UE and LE Nerves

Draw the Brachial Plexus

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Axillary nerve roots

C5-C6

Axillary nerve motor supply

teres minor, deltoid

Axillary nerve sensory supply

Sergeant's patch over lower deltoid

Causes of axillary nerve injury

Shoulder dislocation

Fx of surgical humeral surgical neck

Radial nerve roots

C5-T1

Radial nerve course

Exits axillary fossa through triangular interval; passes posterior to humerus in radial groove between lateral and medial heads of triceps; perforates lateral intermuscular septum; enters cubital fossa, dividing into superficial (cutaneous) and deep (motor) branches

Radial nerve motor supply

triceps brachii and anconeus; all the posterior forearm muscles (brachioradialis, supinator, extensors, + abductor pollicis longus)

Radial nerve sensory supply

- Dorsum of wrist

- Dorsum of thumb

- Lateral hand

- Dorsum of digits 1, 2, 3, to PIP

Causes of radial nerve injury

1) Prolonged compression of the axilla

2) Radial head subluxation (nursemaids elbow) damages annular ligament; common injury in kids < 5yrs.

3) Radial Tunnel Syndrome

4) PIN syndrome

Ulnar nerve roots

C8-T1 (some people C7)

Ulnar nerve course

posterior to medial epicondyle, pierces flexor carpi ulnaris, superficial to flexor retinaculum, enters hand via tunnel of Guyon

Ulnar nerve motor supply

- flexor carpi ulnaris

- medial half of flexor digitorum profundus

- all hypothenar muscles

- dorsal and palmar interosssei of the hand

- medial two lumbrical muscles (3 +4)

- adductor pollics

Ulnar nerve sensory supply

medial hand

palmar and dorsal surfaces of hand

entire fifth finger

ulnar half of the annular finger

Causes of Ulnar nerve injury

Cubital tunnel syndrome

Guyon's canal syndrome

Ulnar claw hand

Proximal vs Distal Ulnar nerve injury

proximal- can't flex 4th + 5th fingers

distal- can't extent 4th + 5th fingers

Median nerve roots

C5-T1

Median nerve course

Lateral to axillary artery; Enters forearm between two heads of pronator teres; enters hand via Carpal Tunnel

Median nerve motor supply

- entire forearm musculature (except flexor carpi ulnaris and medial half of flexor digitorum profundus)

- medial half flexor digitorum profundus

- opponens pollicis

- abductor pollicis brevis

- flexor pollicis brevis

Median nerve sensory supply

Palmar aspect of the hand, thumb, index, middle, and radial half of anularis finger on their palmar surfaces

Dorsal surface of fingers 1-4

Causes of Median nerve injury

Pronator teres syndrome

Carpal tunnel syndrome

Ape hand deformity

musculocutaneous nerve roots

C5-C7

musculocutaneous nerve motor supply

biceps, brachialis, coracobrachialis

musculocutaneous nerve sensory supply

anterolateral forearm

Suprascapular nerve roots

C5-C6

Suprascapular nerve motor supply

supraspinatus and infraspinatus

Subscapular nerve roots

C5-C6

Subscapular nerve motor supply

Teres Major, Subscapularis

Lateral pectoral nerve roots

C5-C7

Lateral pectoral motor supply

pectoralis major

Medial pectoral nerve roots

C8-T1

Medial pectoral nerve motor supply

pectoralis minor

Long thoracic nerve roots

C5-C7

Long thoracic nerve motor supply

serratus anterior

Thoracodorsal nerve roots

C6-C8

Thoracodorsal nerve motor supply

latissimus dorsi

Dorsal scapular nerve roots

C5

Dorsal scapular nerve motor supply

rhomboid major, rhomboid minor, and levator scapula

Subclavius nerve root

C5-C6

Subclavius nerve motor supply

Subclavius

Spinal Accessory nerve motor supply

Trapezius

Sternocleidomastoid

Draw the lumbosacral plexus

Superior Gluteal nerve roots

L4-S1

Superior gluteal nerve motor supply

gluteus medius, gluteus minimus, and tensor fascia lata muscles

Inferior gluteal nerve roots

L5-S2

Inferior gluteal nerve motor supply

gluteus maximus

Piriformis nerve roots

L5-S2

Piriformis nerve motor supply

Piriformis

Obturator nerve roots

L2-4

Obturator nerve course

Enters thigh through obturator canal before splitting into anterior and posterior divisions

Obturator nerve motor supply

Anterior division- adductor longus, adductor brevis, Gracilis

Posterior division- Obturator externes, adductor magnus

Obturator nerve sensory supply

Skin on med thigh

Articular branches to hip and post knee jt

Quadratus Femoris nerve root

L4-S1

Quadratus Femoris nerve motor supply

Gemellus inferior

Quadratus Femoris

Obturator Internus nerve root

L5-S2

Obturator Internus nerve motor supply

Gemellus superior

Obturator Internus

Sciatic nerve root

L4-S3

Sciatic nerve motor supply

biceps femoris, semitendinosus, semimembranosus, adductor magnus

Common injuries Sciatic Nerve

Sciatica

Piriformis Syndrome

Sciatic nerve splits into

tibial nerve and common peroneal nerve

Femoral nerve roots

L2-L4

Femoral nerve motor supply

iliacus, pectineus, sartorius, rectus femoris, vastus medialis/intermedius/lateralis

Femoral nerve sensory supply

Lower and med. thigh via med and lat ant cutaneous nerves

Saphenous

Articular branches to hip and knee jts

Tibial nerve root

L4-S3

Tibial nerve motor supply

Gastroc, Soleus, Plantaris, Popliteus, Tibialis posterior, Flexor hallucis longus, flexor digitorum longus

tibial nerve splits into

medial plantar nerve and lateral plantar nerve

common tibial nerve injuries

Tarsal tunnel syndrome

Medial plantar nerve motor supply

Abductor hallucis

Flexor hallucis brevis

Flexor digitorum brevis

Lumbrical 1

Lateral plantar nerve motor supply

Plantar and Dorsal Interossei

Quadratus plantae

Abductor digiti minimi

Lumbricals 2,3,4

Adductor hallucis

Tibial nerve sensory supply

Posterolateral leg

Plantar aspect of foot (from branches)

Common peroneal nerve roots

L4-S2

Common peroneal nerve course

Splits from sciatic nerve at popliteal fossa into superficial and deep branches

Deep peroneal nerve motor supply

Tibialis anterior

Extensor hallucis longus

Extensor digitorum longus

Extensor digitorum brevis

Peroneus tertius

Deep peroneal nerve injury causes

foot drop, unopposed eversion

Superficial peroneal nerve motor supply

peroneus longus, peroneus brevis

Superficial peroneal nerve sensory supply

Dorsum of foot (except webbing between 1st + 2nd toes) and anteromedial lower leg

Deep peroneal nerve sensory supply

Webbing between 1st & 2nd toes of foot on the dorsal surface