral artery from medial to laterally and exits by piercing its root

Divides into two terminal branches- infrapatellar branch supplying ventromedial aspect of the knee and a descneding branch which supplies the ventromedial aspect of the leg and ankle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Saphenous nerve compression syndrome

A

Occurs at exit point from adductor canal

Characterised by intense pain along medial aspect of the knee with associated numbness in this area and down medial leg.

No motor signs or symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Intense pain along medial aspect of knee and leg

Numbness along medial aspect of knee and leg

Intact motor function

A

Saphenous nerve entrapment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is the largest peripheral nerve in the body?

A

Saphenous

98
Q

Anatomy of the sciatic nerve

A

Deirves from L4-S3

Leaves pelvis through the GSF behind the tendinous origin of piriformis

Courses laterally and downward to innervate semitendinous, semimembranosus, biceps femoris and adductor magnus.

Proceeds to popliteal fossa where it divides into terminal branches- tibial nerve and common peroneal nerve

99
Q

Piriformis syndrome

A

Compression of the proximal segment of the sciatic nerve as it passes underneath the piriformis muscle

Cardinal features are;

Weakness in any or all of the knee flexors, ankle flexors, foot intrinsices. Sensory loss that may involve all of the foot

Can be confiused with lumbosacral radiculopathy

100
Q

Weakness in any or all of the knee felxors, ankles flexors or extensors and foot intrinsics

Sensory loss involving all or part of the feet

A

?Piriformis syndrome

101
Q

Peroneal nerve roots

A

L4 - S2

102
Q

Anatomy of the common peroneal nerve

A

One of two terminal branches of the sciatic nerve taking origin in popliteal fossa.

Courses laterally winding round the neck of the fibula to divide into superficial and deep peroneal nerves

103
Q

Superificial peroneal nerve

A

Branch of common peroneal nerve

Motor innervation to peroneus longus and brevis (foot everters)

Sensory to lower lateral leg and dorsum of the foot excluding the first dorsal webspace

104
Q

Sensory supply of superficial peroneal

A

Lower lateral leg and dorsum of foot excluding first dorsal webspace

105
Q

Deep peroneal nerve

A

Descends deep in anterior compartment of leg

Motor to:

Tibialis anterior, EHL, EDL, EDB

Sensory to:

First dorsal webspace

106
Q

Tibialis anterior function

A

Deep peroneal nerve

Foot dorsiflexion and eversion

107
Q

EHL function

A

Great toe extension

Foot dorsiflexion

Deep peroneal nerve

108
Q

EDL foot function

A

Extensor of four lateral toes

Foot dorsiflexion

109
Q

Function EDB in foot

A

Extenros of

110
Q

Division of deep peroneal nerve

A

Proximal to ankle the nerve becomes superificial and divides into medial and lateral branches

Lateral (motor branch)-> EDB

Medial (sensory)-> first dorsal webspace

111
Q

Most common site of peroneal nerve compression

A

Fibular head

Most superificial location and thus most susceptible to injury

Can be due to extrinsic compression

Deep peroneal nerve most commonly affected but common and superficial may also be

112
Q

Peroneal nerve syndrome

A

Depends on affected branch

Ranges from common peroneal, to ddep or superficai palsy

113
Q

Common peroneal palsy

A

Weakness of foot eversion and toe and foot dorsiflexion

Loss of sensation over dorsum of foot, toes and lateral aspect of lower leg

114
Q

Deep peroneal nerve palsy

A

Weakness of foot and toe dorsiflexion as well as sensory loss involving the first dorsal webspace of foot

115
Q

Superficial peroneal nerve palsy

A

Weakness of foot eversion

Loss of sensation in lateral aspect of lower leg and dorsum of foot and toes excluding first webspace

