p.5
Brachial Plexus Block Techniques
Where should intramuscular injections at the deltoid muscle be administered?
Approximately 2 inches below the acromion, at the middle of the deltoid muscle.
p.10
Median Nerve Injuries and Symptoms
What can cause median nerve entrapment?
Prolonged and repetitive gripping or pronation movements.
p.25
Radial Nerve Injuries and Clinical Presentations
What is a common cause of level II radial nerve injury?
Midshaft fracture of the humerus.
p.32
Ulnar Nerve Injuries and Clinical Presentations
Where does the ulnar nerve travel in relation to the ulnar artery?
Medial to the ulnar artery through Guyon's canal.
p.33
Ulnar Nerve Injuries and Clinical Presentations
What are the two branches the ulnar nerve divides into within the tunnel?
Superficial sensory and deep motor branches.
p.8
Axillary Nerve Injury and Clinical Presentations
Which fracture can damage the axillary nerve?
Fracture of the surgical neck of the humerus.
p.20
Radial Nerve Injuries and Clinical Presentations
What is Saturday night palsy?
A condition caused by prolonged adduction of the arm with a hard object, often during deep sleep after alcohol intoxication.
p.32
Ulnar Nerve Injuries and Clinical Presentations
What causes Guyon's canal syndrome?
Constant pressure on the medial wrist, repetitive wrist movements, fractures/injuries causing swelling at Guyon's canal, and ulnar artery thrombosis.
p.20
Radial Nerve Injuries and Clinical Presentations
What anatomical structure does the radial nerve travel with in the arm?
The profunda brachii artery.
p.40
Ulnar Nerve Injuries and Clinical Presentations
Where does the ulnar nerve run at the elbow?
Superficially at the posterior aspect of the elbow, posterior to the medial epicondyle and medial to the olecranon.
p.31
Ulnar Nerve Injuries and Clinical Presentations
Where does the ulnar nerve travel in relation to the humerus?
Posterior to the medial epicondyle of the humerus.
p.5
Brachial Plexus Block Techniques
What is the effect of an infraclavicular block?
Loss of sensation of all deep structures of the upper limb and loss of cutaneous sensation distal to the middle of the arm.
p.16
Median Nerve Injuries and Symptoms
What symptoms are associated with median nerve injury?
Numbness/tingling at the lateral 2/3 of the palm and palmar surface of the lateral 3.5 digits.
p.10
Musculocutaneous Nerve Injury and Testing
What sensory loss is associated with musculocutaneous nerve injury?
Loss of sensation over the lateral forearm.
p.29
Brachial Plexus Block Techniques
What is the author's opinion on Prof. Shum's description of the radial nerve block at the wrist?
The author doubts its accuracy.
p.16
Median Nerve Injuries and Symptoms
Which branches of the median nerve are affected in this condition?
Both the palmar cutaneous branch and palmar digital branches.
p.33
Ulnar Nerve Injuries and Clinical Presentations
What are the clinical presentations of level II ulnar nerve injury?
They are the same as level I ulnar nerve injury.
p.13
Median Nerve Injuries and Symptoms
What are the causes of level I median nerve injury?
Lower plexus injury, supracondylar fracture of humerus, and median nerve entrapment.
p.5
Long Thoracic Nerve Injury and Symptoms
What are some causes of long thoracic nerve injury?
Trauma to the lateral thoracic cage, surgical procedures, and inflammation affecting the nerve.
p.8
Axillary Nerve Injury and Clinical Presentations
What syndrome can cause axillary nerve injury?
Quadrangular space syndrome.
p.22
Radial Nerve Injuries and Clinical Presentations
Where does the radial nerve descend in relation to the axillary artery?
It descends posterior to the axillary artery.
p.15
Median Nerve Injuries and Symptoms
What happens in a level I median nerve injury?
Almost all flexor muscles in the forearm are paralyzed, except flexor carpi ulnaris and the medial half of flexor digitorum profundus.
p.29
Brachial Plexus Block Techniques
At what point does the superficial branch of the radial nerve start winding around the radius?
Around 2/3 of the way down the forearm.
p.32
Ulnar Nerve Injuries and Clinical Presentations
What structures are associated with Guyon's canal syndrome?
Flexor retinaculum, hamate, pisiform, pisohamate ligament, ulnar artery, and ulnar nerve.
p.32
Ulnar Nerve Injuries and Clinical Presentations
What is Guyon's canal syndrome commonly known as?
