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upper extremity nerves Flashcards

1
Q

upper extremity nerves

A
  1. axillary (C5-C6)
  2. Musculocutaneous (C5-C7)
  3. Radial (C5-T1)
  4. Median (C5-T1)
  5. Ulnar (C8-T1)
  6. Reccurent branch of median nerve (C5-T1)
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2
Q

axillary nerve - origin

A

C5-C6

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3
Q

causes of axillary nerve injury

A
  1. fractured surgical neck of humerus

2. anterior dislocation of humerus

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4
Q

presentation of axillary nerve injury

A
  1. flatened deltoid
  2. Loss of arm abduction at shoulder (>15 degrees)
  3. Loss of sensation over deltoid muscle and lateral arm
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5
Q

musculocutaneous nerve origin

A

C5-C7

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6
Q

causes of musculocutaneous nerve injury

A

upper trunk compression

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7
Q

presentation musculocutaneous nerve injury

A
  1. loss of forearm flexion and supination

2. loss of sensation on lateral forearm

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8
Q

Radial nerve - origin

A

C5-T1

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9
Q

causes of radial nerve injury

A
  1. midshaft fracture of humerus

2. compression of axilla

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10
Q

causes of radial nerve injury - compression of axilla due to (e.g.)

A
  1. crutches

2. sleeping with arm over chair (Saturday night palsy)

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11
Q

Saturday night palsy

A

radial nerve injury due to sleeping with arm over chair

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12
Q

presentation of radial nerve injury

A
  1. wrist drop
  2. decreased grip strength
  3. loss of sensation of over posterior arm/forearm and dorsal hand
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13
Q

forearm is the part of the body which extends from

A

the elbow to the wrist

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14
Q

arm is the part of the body which extends from

A

shoulder to the elbow

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15
Q

radial nerve injury - wrist drop due to loss of

A

elbow, wrist, and finger extension

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16
Q

radial nerve injury - decreased grip extensor - why?

A

wrist extension is necessary for maximal action of flexors

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17
Q

median nerve - origin

A

C5-T1

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18
Q

causes of median nerve injury

A
  1. supracondylar fracture of humerus (proximal lesion)
  2. carpal tunnel syndrome (distal lesion)
  3. wrist laceration (distal lesion)
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19
Q

median injury - presentation

A
  1. ape hand 2. Pope’s blessing 3. loss of wrist flexion
  2. loss of thumb opposition 5. loss of lumbricals of 2nd and 3rd digits 6. loss of flexion of lateral fingers
  3. loss of sensation over thenar eminence
  4. loss of sensation at dorsal and palmar aspects of lateral 3.5 fingers (proximal lesion)
  5. Tinel sign (in carpal tunnel syndrome)
    sensation on in proximal lesions
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20
Q

ape-hand deformity

A

Lack of ability to abduct, flex and oppose the thumb due to paralysis of the thenar muscles

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21
Q

Tinel sign

A

tingling on percussion

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22
Q

pope’s blessing sign is also called

A

Hand of benediction

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23
Q

pope’s blessing sign (Hand of benediction)

A

The ability to flex the digits 2–3 at the metacarpophalangeal joints is lost as is the ability to flex and extend the proximal and distal interphalangeal joints

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24
Q

ulnar nerve origin

A

C8-T1

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25
Q

causes of ulnar nerve injury

A
  1. fracture of medial epicondyle of humerus funny bone (proximal lesion)
  2. fractured hook of hamate (distal lesion)
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26
Q

funny bone

A

the part of the elbow over which passes the ulnar nerve

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27
Q

presentation of ulnar nerve injur

A
  1. ulnar claw on digit extension 2. radial deviation of wrist UPON FLEXION (proximal lesion) 3. Loss of wrist flexion 4. loss of flexion of medial fingers 5. loss of abduction and adduction of fingers (interossei)
  2. loss of actin of medial 2 lumbrical muscles
  3. loss of sensation over medial 1.5 fingers including hypothenar eminence
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28
Q

interossei refer to

A

muscles between certain bones

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29
Q

Reccurent branch of median nerve - origin

A

C5-T1

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30
Q

causes of Reccurent branch of median nerve injury

A

superficial laceration of palm

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31
Q

presentation of Reccurent branch of median nerve injury

A
  1. ape hand (loss of thenar muscle group: opposition, flexion, abduction
  2. no loss of sensation
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32
Q

flatened deltoid - nerve?