116
Q

Weakness of foot eversion and toe and foot dorsiflexion

Loss of sensation over dorsum of foot, toes and lateral aspect of lower leg

A

Common peroneal palsy

117
Q

Weakness of foot and toe dorsiflexion as well as sensory loss involving the first dorsal webspace of foot

A

Deep peroneal nerve palsy

118
Q

Cardinal features of peroneal nerve syndrome

A

Weakness in foot eversion and dorsfilexion of foot and toes

Senosry loss involving lateral lower leg and dorsum of foot an toes

119
Q

Weakness of foot eversion

Loss of sensation in lateral aspect of lower leg and dorsum of foot and toes excluding first webspace

A

Superficial peroneal nerve palsy

120
Q

Tibial nerve roots

A

L4-S3

Terminal branch of sciatic nerve

121
Q

Tibial anatomy at popliteal fossa

A

Distal popliteal fossa-> medial sural cutaneous nerve

Branches to gastrocnemius and then soleus passing distally in the plane between these muscles

122
Q

Formation of sural nerve

A

Medial sural cutaneous nerve (branch of tibial at popliteal fossa) joins the lateral sural cutaneous nerve (branch of the common peroneal nerve) at the level of the Achilles tendon

Sensory to skin on the lateral heel and lateral aspect of the foot and the small toe

123
Q

Tibial nerve anatomy in upper thid of leg

A

Motor branches to tibialis posterior, FDL, FHL

124
Q

TP function

A

Foot invresion

125
Q

FDL function

A

Plantar flexion

126
Q

FHL

A

Plantar flexion of great toe

127
Q

Tibial nerve anatomy at ankle

A

Passes caudal and dorsal to the medial malleolus and under the flexor retinaculum (tarsal tunnel)

Gives off medial calacaneal branch variably, proximal or distal to the tarsal tunnel, pure sesnory branch supplying skin of medial heel

Two terminal branches distally in tarsal tunnel:

Medial plantar nerve- motor to medial intricis, sensory to medial three and a half toes

Lateral plantar nerve- sensory to lateral one and a half toes, and lateral intrinsccs

128
Q

Tarsal tunnel syndrome

A

Burning pain and paraesthesia in any combination of heel (calcaneal), medial sole (medial plantar), lateral sole (lateral plantar)

Weakness of foot intrinsics

129
Q

Draw the cervical plexus

A

https://www.youtube.com/watch?v=xdrzbM8ESNA

130
Q

Suprahyoid muscles

My Gravy Spoon, Darling

A

Mylohyoid

Geniohyoid

Stylohyoid

Digastric

131
Q

Infrahyoid muscles

TOSS

A

Thyrohyoid

Omohyoid

Sternothyroid

Sternohyoid

132
Q

Mylohyoid innervation

A

Supplied by the nerve to mylohyoid, a branch of the inferior alveolar nerve

From V3

133
Q

Geniohyoid innervation

A

Innervated by a branch of ventral ramus of C1 from cervical plexus, which courses with the hypoglossal nerve into the floor of the mouth

134
Q

Stylohyoid innervation

A

CNVII

135
Q

Innervation of diagstric

A

anterior belly- Trigeminal

Posterior velly- CN VII

136
Q

Which is the only suprahyoid muscle not supplied by a cranial nerve?

A

Geniohyoid, supplied by ventral rami of C1 running with hypoglossal

137
Q

Location of ansa cervicalis

A

Behind SCM, closesly related to spinal accessory and hypoglossal nerves

138
Q

Division of cervical plexus

A

Superificial sensory branches

Deep motor branches

139
Q

Superficial sensory branches of cervial plexus

A

Greater occipital nerve

Lesser occipital nerve

Greater auricular nerve

Transverse cervical nerve

Supraclavicular nerve

140
Q

Greater occipital nerve

A

C2

Supplies skin of the posterior scalp

141
Q

Which segment of ansa cervicalis provides no sensory branches

A

C1 as it has no dorsal root

142
Q

Lesser occipital nerve

A

C2 spinal root

Supplies skin overlying the mastoid process extending just above and below the mastoid process to include part of the lateral head and lateral neck

