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Neuroscience_TKJ > Perpheral Nerves (Normal and Pathological) > Flashcards

Perpheral Nerves (Normal and Pathological) Flashcards

1
Q

Which is the posterior root?

A
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2
Q

Which is is the anterior root?

A
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3
Q

Which is the posterior ramus? And what does the posterior ramus do? Can you give any other names for the post. ramus?

A

The posterior ramus = the posterior division of a spinal nerve

It carries information that supplies muscles and sensation to the human back.

  • other names for posterior ramus =
    • dorsal ramus of spinal nerve
    • posterior ramus of spinal nerve
    • posterior primary division
    • The dorsal ramus carries
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4
Q

Which is the posterior root ganglion?

A
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5
Q

Which is the spinal cord?

A
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6
Q

Which is the anterior rami?

What is it? and what does it do? Can you give any other names for this structure?

A

the anterior ramus = the anterior division of a spinal nerve.

The anterior rami supply the antero-lateral parts of the trunk and the limbs. They are mainly larger than the dorsal rami.

aka. ventral rami

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7
Q

Which are the communicating rami?

what are these? and what do they do?

are there any other names for this structure?

A

communicating rami = any of the bundles of nerve fibers connecting a sympathetic ganglion with a spinal nerve and being divided into two kinds:

a: one consisting of myelinated preganglionic fibers — called also white ramus, white ramus communicans

b : one consisting of unmyelinated postganglionic fibers — called also gray ramus, gray ramus communicans

aka. rami communicantes

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8
Q

________ = any of the bundles of nerve fibers connecting a sympathetic ganglion with a spinal nerve

A

rami communicantes; communicating rami

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9
Q
A

rami communicantes; communicating rami

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10
Q

_______**_carries information that **supplies muscles and sensation to the human back.

A

posterior ramus

aka. dorsal ramus

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11
Q

Rami = latin for ____

A

branch

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12
Q

There are two types of rami communicantes

white ramus communicans = consisting of _______ fibers - called also white ramus

gray ramus communicans = consisting of ________ fibers - called also gray ramus

A

myelinated preganglionic

unmyelinated postganglionic

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13
Q

rami communicantes are any of the bundles of nerve fibers connecting a ______ with a _____ and being divided into two kinds:

white ramus - consisting of myelinated preganglionic fibers

gray ramus - consisting of unmyelinated postganglionic fibers

A

sympathetic ganglion; spinal nerve

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14
Q

The brachial plexus contains ventral rami from spinal nerves _____. This plexus innervates the _____ and _____.

The lumbar plexus contains ventral rami from spinal nerves ______.

The sacral plexus contains ventral rami from spinal nerves _____.

The lumbar and sacral plexuses innervate the _____ and lower limbs.

A

C5-T1

pectoral girdle; upper limb

L1-L4

L4-S4

pelvic girdle & lower limbs

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15
Q

The brachial plexus contains ____rami from spinal nerves C5-T1.

______ innervates the pectoral girdle and upper limb.

The lumbar plexus contains _____ rami from spinal nerves L1-L4.

The sacral plexus contains _____ rami from spinal nerves L4-S4.

The ____ and ____ plexuses innervate the pelvic girdle and lower limbs.

A

The brachial plexus

ventral

ventral

lumbar; sacral

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16
Q

After the spinal nerve exits the intervertebral foramen it branches into the ____, ____, & ____.

Each of these structures carries sensory and motor information.

A

dorsal ramsus, ventral ramus and ramus communicans

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17
Q

After the spinal nerve exits the intervertebral foramen it branches into the dorsal ramsus, ventral ramus and ramus communicans.

Each of these structures carries ______ information.

A

sensory and motor

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18
Q

the brachial plexus formed by nerve roots arising from the ___________

A

cervical enlargement at C5 - T1

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19
Q

The Lumbosacral plexus formed by nerve roots arising from the _________

A

lumbosacral enlargement at L1 – S4

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20
Q

what is #1

what does it innervate?

A

dorsal scapular nerve.

rhomboid major; rhomboid minor, levator scapula?

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21
Q

What is #2? What does it innervate?

A

Nerve to subclavius

subclavius mm; which acts to depress the clavicle

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22
Q

What is #3? What does it innervate?

A

Suprascapular nerve. (mixed nerve)

motor sensation to inn. supraspinatus mm. + infraspinatus mm.

supraspinatus = shoulder abductor

infraspinatus = shoulder ER

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23
Q

What is #4?

Where does it come from? And where is it going?

A

Upper trunk of the brachial plexus

comes from C5/6 n. roots

gives rise to anterior and poster division

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24
Q

What is #5?

Where does it come from? And where is it going?

