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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
causes of ulnar nerve injury
1. fracture of medial epicondyle of humerus funny bone (proximal lesion) 2. fractured hook of hamate (distal lesion)
26
funny bone
the part of the elbow over which passes the ulnar nerve
27
presentation of ulnar nerve injur
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) 6. loss of actin of medial 2 lumbrical muscles 7. loss of sensation over medial 1.5 fingers including hypothenar eminence
28
interossei refer to
muscles between certain bones
29
Reccurent branch of median nerve - origin
C5-T1
30
causes of Reccurent branch of median nerve injury
superficial laceration of palm
31
presentation of Reccurent branch of median nerve injury
1. ape hand (loss of thenar muscle group: opposition, flexion, abduction 2. no loss of sensation
32
flatened deltoid - nerve?
axillary
33
ape hand - nerve ?
1. median | 2. reccurent branch of median nerve
34
ulnar claw - nerve?
ulnar
35
decreased grip strength - nerve ?
radial
36
pope's blessing - nerve ?
median
37
tinel sign of hand?
carpal tunnel syndrome
38
supracondylar fracture of humerus - nerve injury?
median
39
wrist drop - nerve?
radial
40
loss of foreman supination - nerve?
musculocutaneous
41
radial nerve injury - nerve of sensation?
loss of sensation over posterior arm/forearm and dorsal hand
42
median nerve injury - sensation
loss of sensation over thenar eminencea and at dorsal and palmar aspects of lateral 3.5 fingers
43
Brachial plexus - origin
C5-T1
44
Brachial plexus - stracure (divisions)
Roots --> Trunks --> Divisions --> Cords --> Branches | before the trunks C5-C7 roots are giving rise to long thoracic nerve
45
Brachial plexus - Roots
C5-T1
46
Brachial plexus - Tranks (types and origin)
1. Upper (C5-C6) 2. Middle (C7) 3. Lower (C8-T1)
47
Brachial plexus - division
- from upper to middle trunk - from middle to upper - from lower to middle
48
Brachial plexus - cords
- middle trunk is becoming posterior and then is divided to axillary and radial nerve - upper trunk becomes lateral - lower trunk becomes medial
49
posterior (middle) trank is divided to
1. axillary nerve | 2. radial nerve
50
Brachial plexus - branches
- together lower and upper trunks give rise to median nerve - lower trunk is becoming ulnar nerve - upper nerve is becoming Musculocutaneous nerve
51
Erb palsy is also called
waiter's tip
52
Erb palsy (waiter's tip) - injury
traction or tear of upper trunk
53
upper trunk origin (roots)
C5-C6
54
causes of Erb palsy (waiter's tip)
infants - lateral traction of neck during delivery | adults - trauma
55
causes of Erb palsy - muscle deficit
1. deltoid 2. suraspinatus 3. infraspinatus 4. Bicepts branchi
56
causes of Erb palsy - functional deficit presentation (and muscle responsible)
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
Klumpke palsy is also called
Claw hand
58
Klumpke palsy (Claw hand) - injury
traction or tear of lower trunk
59
lower trunk roots
C8-T1
60
causes of Klumpke palsy (Claw hand)
infants - upward force on arm during delivery | adults - trauma
61
Klumpke palsy (Claw hand) - adults trauma example
grabbing a tree branch to break a fall
62
Klumpke palsy (Claw hand) - muscle deficits
intrinsic hand muscles 1. lumbricals 2. interossei 3. thenar 4. hypothenar
63
Klumpke palsy (Claw hand) - presentation
total claw hand
64
normal action of hand lumbricals
flex MCP and extend DIP and PIP joints
65
muslce deficit of Klumpke palsy are the same as the .... syndrome
thoracic outlet syndrome
66
thoracic outlet syndrome - injury
compression of lower trunk AND subclavian vessels
67
causes of thoracic outlet syndrome
1. Cervical rib | 2. Pancoast tumor
68
thoracic outlet syndrome - muscle deficit
intrinsic hand muscles 1. lumbricals 2. interossei 3. thenar 4. hypothenar
69
muscle deficit of thoracic outlet syndrome are the same with
Klumpke palsy (Claw hand)
70
thoracic outlet syndrome - presentation
- atrophy of intrinsic hand muscles | - ischemia, pain and edema (due to vascular compression)
71
Winged scapula - injury
lesion of long thoracic nerve
72
long thoracic nerve - origin
C5-C6-C7 (before the formation of the trunks)
73
causes of Winged scapula
1. axillary node dissection after mastectomy | 2. stab wound
74
Winged scapula - muscle deficit
serratus anterior
75
Winged scapula - functional deficit (presentation)
problem on serratus anterior --> inability to anchor scapula to thoracic cage --> cannot abduct arm above the horizontal position
76
hand at rest
balance between the extrinsic flexors and extenors as well as the instinct muscles of the hand (particularly the lumbrical muscles)
77
Distortions of the hand - clawing seen best in
DISTAL lesions of median or ulnar nerves
78
clawing appearance of the hand - pathophysiology
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
claw hand - muscle action
extension of MCP, flexion of DIP and PIP
80
distortion of the hand - proximal vs distal lesions
seen best with distal lesion/less prominent in proximal lesion
81
distortion of the hand - deficits are present during
voluntary flexion of the digits
82
ulnar claw vs pope's blessing sign: location of lession
ulnar claw --> DISTAL ulnar nerve (near to hand) | Pope's blessing --> proximal median nerve
83
ulnar claw vs pope's blessing sign - more prominence during
ulnar claw --> extending fingers/rest | Pope's blessing --> making a fist
84
median claw sign is a result of
distal medial nerve
85
median claw appearance (digitis)
digits 2-3 MCP flexion DIP and PIP extension
86
median claw is more prominence during
extending fingers at rest
87
OK gesture appearance
1-3 digits flexed
88
OK gesture is a result of
proximal ulnar nerve
89
OK gesture is more prominence in
Making a fist
90
thenar eminence atrophy can be seen in
1. median nerve lesion | 2. recurrent branch of median nerve
91
hand muscles
1. thenar 2. hypothenar 3. dorsal interossei 4. palmar interossei 5. lumbricals
92
hand muscles - function of lumbricals
flex MCP and extend DIP and PIP joints
93
hand muscles - dorsal interossei action
abduct the fingers
94
hand muscles - palmar interossei action
adduct the fingers
95
hand muscles - thenar muscles action
oppose abduct and flex
96
hand muscles - hypothenar muscles action
oppose abduct and flex
97
thenar muscles - names
1. opponens pollicis 2. Abductor pollicis brevis 3. flexor pollicis brevis 4. superficial head (deep head by ulnar nerve)
98
hypothenar muscles - names
1. opponens digiti minimi 2. Abductor digiti minimi 3. flexor digiti minimi brevis
99
lesion on the posterior cords of branchial plexus -->
wrist drop
100
musculocutaneous injury - loss of senseation
lateral forearm

Musculoskeletal and Connective Tissue (19 decks)

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