143
Q

Greater auricular nerve

A

C2-3

Supplies skin overlying external ear, parotid and angle of mandible

144
Q

Transvere cervical nerve

A

C2-3

Supplies skin overlying anterior and lateral aspects of the neck from the body of the mandible to the sternum

145
Q

Supraclavicular nerve

A

C3-4

Supply skin just above the clavicle

146
Q

Deep motor branches

A

Branches to the accessory nerve

Ansa cervicalis

Branches to adjacent neck muscles

Phrenic nerve

147
Q

Cervical plexus

Branches to accessory nerve

A

Travel with CN XI to supply SCM (C2-3) and trapezius (C3-4) muscles

148
Q

Ansa cervicalis

A

Loop formed by a superior (C1/2) and inferior root (C2/3)

Superior root fibres run with the hypoglossal enrve for a short distance

Supplies the infrahyoid muscles- head flexors including thyrohyoid, omohyoid, sternohyoid, sternothyroid and geniohyoid (suprahyoid muscle)

149
Q

Cervical plexus- branches to adjacent neck mucles

A

Small muscular branches innervate adjacent muscles of the neck which are flexors and rotators

Include the longus anteriorly, middle scalene laterally and levator scapulae posteriorly

150
Q

Phrenic nerve

A

C3-5

Diahphragm

151
Q

Injuires to cervical plexus

A

Involvement of superficial senosry roots-partial numbess of head or neck

Deep motor- weakness of forward or lateral neck flexion (infrahyoid/scalenes), rotation of head (SCM), rotation of scapula (levator scapulae)

Include penetrating trauma or iatrogenic lesions or mass lesions

152
Q

Unilateral phrenic nerve injury

A

Tolerated whilst patient at rest but may result in SOBOE

153
Q

Bilateral phrenic nerve injury

A

Usually associated with severe ventilatory compromise at rest unless it receives an anastomotic branch from subclavian nerve

Penetrating injury, surgical injury, intrathoracic mass

154
Q

Weakness in:

Lateral neck flexion

Head rotation

Head flexion

Shoulder shurg

Respiration

A

Deep motor branches of ansa cervicalis

Scalene (deep motor)

SCM (spinal accesory)

Infrahyoid (ansa cervicalis)

Diagphragm (Phrenic)

Trapezius (spinal accessory)

155
Q

Etymology phrenic

A

Phren- diaphragm

156
Q

Draw the brachial plexus

A

https://www.youtube.com/watch?v=Z_Y_kVdH9zE

157
Q

Where are the roots of the brachial plexus found?

A

In the posterior traingle of the neck

158
Q

Bordres of posterior triangle

A

SCM anterioly

Trapezius posteriorly

Inferiorly middle third of clavicle

159
Q

Where do the branchial trunks become their divisions

A

In the supraclavicular fossa the three drinks give rise to anterior and posterior divisions

The posterior divisions unite to form the posterior cord

160
Q

Which trunks of the brachial plexus form the lateral cord?

A

anterior divsions of the upper and middle trunk

161
Q

Which trunks form the medial cord

A

Anterior division of the lower trunk

162
Q

How do the brachial plexus cords leave the posterior traingle of the neck

A

Through te otulet between the first rib and clavicle to enter the axilla

163
Q

What are the branches from the roots of the brachial plexusD

A

Dorsal scapular

LTN

164
Q

Function of LTN

A

Serratus anterior

Pulls scapula forward around thorax.

Palsy results in winging of scapula

165
Q

Function of dorsal scapular nerve

A

Supplies rhomboids

Scapular retraction around the scapularthoracic joint

Levator scapulae:

The levator scapulae functions to elevate the scapula and tilt the glenoid cavity inferiorly by rotating the scapula downward. If the scapula is fixed, a contraction of the levator scapulae leads to the lateral flexion of the cervical vertebral column to the side and stabilizes the vertebral column during rotation.