A

middle trunk

comes from C7 n. root

helps to forms anterior and posterior divisions of brachial plexus

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25
Q

What is #6?

Where does it come from? And where is it going?

A

lower trunk

C8/T1 nerve roots

helps form the anterior and posteior divisions of the brachial plexus

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26
Q

What is #7?

Where does it come from? And where is it going?

A

Divisions → of the brachial plexus

forms anterior and posterior divisions that will become anterior, posterior, and medial cords of brachial plexus

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27
Q

What is #8?

Where does it come from? And where is it going?

A

Anterior division of the brachial plexus

forms the lateral cord + medial cord

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28
Q

What is #9?

Where does it come from? And where is it going?

A

posterior division

helps form posterior cords

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29
Q

What is #10?

Where does it come from? And where is it going?

A

Cords of the brachial plexus

Roots → Trunks → Division → Cords → Branches

(randy travis drink cold beer)

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30
Q

What is #11?

Where does it come from? And where is it going?

A

Lateral Cord (C5-6-7)

Formss the anterior divisions of upper trunk + middle trunk (C5-6-7)

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31
Q

What is #12?

Where does it come from? And where is it going?

A

Posterior Cord (C5-T1)

comes from the upper, middle, and lower trunk

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32
Q

What is #13?

Where does it come from? And where is it going?

A

Medial Cord (C8-T1)

comes from the anterior division of the lower trunk

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33
Q

What is #14?

Where does it come from? And where is it going?

A

Branches of brachial plexus

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34
Q

What is #15?

Where does it come from? And where is it going?

A

Branch of brachial plexus

Musculocutaneous n.

(C5-C7)

innervates the three muscles of the anterior compartment of the arm: the coracobrachialis, biceps brachii, and brachialis. It is also responsible for cutaneous innervation of the lateral forearm

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35
Q

What is #17?

Where does it come from? And where is it going?

A

Axillary nerve

comes from the Posterior Cord

C5-C6

inn. Deltoid mm + Teres minor

Deltoid muscle = shoulder abductor, flexor, extensor

Teres minor = Sh ER

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36
Q

What is #18?

Where does it come from? And where is it going?

A

radial nerve

(C5-C8)

comes from posterior cord

  • Inn. the posterior portion of the arm + forearm
  • innervates medial + lateral heads of the triceps brachii
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37
Q

What is #19?

Where does it come from? And where is it going?

A

Median nerve

comes from Median + Lateral cords (C5-C8)

  • inn = anterior forearm and hand
    • flexor digitorum superficialis + pronator quadratus get sole innervation by the median nerve
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38
Q

What is #20?

Where does it come from? And where is it going?

A

Ulnar Nerve

comes from medial cord (C8-T1)

  • the flexor muscles of the forearm
    • flexor carpi ulnaris + flexor digitorum profundus.
  • Intrinsic muscles of the hand
    • palmaris brevis
    • lumbricals
    • hypothenar
    • interossei muscles
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39
Q

What is #21?

Where does it come from? And where is it going?

A

Medial cutaneous nerve of FOREARM

aka. (medial antebrachial cutaneous nerve)

C8-T1

median cord → Medial cutaneous nerve of FOREARM

supplies = anterior + medial aspects of forearm + wrist

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40
Q

What is #22?

Where does it come from? And where is it going?

A

medial cutaneous n. of the arm

aka. medial brachial cutaneous nerve

(C8-T1)

  • provides sensation to the medial cutaneous aspect of the arm.
  • It is the smallest and most medial branch of the brachial plexus
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41
Q

What is #23?

Where does it come from? And where is it going?

A

thoracodorsal n.

comes from the posterior cord

(C6-C8)

innervates latissimus dorsi muscle.

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42
Q

What is #24?

Where does it come from? And where is it going?

A

subscapular nerve

(C4-C6)

upper trunk → posterior cord → subscapularis muscle (IRs +adducts the humerus)

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43
Q

What is #25?

Where does it come from? And where is it going?

A

medial pectoral nerve

(C7-C8) → lower trunk → medial cord → sternal head of pec major + Pec minor

  • Pec major action = flexion, adduction, and IR of the humerus
  • pec minor = stabilization, depression, abduction/ protraction, IR and downward rotation of the scapula
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44
Q

What is #26?

Where does it come from? And where is it going?

A

Long Thoracic Nerve

C5-C7 → superior trunk → passes posterior to the brachial plexus → Serratus Anterior muscle

(some people have C8 inn. of SA)

  • SA action
    • shoulder protraction (during punching)
    • upward rotation of scapula during lifting
    • assists with breathing
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45
Q

What is #27?

Where does it come from? And where is it going?