Handlebar or Cyclist's palsy.
p.8
Axillary Nerve Injury and Clinical Presentations
What is a common cause of axillary nerve injury related to the shoulder?
Anterior inferior dislocation of the GH joint.
p.25
Radial Nerve Injuries and Clinical Presentations
What is the effect of a midshaft humeral fracture on elbow and shoulder extension?
There is no problem with elbow and shoulder extension due to prior motor branches to the triceps.
p.20
Radial Nerve Injuries and Clinical Presentations
Why is the radial nerve prone to compression?
It is located near the upper arm close to the axilla.
p.4
Klumpke's Palsy and Its Causes
What are common causes of Klumpke's palsy?
Sudden upward pull of the upper limb or excessive pull of a baby's upper limb during delivery.
p.7
Axillary Nerve Injury and Clinical Presentations
What structures pass through the quadrangular space?
The axillary nerve and posterior circumflex humeral vessels.
p.40
Ulnar Nerve Injuries and Clinical Presentations
What is the effect of an ulnar nerve block at the elbow?
It is similar to level I ulnar nerve injury.
p.23
Radial Nerve Injuries and Symptoms
What does the deep branch of the radial nerve continue as?
The posterior interosseous nerve.
p.22
Radial Nerve Injuries and Clinical Presentations
What two cutaneous branches does the radial nerve give out in the radial groove of the humerus?
The inferior lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm.
p.8
Axillary Nerve Injury and Clinical Presentations
What vessels does the axillary nerve accompany?
The posterior circumflex humeral vessels.
p.11
Median Nerve Injuries and Symptoms
What forms the carpal tunnel at the wrist?
A deep arch of carpal bones and the flexor retinaculum.
p.12
Median Nerve Injuries and Symptoms
What are the clinical presentations associated with the palmar cutaneous branch of the median nerve?
They are the same as level II median nerve injury.
p.10
Musculocutaneous Nerve Injury and Testing
How is the biceps tendon reflex tested?
By tapping the biceps tendon at the cubital fossa.
p.32
Ulnar Nerve Injuries and Clinical Presentations
What are the medial and lateral boundaries of Guyon's canal?
Medial boundary: Pisiform bone and pisohamate ligament; Lateral boundary: Hook of hamate.
p.11
Median Nerve Injuries and Symptoms
What happens to the median nerve after traversing the cubital fossa?
It passes between the ulnar and humeral heads of the pronator teres.
p.28
Radial Nerve Injuries and Clinical Presentations
What area does the superficial branch of the radial nerve supply?
The skin on the dorsum of the lateral 2.5 digits (except tips).
p.16
Median Nerve Injuries and Symptoms
What causes atrophy of the thenar muscles?
Lack of stimulation from the recurrent branch of the median nerve.
p.10
Musculocutaneous Nerve Injury and Testing
What is the primary function of the musculocutaneous nerve?
It supplies all flexor muscles of the anterior compartment of the arm.
p.7
Axillary Nerve Injury and Clinical Presentations
What is a common cause of Quadrangular Space Syndrome?
Frequent carrying of heavy backpacks.
p.7
Axillary Nerve Injury and Clinical Presentations
Which activities can lead to Quadrangular Space Syndrome in athletes?
Frequent arm abduction and medial rotation.
p.39
Ulnar Nerve Injuries and Clinical Presentations
What is the sensory loss area for the palmar aspect of the medial 1.5 digits?
Superficial branch of the ulnar nerve.
p.25
Radial Nerve Injuries and Clinical Presentations
What should be considered when evaluating elbow extension in a midshaft humeral fracture?
Only the action of the long head of triceps should be considered.
p.39
Ulnar Nerve Injuries and Clinical Presentations
Which area is spared from sensory loss in ulnar nerve injury?
Medial half of the dorsum of the hand.
p.19
Median Nerve Injuries and Symptoms
What test is used to assess median nerve function by asking the patient to make a fist?
Hand of Benediction test.
p.33
Ulnar Nerve Injuries and Clinical Presentations
What can cause ulnar nerve injury related to the elbow?
Medial epicondyle avulsion and elbow dislocation.
p.29
Brachial Plexus Block Techniques
What discrepancy does the author point out?
The difference between the illustrations by Netter and Prof. Shum.
p.41
Ulnar Nerve Injuries and Clinical Presentations
Which muscles are primarily supplied by the ulnar nerve?
