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Peds neuro boards, V2 > Plexopathies / preipheral nerves > Flashcards

Plexopathies / preipheral nerves Flashcards

1
Q

Lesion of the lateral cord causes__(3)__

A
  1. Sensory loss over lateral forearm
  2. Weakness of elbow
  3. Weakness of wrist flexion
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2
Q

Lesion of the medial cord causes __(3)__

A
  1. sensory loss over medial forearm
  2. some weakness of long finger flexors
  3. weakness of intrinsic hand muscles
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3
Q

Ulnar Nerve

Roots

Motor (4)

Sensory

Lesion = ____

A
  1. Roots: 7,8,T1
  2. Motor
    1. finger abduction
    2. finger adduction
    3. flexion of digits 4-5
    4. Wrist flexion
  3. Sensory (below)
  4. Lesion =
    1. Claw hand deformity
      1. hyperextension of last 3 digits at metacarpophalangeal joints
      2. flexion at interphalangeal joints
    2. lack of sensation to 5th digit and medial 4th digit
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4
Q

Damage to anterior interosseus nerve

A

Anterior interosseous nerve syndrome

  1. Pain in arm / forearm
  2. Weakness of forearm pronation
  3. Weakness of flexion of terminal phalanx of thumb
  4. weakness of flexion of terminal phalanges of 2nd and 3rd digits
  5. normal sensation
  6. “teardrop sign” - unable to make “OK” sign; looks squashed
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5
Q

Phalen’s sign

A

wrist flexion produces parathesias in median nerve distribution

(carpal tunnel syndrome)

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6
Q

Tinel’s Sign

A

Tapping over median nerve at wrist elicits parasthesias in the median nerve distribution

(carpal tunnel syndrome)

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7
Q

How to differentiate between an ulnar nerve lesion and a T1 radiculopathy

A

Test the abductor pollicis brevis (innervated by median nerve)

1.

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8
Q

Cubital tunnel syndrome

A
  1. compression of ulnar nerve in cubital tunnel (at elbow)
  2. Symptoms
    1. decreased grip
    2. problems with finger dexterity
    3. numbness and parasthesias in ulnar distribution
    4. +/- claw hand
    5. +/- Formet’s sign
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9
Q

Fromet’s sign

A
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10
Q

Branches of the lateral cord (4)

A
  1. Lateral cutaneous nerve of forearm (5,6)
  2. Lateral pectoral nerve (5,6,7)
  3. musculocutaneous nerve (5,6,7)
  4. median nerve (5,6,7,T1) [along with medial cord]
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11
Q

Damage to musculocutaneous nerve

A
  1. loss of sensation of medial ventral and lateral dorsal foream
  2. difficulty supinating forearm
  3. difficulty flexing elbow
  4. absent biceps reflex

“think of what you do during a bicep curl”

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12
Q

Radial nerve

  1. roots
  2. Motor (4)
  3. sensory
A
  1. Roots
    1. 5,6,7,8
  2. Motor = “fencers posture”
    1. extension @ elbow
    2. Extension @ wrist
    3. Forearm supination
    4. Thumb extension
  3. Sensory (below)
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13
Q

Median Nerve

  1. Roots
  2. Motor
  3. Sensory
A
  1. Roots: 5,6,7
  2. Motor
    1. Flexion of Digits 1 + 2
    2. Thumb opposition
    3. wrist flexion
    4. Forearm pronation
  3. Sensory (below)
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14
Q

Posterior Cord:

  1. Branches
  2. Symptoms of Lesion (3)
A
  1. Branches = “rats”
    1. Radial (5,6,7,8)
    2. Axillary (5,6)
    3. Thoracodorsal (6,7,8)
    4. Subscapular(5,6,7)
  2. Lesion
    1. Sensory loss of posterior arm and hand (radial)
    2. weak shoulder abduction (axillary, subscapular, thoracodorsal)
    3. Weak extension of fingers, wrist, and elbow (radial)
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15
Q

Axillary Nerve

Roots

Motor

Sensory

Commonly injured in__2__

A
  1. Roots: 5,6
  2. Motor
    1. Shoulder abduction 15*-90*
    2. external rotation
  3. Sensory (below)
  4. Commonly injured in:
    1. humerous fractures
    2. SHoulder dislocation
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16
Q