A

Lateral Pectoral Nerve

innervates clavicular head of pec major, which

C5-C6 → upper trunk → lateral cord → (clavicular) pec major mm

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46
Q

The Musculocutaneous N. comes from which cord? and which nerve roots?

A

Lateral cord

C5-C7

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47
Q

The Axillary N. comes from which cord? and which nerve roots?

A

posterior cord C5-C6

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48
Q

The Radial N. comes from which cord? and which nerve roots?

A

Posterior cord, C5-8

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49
Q

The Median N. comes from which cord? and which nerve roots?

A

Median and Lateral cords, C5-8

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50
Q

The Ulnar N. comes from which cord? and which nerve roots?

A

Medial cord, C8-T1

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51
Q

The Medial Cutaneous nerve of forearm comes from which cord? and which nerve roots?

A

Medial cord, C8-T1

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52
Q

The Thoracodorsal nerve comes from which cord? and which nerve roots?

A

Posterior cord, C6-8

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53
Q

The Subscapular nerve comes from which cord? and which nerve roots?

A

Posterior cord, C5-C6

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54
Q

The Dorsal Subscapular nerve comes from which cord? and which nerve roots?

A

Plexus root, C(3-4)5

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55
Q

The Lateral Pectoral Nerve comes from which cord? and which nerve roots?

A

Lateral cord, C5-7

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56
Q

The Medial Pectoral nerve comes from which cord? and which nerve roots?

A

Medial cord, C7-8

Snyder = C8-T1

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57
Q

The Nerve to Subclavius comes from which cord? and which nerve roots?

A

plexus root

C5-C6

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58
Q

The Suprascapular nerve comes from which cord? and which nerve roots?

A

Upper Trunk, C4-C6

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59
Q

Posterior cord nerve branches are:

(hint: STAR or ARTS)

A

axillary n

radial n.

thoracodorsal n.

subscapular n.

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60
Q
A
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61
Q

What are the 5 important nerves in the arm?

(hint: 3 musc. men assassinate 5 rats, 4 mice, & 3 OK uncles)

A

Radial n.

median n.

ulnar n.

musculocutanous n

axillary n.

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62
Q

Motor functions of the ulnar nerve = ____

A

finger adduction & abduction (BUT NO THUMB ABD)

thumb add.

flexion of digits 4+ 5

wrist flexion + adduction

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63
Q

region of sensory loss with neuropathy of the ulnar n =____

A

loss of sensation in digits 4+ % on dorsal and palmar side

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64
Q

Motor functions of the axillary nerve = ____

A

abd of arm at shoulder beyond 15 degrees

so loss of axillary n. = can’t abd shoulder past 15 degrees; supraspinatus would abd arm in the first 15 degrees

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65
Q

region of sensory loss with neuropathy of the axillary n =____

A

mid arm sensation loss (around deltoid insertion)

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66
Q

Motor functions of the musculocutaneous nerve = ____

A

flexion of arm at elbow + supination of forarm

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67
Q

region of sensory loss with neuropathy of the musculocutaneous n =____

A

front and back of forearm

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68
Q

Motor functions of the radial nerve = ____

A

extension of all arm, wrist, & finger joints

BELOW the shoulder: forearm supination; thumb abd (in plane of palm)

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69
Q

region of sensory loss with neuropathy of the radial n =____

A

loss of sensation on the back of the arm (central area)

elbow

down the forarm along C5? dermatome?

dorsal aspects of metacarpals 2,3 + thumb

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70
Q

Motor functions of the median nerve = ____

A

thumb flexion + opposition

flexion of digits 2+ 3

wrist flexion + abduction

forearm pronation

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71
Q

region of sensory loss with neuropathy of the median n =____

A

palmar side = loss of sensation along hand of benediction (thumbs + digits 2 &3)

dorsal side = digits 2,3, half of 4 (DIP- metacarpal area)

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72
Q

Radial nerve _____ the thumb in the plane of _____

A

abducts; the palm

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73
Q

Ulnar nerve _____ the thumb in the plane of _____

A

adducts; the palm

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74
Q

Median nerve ______ the thumb. Also it abducts the thumb______ to the plane of the thumb (not shown)

A

opposes; perpendicular

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75
Q

nLumbosacral plexus formed by nerve roots arising from the lumbosacral enlargement at _____

A

L1 – S4

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76
Q

Rami → Dorsal Ramus → ___, (nerve roots), ____→ Erector Spinae

A

T1-12, L1-5, S1-3

77
Q

erector spinae develop from the _____ rami of T1-12, L1-5, S1-3

A

dorsal

78
Q

the Lumbar plexus develops from ____ ramii of ____

A

anterior

L1-L4

79
Q

_____plexus dev from ant ramii of L1-L4

A

Lumbar

80
Q

_____ dev from ant ramii of S1-S4

A

Sacral plexus

81
Q

Sacral plexus dev from ___ ramii of ____

A

anterior; S1-S4

82
Q

Where is the iliohypogastric nerve? what does it supply and what does it do?