Almost all intrinsic muscles of the hand responsible for abduction and adduction, specifically the palmar and dorsal interossei.
p.16
Median Nerve Injuries and Symptoms
What are the causes of median nerve injury?
Wrist laceration and carpal tunnel syndrome.
p.16
Median Nerve Injuries and Symptoms
What is a key clinical presentation of median nerve injury?
No hand of benediction; the patient is able to make a fist.
p.4
Klumpke's Palsy and Its Causes
What is Klumpke's palsy?
A lower plexus (C8-T1) injury caused by sudden upward pull of the upper limb or excessive pull during delivery.
p.29
Brachial Plexus Block Techniques
Where does the author believe the superficial branch of the radial nerve is situated?
Directly lateral to or even posterior to the styloid process of the radius.
p.40
Ulnar Nerve Injuries and Clinical Presentations
Where can an ulnar nerve block be performed at the elbow?
Just proximal to the cubital tunnel.
p.11
Median Nerve Injuries and Symptoms
What can cause compression of the median nerve?
Hypertrophy of the pronator teres due to excessive use.
p.20
Radial Nerve Injuries and Clinical Presentations
What are the clinical presentations of radial nerve injury?
They are the same as those for level I radial nerve injury.
p.41
Ulnar Nerve Injuries and Clinical Presentations
What is a test for ulnar nerve function?
Ask the patient to abduct the fingers against resistance or hold a thin object between two fingers by adduction.
p.12
Median Nerve Injuries and Symptoms
What area does the palmar cutaneous branch of the median nerve innervate?
Skin over the thenar eminence and lateral 2/3 of the palm.
p.12
Median Nerve Injuries and Symptoms
Why is the palmar cutaneous branch spared in carpal tunnel syndrome?
Because it is given off before the median nerve enters the carpal tunnel.
p.41
Ulnar Nerve Injuries and Clinical Presentations
What should a patient with ulnar nerve injury be unable to do?
Perform actions involving finger abduction and adduction.
p.5
Brachial Plexus Block Techniques
What can poor intramuscular injection technique lead to?
Damage to the axillary nerve or radial nerve.
p.8
Axillary Nerve Injury and Clinical Presentations
What leads to atrophy of the deltoid and teres minor muscles?
Prolonged denervation or chronic lack of stimulation.
p.20
Radial Nerve Injuries and Clinical Presentations
Where does the radial nerve cross in the arm?
The inferior boundary of teres major.
p.25
Radial Nerve Injuries and Clinical Presentations
Where does the radial nerve descend in relation to the humerus?
In the radial groove of the humerus, alongside the profunda brachii artery.
p.6
Long Thoracic Nerve Injury and Symptoms
What nerve roots does the long thoracic nerve originate from?
C5 – C7 nerve roots of the brachial plexus.
p.39
Ulnar Nerve Injuries and Clinical Presentations
What happens to the claw hand in a lower (level II) ulnar nerve injury?
It becomes more severe due to unopposed flexion from both FDP and FDS.
p.31
Ulnar Nerve Injuries and Clinical Presentations
What are common causes of ulnar nerve entrapment?
Frequent flexion of the elbow, arthritis, bone spurs, previous fractures/dislocations of the elbow.
p.15
Median Nerve Injuries and Symptoms
What muscles does the median nerve innervate in the forearm?
All muscles in the flexor compartment except flexor carpi ulnaris and the medial half of flexor digitorum profundus.
p.10
Musculocutaneous Nerve Injury and Testing
What indicates a normal response during the biceps tendon reflex test?
Involuntary contraction of the biceps (flexion of elbow).
p.25
Radial Nerve Injuries and Clinical Presentations
Which head of the triceps brachii is likely paralyzed in a level II radial nerve injury?
The lateral head of the biceps.
p.39
Ulnar Nerve Injuries and Clinical Presentations
Which fingers cannot be adducted in ulnar nerve injury?
All fingers; 2nd to 5th fingers cannot be abducted.
p.23
Radial Nerve Injuries and Symptoms
What area does the dorsum of the hand supply?
The skin of the posterolateral surface.
p.32
Ulnar Nerve Injuries and Clinical Presentations
What forms the roof and floor of Guyon's canal?