Symptosm of C7 radiculopathy (4)

A
  1. sensory loss over middle finger
  2. weakness of triceps
  3. weakness of wrist extension
  4. diminished or absent triceps reflex
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17
Q

Nerves receiving input exclusively from the medial cord (3)

  1. Roots
  2. Motor
  3. Sensory
A

Median pectoral nerve (C8, T1)

  1. Pectoralis major (adducts arm, rotates arm medially)
  2. pectoralism minor (lowers scapula, pulls shoulder forward)

Medial cutaneous nerve of Arm (C8,T1)

Medial cutaneous nerve of forearm (C8/T1)

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18
Q

How do you idifferentiate an ulnar nerver lesion from a T1 radiculopathy?

A
  1. test abductor pollicis brevis (originates from T1, but innervated by median nerve)
  2. Can they abduct thumb perpendicular to hand?
    1. Yes = ulnar
    2. No = T1 radiculopathy
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19
Q

Causes of Medial versus Lateral scapular winging

A

“don’t get caught in the Late, 11th hour trap

Medial winging: long thoracic nerve (serratus anterior)

Lateral winging: Cranial nerve XI > trapezius

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20
Q

How to differentiate betwen injury to radial nerve at:

Spiral groove

Axilla

A
  1. Spiral groove: “groovy saturday night palsy”
    1. wrist + finger drop
    2. weakness of supination
    3. (mild) weakness of elbow flexion
    4. Sensory loss @dorsum of hand
    5. Can extend elbow just fine! (triceps and aconeus branch before spiral groove)
  2. @axilla
    1. Saturday night palsy + decreased elbow extension
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21
Q

Thoracodorsal nerve

  1. Roots
  2. Motor
A
  1. Roots: C6,C7,C8
  2. Motor
    1. Latissimus dorsi
      1. adducts arm
      2. internally rotates arm
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22
Q

Radiculopathy:

C7 (4)

C8 (2)

T1 (4)

A
  1. C7
    1. weakness of elbow extension
    2. weakness of wrist extension
    3. weakness of forearm pronation
    4. Sensory loss to 34d and 4th digits
  2. C8
    1. Weakness of distal phalanx of 2nd and 3rd digits
    2. little finger parasthesia
  3. T1
    1. “C8” plus
    2. decreased sensation at axilla
    3. motor defecit of intrinsic hand
    4. horners
23
Q

Hornblowers sign

Used to assess for __

How to test it

A
  1. Used to test for tears to teres minor
  2. How to test it
    1. hold arm @90 degrees to scapular plane
    2. elbow flexed @ 90 degrees
    3. patient instructed to externally rotate against resistance
24
Q

Nerves, compartments, and muscles of Leg

A

“Frequently Asked Questions I Obviously Merit Graceful Answers I To Please Some Fine Folks”

Femoral nerve: Anterior Compartment: Quadriceps muscle

Obturator nerve: Medial Compartment: Gracillis and adductor muscles

Tibial nerve: Posterior compartment: Soleus, Foot Flexors

​

25
Q

Reflex arcs and nerve roots

  1. Biceps
  2. Brachoradialis
  3. triceps
  4. Knee
  5. Ankle
A
  1. biceps - C5/C6
  2. Brachioradialis - C5/C6
  3. triceps - C7
  4. Knee - L3, L4
  5. Ankle - S1, S2
26
Q

Klumpke’s Palsy

when does it happen?

What is injured?

Symptoms (3)

A
  1. Injured during birth (hyper-adduction)
  2. injured
    1. lower trunk of brachial plexus
  3. Symptoms
    1. “claw hand” due to weakness of:
      1. intrinsic hand muscles
      2. Finger flexors
    2. +/- Horners syndrome (due to 1st thoracic nerve root)
      1. Anhydrosis
      2. ptosis
      3. miosis
27
Q

Horners syndrome

What is injured?

What are the symptoms?

