NPTE UE and LE Nerves

Where does the Axilary n. originate from?

Branch of the posterior cord of brachial plexus

Axilary n. Nerve Roots

C5-6

Axillary n. Motor Supply

Teres Minor, Deltoid

Axillary n. Sensory Supply

Becomes the Upper lateral cutaneous nerve and supplies the skin covering the lower half of the deltoid and upper part of the long head of triceps

What can injure the Axillary n.?

Dislocation of shoulder, fracture of surgical neck of humerus

What are the effects of the Axillary n. injury?

Square shoulder - from deltoid muscle atrophy, sensory loss over lower half of deltoid

Where does the Radial n. originate from?

Branch of posterior cord of brachial plexus

Radial n. Nerve Roots

C5-T1

Radial n. Path

Exits axilla via triangular interval, travels down humerus in radial groove, at the elbow the nerve pierces the lateral muscular septum anterior to the lateral epicondyle and passes under the origin of the ECRB; then divides into superficial and deep branches

Radial n. motor supply

Triceps, Anconeus, Brachioradialis, Supinator, ECRL, ECRB, ECU, ED, EDM, EPL, EPB, EI, APL

Radial n. sensory supply

Lower lateral cutaneous nerve (lower half of lateral arm), Posterior Cutaneous Nerve of Arm (Skin of back of arm), Posterior Cutaneous Nerve of Forearm (skin of back of forearm), Superficial Branch (lateral half of dorsum of hand, lateral two and half digits including thumb.

How can the radial n. be injured?

Can be injured in axilla, musculospiral groove, around radial neck. Radial tunnel syndrome, posterior interosseous nerve syndrome, wrist drop

Where does the ulnar nerve originate from?

Branch of medial cord of brachial plexus

Ulnar n. Nerve Roots

C7-T1

Ulnar n. Path

passes behind the medial epicondyle, pierces the flexor carpi ulnaris to enter forearm, superficial to felxor retinaculum, enters hand via Guyon's canal

Ulnar n. Motor Supply

Dorsal Interossei, Palmar Interossei, Adductor Pollicis, Opponens Digit minimi, Flexor digiti minimi, Abductor Digiti minimi, flexor pollicis brevis, flexor digitorium profundus, Flexor carpi ulnaris, Lumbricals

Ulnar n. Sensory Supply

Palmar Cutaneous branch (medial 1/2 of palm), Dorsal Cutaneous Branch (skin of dorsal aspect of medial one and half fingers) , Superficial Branch (supplies 1/2 of 4th, 5th digit

What can Ulnar n. lesions cause?

Cubital Tunnel Syndrome (compression at elbow), Guyon's Canal Syndrome, Ulnar Claw hand (hyperextension at 4th, 5th MCP, Flexion at 4th, 5th due to weakness of FDP

Where does the median n. originate?

from medial and lateral cord of brachial plexus

Median n. Nerve Roots

C5-T1

Median n. Path

Descends lateral to brachial artery, enters forearm between two heads of pronator teres muscle, enters hand via Carpal Tunnel

Median n. Motor Supply

FDP, FDL, PQ, APB, PT, OP, PL, Lumbricals, FCR, FDS, FPB

Median n. Sensory Supply

Palmar Cutaneous Branch (skin of lateral two-thirds of palm), Palmar Digital branches (supplies dorsal tips of 1st, 2nd, & 3rd finger, palmar skin of lateral three and half fingers

What are common median nerve injuries?

Pronator Teres Syndrome, Carpal Tunnel syndrome, Ape hand deformity

Where does the musculocutaneous n. originate?

branch of the lateral cord of brachial plexus

Musculocutaneous N. Nerve Roots

C5-C7

Musculocutaneous n. Motor Supply

Biceps, Brachialis, Coracobrachialis,

Musculocutaneous N. Sensory Supply

lateral cutaneous nerve of forearm: supplies the skin on lateral side of forearm

Where does the suprscapular n. originate from?

Arise from upper trunk of brachial plexus

Suprascapular n. Nerve Roots

C5-C6

Suprascapular n. Motor Supply

Infraspinatus, Supraspinatus

Where does the subscapular nerve originate from?

Posterior cord of brachial plexus

Subscapular n. Nerve Roots

C5-C6

Subscapular n. Motor Supply

Teres Major (lower), Subscapularis (lower and upper)

Where does the lateral pectoral n. originate?

Branch of lateral cord of brachial plexus

Lateral Pectoral n. Nerve Roots

C5-C7

Lateral Pectoral n. Motor Supply

Pectoralis Major

Where does the Medial Pectoral n. originate?

branch of medial cord of brachial plexus

Medial Pectoral n. Nerve Roots

C8, T1

Medial Pectoral n. Motor Supply

Pectoralis Minor

Where does the Long Thoracic n. originate?

arise from roots of brachial plexus

Long Thorcic n. Nerve Roots

C5-C7

Long Thoracic n. Motor Supply

Serratus Anterior

What can injury to the long thoracic n. cause?