Roof: Palmar (volar) carpal ligament; Floor: Transverse carpal ligament (flexor retinaculum).
p.25
Radial Nerve Injuries and Clinical Presentations
Why can the remaining heads of the triceps maintain extension despite the injury?
Because they have already received motor branches from the radial nerve before the site of injury.
p.40
Ulnar Nerve Injuries and Clinical Presentations
What happens if the palmar branch of the ulnar nerve is severed in wrist laceration?
It leads to total loss of sensation (anesthesia) over the skin of the hypothenar eminence.
p.6
Long Thoracic Nerve Injury and Symptoms
Where does the long thoracic nerve run in relation to the clavicle and the first rib?
It passes between the clavicle and the first rib.
p.7
Axillary Nerve Injury and Clinical Presentations
What are the boundaries of the quadrangular space?
Superior: Inferior margin of teres minor; Lateral: Surgical neck of humerus; Inferior: Superior margin of teres major; Medial: Lateral margin of long head of triceps brachii.
p.20
Radial Nerve Injuries and Clinical Presentations
What causes radial nerve entrapment (Supinator syndrome)?
Repetitive supination and pronation, common in swimmers and violinists.
p.13
Median Nerve Injuries and Symptoms
From which cords of the brachial plexus does the median nerve arise?
From both medial and lateral cords.
p.23
Radial Nerve Injuries and Symptoms
What does the posterior interosseous nerve supply?
All extensor muscles of the forearm.
p.40
Ulnar Nerve Injuries and Clinical Presentations
What is the effect of an ulnar nerve block at the wrist?
It is similar to level II ulnar nerve injury.
p.22
Radial Nerve Injuries and Clinical Presentations
What type of fracture can damage the radial nerve?
A midshaft fracture of the humerus.
p.35
Ulnar Nerve Injuries and Clinical Presentations
What does the palmar cutaneous branch of the ulnar nerve supply?
The skin over the hypothenar eminence and medial palm.
p.28
Radial Nerve Injuries and Clinical Presentations
What is the effect of blocking the superficial branch of the radial nerve at the wrist?
Similar to level IV radial nerve injury.
p.11
Median Nerve Injuries and Symptoms
How does the median nerve enter the hand?
By travelling within the carpal tunnel, lateral and deep to the palmaris longus tendon.
p.21
Brachial Plexus Anatomy and Injuries
From which part of the brachial plexus does the radial nerve arise?
As a continuation of the posterior cord.
p.18
Median Nerve Injuries and Symptoms
What is the effect of an upper median nerve block?
Similar to level I median nerve injury.
p.1
Brachial Plexus Anatomy and Injuries
Where does the brachial plexus originate?
At the neck and extends into the axilla, passing under the clavicle.
p.36
Ulnar Nerve Injuries and Clinical Presentations
What is the action of the 3rd and 4th lumbricals?
Flexes MCP joint while extending DIP and PIP joints of the 4th and 5th fingers.
p.17
Median Nerve Injuries and Symptoms
What is the role of the recurrent branch of the median nerve in level II median nerve injury?
It is not spared because it is given off distal to the wrist.
p.30
Radial Nerve Function Testing
What does the triceps tendon reflex test assess?
The integrity of the upper radial nerve and C7 spinal segment.
p.9
Axillary Nerve Injury and Clinical Presentations
How do you test the lateral part of the deltoid?
Ask the patient to abduct the arm against resistance.
p.26
Radial Nerve Injuries and Symptoms
What is finger drop?
A condition where the fingers cannot be extended.
p.22
Radial Nerve Injuries and Clinical Presentations
What anatomical structure does the radial nerve cross to enter the extensor compartment of the arm?
The inferior boundary of teres major.
p.38
Ulnar Nerve Injuries and Clinical Presentations
What are the common causes of level I ulnar nerve injury?
Wrist laceration, pisiform/hamate fracture, and Guyon’s canal syndrome.
p.11
Median Nerve Injuries and Symptoms
What are the clinical presentations associated with median nerve compression?
They are the same as level I median nerve injury.
p.38
Ulnar Nerve Injuries and Clinical Presentations
Where does the ulnar nerve traverse in the wrist?
Through Guyon’s canal, situated between the pisiform and hook of hamate.
p.11
Median Nerve Injuries and Symptoms
What are some causes of carpal tunnel syndrome?
Trauma, repetitive use of vibrating machinery, rheumatoid arthritis, and pregnancy.
p.1
Spinal Accessory Nerve Function Testing
What happens if the spinal accessory nerve is damaged?
