lecture 6 - Distal Limb Vessels, Nerves, & Blocks - Pimentel

C6; T2

The brachial plexus is from _____ to _____

suprascapular

The _____ nerve passes over the scapula and supplies the supra- and infraspinatus muscles

suprascapular

Damage to the _____ nerve gives the horse a "Sweeny" shoulder - atrophy of the supra and infraspinatus, shoulder instability, and shoulder "slip"

fix the shoulder in place

What is the main action of the infra and supraspinatus muscles?

horses do not have an acromion, so the nerve is exposed

Why is common for horses to have a suprascapular nerve injury?

subscapular muscle

The subscapular nerve supplies the _____

axillary

Normally, the _____ nerve is found between the subscapular and teres major muscles

shoulder

The axillary nerve supplies the muscles of the _____

musculocutaneous

The _____ nerve is associated with the muscles that flex the shoulder

brachial artery

What does the median nerve run with in the medial region?

medial artery

What does the brachial artery become in the forearm?

flexor (digital & carpal)

The median nerve is associated with the movement of the _____ muscles

median; musculocutaneous

The ansa axillaris is found around the axillary blood vessel, joining the _____ nerve with the _____ nerve

median nerve

What is the main innervation for the palmar surface of the "palm"?

radial

The _____ nerve is a large nerve trunk that comes from the brachial plexus, which hides between the heads of the triceps medially and laterally

extensor muscles of the carpus & digit

The lateral branches of the radial nerve innervate what?

radial nerve

What is the main nerve for extension?

1. triceps

2. extensor muscles of carpus & digits

What muscles does the radial nerve innervate? (2)

ulnar; median

The _____ and _____ nerves share the same "root"

ulnar

The _____ nerve is associated with the flexors of the carpus and digits

1. extensor carpi radialis

2. common digital extensor

Name 2 muscles that extend the carpus

median

The _____ nerve is the main nerve that gives us the medial and lateral palmar nerves

lateral palmar

The _____ nerve is a nerve that has both median and ulnar nerve association

digit

When the medial and lateral palmar nerves pass the metacarpus and reach the digit, we must add the word _____ to the name

1. lateral palmar metacarpal

2. medial palmar metacarpal

The lateral palmar nerve can become what 2 smaller & deeper nerves?

1. metacarpal bone III

2. interosseus ligament

The lateral and medial palmar metacarpal nerves are located between what 2 things?

ulnar

The _____ nerve is the main nerve that gives us the dorsal branch and lateral palmar nerve

medial cutaneous antebrachial

From the musculocutaneous muscle, we get the _____ nerve

1. ulnar nerve

2. median nerve

The main innervation of the distal thoracic limb comes from what nerves? (2)

1. lateral palmar

2. medial palmar

The "palm" is innervated by what 2 main nerves?

digital palmar nerves

When the 2 palmar nerves reach the digit, the name changes to lateral and medial _____

1. axillary

2. brachial

3. median

What are the 3 main arteries of the thoracic limb?

humeral

The axillary and brachial arteries supply the _____ area

antebrachium

The median artery supplies the _____

hand

The _____ artery is the main blood supply for the "_____"

lateral palmar digital; medial palmar digital

Median artery -> medial palmar artery -> _____ and _____ arteries

lateral palmar

The _____ artery is a very tiny artery that branches from the radial artery

median artery

Almost all of the blood supply for the thoracic limb comes from the _____

carpal net (rete carpi dorsalis)

What is the most important supplier of blood to the dorsal area of the carpus?

larger

The medial palmar artery is [smaller/larger] than the lateral palmar artery

true

T/F - The blood supply to the thoracic limb dorsally is very poor

L4; S2

Lumbar sacral plexus is from _____ to _____

1. cranial and caudal gluteal

2. femoral (with saphenous)

3. obturator

4. ischiatic (sciatic)

What are the 4 main nerves of the LS plexus?

proximal

The cranial and caudal gluteal nerves supply more _____ muscles of the pelvic limb

saphenous

Femoral nerve becomes _____ nerve

tibial; common fibularis (superficial and deep)

Ischiatic (sciatic) nerve becomes the _____ and _____ nerves

femoral

What nerve mainly supplies the quadriceps?

adductors

What muscle group is associated with the obturator nerve?

sciatic

What nerve is found deep to the biceps femoris?

common fibularis; tibial

The sciatic nerve branches into 2. The _____ nerve goes cranial to the limb and the _____ nerve stays back, in the caudal part of the leg.

tibial

The main innervation of the distal pelvic limb is given by the _____ nerve

fibular

The cranial tibia is associated with the _____ nerve

tibial

The caudal tibia is associated with the _____ nerve

saphenous

The craniomedial tibia is associated with the _____ nerve

1. lateral plantar metatarsal

2. medial plantar metatarsal

What 2 things stem from the deep plantar arch?

true

T/F - It is the same artery from the tibia to the pes, but with different branches

nerve block

Putting anesthetic around the nerve, not in the nerve, to numb it

palmar digital nerves (metacarpal phalangeal joint, down)

What nerves do we target with the palmar digital nerve block?

1. Sole

2. Navicular Apparatus

3. Coffin joint

4. Distal flexor tendon sheath

5. Distal sesamoidean ligaments

6. Loss of skin sensation at the heel

The palmar digital nerve block numbs what areas? (6)

palmar digital nerves

What nerves do we target with the abaxial sesamoid nerve block?

1. Foot

2. Middle Phalanx

3. Pastern joint

4. Distal P1

5. Distal SDF and DDF

6. Distal sesamoidian ligaments

7. Distal annular ligament

8. +/- Fetlock joint

The abaxial sesamoid nerve block numbs what areas? (6)

1. Palmar metacarpal/metatarsal nerves

(adjacent to splint)

2. Palmar nerves (between suspensory and DDFT)

What nerves do we target with the low 4-point nerve block?

1. All structures previously mentioned

2. Fetlock joint

3. Suspensory Branches

4. More proximal SDF/DDF tendons

The low 4-point nerve block numbs what areas? (6)

1. Medial and lateral palmar nerves

2. Medial and lateral palmar metacarpal

nerves

What nerves do we target with the front limb high 4-point nerve block?

1. Flexor tendons

2. Splint bones

3. Interosseous ligaments (between MC2/4 and MC3)

4. Proximal suspensory ligament

5. Inferior check ligament

The front limb high 4-point nerve block numbs what areas? (6)

1. Medial and lateral plantar nerves

2. Medial and lateral plantar metatarsal nerves

3. Dorsal metatarsal nerves

What nerves do we target with the hind limb high 4 (6) -point nerve block?