A

supplies sensation to skin over the lateral glute + hypogastric regions

motor to the internal oblique mm + transverse abdominal mm

83
Q

The Lumbar Plexus gives rise to which nerves?

(Hint: FLOG)

A
  • Obturator nerve (L2-4)
  • Femoral nerve (L2-4)
    • branches off femoral → Saphenous nerve
  • Lateral (ant) femoral cutaneous n. (L2-3)
  • Genitofemoral nerve (L1-2)
84
Q

Obturator nerve

Has what nerve roots? Comes from which division of the lumbar plexus

A

anterior division

L2-L4

85
Q

Femoral Nerve

Has what nerve roots? Comes from which division of the lumbar plexus

A

posterior dvision

L2-L4

86
Q

Saphenous nerve

branches off what nerve, and comes from which division of the sacral plexus

A

femoral nerve

posterior division

87
Q

Lateral (ant) femoral cutaneous n.

Has what nerve roots?

A

(L2-L3)

88
Q

Genitofemoral nerve

A

L1-2

89
Q

the Sacral Plexus gives off which nerves? (6)

A
  • sciatic n
    • common fibular nerve
    • tibial n.
  • Superior Gluteal nerve
  • Inferior Gluteal nerve
  • Posterior femoral cutaneous nerve
  • Pudendal nerve, S2-4
90
Q

The sciatic nerve gives off two branches. name them

A

tibial nerve (L4-S2) → Snyder (L4-S3)

common fibular nerve (L2-S1)

91
Q

tibial nerve is part of which plexus?

what are its nerve roots? and which division?

what nerve does it give rise to?

A

Anterior Division

L4-S2 (TKJ) ; L4-S3 (Snyder)

gives rise to Sural Nerve

92
Q

the common fibular nerve is a part of which plexus?

It has what n. roots and comes from which division?

(aka. peroneal n)

A

Sacral Plexus

Posterior Division

L4-S1

93
Q

FLOG is the acronym for which plexus?

A

Lumbar

94
Q

What nerves belong to the sacral plexus?

(HINT: SIPP-S(TC))

A

Superior gluteal nerve

Inferior gluteal nerve

Posterior femoral cutaneous nerve

pudendal nerve

____

Sciatic nerve

tibial

common fibular nerve

95
Q

Superior Gluteal nerve

which plexus? which division? which nerve roots?

A

sacral

Posterior Division, L4-S1

96
Q

inferior gluteal nerve

which plexus? which division? which nerve roots?

A

sacral

posterior, L5-S2

97
Q

Posterior femoral cutaneous nerve

which nerve roots?

A

S1-S3

98
Q

Pudendal nerve

which nerve roots?

A

S2-S4

99
Q
A
100
Q

Important nerves in the leg are:

___________________________________

A

obturator n

sciatic n

femoral n

tibial n

superificial fibular n

deep fibular nerve

101
Q

What are the major motor functions of the tibial nerve?

A

foot plantar flexion, INV, toe flexion

102
Q

Region of sensory loss that would occur with a tibial (posterior) neuropathy = ____

A

bottom of the foot

103
Q

which areas would have loss of sensation with a superficial fibular nerve neuropathy

A

Loss of sensation over the lateral compartment of the lower leg + the dorsal aspect of the foot (except btwn great toe and middle toe)

superficial fibular nerve supplies the fibularis longus and the fibularis brevis. These muscles form the lateral compartment of the lower leg.

104
Q

Motor function of the superficial fibular nerve = ____

A

foot eversion

superficial fibular nerve supplies the fibularis longus and the fibularis brevis. These muscles form the lateral compartment of the lower leg.

105
Q

Motor function of the deep fibular nerve = ____

A

dorsi flexion; great toe extension

deep fib nerve inn.s the anterior compartment of the leg.

106
Q

neuropathy of deep fibular nerve would result in = ____

A

loss of sensation in the toe space between the great toe and the 2nd toe

107
Q
A
108
Q

Upper Extremity nerve injuries

Erb-Duchenne Palsy is an injury to which plexus? which trunk?

what happens?

what pose might patient display?

A

brachial plexus; upper trunk injury

Loss of C5-6 muscles → Deltoid, biceps, infraspinatus, wrist extensors

dead giveaway presentation = “Bellman’s” or “Waiter’s Tip” pose

(wrist flexion, sh IR, sh add)

109
Q

Upper Extremity nerve injuries

how might Erb’s Palsy happen?

what is the prognosis?