A
  1. Injury to first throacic nerve root
  2. Features
    1. Ptosis
    2. anhydrosis
    3. miosis
28
Q

Posterior Femoral cutaneous nerve

Roots

Functions (2)

A
  1. Roots: S1, S2, S3
  2. Functions:
    1. Sensation to posterior thigh
    2. Popliteal Fossa
29
Q

Pudendal Nerve

Roots

Motor (2)

Sensory (3)

A
  1. Roots: S1, S2, S3, S4
  2. Motor
    1. External urethra
    2. Anal sphincters
  3. Sensory
    1. Perineum
    2. External genitalia
    3. Anus
30
Q

Sciatic Nerve

Roots

Complete sciatic neuropathy results in:

Motor: (3)

Sensory: (2)

Other

A
  1. Roots: L3, L4, L5, S1, S2, S3
  2. Motor
    1. Weakness of knee flexion
    2. Weakness of all movements of ankles / toes
      1. (can result in foot drop)
    3. Ankle jerk impaired / absent
  3. Sensory
    1. impaired sensations below knee EXCEPT
      1. NOT medial foot
      2. NOT medial leg
31
Q

Tarsal tunnel syndrome:

Caused by ____

Symptoms (3)

A
  1. Caused by injury to tibial nerve and it’s branches in the tarsal tunnel (duh)
  2. Symptoms
    1. burning pain in ankle and/or foot that worsens:
      1. When weight bearing
      2. at night
    2. Peri-malleolar pain
    3. parasthesias of sole
32
Q

Tibial Nerve

Roots (5)

Motor (3)

Testing note

A

“tibial nerves lets you tiptoe”

  1. Roots: L4, L5, S1, S2, S3
  2. Motor
    1. Plantar flexion
    2. Foot inversion
    3. achilles reflex (efferent)
  3. Test
    1. test while foot is plantar flexed to eliminate effect of tibialis anterior (inn. by deep fibular nerve)
33
Q

Branches of femoral nerve

34
Q

Lateral femoral cutaneous nerve of thigh

Roots

Sensation

Related condition

A
  1. Roots, L2, L3
  2. Sensation (below)
  3. Related condition: meralgia parasthetica
    1. sensation loss of lateral thigh
    2. Caused by
      1. tight clothing
      2. pregnancy
      3. obesity
      4. heavy weights carried at waist
35
Q

Naughty nerves:

Iliohypogastric

  1. Roots
  2. Motor (2)
  3. Sensory (3)

Ilioinguinal nerve

  1. Roots
  2. Motor (2)
  3. Sensory (3)

Genitofemoral nerve

  1. Roots
  2. Motor (1)
  3. sensory (2)
A
  1. Iliohypogastric nerve (T12-L1)
    1. Motor
      1. Internal oblique
      2. transversus abdominus
    2. Sensory
      1. Sensation to hip
      2. outer buttocks
      3. abdomen above pubis
  2. Ilioinguinal nerve (T12-L1)
    1. Motor
      1. internal oblique / transversus abdominus
    2. Sensation
      1. medial thigh
      2. pubis
      3. external genitalia
  3. Genitofemoral (L1, L2)
    1. Motor: cremasteric reflex
    2. Sensation
      1. upper thigh
      2. external genitalia
36
Q

Trendelenberg Sign

What is weak?

Sign?

A
  1. Weakness of gluteus medius and minimus
    1. (superior gluteal nerve)
  2. Sign
    1. lowering of contralateral hip when standing on leg on affected sign
37
Q

Piriformis syndrome

What Causes it?
What are the symptoms?

A
  1. Cause
    1. Compression of sciatic nerve by piriformis muscle as it passes through sciatic notch
  2. Symptoms
    1. Buttock Pain
    2. Sciatica
38
Q

Obturator nerve

Roots

Motor (5)

Sensation (1)

Can be injured during _____

A
  1. Roots: L2, L3, L4
  2. Motor
    1. Difficulty adducting thigh
    2. difficult rotating thigh
    3. difficulty flexing knee
  3. Sensation
    1. Medial thigh
  4. Damaged during child birth
39
Q

Common Peroneal Nerve

Roots
Branch 1(2)
Branch 2 (3)

Symptoms of common peroneal neuropathy

A
  1. Common peroneal nerve (L4, L5, S1, S2)
  2. Deep Peroneal nerve
    1. Dorsiflexes foot
    2. Sensation between 1st and 2nd toes
  3. Superifical peroneal nerve
    1. Foot Eversion
    2. Sensation to mid calf
    3. sensation to lower calf
  4. Common peroneal neuropathy
    1. Foot drop
      1. High stepping gait
      2. weak dorsiflexion
    2. Numbness of
      1. Dorsum of foot
      2. first web space
40
Q