166
Q

Nerve roots dorsal scapular

A

C5

167
Q

Nerve roots LTN

A

C5, 6, 7

168
Q

Branches from the trunk of the brachial plexus

A

Nerve to subclavius

Suprascapular nerve

Both from upper trunk

169
Q

Nerve to subclavius

A

From upper trunk of brachial plexus

Supplies subclavius muscle but may also contain accessory nerve fibres that join the phrenic nerve in the mediastinum

170
Q

Suprascapular nerve

A

Infraspinatus- external rotation

Supraspinatus- abduction

171
Q

Branches from divisions of brachial plexus

A

None

172
Q

Branches of lateral cord of brachial plexus

A

Lateral pectoral

Muscultocutaneous

Lateral root of median nerve

173
Q

Lateral pectroal nerve

A

Supplies pec major

174
Q

Musculocutaneous nerve

A

BBC

and

Lateral cutaneous nerve of forearm

175
Q

Branches of medial cord of brachial plexus

A

Medial pectroal

Medial brachial cutaneous

Medial antebrachial cutnaeous

Ulnar

Medial root of median nerve

176
Q

Medial pectroal nerve

A

Pectoralis major and minor

177
Q

Medial brachial cutaneous nerve

A

Sensory to skin on medial aspect of forearm

178
Q

Medial antebrachial cutaneous nerve

A

Skin on medial aspect of the forearm

179
Q

Branches of posterior cord of brachial plexus

A

Upper subscapular

Thoracodorsal

Lower subscapular

Termiantes as axillary and raidal nerves

180
Q

Upper subscapular

A

Supplies upper part of subscapularis

181
Q

Lower subscapular nerve

A

Lower part of subscapularis

182
Q

Thoracodorsal nerve

A

Supplies lat dorsi

183
Q

Axillary nerve

A

Supplies delotid and skin overlying muscle (regimental patch)

184
Q

Common brachial plexus klesions

A

Traumatic:

Erb-Duchenne

Dejerine Klumpke

Entire plexus

Isolated lateral, medial, posterior cords

Non-traumatic:

Throacic outlet syndrome

Radiation brachial plexoparhy

Neuralgic amyotrophy

185
Q

Describe Erb-Ducheenne Brachial plexus injury

A

Upper brachial plexus, traction on the C5/6 roots, excessive lateral displacement of the head to contralateral side or downward displacement of ipsilateral shoulder e.g. fall on shoulder

Arm internally rotated and adducted, forearm extend and pronated. Palm faces out and backwards-> waiter’s tip

Impairment of shoulder abduction (deltoid and supraspinatius)

Impariment of elbow flexion (Biceps, BR and brachialis involvement)

Impairment of external rotation of arm (infraspinatus involvement)

Impairment of supination (biceps)

Sensory loss limited to sin over deltoid

Depressed or absent biceps and BR reflexes

186
Q

Arm internally rotated and adducted, elbow extended and pronated, palm faces out and back. Numbness over regimental patch

A

Upper brachial plexus injury

Erb-Duchenne

Impairment of shoulder abduction (deltoid and supraspinatus)

Impariment of elbow flexion (Biceps, BR and brachialis involvement)

Impairment of external rotation of arm (infraspinatus involvement)

Impairment of supination (biceps)

Sensory loss limited to sin over deltoid

Depressed or absent biceps and BR reflexes

187
Q

Describe Dejerine-Klumpke brachial plexus injury

A

Lower brachial plexus injury involving traction on C8 and T1 roots, associated with hyperabduction of the arm.