Winged Scapula

Where does the Thoracodorsal n. originate?

branch of posterior cord of brachial plexus

Thoracodorsal N. Nerve Roots

C6-C8

Thoracodorsal n. Motor Supply

Latissimus Dorsi

Where does the Dorsal Scapular n. originate?

root of brachial plexus

Dorsal Scapular N. Nerve Root

Rhomboid Minor, Rhomboid major, Levator Scapulae

Where does the nerve to Subclavius originate?

upper trunk of brachial plexus

Subclavius Nerve Root

C5-C6

Subclavius Motor Supply

Subclavius

Muscles of Scapular Elevation

Upper trapezius, levator scapulae, rhomboids

Muscles of Scapular Protraction

Serratus Anterior, Pectoralis Minor and Major

Muscles of Scapular Depression

Seratus Anterior, Pectoralis minor and major, Lower Trapezius, Latissimus Dorsi

Muscles of Scapular Retraction

Trapezius, Rhomboids

Muscles of Scapular Downward rotation

Levator Scapula, Rhomboids, Pectoralis Minor

Muscles of Scapular Upward Rotation

Serratus Anterior, trapezius (upper and lower fibers)

Spinal Accessory N. (CNXI) Motor Supply

Trapezius, Sternocleidomastoid

Superior Gluteal Nerve Root

L4-S1

Superior Gluteal N. Motor Supply

Gluteus Medius, Gluteus Minimus, Tensor Fascia Latae

Inferior Gluteal Nerve Root

L5-S2

Inferior Gluteal N. Motor Supply

Gluteus Maximus

Nerve to Piriformis Nerve Roots

L5-S2

Nerve to Piriformis Motor Supply

Piriformis

Obturator Nerve Root

L2-L4

Obturator Nerve Pathway

enters the thigh by passing through the obturator canal, bifurcates into anterior & posterior divisions

Anterior Obturator N. Motor Supply

Adductor Longus, Adductor Brevis, Gracilis

Posterior Obturator N. Motor Supply

Obturator Externus, Adductor Magnus

Obturator N. Sensory Supply

cutaneus branch of obturator nerve supplies skin of medial thigh

Nerve to Quadratus Femoris Nerve Roots

L4-S1

Nerve to Quadratus Femoris motor supply

Gemellus inferior, quadratus femoris

Nerve to Obturator Internus Nerve Root

L5-S2

Nerve to Obturator Internus Motor Supply

Gemellus Superior, Obturator Internus

Sciatic Nerve Root

L4-S3

Sciatic Motor Supply

Biceps Femoris, Semitendinosus, Semimembranosus, Adductor Magnus

Sciatica

herniated disc or bone spur that compresses the sciatic nerve and causes radiating pain

Piriformis Syndrome

piriformis spasm or tightness compresses the sciatic nerve

Femoral Nerve Root

L2-L4

Femoral N. Pathway

passes through femoral triangle along with femoral artery

Femoral N. Motor Supply

Iliacus, Pectineus, Sartorius, Rectus Femoris, Vastus Medialis/intermedius/Lateralis

Femoral N. Sensory Supply (Medial Cutaneus)

branch of anterior division of femoral nerve. Supplies the skin on medial side of lower two third of thigh

Femoral N. Sensory Supply (Intermediate Cutaneus)

Branch of anterior division of femoral nerve - supplies skin on front of thigh

Femoral N. Sensory Supply (Saphenous N.)

branch of posterior division of femoral nerve, supplies the skin on the medial side of leg

Tibial Nerve Root

L4-S3

Tibial N. Motor Supply

Gastrocnemius, Soleus, Plantaris, Popliteus, Tibialis posterior, flexor hallucis longus, flexor digitorum longus

Tarsal Tunnel Syndrome

Flexor Retinaculum creates a tunnel in which the nerve, artery, and vein pass through - posterior tibial nerve compression or irritation can occur

Medial Plantar N.

branch of tibial n.

Medial Plantar N. Motor Supply

Abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, lumbrical 1

Lateral Plantar N.

Tibial N. Branch

Lateral Plantar N. Motor Supply

Plantar interossei, dorsal interossei, quadratus plantae, abductor digiti minimi, lumbricals 2,3,4, Adductor hallucis

Sural N.

branch from tibial nerve and common fibular nerve form the sural nerve - which supplies the skin over lower posterolateral leg

Tibial n. Medial Calcaneal Branches Sensory Supply

Supplies skin over heel

Tibial N. Medial Plantar Nerve Sensory Supply

supplies skin on medial side of sole

Tibial N. Lateral Plantar N. Sensory Supply

supplies skin on lateral side of sole

Common Peroneal Nerve Root

L4-S2

Common Peroneal N. Pathway

originates from sciatic n. at popliteal fossa, bifurcates just below the neck of fibular into deep and superficial.

Deep Peroneal N. Motor Supply

Tibialis Anterior, Extensor Hallucis Longus, Extensor Digitorum Longus, Extensor Digitorum Brevis, Peroneus Tertius

Deep Peroneal N. Injury

Foot drop and unopposed eversion during gait

Superficial Peroneal N. Root

L4-S2