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S&F 1 > Upper Limb Nerve Injuries > Flashcards

Upper Limb Nerve Injuries Flashcards

Ziermann

1
Q

The roots of the brachial plexus comes from which rami?

A

Ventral Rami C5-T1

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2
Q

The roots of the brachial plexus are located where?

A

Deep to the anterior scalene muscle (ASM)

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3
Q

Where do the ventral primary rami unite to for the 3 trunks?

A

at the lateral border of the ASM

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4
Q

The anterior division of the trunks supply what?

A

Anterior muscles and skin of the upper limb

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5
Q

The posterior division of the trunks supply what?

A

Posterior muscles and skin

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6
Q

When entering the axilla, the divisions pass deep to what?

A

The clavicle

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7
Q

Where does the brachial plexus end?

A

In the axilla as cords give rise to main nerve branches of the upper limb

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8
Q

Anterior medial arm/forearm cutaneous innervation

A

Medial cutaneous nerves of the medial cord

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9
Q

Anterior lateral forearm cutaneous innervation

A

Continuation of the musculocutaneous nerve, which is the lateral ante brachial cutaneous nerve

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10
Q

Posterior medial arm cutaneous innervation

A

Medial brachial cutaneous nerve

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11
Q

Posterior medial forearm cutaneous innervation

A

Medial antebrachial cutaneous (C8, T1)

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12
Q

Posterior lateral forearm cutaneous innervation

A

Continuation of the musculocutaneous nerve, which is the lateral ante brachial cutaneous nerve

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13
Q

Anterior lateral arm cutaneous innervation

A

Axillary near deltoid

Radial - under axillary innervation

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14
Q

Posterior lateral arm/forearm cutaneous innervation

A

Axillary near deltoid

Radial the rest of the way down

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15
Q

What is cutaneous innervation?

A

based on clinical findings in a living person

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16
Q

Dermatomes

A

Based on development
Surface of the skin is divided into specific areas (connective tissue, including dermis)
derived from somites

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17
Q

What is segmental innervation?

A

A dermatome is an area of skin in which sensory nerves derive from a single spinal nerve root

18
Q

Avulsion

A

most sever type

Nerve is torn from spine (pull the root of the brachial plexus out the neck)

19
Q

Rupture

A

nerve is torn but not at the spinal attachment (nerve stretched and ruptured in two parts

20
Q

Neuroma

A

nerve has torn and healed but scar tissue puts pressure on injured nerve and prevents it from conduction signals to muscles

21
Q

Neuropraxia

A

Stretched

Nerve has been damaged but not torn

Most common type of of brachial plexus injury

22
Q

Most severe brachial plexus injuries are caused by which two events?

A

Car and motorcycle accidents

these can leave arm paralyzed, with loss of function and sensation

23
Q

For avulsion and rupture injuries, can they be repaired?

A

there is no potential for recovery unless surgical reconnection is made in a timely manner

24
Q

For neuroma and neuropraxia, can they be repaired?

A

potential for recovery varies

Most people with neurpraxia injuries recover spontaneously with a 90-100% return of function

25
Q

Stingers/burners

A

Minor brachial plexus injuries
common causes: contact sports

Stinger -> compression or over-stretching of nerves

26
Q

Root injury

A

lateral flexion of neck toward the side of symptoms

- foraminal narrowing (compression), especially in the presence of an underlying disc herniation or osteophyte

27
Q

Plexus injury

A

neck and upper trunk vulnerable to direct blows or stretching from distraction of neck away from shoulder

28
Q

What are the two nerve roots that are most commonly affected?

A

C5 and C6

29
Q

Erb’s palsy

A

Paralysis of upper brachial plexus (C5, C6) > Upper trunk damaged

30
Q

What are the most commonly involved nerves of Erb’s Palsy?

A

Suprascapular (C5-C6) - Paralysis of muscles
Musculocutaneous (C5-C7) - Paresis of muscles
Axillary (C5-C6) - Paralysis of muscles

31
Q

If roots are damaged above the junction of C5 and C6 what results?

A

paralysis of rhomboids (dorsal scapular n.) and serratus anterior (long thoracic n, C5-C7) is added, producing weakness in retraction and protraction the scapula

32
Q

What is the most common area for the upper brachial plexus to be damaged?

A

Upper trunk

33
Q

What are the nerves that only contains C5 and C6 nerve fibers?

A

Axillary nerve
Lower subscapular
Upper subscapular

34
Q

What is the characteristic sign of Erbs Palsy?

A

Waiters tip deformity

Arm - rotated medially (loss of lateral rotators of the shoulder- rotator cuff muscles)
Arm - hangs (lack of abduction - deltoid and supraspinatis
Forearm - extended and pronated (weakness of arm flexors and biceps; weak supinator - C5-C6 radial nerve)

35
Q

What is Klumpke’s Palsy? and it’s symptoms?

A

Paralysis of the lower brachial plexus (C8, T1)

Symptoms: Claw hand, severe pain, loss sensation, dermatome numbness

36
Q

What are the affected nerves in Klumpke’s Palsy?

A 
medial pectoral nerve 
Medial brachial cutaneous 
Medial antebrachial cutaneous 
Ulnar n.  (main nerve affected) 
Radial n. 
Median n.
37
Q

What is claw hand?

A

Affected forearm tends to lie flat and the wrist and fibers are tightened
Hyperextension of the hand at the metacarpalphalangeal jointed flexion of the hand at the interphalangeal joint

38
Q

What are the muscles paralyzed in Klumpke’s palsy?

A

Flexor carpi ulnaris
Medial half of flexor digitorium profundus
most intrinsic hand muscles (ulnar)
Pecotralis minor (medial pectoral nerve)

39
Q

How do you test for Erb’s Palsy

A

Weakness in supinator

Radial nerve affected (C5-T1)

40
Q

How do you test for Klumpke’s palsy?

A

check intrinsic hand muscles
Flexors of the wrist and fingers
Check lumbrical function

Looking to see if ulnar (C8,T1) and median nerve (C5-T1) is ok

S&F 1 (25 decks)

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