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204-theme 2 -anatomy > T2 l11 > Flashcards

T2 l11 Flashcards

1
Q

what type of cell does lower motor neuron injuries arise from

A

Anterior horn cell

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2
Q

what is the difference between lower motor neuron and upper motor neuron injuries in the upper limb

A

UMN:

  • Held in flexed posture if chronic.
  • Increased tone
  • Pyramidal weakness (Flexor muscles stronger than extensors)
  • Brisk reflexes.
  • Sensory level

LMN:

  • Wasting/Fasciculations
  • Flaccid tone
  • Weakness in either a myotomal distribution or a peripheral nerve distribution
  • Reduced reflexes.
  • Dermatomal or peripheral nerve distribution of sensory loss.
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3
Q

where are the 3 anatomical regions for localising the lesions within the brachial plexus

A

Roots

Brachial plexus

Peripheral nerve

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4
Q

what do myotomes describe

A

Relationship between the spinal nerve & muscle

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5
Q

what do dermatomes describe

A
  • Relationship between the spinal nerve & skin -is an area of the skin supplied by nerve fibres originating from a single dorsal nerve root.
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6
Q

what are the myotomes and muscle actions of roots c5-8 and T1

A

c5- deltoid-shoulder abduction

c6-Biceps, brachialis, Brachioradialis- elbow flexion

c7-Triceps, Superficial forearm extensors, superficial forearm flexors- elbow extension, wrist extension and wrist flexion

c8- Forearm extensors, deep forearm flexors- finger extension and finger flexion

T1- Intrinsic hand muscles - finger abduction -

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7
Q

describe some reflexes and the roots its supplied by through the named nerve

A

Biceps reflex – C5 reflex conveyed through the musculocutaneous nerve.​

Supinator jerk – C6 reflex conveyed through the radial nerve.​

Triceps jerk – C7 reflex conveyed through the radial nerve.​

Finger jerk – C8 reflex conveyed through the median and ulnar nerve.​

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8
Q

what occurs to reflexes in LMND

A

Reflexes are depressed

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9
Q

what are the causes of nerve root impingement

A
  • Nucleus pulposus herniation into spinal canal
  • pain – radiates/ aggravated by neck movement​

​

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10
Q

what are the consequences of nerve root impingement

A
  • sensory loss​
  • weakness​
  • reflex loss​
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11
Q

What are the types of nerve plexus injuries

A

Avulsion: Tearing of the nerves from its attachment at the spinal cord. – Require surgical repair​

Rupture: Tearing of the nerves but not from its attachment to the spinal cord – Require surgical repair​

Neuroma: tumour or growth of the nerve tissue. Can arise from the axon or myeloma – Require surgical repair​

Neurapraxia: Axons remain intact, but myelin damage cause an interruption of the impulse down the nerve fibre – Good prognosis.

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12
Q

describe motor cycle injury

A

Flail arm- cervical root avulsion:

C5-T1 lesions causing flail arm​
Left shoulder subluxation​
Atrophy of the left deltoid, supraspinatous and infraspinatous

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13
Q

What are the causes of brachial plexus injury

A

Trauma​

  • Erb-Duchenne type paralysis: Avulsion of C5,C6 roots.​
  • Klumpke paralysis: Avulsion of C8, T1 roots.​

Cancer​

  • Lung cancer: Pancoasts tumour​
  • Radiotherapy​

Inflammatory​
-Brachial neuritis​

Structural​
Thoracic outlet syndrome ​

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14
Q

what is erbs palsy

A 
upper plexus palsy​
C5/C6 innervated muscles​
Superior trunk of brachial plexus​
(adults- blow to shoulder)​
​
Weak muscles include -​
Biceps (flexes the arm)​
Brachioradialis (flexes the arm in semi-prone position)​
Deltoid (abducts the arm) ​
Supraspinatus (abducts the arm)​
Supinator (externally rotates the arm)​
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15
Q

what is ‘waiters tip

A 
rm cannot be-​
Elevated​
Abducted ​
External rotated​
Flexed at elbow​
​
But fingers unimpaired ​
Hand works but arm does not!​
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16
Q

what is KLUMPKEs palsy

A

Clutching for an object when falling from a height. ​
- Inferior trunk plexus injury involving C8/T1​
​
Involves trunk that supplies median and ulnar nerves​
​
Unable to flex wrist or fingers​
Weakness of all small muscles of the hand​
Sensory loss hand and inner border of forearm ​
​
May lead to a claw hand​
​
Arm works but hand​
does not!​-LMND
​
​

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17
Q

Describe metastatic branchial plexopathy

A

Pancoast tumour -(lung)ast tumour (lung) – infiltration of the lower brachial plexus​
Pain in shoulder girdle and inner arm.​
Ipsilateral horners syndrome​

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18
Q

describe Radiation induced brachial plexopathy​

A

Mean 6 yrs post radiation​
Associated with treatment for breast, lung cancer and lymphoma​
Pain is not a consistent feature​
Predilection for upper brachial plexus​

