Upper Extremity Neurology

Question 1

Cervical plexus

Answer 1

The cervical plexus is a network of nerves from C1-C4. We are only responsible for knowing the supraclaviular N because they innervate the skin on the neck and shoulder.

There are 3.

Lateral supraclaviular N
Middle supraclaviular N
Medial supraclaviular N

Question 2

What is the only cervical plexus nerve we have to know and why?

Answer 2

Supraclavicular nerve.

There are 3. It is important to know them because they innervate the skin on the neck and shoulder

Question 3

What is Erb-Duchenne Palsy?

Answer 3

Erb-Duchenne Palsy occurs when there damage to the upper part of the brachial plexus.

This can occur when there dramatic increase in angle of your neck and shoulder, causing the damage to the anterior rami of your spinal roots at C5/C6.

A person with Erb Palsy syndrome will have WAITERS TIP ARM

1. Medially Rotated
2. Adducted
3. Extended elbow

Question 4

What is another name for Erb’s Duchenne Palsy?

Answer 4

Waiter’s Tip Arm

Question 5

In Erb’s Palsy, where is the damage in the brachial plexus?

Answer 5

Upper brachial Plexus.

Usually C5/C6 anterior rami.

Question 6

Klumpke Palsy is a upper/lower brachial plexus injury.

Answer 6

LOWER

Question 7

What is the presentation for someone with Klumpke Palsy?

Answer 7

Claw hand- person claws their hand when trying to make a fist

Question 8

What is the presentation for someone with Erbs Palsy?

Answer 8

Waiters Tip Arm

Question 9

What is Klumpke Palsy?

Answer 9

Klumpke Palsy is going to be caused by damage to the lower brachial plexus, often caused by when you stretch your arm too far away from your trunk.

Ex. Falling off a tree and holding onto the branch.

Question 10

What part of the brachial plex is damaged in Klumpke Palsy?

Answer 10

C8/T1.

Question 11

John and Beth were having a contest: who can hang on the monkey bars for the longest.

If they do this for too long, what can happen?

Answer 11

Prolonged periods of working with your hands over your head can compress the [posterior, medial and lateral cords] of their brachial plexus.

Thus, John and Beth would have pain radiating down their arm, loss of sensation, tigling and weaking of hands

Question 12

What happens if we injure the [musculocutaneous N]?

Answer 12

Our musculocutaneous n innervates our brachial flexors. It also has a branch coming off of it, called the [lateral antebrachial cutaneous nerve], which provides sentsation for our lateral forearm.

Damage to our MSC nerve would:

1. Paralyze our brachial flexors
2. Not allow us to flex our shoulder and elbow
3. Cause numbness in our lateral forearm,

But we may still be able to flex and supinate because we have our (supinator and our brachioradialis m)

Question 13

What happens if we injure our AXILLARY NERVE

Answer 13

1. Deltoid atrophy.
2. Paralysis of Teres Mijor and Deltoid Muscle
3. Loss of sensation over the superior lateral part of our brachial arm.
4. We cannot abduct 15-90 Degrees

Question 14

What is in our triangular interval?

Answer 14

1. Deep brachial artery

2. Radial Nerve

Question 15

What is in our quadrangular space?

Answer 15

1. Axillary nerve

2. Posterior circumflex humeral artery

Question 16

Jimmy damaged his radial nerve. What will happen?

Answer 16

Radial nerve is responsible for extension.
He will develop wrist drop.

1. Cannot extend the elbow.
2. Cannot abduct or extend the thumb.
3. Cannot extend the wrist

Question 17

Damage to the Median Nerve at the wrist

Answer 17

The recurrent branch of the medial nerves innervates your thumb muscles and the 1st and second lumbrical.

Apes hand- Adducted thumb and thenar eminenance atrophy.

Question 18

Damage to the Median Nerve at the elbow

Answer 18

Hands of benediction–> you could not flex your 2nd and 3rd digit + Apes hand (thumb is abducted and thenar muscle atrophy)

Question 19

What nerves come off the upper trunk?

Answer 19

1. N to the subclavius

2. Suprascapular N

Question 20

What nerves come off the lateral cord?

Answer 20

1. lateral pectoral n

Question 21

What nerves come off the posterior cord?

Answer 21

1. Upper subscapular n
2. Lower subscapular n.
3. thoracodorsal n

Question 22

What nerves come off the medial cord?

Answer 22

1. medial pectoral n
2. medial brachial cutaneous n
3. medial antebrachial cutaneous n

Question 23

Injury to the radial nerve will cause

Answer 23

Depends where:

1. Wrist drop (cannot extend the wrist)
2. Elbow extension
3. Thumb abduction and extension (because remember your pollicis muscles are extensors)

Question 24

Other symptoms of Erb’s Palsy:

Answer 24

muscle atrophy of the affected arm.

Bird-winging of the affected scapula.

Question 25

Klumpe Palsy presentation

Answer 25

Forearm is supinated
Fingers are flexed at DIPS and PIPS
Metacarpophalangeal joints are extended

Question 26

Damage to the ulnar nerve can occur in one of four places

Answer 26

1. posterior to the medial humeral epicondyle
2. between the ulnar and humeral heads of the flexor carpi ulnaris
3. wrist
4. hand

Question 27

Overall result of ulnar n damage?

Answer 27

1. extensive loss of sensory and motor control in the hand

2. When a fist is made, appears as claws hand

Question 28

t10-L1 damage

Answer 28

big leg braces

Question 29

L2-L3

Answer 29

short leg braces (cane)

Question 30

Thoracic spinal nerve

Answer 30

interCOSTObrachial nerve

comes off of the 2nd rib.