Claw hand deformity with sesnosry loss in the ulnar distribution of hand and forearm +/- ipsilateral Horners

Deep tendon reflexes intact

188
Q

Claw hand deformity with sesnosry loss in the ulnar distribution of hand and forearm +/- ipsilateral Horners

Deep tendon reflexes intact

A

?Klumpke’s

189
Q

Explain the ulnar claw

A

Fingers extended at MCPJ due to unopposed action of the extensor digitorum (radial), flexed and IPJ due to unopposed action of the FD muscles (median)

Lumbricals and interossei normally provide flexion atthe MCPJ and extension at teh IPJ

190
Q

Describe complete brachial plexus injury

A

Rare

High speed vehicular accident

Completely paralysed, asensate, areflexic limb

191
Q

Describe lateral cord palsy

A

Loss of function of the median and musculocutaneous nerves

Impairment in elbow flexion and supination and impairment of forearm pronation, radial wrist flexion, wrist flexion, PIP flexion, a distal phalanx of thumb flexion, 2nd and 3rd DIP flexion impairment, impaired forearm supination.

Numbness in the lateral forearm

Biceps hyporeflexia

192
Q

Impairment in elbow flexion and supination and impairment of forearm pronation, radial wrist flexion, wrist flexion, PIP flexion, a distal phalanx of thumb flexion, 2nd and 3rd DIP flexion impairment, impaired forearm supination.

Numbness in the lateral forearm

Biceps hyporeflexia

A

Lateral cord palsy

193
Q

Describe medial cord palsy

A

Primarily affect the ulnar and median nerve

Impairment of ulnar wrist flexion, impairment of DIPJ flexion 3 and 4, finger abduction

Impairment of thumb abduction, opposition, proximal phalanx flexion

Sensory loss in the medial aspect of arm and forearm.

Deep tendon reflexes intact

194
Q

Impairment of ulnar wrist flexion, impairment of DIPJ flexion 3 and 4, finger abduction

Impairment of thumb abduction, opposition, proximal phalanx flexion

Sensory loss in the medial aspect of arm and forearm.

Deep tendon reflexes intact

A

Medial cord palsy

195
Q

Describe posterior cord palsy

A

Subscapular, thoracodorsal, axillary and radial nerves

Impairment of internal rotation of humerus (subscapular)

Impaired adduction of elevated arm (TD)

Impaired abduction (supraspinatus)

Impairment of elbow extension, wrist extension, forearm supination, finger extension

Sensory loss over entire extensor surface of the arm and forearm, dorsum of hand and first four finger

Absent or depressed triceps reflex

196
Q

mpairment of internal rotation of humerus (subscapular)

Impaired adduction of elevated arm (TD)

Impaired abduction (supraspinatus)

Impairment of elbow extension, wrist extension, forearm supination, finger extension

Sensory loss over entire extensor surface of the arm and forearm, dorsum of hand and first four finger

Absent or depressed triceps reflex

A

Posterior cord lesion

197
Q

Vascular thoracic outlet syndrome

A

Compression of subclavian artery or vein

198
Q

Neurogenic thoracic outlet syndrome

A

Medial or lateral tunrk of brahcial plexus compression

199
Q

Causes of thoracic outlet syndrome

A

Usually due to several anatomic anomalies in the region, most common is an incomplete cervical rib with a fascial band extending from the tip to the first rib.

Elongated C7 transverse process

Complete cervical rib

Anomalous insertion of anterior and medial scalene muscles

200
Q

Shoulder and arm pain

Slight wasting and weakness of the hypothenar, interosseous, adductor pollicis and deep flexor muscles of fourth and fifth fingers

Numbness and tingling along the medial aspect of the forearm and hand

A

Thoracic outlet syndrome

201
Q

Describe thoracic outlet syndrom

A

Vascular or neurogenic compression of the subclavian artery/vein or medial cord or lateral trunk of brachial plexus

Shoulder and arm pain

Slight wasting and weakness of the hypothenar, interosseous, adductor pollicis and deep flexor muscles of the fourth and fifth fingers

Reflexes usually preserved

May complain of numbness and tingling along medial aspect of forearm and hand

202
Q

Apical lung tumour syndrome

A

Pancoast’s tumour, usually SCC in the superior sulcus of lung

May compress or envelope lower brachial plexus

May have symptoms similar to thoracic outlet syndrome with posterior cord involvement including weakness of triceps

May precede diagnosis of tumour

203
Q

Pevious Breast Ca, RTx

Delayed onset intrinsic hand weakness associated with distal paraesthesias and sensory loss.