19
Q

Describe idiopathic brachial neuritis

A

Parsonage – Turner Syndrome

Aetiology not clear, infectious, post-infectious ​
Severe pain over days; as pain diminishes, it is followed by weakness and wasting (motor>sensory)​
Typically monophasic ​
Rarely bilateral​
MRI shows thickening and enhancement.​
NCS/EMG is useful for prognostication.​
Treatment:​
Analgesia, physiotherapy​
Limited evidence for the use of steroids​

20
Q

describe thoracic outlet syndrome

A

Variations in anatomy cause compression sites:​

  • Between anterior and middle scalene muscles​
  • Beneath clavicle in the costoclarvicular space​
  • Beneath tendon of Pectorlis minor​
21
Q

what are the neurogenic symptoms of thoracic outlet syndrome

A

Paresthesia, numbness, weakness​

Not localised to specific nerve distribution​

Reproducibly aggravated by elevation or sustained use of arms or hands.​

22
Q

what are the vascular causes of thoracic outlet syndrome

A

Forearm fatigue within minutes of use.​

Swelling and cynaosis​

Collateral venous patterning over the ipsilateral shoulder, chest wall and neck.​

Rarely pain, pallor and coldness (arterial involvement).​

Lower BP on affected arm, diminished distal pulses.

23
Q

learn brachial plexus slide 27

A

how was it

24
Q

what causes a winged scapula

A 
Long thoracic nerve ​
may be injured by blows or pressure ​
in the posterior triangle of the neck ​
​
or during a radical mastectomy.​

Long thoracic nerve supplies the serratus anterior muscle.​
The serratus anterior muscle pulls the medial border of the scapula ​
to the posterior thoracic wall and stabilises it there​
Impairment of the long thoracic nerve leads to “winging” of the scapula
​

25
Q

what are the 2 common sites of compression of the median nerve

A
  • Wrist (Carpel tunnel syndrome)​

- Elbow​

26
Q

what is the mneumonic for the supplies of the median nerve

A

L ateral 2 lumbricals​
O pponens pollicis​
A bductor pollicis brevis​
F lexor pollicis brevis​

27
Q

what causes thenar wasting

A

median nerve compression????

28
Q

learn the anatomy of the carpal tunnel

A

how was it

29
Q

what are the causes of carpal tunnel syndrome

A 
Causes include:​
Diabetes​
Pregnancy​
Hypothyroidism​
Rheumatoid arthritis​
Repetitive strain
Median N.​
Entrapment at ​
Carpal Tunnel​
(also damaged in​
wrist fractures)​​
30
Q

where does the anterior interosseous nerve arise from

A

median nerve just below the elbow

31
Q

what is the AIN prone to

A 
Prone to compression between 2 heads of​
pronator teres muscle​
​
Gripping tightly with forced pronation​
​
Prolonged use of a screwdriver!​
​
​
May also be damaged in careless blood taking​
32
Q

describe the anterior interosseous nerve syndrome

A

Pure motor branch of the median nerve​

weakness in flexors of ip joint of thumb (flexor policis longus) ​

& dip joints of index and middle fingers – (flexor digitorum profundus)​
weakness of pronation​

33
Q

what is the sensory innervation of the median nerve in the forearm versus carpal tunnel​

A

?????????

34
Q

look at picture of

A

Ulnar nerve palsy at the wrist

35
Q

what is ulnar claw

A

Higher lesion in the upper limb: ​
Paralysis of the ulnar half of the flexor digitorum profundus (FDP), interossei and lumbricals. The ring and little fingers are not flexed and there is no claw.​
​
Lesion at the wrist: ​
Flexion at the DIP (FDP is intact) ​
Flexion at the PIP (interossei are paralysed)​
hyperextention at the MCP (lubricals are paralysed). ​

36
Q

what can affect the sensory innervation of the ulnar nerve

A

lesion proximal to dorsal cutaneous branch

Lesion distal to dorsal cutaneous branch​

Lesion distal to palmar cutaneous branch​​

37
Q

Look at slide 43

A

how was it

38
Q

what is froments sign

A

Weakness of adductor pollicis leads to the Froment’s sign.​

​

39
Q

what does the ulnar nerve supply vs C8

A

slide 45
C8​
All finger extensors (radial nerve)​
FDP of Index/middle (median nerve)​

40
Q

what is Saturday night palsy

A

Radial nerve palsy

41
Q

describe nerve conduction studies

A

Useful in determining the amplitude and velocity of a peripheral nerve​

42
Q

difference between axonal and demyelinating differences in amplitude

A

Axonal loss results in a decrease in amplitude​

Demyelinating results in a decrease in velocity​

slide 50

43
Q

neurogenic vs myogenic

A

Needle EMG measures the electrical activity of the muscle during voluntary contraction. The pattern of the electrical activity can help distinguish a lesion arising from the nerve (neurogenic) vs muscle (myopathic)​

204-theme 2 -anatomy (15 decks)

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