EMG findings:

Dermatomyositis

A
  1. large amplitude, long duration, complex motor unit action potentials
41
Q

Diagnostic histopathologic feature for dermatomyositis

A

Perifascicular atrophy

42
Q

Differentiate fibers from Corticospinal Tract (CST) and Corticular pathway (CRP)

A

CST = control of movements of distal extremities (particularly fine motor movements of hand)

CRP: innervates proximal and axial muscles

43
Q

Patient complains of pain when pronating arm + tingling of digits 1-3

Weakness of wrist flexion and thumb abduction

How to differentiate Median nerve palsy above versus at the elbow?

A

Pronator teres syndrome (median nerve compression at elbow) = NORMAL strength, while above the elbow lesion would result in weakness

Fun fact: pronator teres is not affected since it is innervated before the elbow.

44
Q

Patient with Pain and weakness of finger extension. Locate lesion based on the following:

  • wrist drop + inability to supinate + sensory loss of dosurm of hand, but Present tricep reflex
  • Wrist drop + inabilty to supinate + sensory loss of hand, and ABSENT tricep reflex
  • No problems with supination, no problem with wrist extension
A
  • Radial nerve impingment at spiral groove (due to unaffected tricep)
  • Radial nerve impingment at axilla
  • Radial nerve just proximal to elbow (posterior interosseous neuropathy)
45
Q

Differentiate the following

A-Alpha fibers (2)
A-Beta fibers (1)
A-Delta fibers (2)
C-Fibers (2)

A
  • A-alpha
    • fastest and largesst sensory nerves
    • carry information from gogli tendonx and muscle spindles
  • A-Beta
    • cutaneous mechanoreceptors
  • A-Delta
    • “fast pain” fibers
    • thinly myelinated
  • C-fibers
    • “slow” pain
    • unmyelinated
46
Q

Patient is recovering in Spinal trauma wards. Unable to move below lesion, no pain / temp sensation, but is able to feel vibration and tell where his foot is when he closes his eyes

What three other things should you caution him about?

A

Anterior spinal cord syndrome

  • Urinary retention
  • intestintal obstruction
  • Flaccid anal sphincter
47
Q

What Nerve roots are likely affected?

  1. Hamstring weakness
  2. Numbness of dorsum of foot
  3. weakness of dorsiflexion and hamstrings
  4. Weakness of hip flexors
  5. Weakness of quads + medial calf numbness
A
  1. Weakness of hamstring
    1. L5, S1, S2
  2. Numbness of dorsum of foot
    1. Sciatic nerve (L4, L5, S1, S2, S3)
    2. Common peroneal (L4, L5, S1, S2)
    3. L5, S1 dermatomes
  3. Weakness of dorsiflexion and hamstrings
    1. S1, S2
  4. Weakness of hip flexors
    1. Femoral nerve (L2, L3, L4)
  5. Weakness of quadriceps + numbness of calf
    1. L4 radiculopathy
48
Q

Patient presents with Erb-Duchenne palsy

What nerve roots are affecte?

49
Q

Radiculopathies and symptosms:
C5 (1)
C6 (3)
C7 (3)
C8 (2)
T1 (3)

A
  1. C5
    1. Loss of sensation of lateral arm
  2. C6 (think musculocutaneous + sensory of median nerve)
    1. loss of innervation to thumb, index finger, and lateral FOREarm
    2. Weaknesss of biceps, brachioradialis, and pronator teres
    3. Diminished Biceps and brachioradialis reflex
  3. C7 (think about quickly giving someone the finger)
    1. Sensory loss over middle finger
    2. triceps weakness
    3. diminished triceps reflex
  4. C8
    1. Senosry loss and pain over medial hand and forearm
  5. T1
    1. Sensory loss and pain over medial arm and axilla
    2. intrinsic hand muscle weakness
50
Q

Surfer’s Myopathy

A

vascular insufficiency of spinal cord from sudden hyperextension of neck or back

51
Q

Erb-Duchenne palsy = damage to what nerve root?

52
Q

Symptoms of L4 radiculopathy

A

Quadriceps weakness, numbness of medial calf

53
Q

Erbs palsy affects what roots?

Peds neuro boards, V2 (29 decks)

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