A

Common with traction between neck and shoulder

  • Difficult delivery
  • Motorcycle accidents

Prognosis = depends on severity (think a few months ago)

110
Q

Upper Extremity nerve injuries

this patient displays _____ which is an injury to _____?

A

upper trunk of brachial plexus

adduction, IR, elbow extension, wrist flexion

Weak deltoid – adduction

Weak biceps – extended elbow

Weak infraspinatous – internally rotated

Weak wrist extensors – wrist flexed

111
Q

Upper Extremity nerve injuries

this patient displays Erb’s Palsy, which means they likely have weakness in which muscles?

A

Weak deltoid → causes the adduction

Weak biceps -→ causes extended elbow

Weak infraspinatous → causes IR

Weak wrist extensors → causes wrist flexion

112
Q

Upper Extremity nerve injuries

this patient displays Erb’s Palsy,

a weak ____mm. results in the adducted arm

A

deltoid

113
Q

Upper Extremity nerve injuries

this patient displays Erb’s Palsy,

a weak ____mm. results in the extended elbow

A

bicep

114
Q

Upper Extremity nerve injuries

this patient displays Erb’s Palsy,

a weak ____mm. results in the IR

A

infraspinatus

115
Q

Upper Extremity nerve injuries

this patient displays Erb’s Palsy,

weak ____mm. results in the wrist flexion

A

wrist flexors

116
Q

Upper Extremity nerve injuries

A Brachial Plexus Lower Trunk Injury results in a loss of ____ muscles

A

C8-T1

  • Hand and finger extension weakness
  • Atrophy of hypothenar muscles
  • Sensory loss ulnar aspect of hand/forearm
117
Q

Upper Extremity nerve injuries

loss of C8-T1 muscles are _______ plexus injuries that result in

  • _____ weakness
  • Atrophy of _____ muscles
  • Sensory loss on ______
A

Lower brachial plexus

  • Hand and finger extension
  • hypothenar
  • ulnar aspect of hand/forearm
118
Q

Upper Extremity nerve injuries

Patient comes to you and complains of hand and finger extension weakness, atrophy of hypothenar muscles, and sensory loss in the ulnar aspect of their hand/forearm.

MOI= Stretch injury; caused by upward traction movement.

What type of injury is this?

A

Lower brachial plexus injury

C8-T1 are affected

119
Q

Upper Extremity nerve injuries

TOS is what type of injury?

what happens in TOS?

A

lower brachial plexus injury

in TOS

  • the lower brachial plexus is compressed as it passes between the clavicle and the 1st rib
  • UE flexion and external rotation increases the compression → symptoms worsen
  • Decreased brachial arterial pulses (Roos test)
120
Q

Upper Extremity nerve injuries

TOS is a _____ plexus injury,

  • ______brachial plexus is compressed as it passes between the ____ and the ______.
  • ____ and ____ increases the compression → symptoms worsen
  • Decreased ______ (Roos test)
A

Lower trunk brachial plexus

  • the lower; clavicle; 1st rib
  • UE flexion & ER
  • brachial arterial pulses
121
Q

Upper Extremity nerve injuries

Pancoast’s syndrome = an apical lung tumor that extends into the lower brachial plexus. The _______ nerve is occasionally involved as it loops downward into the thorax, producing hoarseness

A

Lower trunk brachial plexus injury

Recurrent laryngeal

122
Q

Upper Extremity nerve injuries

what might this represent?

A

pancoast’s injury = an apical tumor that extends into the lower brachial plexus.

can affect the recurrent laryngeal nerve as it decends into the drunk, producing hoarseness

123
Q

Upper Extremity nerve injuries

You suspect your patient has TOS, what special test might you perform to confirm/ deny your suspicions? and how would this test be performed?

A

Roo’s Test

Roos test = pt flexes elbow to 90; shoulder abducted to 90 and repeatedly open close hand for 1-3 min and watch for reproduction of symptoms.

124
Q

Upper Extremity nerve injuries

Axillary neuropathy = _____

it is caused by ______

is can also be mixed up with

A

Axillary neuropathy = Weakness and numbness in the (lateral) shoulder

  • can be caused by: Dislocation/ fracture of the proximal humerus → can lead to can compression of the axillary nerve
  • Differentiated from C5 root pathology via biceps strength + rotator cuff tear (make sure to test sensation at lateral shoulder)
125
Q

Upper Extremity nerve injuries

Radial neuropathy = ______

A
  • Weakness that occurs
    • in all extensors of the elbow, hand, & fingers
    • weakness in forearm supination
  • Loss of triceps reflex → [Hint * practice deep tendon reflexes]
  • Sensory loss in a radial nerve distribution
  • Wrist drop is often present
126
Q

Upper Extremity nerve injuries

Radial Neuropathy: can we caused by _____

A
  • Sleeping with arm over park bench → known as “Saturday night palsy”
  • Improper crutch use → “crutch palsy”
  • Fracture of humerus damaging the nerve as it enters spiral groove
127
Q

Upper Extremity nerve injuries

A patient comes in and tell you he fell asleep on a park bench with his arms displayed like the picture. You perform some tests, and note that he displays weakness in all extensors of his elbow, hand, and fingers. Tricep reflex is 0/4. Sensory testing is 2/5 along the radial nerve distribution. He is right-handed, and displays a wrist drop on that hand. He mentions also having a hard time turning his key to the right, to get through his front door.