A

axillary

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33
Q

ape hand - nerve ?

A
  1. median

2. reccurent branch of median nerve

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34
Q

ulnar claw - nerve?

A

ulnar

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35
Q

decreased grip strength - nerve ?

A

radial

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36
Q

pope’s blessing - nerve ?

A

median

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37
Q

tinel sign of hand?

A

carpal tunnel syndrome

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38
Q

supracondylar fracture of humerus - nerve injury?

A

median

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39
Q

wrist drop - nerve?

A

radial

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40
Q

loss of foreman supination - nerve?

A

musculocutaneous

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41
Q

radial nerve injury - nerve of sensation?

A

loss of sensation over posterior arm/forearm and dorsal hand

42
Q

median nerve injury - sensation

A

loss of sensation over thenar eminencea and at dorsal and palmar aspects of lateral 3.5 fingers

43
Q

Brachial plexus - origin

44
Q

Brachial plexus - stracure (divisions)

A

Roots –> Trunks –> Divisions –> Cords –> Branches

before the trunks C5-C7 roots are giving rise to long thoracic nerve

45
Q

Brachial plexus - Roots

46
Q

Brachial plexus - Tranks (types and origin)

A
  1. Upper (C5-C6)
  2. Middle (C7)
  3. Lower (C8-T1)
47
Q

Brachial plexus - division

A
  • from upper to middle trunk
  • from middle to upper
  • from lower to middle
48
Q

Brachial plexus - cords

A
  • middle trunk is becoming posterior and then is divided to axillary and radial nerve
  • upper trunk becomes lateral
  • lower trunk becomes medial
49
Q

posterior (middle) trank is divided to

A
  1. axillary nerve

2. radial nerve

50
Q

Brachial plexus - branches

A
  • together lower and upper trunks give rise to median nerve
  • lower trunk is becoming ulnar nerve
  • upper nerve is becoming Musculocutaneous nerve
51
Q

Erb palsy is also called

A

waiter’s tip

52
Q

Erb palsy (waiter’s tip) - injury

A

traction or tear of upper trunk

53
Q

upper trunk origin (roots)

54
Q

causes of Erb palsy (waiter’s tip)

A

infants - lateral traction of neck during delivery

adults - trauma

55
Q

causes of Erb palsy - muscle deficit

A
  1. deltoid
  2. suraspinatus
  3. infraspinatus
  4. Bicepts branchi
56
Q

causes of Erb palsy - functional deficit presentation (and muscle responsible)

A
  1. abduction (arms hangs by side) (deltoid, supraspinatus)
  2. Lateral rotation (arm medially rotated) (infraspinatus)
  3. flexion and sunipation (arm extended and pronated) (bicepts branchi)
57
Q

Klumpke palsy is also called

58
Q

Klumpke palsy (Claw hand) - injury

A

traction or tear of lower trunk

59
Q

lower trunk roots

60
Q

causes of Klumpke palsy (Claw hand)

A

infants - upward force on arm during delivery

adults - trauma

61
Q

Klumpke palsy (Claw hand) - adults trauma example

A

grabbing a tree branch to break a fall

62
Q

Klumpke palsy (Claw hand) - muscle deficits

A

intrinsic hand muscles

  1. lumbricals
  2. interossei
  3. thenar
  4. hypothenar
63
Q

Klumpke palsy (Claw hand) - presentation

A

total claw hand

64
Q

normal action of hand lumbricals

A

flex MCP and extend DIP and PIP joints

65
Q

muslce deficit of Klumpke palsy are the same as the …. syndrome

A

thoracic outlet syndrome

66
Q

thoracic outlet syndrome - injury

A

compression of lower trunk AND subclavian vessels

67
Q

causes of thoracic outlet syndrome

A
  1. Cervical rib

2. Pancoast tumor

68
Q

thoracic outlet syndrome - muscle deficit

A

intrinsic hand muscles

  1. lumbricals
  2. interossei
  3. thenar
  4. hypothenar
69
Q

muscle deficit of thoracic outlet syndrome are the same with

A

Klumpke palsy (Claw hand)

