quiz 2 Flashcards
Median Nerve Palpation
First palpable in medial intermuscular septum of brachium.
Runs with ulnar nerve & brachial artery until mid-brachium, then continues with brachial artery.
Palpation between biceps & triceps may elicit symptoms.
Thumb on medial epicondyle, pressing superolateral, targets median nerve.
Swiveling thumb inferolateral while engaging pronator may recreate symptoms.
Deep motor branch (anterior interosseous nerve) passes through pronator teres.
Runs deep in mid-forearm; superficial sensory & palmar cutaneous branches emerge distally.
Digital sensory branch supplies digits 1-3 & lateral 4th digit palmar aspect & fingertips.
Median Nerve Anatomy
Terminates from medial & lateral cords of brachial plexus.
Roots: C5-C8 & T1.
Median Nerve autonomic impact
Possible trophic changes (edema, nail changes, skin fragility, sweating).
Median nerve motor
Forearm flexors, pronators, lateral lumbricals, thenar eminence.
Median nerve sensory
Skin over thenar eminence & palm (digits 1-3, lateral 4th); palmar surface of digits 1-3 & lateral 4th (through carpal tunnel); fingertips (through carpal tunnel).
Median nerve injury risks
High autonomic fiber content increases risk of causalgia & Reflex Sympathetic Dystrophy.
Median nerve deformities
Ape hand, Oath hand.
Pronator Teres Syndrome
Compression at pronator teres (neuropraxia, not degeneration).
Possible Struther’s ligament compression (1-13% of people).
Symptoms: Heavy forearm, numbness in thumb/index/palm, weak thenar muscles, pain with elbow (not wrist) movement, no nocturnal symptoms.
Differential: C6 nerve root, CFT injury, carpal tunnel syndrome, TrP - flexor pollicis longus, pronator teres, palmaris longus.
Treatment: Pronator teres release, nerve glides, full median nerve pathway work, forearm massage.
Home Care: Nerve glides, forearm strength/stretch, contrast hydro
Carpal Tunnel Syndrome (CTS)
Neuropraxia, not degeneration.
Carpal Tunnel: Formed by carpal bones (floor) & flexor retinaculum (roof); contains median nerve, FDS/FDP tendons, FPL tendon.
Causes: Space decrease (lesion, edema), tunnel content swelling (inflammation, tendonitis).
CTS vs. Pronator Teres Syndrome timing/location
Night pain → CTS; No night pain → Pronator Teres.
Finger symptoms (not palm) → CTS; Palm symptoms → Pronator Teres.
Radial Nerve Anatomy
Terminates from posterior cord of brachial plexus.
Roots: C5-C8 & T1.
Radial nerve Palpation
Emerges from triangular interval (teres major, long head of triceps, humerus).
Travels under lateral head of triceps toward elbow.
Moves anterior to lateral epicondyle into space between brachialis & brachioradialis.
Divides into deep motor branch (posterior interosseous nerve) & superficial sensory branch.
Deep motor branch: Passes through supinator (arcade of Frohse), innervates extensor muscles.
Superficial sensory branch: Runs under brachioradialis, emerges near tendon transition, remains superficial to wrist.
Innervation: Dorsum of digits 1-3 (excluding fingertips).
Radial Nerve Function
Motor: Triceps, anconeus, supinator, brachioradialis, ECRL, ECRB, ED, EDM, ECU, APL, EPB, EPL, EI.
Sensory: Dorsum of digits 1-3 (excluding fingertips).
Radial Nerve Injuries
Types: Neuropraxia, axonotmesis, neurotmesis.
MOI: Humeral/radial fractures, elbow dislocation, prolonged pressure, crutch palsy, Saturday night palsy, supinator syndrome.
Symptoms (Degeneration)
Wrist drop (loss of wrist & finger extensors).
Proximal lesion: Sensory & motor affected.
Distal lesion: May affect only one branch.
Possible: Muscle wasting, dorsal hand swelling, anesthesia at web of thumb.
Radial Nerve Palsy:
Lesion at spiral groove (motor & sensory loss).
Saturday Night Palsy
Axilla compression; temporary or axonotmesis.
PIN Syndrome
Entrapment at arcade of Frohse; motor loss, no sensory deficit.
Superficial Radial Nerve Syndrome (Wartenberg’s):
Paresthesia over dorsal radial hand, pain in distal radial forearm.
Radial Nerve Assessment
Superficial radial nerve provocation: Aggravated by ulnar deviation, wrist flexion, or percussion over lateral radial border.
Supinator/radial tunnel syndrome: Weakness in supinator/ECRB, possible atrophy.
Upper Limb Tension Test 3
Where does the Ulnar Nerve originate?
The Ulnar Nerve is the terminus of the medial cord of the brachial plexus, from C8 & T1.
What is Bishop’s Hand (Benediction Hand)?
Loss of ulnar lumbricals causes digits 4 & 5 to rest in a position opposite to the lumbricals’ action
Claw Hand?
Same as Bishop’s hand but with some abduction of digits 4 & 5.
What does Froment’s Sign indicate?
Loss of adductor pollicis, leading to compensatory recruitment of flexor pollicis longus.