What do you suspect he has?

A

Saturday night palsy/ radial neuropathy

turning his key to the right → Forearm supination

128
Q

Upper Extremity nerve injuries

In saturday night palsy, the brachioradialis mm, will test weak.

A

…

129
Q

Upper Extremity nerve injuries

In saturday night palsy, paresthesia can occur over which portion of the hand?

A

dorsum of hand, thumb and index finger

130
Q

Upper Extremity nerve injuries

Median neuropathy = _____

A
  • Weakness of :
    • wrist flexion and abduction
    • opposition of the thumb
    • flexion of the second and third digits

Sensory loss in the median nerve distribution

131
Q

Upper Extremity nerve injuries

this patient displays _____

A

radial neuropathy

loss of sensation on the dorsum of hand, thumb and index finger

132
Q

Upper Extremity nerve injuries

Weakness of wrist flexion and abduction, opposition of the thumb, flexion of the second and third digits. As well as sensory loss in the median nerve distribution are the symptoms of _______

A

Median neuropathy

“honeymooner’s palsy”

133
Q

Upper Extremity nerve injuries

name 3 ways median neuropathy might occur

A

Sleeping with lover’s head resting on the upper arm

Fractures of the humerus or distal radius

Entrapment can occur as the nerve passes through the pronator teres muscle

134
Q

Upper Extremity nerve injuries

Fractures of the humerus or distal radius can result in _____

A

median neuropathy

135
Q

Upper Extremity nerve injuries

A

…

136
Q

Upper Extremity nerve injuries

Carpal tunnel syndrome is what type of neuropathy?

What happens in carpal tunnel syndrome?

A

Median neuropathy

Carpel Tunnel Syndrome = and Entrapment syndrome

caused by compression of median nerve as it passes together with the tendons of the hand under the flexor retinaculum on the flexor surface of the wrist

137
Q

Upper Extremity nerve injuries

Carpal tunnel syndrome affects the ____ nerve

the best muscle to test when suspecting carpal tunnel syndrome = ____. Although ____ and ____ can also be weak.

sensory loss will occur in which digits?

paresthesias radiating up arm can happen at what time of the day?

A

median

abductor pollicis brevis = best muscle!

Thumb flexion & opposition also weak

Sensory loss in first, second, and third digits

Night-time paresthesias radiating up arm

138
Q

Upper Extremity nerve injuries

Your patient comes in and complains of numbness in their 1st, 2nd, and third digits. They display the hands of benediction. In their subjective, you clarify that this paresthesia worsens at night. Upon examination you find that the abductor pollicis brevis tests positive for weakness with a 2/5 MMT score. What do you suspect this injury is?

A

median nerve palsy

139
Q

Upper Extremity nerve injuries

Nerve entrapment at the elbow in the cubital canal/tunnel (funny bone) results in

A

ulnar neuropathy

140
Q

Upper Extremity nerve injuries

Ulnar neuropathy is caused by: _____

A

ulnar entrapment at the elbow in the cubital canal/tunnel (funny bone)

141
Q

Upper Extremity nerve injuries

A
142
Q

Upper Extremity nerve injuries

What is Tardy ulnar palsy?

A

Delayed result of a post-traumatic, degenerative, or congenital increased carrying angle of the elbow

143
Q
  • Fractures of the medial epicondyle or Compression after resting the elbows on a hard table can cause ______
A

ulnar neuropathy

144
Q

Tardy ulnar palsy is the delayed result of a _____, _____, or congenital _____.

A

post-traumatic, degenerative, increased carrying angle of the elbow

145
Q

Your patient comes with complaints of weakness/ pain performing wrist flexion and adduction, finger ab/adduction and flexion of 4th and 5th digits. What do you suspect is going on?

A

patient displays ulnar claw

classic display of ulnar neuropathy

146
Q

your patient comes in and displays weakness in wrist flexion and abduction, weakness in finger abd/add, as well as flexion of the 4th and 5th digits. You also notice atrophy along the dark blue areas of the hands. What could be the patient’s condition?