70
Q

thoracic outlet syndrome - presentation

A
  • atrophy of intrinsic hand muscles

- ischemia, pain and edema (due to vascular compression)

71
Q

Winged scapula - injury

A

lesion of long thoracic nerve

72
Q

long thoracic nerve - origin

A

C5-C6-C7 (before the formation of the trunks)

73
Q

causes of Winged scapula

A
  1. axillary node dissection after mastectomy

2. stab wound

74
Q

Winged scapula - muscle deficit

A

serratus anterior

75
Q

Winged scapula - functional deficit (presentation)

A

problem on serratus anterior –> inability to anchor scapula to thoracic cage –> cannot abduct arm above the horizontal position

76
Q

hand at rest

A

balance between the extrinsic flexors and extenors as well as the instinct muscles of the hand (particularly the lumbrical muscles)

77
Q

Distortions of the hand - clawing seen best in

A

DISTAL lesions of median or ulnar nerves

78
Q

clawing appearance of the hand - pathophysiology

A

DISTAL lesions of median or ulnar nerves –> remaining exrinsic flexors of the digits exaggerate the loss of the lumbricals the loss of the lumbricals –> extension of MCP, flexion of DIP and PIP

79
Q

claw hand - muscle action

A

extension of MCP, flexion of DIP and PIP

80
Q

distortion of the hand - proximal vs distal lesions

A

seen best with distal lesion/less prominent in proximal lesion

81
Q

distortion of the hand - deficits are present during

A

voluntary flexion of the digits

82
Q

ulnar claw vs pope’s blessing sign: location of lession

A

ulnar claw –> DISTAL ulnar nerve (near to hand)

Pope’s blessing –> proximal median nerve

83
Q

ulnar claw vs pope’s blessing sign - more prominence during

A

ulnar claw –> extending fingers/rest

Pope’s blessing –> making a fist

84
Q

median claw sign is a result of

A

distal medial nerve

85
Q

median claw appearance (digitis)

A

digits 2-3
MCP flexion
DIP and PIP extension

86
Q

median claw is more prominence during

A

extending fingers at rest

87
Q

OK gesture appearance

A

1-3 digits flexed

88
Q

OK gesture is a result of

A

proximal ulnar nerve

89
Q

OK gesture is more prominence in

A

Making a fist

90
Q

thenar eminence atrophy can be seen in

A
  1. median nerve lesion

2. recurrent branch of median nerve

91
Q

hand muscles

A
  1. thenar
  2. hypothenar
  3. dorsal interossei
  4. palmar interossei
  5. lumbricals
92
Q

hand muscles - function of lumbricals

A

flex MCP and extend DIP and PIP joints

93
Q

hand muscles - dorsal interossei action

A

abduct the fingers

94
Q

hand muscles - palmar interossei action

A

adduct the fingers

95
Q

hand muscles - thenar muscles action

A

oppose abduct and flex

96
Q

hand muscles - hypothenar muscles action

A

oppose abduct and flex

97
Q

thenar muscles - names

A
  1. opponens pollicis
  2. Abductor pollicis brevis
  3. flexor pollicis brevis
  4. superficial head (deep head by ulnar nerve)
98
Q

hypothenar muscles - names

A
  1. opponens digiti minimi
  2. Abductor digiti minimi
  3. flexor digiti minimi brevis
99
Q

lesion on the posterior cords of branchial plexus –>

A

wrist drop

100
Q

musculocutaneous injury - loss of senseation

A

lateral forearm

Musculoskeletal and Connective Tissue (19 decks)

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