Atrophy

A

Radiation plexopathy

Severe pain as a presenting symptom may point to malignant infiltration of the plexus

Tends to be >1y post-irradiation.

204
Q

Parsonage-Turner Syndrome

A

Abrupt onset of shoulder girdle or scapular pain

Followed by prominent weakness and atrophy of the upper arm muscle.

Movement or activity of the shoulder muscles tends to aggravate the pain, which is usually quite severe

May be preceded by infectious events

Pain persists for up to 2/52 5then abates, weakness and atrophy usually appear when pain disppaers.

205
Q

Abrupt onset of shoulder girdle or scapular pain

Followed by prominent weakness and atrophy of the upper arm muscle.

Movement or activity of the shoulder muscles tends to aggravate the pain, which is usually quite severe

May be preceded by infectious events

A

Parsonage-Turner Syndrome

206
Q

Draw the lumbosacral plexus

A

https://www.youtube.com/watch?v=T_GlJu0dxkA

207
Q

Anatomy of lumbar plexus

A

Union of the ventral rami of T12 to L4

Upper part- T12-L2, 3 nerves with sensory branches

Lower part L2-4, 2 mixed nerves femoral and obturator, 1 sensory nerve LFC)

After leaving the psoas muscle, the upper nerves of the lumbar plexus each run parallel to the lower intercostal nerves where they help supply the transverse and olbique abdominal muscles

208
Q

Iliohypogastric

A

T12-L2

Two cutaneous branches, anterior and lateral

Anterior- skin over anterior wall about pubis

Lateral- skin over outer buttock and hip

209
Q

Ilioinguinal nerve

A

L1

Skin of medial thigh below the IL and skin of symphysis pubis and external genitalia

210
Q

Genitofemoral nerve

A

L1-2

Two branches

Genital- Skin over scrotum

Femoral- skin over femoral triangle

Motor to cremaster

211
Q

Nerve roots of femoral nerve

A

L2-L4

212
Q

Anatomical course of femoral nerve

A

Mixed motor/sensory nerve that arises within psoas

Runs in the groove between the psoas and iliacus (hip flexors), which it supplies

Descends behind the inguinal ligament to enter the femoral triangle and divide into anterior and posterior divisions

213
Q

Innervation of psoas major

A

Direct branches of ventral rami from lumbar plexus L1-3

214
Q

Innervation of iliacus

A

Femoral nerve L2-4

215
Q

Anterior division of the femoral nerve

A

Supplies a muscular branch to sartorius (external rotator of thigh)

Sensory to skin of the anterior and medial aspects of thigh- the anterior cutaneous nerve of thigh

216
Q

Supplies a muscular branch to sartorius (external rotator of thigh)

Sensory to skin of the anterior and medial aspects of thigh- the anterior cutaneous nerve of thigh

A

Anterior division of femoral nerve

217
Q

Posterior division of femoral nerve

A

Supplies a muscular branch to quadriceps (extensor)

Sensory to skin over medial aspect of leg and foot (saphenous nerve)

218
Q

Supplies a muscular branch to quadriceps (extensor)

Sensory to skin over medial aspect of leg and foot (saphenous nerve)

A

Posterior division of femoral nerve

219
Q

Function of femoral nerve

A

Hip extension

External rotation

Leg extension

Sensation of anteromedial thigh and medial leg and foot

220
Q

Obutrator nerve roots

A

L2-4

221
Q

Anatomical course of obturator

A

Mixed motor/sensory nerve that arises within psoas and passes through the obturator canal, descending into the medial thigh.

