Ortho: Tendons and Nerves Quiz

Axillary nerve motor functions

Shoulder abduction 15-90 degrees

Musculocutaneous nerve motor functions

elbow flexion

forearm supination

Radial nerve motor functions

elbow extension

forearm supination

wrist extension

thumb extension

digit extension

Median nerve motor functions

forearm pronation

wrist flexion

radial deviation

flexion of thumb, index, and long finger

Ulnar nerve motor functions

wrist flexion

ulnar deviation

flexion of ring and small digits

abduction/adduction of digits

extensor zone 1

extensor zone 2

extensor zone 3

extensor zone 4

extensor zone 5

extensor zone 6

extensor zone 7

extensor zone 8

extensor zone 1&2 immobilization

DIP extension orthosis

extensor zone 3&4 immobilization

- Finger gutter, full IP extension, taped in place

- Hand-based outrigger allowing 30 degrees of PIP flexion

- Finger gutter taped in place between exercises, exercise template with 30 degrees of PIP flexion, 20 degrees DIP flexion

extensor zone 5,6,7 immobilization

- Full-length resting pan in partial wrist extension and full digit extension or slight MP flexion

- Dynamic MP extension outtrigger allowing 30 degrees of MP flexion

- Immediate active extension orthosis using wrist support and yoke or dynamic outrigger removed for active extension

extensor zones 1&2 injury assessment

can they extend DIP

extensor zones 3&4 injury assessment

Central slip/possible lateral bands

Can they extend IP

Boutonniere?

extensor zones 5,6,7 injury assessment

Can they extend MPs

extensor zone 8 injury assessment

Can they extend their wrist?

High Brachial plexus injury

Erb's palsy

MOI - increased angle between neck and shoulder, traction to the brachial plexus

- Scapular depression, internal rotation, wrist flexion

Low brachial plexus injury

Klumpke's palsy

MOI - excessive upward pull of UE, traction on lower brachial plexus

- forearm supinated, elbow flexed, clawing of hand

musculocutaneous nerve sensory innervations

Coracobrachialis

bicep brachii

greater portion of the brachialis

axillary nerve sensory innervations

deltoid

teres minor

long head of triceps brachii

radial nerve sensory innervations

Triceps

Brachioradialis

Anconeous

Extensor carpi radialis longus

Extensor carpi radialis brevis

radial nerve motor only innervations (Posterior interosseous nerve (PIN)

Supinator

ECU

EDC

EDM (or EDQ)

APL

EPL

EPB

EDI (or EI)

Median nerve sensory innervations

pronator teres

Flexor carpi radialis

palmaris longus

Flexor digitorum superficialis

Abductor pollicus brevis o

pponens

flexor pollicis brevis

lumbricals 1 and 2

Median nerve motor only innervations (anterior interosseous nerve (AIN)

FDP I & II (Digits II & III)

FPL

Pronator quadratus

ulnar nerve sensory innervations

flexor carpi ulnaris

flexor digitorum profundus digits 4 and 5

musculocutaneous nerve

axillary nerve

radial nerve

median nerve

ulnar nerve

Dorsal compartment 1

Abductor pollicis longus (APL)

Extensor pollicis brevis (EPB)

-thumb abduction and extension)

Dorsal compartment 2

Extensor carpi radialis longus (ECRL)

Extensor carpi radialis brevis (ECRB)

- wrist extension

Dorsal compartment 3

Extensor pollicis longus (EPL)

- thumb extension mostly IP

Dorsal compartment 4

Extensor digitorum communis (EDC)

Extensor Indicus Proprius (EIP)

- MP extension and independent index extension

Dorsal compartment 5

Extensor digiti minimi (EDM)

- independent small finger extension

Dorsal compartment 6

Extensor carpi ulnaris (ECU)

- wrist extension, ulnar deviation

Provocative testing for thoracic outlet syndrome

Roos

Adson's

Roos test

Adson's Test

Wartenberg syndrome

Entrapment of superficial radial N between brachioradialis and ECRL

- loss of sensation or hypersensitivity throughout the RSN region of the hand

- Positive Tinel's

- Painful with thumb adduction and ulnar deviation

- Associated with extensive irritation at RSN (watch too tight, sleeping with a hair tie on the wrist)

Treatment

- thumb spica

- padding

- radial nerve gliding

Wartenberg sign

Unable to adduct pinky, resting in abduction

Associated with a laceration to the ulnar nerve

Tinel's sign

Provocative testing for carpal tunnel

Tinel's sign

Phalen's test

phalen's test

Provocative testing for cubital tunnel

Tinel's sign

Elbow flexion test

Test for sublux over medial epicondyle on elbow

elbow flexion test

cubital tunnel test; hold elbow in flex for 5 min with wrist neut to elicit symptoms

Flexor tendon zone 1

FDP

Jersey finger

Flexor tendon zone 2

no man's land

FDP goes through FDS

Flexor tendon zone 3

palm of hand

Flexor tendon zone 4

carpal tunnel

Flexor tendon zone 5

wrist

Brachial plexus origins

C5

C6

C7

C8

T1

Brachial plexus terminal branches

Musculocutaneous nerve

Axillary nerve

Radial nerve

Median nerve

Ulnar nerve

Flexor digitorum superficialis (FDS) assessment

Flexes PIP

The healthcare provider isolates it by holding all other fingers straight while the patient flexes the middle joint.

Flexor digitorum profundus (FDP) assessment

Flexes DIP

The provider holds all fingers in extension, then asks the patient to bend only the fingertip joint.