Week 3

Question 0

Cutaneous inner actions refer to areas innervated by specific peripheral nerves which can contain fibers from ________spinal nerve roots

Answer 0

Multiple spinal nerve roots

Question 1

An area of skin which is innervated by a single spinal nerve?

Answer 1

Dermatomes

Question 2

True or false?
Vast majority of patients with plexus injuries are otherwise healthy unless disabled by pain, generally remain active and are able to carry out ADL’s with the use of one hand?

Answer 2

True

Question 3

What Are the biomechanical principles?

Answer 3

To prevent deformity
To correct deformity
Position limb to obtain maximal function
5 degrees of supination

Question 4

What are some patient considerations?

Answer 4

~Most patients Re independent with one hand but bilateral activities should be facilitated
~Device shouldn’t interfere with remains ability
~Device needs to allow independent donning/doffing
~Cost must be considered vs. length of use & potential for benefit

Question 5

Axillary nerve injury is the loss of active __________________
Sensory loss on lateral side of proximal arm

Answer 5

Shoulder abduction and flexion

Question 6

Orthotic assistance is limited to functional arm support to decrease gravitational pull on the Glenohumeral joint- deltoid and teres minor for what nerve injury?

Answer 6

Axillary nerve injury

Question 7

Due to loss of biceps and brachialis, the patient loses all useful elbow flexor strength and can be compensated if the pronator teres and brachii radialis are well contained is what nerve lesion injury?

Answer 7

Musculocutaneous Nerve lesion

Question 8

Radial nerve lesion is also known as?

Answer 8

Wrist drop - loss of extensor muscles

Question 9

What are the three levels of radial nerve lesion?

Answer 9

Below the elbow
Mid-humerus
Axillary level

Question 10

The finger and thumb Extensors and long thumb abductor loses motor function is what level of radial nerve lesion?

Answer 10

Below the elbow

Question 11

What orthotic treatment is recommended for radial nerve lesion below the elbow?

Answer 11

HO or WHO

With IP extension assist (MP extension stop if patient becomes hyper mobile at MP joint)

Question 12

Wrist extensor paralysis is added to the absence of finger and wrist extensor control which greatly affects grasp and pinch coordination because the finger Flexors cannot contract sufficiently to maintain grasp is what level of radial nerve lesion?

Answer 12

Radial nerve lesion mid humerus

Question 13

What is the orthotic treatment recommendation for radial nerve lesion mid humerus?

Answer 13

Static control at the wrist to counteract the effects of gravity and pull of the finger Flexors as they contract
Static WHO

Question 14

In addition to wrist and hand Extensors, when the lesion occurs at the axillary level, the triceps motor function becomes affected is what level of radial nerve lesion?

Answer 14

Radial nerve lesion axillary level

Question 15

What are the most common mechanisms of injury for radial nerve lesion -axillary level?

Answer 15

Poorly fit crutches

Falling asleep with arm over a chair -Saturday night palsy

Question 16

What are the ulnar nerve lesion levels of involvement?

Answer 16

Wrist

Elbow or above

Question 17

Absent intrinsic muscle action in the ring and little finger and sensory loss of palmar and dorsal aspect of 5th digit and 1/2 of 4th digit is what level of ulnar nerve lesion?

Answer 17

Wrist

Question 18

What is the common mechanism of injury for a ulnar nerve injury -wrist?

Answer 18

Is a cut horizontally at the wrist -suicide attempt

Question 19

Claw hand or ulnar palsy is also referred to as?

Answer 19

An intrinsic minus hand

Question 20

Volkmann’s ischemic contracture occurs when?

Answer 20

There is a lack of blood flow (ischemia) to the forearm

Question 21

For ulnar nerve lesion-wrist the claw hand position of the fingers can be readily corrected with an?

Answer 21

Orthotic MP extension stop

Question 22

The flexor Digitorum profundus muscle (of the 4th and 5th fingers) loses motor function, in addition to the intrinsic hand muscles is what ulnar nerve injury level?

Answer 22

Elbow and above

Question 23

Due to paralysis of the flexor carpi ulnaris, the hand will deviate________ during radiocarpal flexion?

Answer 23

Radially

Question 24

What is the most common mechanism of injury for a ulnar nerve injury of elbow or abov?

Answer 24

Fracture of the medial epicondyle of the humerus

Question 25

What are the two sites of median nerve lesion injury involvement?

Answer 25

Wrist | Elbow or above

Question 26

The __________________ is the absolute pathway for all sensory fibers from critical areas, which also includes the radial side of the index finger

Answer 26

Median nerve lesion

Question 27

The median nerve motor supply include what muscles?

Answer 27

The thumb intrinsic muscles and the extrinsic Flexors of the thumb, index and middle finger

Question 28

Only the thumb intrinsics ( Lumbricals to index and middle finger ) are paralyzed is what median nerve lesion level?

Answer 28

Wrist

Question 29

What is the mechanism of injury for median nerve injury of the wrist?

Answer 29

A horizontal cut on the wrist -suicide attempt | Carpal tunnel syndrome

Question 30

For a median nerve injury the patient will present with _________?

Answer 30

``` Ape hand Patient will have sensory loss on the palmAr and dorsal aspects of the: palmar aspect of the thumb Index Middle 1/2 ring finger ```

Question 31

``` Weakened wrist flexion ( hand will radially deviate) Loss of : flexion at digits 1-3 Pronation Thumb abduction Thumb opposition ```

Answer 31

Median nerve injury-elbow and above

Question 32

What is the mechanism of injury for median nerve injury of the elbow and above?