A

siminan hand

median and ulnar palsy/ neuropathy

147
Q

Lower Extremity nerve injuries

How might femoral neuropathy present?

A

Weakness of hip flexion and knee extension

Loss of patellar reflex

Sensory loss in anterior thigh

148
Q

Lower Extremity nerve injuries

Your patient presents with weakness of hip flexion and knee extension as well as loss of their patellar reflex. They also display sensory loss in anterior thigh. What might be the cause for this patient’s condition?

A

femoral neuropathy

149
Q

Lower Extremity nerve injuries

Femoral neuropathy presents with

  • Weakness of _____and ______
  • Loss of ______
  • Sensory loss in ______
A

hip flexion; knee extension

patellar reflex

anterior thigh

150
Q

Lower Extremity nerve injuries

what can cause femoral neuropathy?

A
  • Injury during pelvic surgery
  • Compression by a retroperitoneal hematoma or a pelvic mass
151
Q

Lower Extremity nerve injuries

sciatic neuropathy can be caused by: ____

A
  • Posterior hip dislocation
  • Acetabular fracture
  • Intramuscular injection placed too medially and inferiorly in the buttocks
152
Q

Lower Extremity nerve injuries

  • Posterior hip dislocation, Acetabular fracture, and Intramuscular injection placed too medially and inferiorly in the buttocks can cause _____
A

sciatic neuropathy

153
Q

Lower Extremity nerve injuries

these signs and symptoms should lead you to suspect:_____

  • Weakness in all foot/ankle muscles and knee flexion
  • Loss of Achilles reflex
  • Sensory loss in the foot and lateral leg below the knee
A
154
Q

Lower Extremity nerve injuries

Sciatic neuropathy presents with Weakness in ____ and _____, Loss of ____, and Sensory loss in the _____

A

all foot/ankle muscles; knee flexion

Achilles reflex

foot and lateral leg below the knee

155
Q

Lower Extremity nerve injuries

Your patient experiencing weakness in all foot/ankle muscles and displays weak knee flexion. While performing motor and sensory testing, you get a positive test for loss of the achilles reflex, sensation in the foot and lateral leg (below the knee) tests for 0/5. PMHx reveals acetabular fracture

A

sciatic neuropathy

  • Weakness in all foot/ankle muscles and knee flexion
  • Loss of Achilles reflex
  • Sensory loss in the foot and lateral leg below the knee
156
Q

Lower Extremity nerve injuries

Sciatica is a vague term that refers to all disorders causing painful paresthesias along the sciatic nerve distribution.

It is caused by: ______

A

compression of the lumbosacral roots by disc material or osteophytes

157
Q

compression of the lumbosacral roots by disc material or osteophytes that causes paresthesia along the sciatic nerve distribution is a condition known as _____

A

Sciatica

158
Q

the following signs and symptoms are displayed in ______

  • Plantar flexion severely compromised
  • Functionally: cannot effectively stand on toes or curl toes.
  • Sensation lost to a majority of the sole of the foot
A

Tibial Nerve Injury

159
Q

in tibial nerve injuries, ________ is severely compromised, and _____ is lost on majority of the sole of the foot. Functionally, the patient cannot effectively _____ on toes or curl toes.

A

plantar flexion

sensation

stand

160
Q

The following displays what type of injury?

  • Plantar flexion severely compromised
  • Functionally: cannot effectively stand on toes or curl toes.
  • Sensation lost to a majority of the sole of the foot
A

Tibial Nerve Injury:

161
Q

What is anterior compartment syndrome?

A

Loss of motor activity due to compression of deep fibular/peroneal nerve

162
Q

Loss of dorsiflexion, eversion, and toe extension due to compression of deep fibular/peroneal nerve is known as ______

A

anterior compartment syndrome

163
Q

In ________

the patient will present with severe pain during passive plantar flexion, eversion, and flexion of the toes as well inability to dorsiflex, invert, and extend the toes.

along with progressive ischemic pain, pale foot, swelling in the leg, numbness/paresthesia

A

anterior compartment syndrome

164
Q

Sensory loss to 1st interdigital cleft occurs with

A

anterior compartment syndrome

165
Q

anterior compartment is an urgent condition that requires surgical intervention for tx. some presenting signs and symptoms that can be seen are: _____, _____, _____, and ______.