Motor to adductor muscles of the thigh

Sensory to the skin over the medial aspect of the thigh

222
Q

Mixed motor/sensory nerve that arises within psoas and passes through the obturator canal, descending into the medial thigh.

Motor to adductor muscles of the thigh

Sensory to the skin over the medial aspect of the thigh

A

Obturator nerve

223
Q

What is the only muscle of the medial compartment of thigh not supplied by obturator

A

Hamstring portion of adductor magnus (tibial portion of sacral)

224
Q

What are the four groups of nerves formed by the sacral plexus

A

Motor gluteal nerves

Posterior femoral cutaneous nerve (sensory)

Pudendal (mixed)

Sciatic (mixed)

225
Q

Superior gluteal nerve roots

A

L4-S1

226
Q

Anatomical course of superior gluteal nerve

A

Passes above piriformis to supply glkuteus medius, gluteus minimus and TFL which are abductors and internal rotators of the thigh

227
Q

Inferior gluteal nerve roots

A

L5-S2

228
Q

Anatomical course of inferior gluteal nerve

A

Passes below piriformis to supply gluteus maximus, major hip extensor

229
Q

Posterior femoral cutaneous nerve roots

A

S1-S3

230
Q

Anatomical course of PFC

A

Sensory nerve leaves the pelvis to enter buttock via the greater sciatic notch

Supplies skin of posterior thigh and popliteal fossa

231
Q

Pudendal nerve roots

A

S2-4

232
Q

Anatomical course of pudendla nerve

A

mixed leaves pelvis to enter perineum via the greater sciatic notch

Motor to perineal muscles and external anal sphincter

Sensory to skin of perineum, penis, scrotum and anus

233
Q

Features of lesions of the lumbar plexus

A

Usually incomplete, abdominal pathology

Motor: weakness in hip flexion, leg extension, thigh external rotation and thigh adduction

Sensory loss to the inguinal and genital region, lateral thigh, anterior and medial thigh, medial leg and foot

Absent femoral or genitofemoral reflexes

234
Q

Usually incomplete, abdominal pathology

Motor: weakness in hip flexion, leg extension, thigh external rotation and thigh adduction

Sensory loss to the inguinal and genital region, lateral thigh, anterior and medial thigh, medial leg and foot

Absent femoral or genitofemoral reflexes

A

Lumbar plexus lesion

235
Q

Sacral plexus lesions

A

Usually incomplete

Pelvic

Weakness in the abduction and internal rotation of the thigh, hip extension, knee flexion and all muscles of leg and foot

Sensory loss in posterior thigh and most of leg and foot except medial aspect

Absent achilles

Bowel and bladder control compromised

236
Q

Neurotransmitter of postganglionic SNS

A

NAdr except for adrenal medulla (Adr) and sweat glands (NACh)

237
Q

What causes the functional divergence of the symapthetic nervous system

A

Preganglionic SNS fibres characteristically synapse on several postganglionic neurones

In contrast to PNS in which the ganglionic innervation is relatively discrete

238
Q

Afferent sympathetic fibres

A

Pass through sympathetic ganglia without synapsing

Enter spinal nerves via white communicating rami and synapse in thoracolumbar DRG

239
Q

Afferent fibres carrying visercal pain related impulse run in

A

Sympathetic fibfes

In contrast to other visceral afferent stimuli which travel with parasympathetics

240
Q

Hering-Bruer reflex

A

Ventilatory reflex protecting lung from hyperinflatoin

As lung inflates afferent impulses are sent to expiratory centre through relay in nucleus of the solitary tract

expiratory centre in turn inhibits the inspiratory centre and promotes passive expirration.

241
Q

Termination of autonomic afferent fibres from baroreceptors

A

In the nucleus solitarius

242
Q
A