Answer 32

Due to supra condylar humeral fracture

Question 33

For a median nerve injury of the elbow and above the patient can present with?

Answer 33

Ape hand | Hand of benediction - also known as the popes hand

Question 34

Ape hand occurs when the Thenar eminence is __________

Answer 34

Flattened

Question 35

Occurs when the patient attempts to make a fist and the index and middle fingers remain extended, while the 4th and 5th fingers flex

Answer 35

Hand of benediction

Question 36

What are the 4 types of brachial plexus injuries that occur at birth?

Answer 36

Neuroma Rupture Avulsion Neuro praxia

Question 37

What is a neuroma?

Answer 37

Nerve root has attempted to heal on its own | The neuroma is the scar tissue that grows around and decreases the signal strength sent to the muscles

Question 38

What is a rupture?

Answer 38

Where the nerve is torn but not at the spinal attachment

Question 39

What is an Avulsion?

Answer 39

Occurs when the nerve root is torn at the location where it exits (vertebra foramen)

Question 40

What is neuropraxia?

Answer 40

Occurs when the nerve is damaged (stretched but not torn)

Question 41

Presents with adducted and internally rotated shoulder, extended elbow and pronated wrist (waiter's tip" presentation) Occurs in about 0.7 in1000 births

Answer 41

Erb's palsy

Question 42

What portion of the brachial plexus is affected in Erb's palsy?

Answer 42

Upper portion of the brachial plexus | C5, C6

Question 43

What is the mechanism of injury for Erb's palsy?

Answer 43

In most cases is traction on the plexus during delivery

Question 44

In Erb's palsy treatment should be deferred for ____ to ______ days, then physical therapy and splinting should be undertaken

Answer 44

7 to 10 days

Question 45

Caused by a sudden shoulder abduction motion and loss of ulnar nerve sensory areas

Answer 45

Klumpke's palsy

Question 46

What is the treatment recommendation for klumpke's palsy?

Answer 46

Most patients do well with a WHO

Question 47

What is the portion of the brachial plexus is klumpke's palsy?

Answer 47

Lower segment involvement (loss of hand intrinsic muscles) | C7,8, T1

Question 48

Due to impingement of the ulnar nerve in klumpke's palsy, patients will present a "__________" and?

Answer 48

Claw hand" Wrist in extreme extension because of the un opposed wrist extensors Hyperextension of MCP due to loss of hand intrinsic muscles Flexion of IP joints due to loss of hand intrinsic muscles

Question 49

Patients with C 1-3 Level impairment can perform what ADL's?

Answer 49

Total dependence on caregiver

Question 50

What are some recreational activities can C 1-3 level impairments can do?

Answer 50

Discussion groups, spectator sports, reading and painting (by mouth)

Question 51

What is the available movement for C 1-3 Level impairment?

Answer 51

Neck control

Question 52

What are some orthotic treatment recommendation for C 1-3 Level Impairment?

Answer 52

Positional WHO's | Resting hand splint

Question 53

Patients with C 4 Level impairment can perform what ADL's?

Answer 53

Total dependence ( may incorporate external power systems

Question 54

What recreational activities can C4 Level impairment can do?

Answer 54

Discussion groups, spectator sports, reading and painting (by mouth)

Question 55

What are the available muscles for a C4 Level impairment?

Answer 55

Diaphragm and trapezius

Question 56

What are the orthotic treatment recommendations for a C4 Level impairment?

Answer 56

Mobile arm support, powered tenodesis WHO and or static WHO

Question 57

Patients with C 5 Level impairment can perform what ADL's?

Answer 57

Can independently feed, groom, and complete light home-keeping duties

Question 58

What recreational activities can C5 level impairment do?

Answer 58

Board games, card games, art and crafts

Question 59

What are the available muscles for a C 5 level impairment?

Answer 59

Deltoid, biceps, supinator, rotator cuff group, don't have wrist Extensors

Question 60

What is the orthotic treatment recommendation for a C5 level impairment?

Answer 60

Mobile arm support (initially), ratchet WHO or Powered tenodesis WHO

Question 61

Patients with C 6 Level impairment can perform what ADL's?

Answer 61

Can independently feed, grooming, independent transfer and driving (hand control)

Question 62

What recreational activities can C 6 level impairment do?

Answer 62

Wheelchair sports, archery, gardening

Question 63

What are the available muscles for C 6 Level impairment?

Answer 63

extensor carpi radialis Longus and Brevis Pronator teres Pectoralis major

Question 64

What are the orthotic treatment recommendations for C6 level impairment?

Answer 64

Wrist driven- WHO

Question 65

Patients with C 7 Level impairment can perform what ADL's?

Answer 65

Total independence and driving car with hand controls

Question 66

What recreational activities can a C7 level impairment do?

Answer 66

Wheelchair sports Archery Gardening

Question 67

What are the muscles are available for C7 level impairment?

Answer 67

Triceps, latissimus dorsi, extensor Digitorum, flexor carpi radialis, flexor Digitorum

Question 68

What are the orthotic treatment recommendations for a C7 level impairment?

Answer 68

Wrist driven WHO (initially) | Static WHO

Question 69

Patients with C8-T1 Level impairment can perform what ADL's?

Answer 69

Total independence and driving car with hand controls

Question 70

What recreational activities can C8-T1 impairments do?

Answer 70

Wheelchair sports

Question 71

What muscles are available for C8-T1 impairments?

Answer 71

Interossei, Lumbricals, Thenar and hypothenar muscles

Question 72

What is the orthotic recommendation for C8-T1 level impairment?

Answer 72

HO (initially)