NPTE Nerve Roots and Peripheral Nerves

what nerves come off of the posterior cord of the brachial plexus

radial nerve, thoracordorsal, lower subscapular, upper subscapular

dorsal scapular nerve innervates what muscles

rhomboids, levator scapulae

suprascapular innervates what muscles

supraspinatus and infraspinatus

lateral pectoral innervates what muscle

pec major

Upper subscapular nerve innervates what muscles?

subscapularis

Lower subscapular nerve innervates what muscles?

teres major and subscapularis

thoracordorsal nerve innervates what muscle

lats

musculocutaneous nerve innervates what muscles

coracobrachialis, biceps brachii, brachialis

axillary nerve innervates what muscle

deltoid, teres minor

Median nerve innervates what muscles?

Pronator teres, abductor pollicis brevis, and wrist flexor mm.

radial nerve innervates what muscles

triceps, anconeus, extensor radialis longus, extensor radialis brevis, supinator

branches of median nerve

anterior interosseous nerve

palmar cutaneous nerve

branch of the radial nerve

posterior interosseous nerve

C3 myotome

head side flexion

muscles for thumb extension

extensor pollicis longus and brevis

muscles for wrist extension

extensor carpi radialis brevis and longus

muscles for wrist flexion

flexor carpi radialis, flexor digitorum superficialis

C6 myotome

elbow flexion, wrist extension

C7 myotome

elbow extension, wrist flexion

what is neuropraxia

transient block, no wallerian degeneration, pain, no muscle wasting, "fall asleep"

axonotmesis

nerve preserved, axons damaged, Wallerian degeneration

neurotmesis

most severe grade of injury to a peripheral nerve. all components are damaged and irreversible. all motor and sensory loss is permanently impaired.

clinical findings with damage to spinal accessory nerve

neck, shoulder, medial scapular pain, decreased cervical lordosis, downwardly rotated scapula, lateral winging of scapula

clinical findings with damage to suprascapular nerve

dull ache lateral shoulder, atrophy and weakness of the infraspinatus, increased scapula elevation during arm elevation

clinical findings with damage to long thoracic nerve

weak scapular protraction, weakness with upward rotation of scapula, medial winging of medial scapula

suprascapular sensory innervation

GH capsule

musculocutaenous damage clinical findings

lateral arm sensory changes, weakness/atrophy biceps, brachialis, coracobrachialis, diminished biceps reflex

musculoctaneous nerve sensory component

lateral forearm

damage to axillary nerve clinical findings

axillary pain, deltoid area paresthesia, atrophy deltoid and teres minor, elevation weakness, anterior shoulder dislocation

axillary nerve sensory component

proximal lateral arm

radial nerve clinical findings

triceps weakness, extensors of forearm weakness, webspace sensory loss, dorsal hand/forearm sensory loss, wrist drop

PIN syndrome

motor loss of finger extension

posterior interosseous nerve muscles

extensors, supinator, abductor pollicis longus

radial nerve sensory

dorsal arm, dorsal forearm, dorsal hand, 1st interosseous space thumb

anterior interosseus nerve muscles

flexor pollicis longus, pronator quadratus, flexor digitorum profundus, "tip to tip" pinch grip ( if damaged unable to make the OK sign)

median nerve damage clinical findings

ape hand, opposition weakness, weak grasp, pronation weakness, radial deviation weakness, when attempting to make a fist the first 3 fingers would not flex

ulnar nerve damage clinical findings

ulnar claw, inability to extend PIP and DIP, inability to abduct fingers, inability to adduct thumb, weakness with ulnar deviation, hypothenar wasting, loss of sensation of the 4-5 fingers

froments sign

ulnar dysfx

-FROMents=pull FROM my hands

erbs palsy

upper brachial plexus injury C5-C6

Klumpkes palsy

lower brachial plexus injury C7-T1

Weakness of elbow flexion and wrist extension, diminished brachioradialis reflex?

C6 myotome

Sensory loss over webspace of thumb?

radial nerve

Weakness with shoulder abduction and external rotation?

axillary nerve

Weakness with shoulder abduction and sensory loss of anterior forearm, diminished biceps reflex?

C5

No tip-to-tip pinch of 1st-2nd fingers?

AIN syndrome

Deep shoulder pain, weakness with external rotation?

suprascapular nerve

Ape hand indicates lesion to what nerve

median nerve

paracentral disc herniation example

L4 nerve root comes below L4 but has already made its escape and does hit the L4 disc but instead will hit the L5 disc

A patient has an MRI showing a L4-5 paracentral intervertebral disc herniation. What grouping of symptoms is most likely to be present

Weakness with great toe extension, paresthesia dorsum of foot

femoral nerve muscle innervation

iliopsoas, sartorius, pectineus, quadriceps femoris

femoral nerve sensory innervation

anterior and medial surface of thigh, medial knee, proximal leg, saphenous nerve

femoral nerve lesion clinical findings

knee buckling, knee extension weakness, anterior knee pain, sensory loss medial aspect of leg below knee, forward trunk lean during GAIT

obturator nerve muscle innervation

adductor longus/brevis, gracilis, adductor magnus, obturator externus

sensory innervation of obturator nerve

small area on medial thigh/groin

clinical findings of obturator nerve

loss of external rotation and adduction

superior gluteal nerve nerve roots

L4-S1

superior gluteal nerve muscle innervation

glut med, glut min, tensor fascia lata

inferior gluteal nerve nerve roots

L5-S2

inferior gluteal nerve muscle innervation

glut max

superior gluteal nerve lesion clinical findings

trendelenburg gait

inferior gluteal nerve lesion clinical findings

posterior trunk lean at initial contact

branches of sciatic nerve

tibial, common peroneal, superficial peroneal, deep peroneal

tibial nerve muscle innervation

gastroc, soleus, popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis longus

tibial nerve sensory innervation

sural nerve is the sensory component, posterolateral lower leg and lateral foot

superficial peroneal nerve muscle innervation

fibularis longus and brevis

superficial peroneal nerve sensory component

lower leg and dorsum of foot

deep peroneal nerve muscle innervation

tibialis anterior, extensor digitorum longus, extensor hallucis longus

deep peroneal nerve sensory component

1st webspace of foot

which muscle will be most helpful to avoid excessive pronation

tibialis posterior to promote inversion and avoid pronation

Tarsal Tunnel Syndrome

compression of the tibial nerve in the tarsal tunnel

where is the tarsal tunnel

space occupying lesion at medial malleolus under flexor retinaculum ligament

where is pain at with tarsal tunnel syndrome

medial heel, medial arch, worse with standing/walking

motor signs with tarsal tunnel syndrome

weak foot intrinsic

range of motion with tarsal tunnel syndrome

full active ROM but may have pain with pronation

Weak dorsiflexion and sensory loss over 1st webspace of foot? what nerve impaired

deep peroneal nerve

1+ patellar tendon reflex, weak hip flexion, loss of sensation on medial malleolus? what nerve impaired

femoral nerve

weak eversion what nerve is lesioned

superficial peroneal nerve

Weak toe flexion, lateral foot paresthesia?

tibial nerve