A

along with progressive ischemic pain

pale foot

swelling in the leg

numbness/paresthesia

166
Q

compression, laceration, and stretch of the ______nerve as it passes around the fibular head near the skin surface causes ______

A

common peroneal

Peroneal Nerve palsy

167
Q
  • forced inversion
  • tight stockings, casts, or ski boots
  • Crossed legs
  • Trauma (fibular head fracture)

can be causes for ________

A

Peroneal nerve palsy

168
Q

Peroneal nerve palsy is caused by: _____, _____, ______, _____

A
  • forced inversion (stretching the common peroneal nerve)
  • tight stockings, casts, or ski boots
  • Crossed legs
  • Trauma (fibular head fracture)
  • lacerations
169
Q

A patient who had a fibular head fracture. During your subjective, the patient mentioned their cast gave them a lot of issues as it seemed to fit too tight. You perform a sensory assessment and notice impaired sensation over dorsolateral foot and shin (3/5). During your motor assessment you observe weak dorsiflexion and eversion. You also note a “foot drop” during your gait analysis. You suspect your patient has _____

A

Peroneal Nerve palsy

170
Q

patient presentation of _____

  • “foot drop” with weak foot dorsiflexion and eversion
  • Sensory loss over the dorsolateral foot and shin.
A

peroneal nerve palsy

171
Q
A
172
Q

Meralgia Paresthetica

a condition characterized by tingling, numbness and burning pain (paresthesias + loss of sensation) in the outer part of the thigh.

caused by entrapment of the lateral cutaneous nerve as it passes under the inguinal ligament or fascia lata.

No motor involvement or reflex changes*

A
173
Q

a condition characterized by paresthesias + loss of sensation such as tingling, numbness and burning pain in the outer part of the thigh is characteristic of _____ .

A

Meralgia Paresthetica

174
Q

Meralgia Paresthesia is caused by ____

some lifestyle factors that may contribute to meralgia paresthesia are ____

A

Entrapment of the Lateral cutaneous nerve as it passes under the inguinal ligament or fascia lata

obesity, pregnancy, weight loss, heavy equipment belts

175
Q

T/F

Unlike other neuropathies, there is no motor involvement or reflex changes in meralgia paresthesia

A

true!

176
Q

Morton’s metatarsalgia

NOT MORTON”S NEUROMA

A

Tight fitting shoes can compress the digital nerves, especially of the 3rd and 4th toes, producing patches of numbness and paresthesias

177
Q

Tight fitting shoes can compress the digital nerves, especially of the 3rd and 4th toes, producing patches of numbness and paresthesias is characteristic of

A

Morton’s metatarsalgia

178
Q

Morton’s metatarsalgia = patches of numbness and paresthesias at ______. Caused by _____that _____.

A

the 3rd and 4th toes

tight fitting shoes

can compress the digital nerves

179
Q

NCV = _____

A

Nerve conduction studies

Stimulating electrodes are placed on the skin overlying a nerve, and recording electrodes are placed over a muscle innervated by the nerve

180
Q

In NCV’s, Stimulating electrodes are placed on _______, and recording electrodes are placed _______. –With stimulus, a _____ or ______can be recorded

A

the skin - overlying a nerve

over a muscle - innervated by the nerve

compound motor action potential (CMAP)

sensory nerve action potential (SNAP)

181
Q

Know that if a nerve injury is suspected, an ____ is what we order for the patient

A

NCV (nerve conduction study)

182
Q

In NCV’s, There are standard values for SNAP (Absent to reduced sural amplitude) and CMAP (Compound Motor Action Potential) latencies or conduction velocities for each major nerve when stimulated at various points along the nerve.

  • Can detect demyelination or axonal destruction
A
183
Q

EMG = electromyography,

When conducting an evaluation, an electrode is inserted _____. MUP’s (_____) are recorded from the muscle cells

A

directly into the muscle

MUP’s = Motor unit action potentials

Recruitment pattern – synergy (UMN)

Fasciculations – (LMN)

184
Q

Sensory NCS (SNAP) Absent to reduced sural amplitude with borderline conduction velocities Motor NCS (CMAP) Normal to mildly prolonged distal latencies, reduced amplitudes, borderline conduction velocities

The summation of the sensory neuron APs of a peripheral nerve is termed the Sensory Nerve Action Potential (SNAP). In antidromic recording, the stimulus is delivered in the opposite of the physiologic direction (in sensory NCS, this is proximal to distal). Orthodromic recording measures AP propogation in the normal physiological direction and is distal to proximal for sensory NCS. The more common method of recording SNAPs is antidromic due to larger signal amplitudes and ease of recording2

The summation of the motor neuron APs, transmission through the neuromuscular junction and subsequent muscle fiber AP is termed the Compound Motor Action Potential (CMAP). The CMAP includes information about the number of afferent motor axons the nerve contains, the diameter and amount of myelin of those axons, the function of the neuromuscular junction (NMJ), and the number of excitable muscle fibers

A
185
Q

median neuropathies

A
186
Q
A
187
Q
A
188
Q

atrophy as a result of median neuropathy

A
189
Q

ulnar neuropathy

A

Neuroscience_TKJ (4 decks)

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