The patient will be unable to perform shoulder shrugging and head rotation.
p.18
Median Nerve Injuries and Symptoms
What sensory deficits occur with wrist laceration injuries?
Sensory loss over the lateral 2/3 of the palm and palmar surface of the lateral 3.5 digits.
p.27
Radial Nerve Injuries and Clinical Presentations
What is the condition of elbow and shoulder extension in a radial nerve injury?
There is no problem with elbow and shoulder extension because the triceps brachii has received full motor supply proximal to the site of injury.
p.3
Musculocutaneous Nerve Injury and Testing
Which nerve innervates the supinator muscle?
Posterior interosseous nerve (branch of radial nerve) (C6, C7).
p.11
Median Nerve Injuries and Symptoms
What is a notable feature of the median nerve before it enters the carpal tunnel?
It gives off a palmar cutaneous branch.
p.21
Brachial Plexus Anatomy and Injuries
Which nerve does the radial nerve give out in the axilla?
The posterior cutaneous nerve of the arm.
p.24
Radial Nerve Injuries and Clinical Presentations
Which nerve is responsible for sensory loss in the posterior forearm?
Posterior cutaneous nerve of forearm.
p.9
Axillary Nerve Injury and Clinical Presentations
What happens to arm abduction beyond 15° if deltoid function is compromised?
The arm cannot be abducted further as the function of deltoid cannot be replaced by any other muscles.
p.37
Ulnar Nerve Injuries and Clinical Presentations
What is the role of the adductor pollicis?
Adducts the thumb at the MCP joint.
p.9
Musculocutaneous Nerve Injury and Testing
What is the anatomical origin of the musculocutaneous nerve?
It is the continuation of the lateral cord of the brachial plexus, containing fibers from C5 – C7 roots.
p.31
Ulnar Nerve Injuries and Clinical Presentations
What anatomical structure forms the cubital tunnel?
The tendinous arch joining the two heads of the flexor carpi ulnaris (FCU).
p.31
Ulnar Nerve Injuries and Clinical Presentations
How does elbow flexion affect the cubital tunnel?
It reduces the space of the cubital tunnel, potentially exacerbating the condition.
p.23
Radial Nerve Injuries and Symptoms
What can cause entrapment of the deep branch of the radial nerve?
Between the two heads of the supinator muscle.
p.6
Long Thoracic Nerve Injury and Symptoms
What is the result of long thoracic nerve injury on the action of trapezius and rhomboids?
Their action is not antagonized, leading to retraction.
p.13
Median Nerve Injuries and Symptoms
Where does the median nerve descend in relation to the brachialis?
On the surface of the brachialis to the cubital fossa, medial to the brachial artery.
p.38
Ulnar Nerve Injuries and Clinical Presentations
What is the action of the 3rd and 4th lumbricals?
Flexes MCP joint while extending DIP and PIP joints of the 4th and 5th fingers.
p.21
Brachial Plexus Anatomy and Injuries
What are some causes of radial nerve injury?
Nerve injection injury, posterior glenohumeral dislocation, Saturday night palsy.
p.18
Median Nerve Injuries and Symptoms
Where is the upper median nerve block located?
Medial to the brachial artery at the cubital fossa.
p.36
Ulnar Nerve Injuries and Clinical Presentations
Which muscles are innervated by the deep branch of the ulnar nerve?
3rd and 4th lumbricals, interosseous muscles, and flexor digiti minimi brevis.
p.27
Radial Nerve Injuries and Clinical Presentations
Is there any sensory loss in this radial nerve injury?
No, there is no sensory loss because all cutaneous branches of the radial nerve have been given off proximal to the site of injury.
p.24
Radial Nerve Injuries and Clinical Presentations
How does the branching of the posterior cutaneous nerve of the arm affect sensory loss?
Sensation over the posterior arm is variably affected depending on how high the nerve branches off.
p.35
Ulnar Nerve Injuries and Clinical Presentations
What small motor branch does the superficial branch of the ulnar nerve give off?
A small motor branch to the palmaris brevis muscle.
p.37
Ulnar Nerve Injuries and Clinical Presentations
What is the function of the adductor digiti minimi?
Adducts the little finger at the MCP joint.
p.37
Ulnar Nerve Injuries and Clinical Presentations
Which nerve innervates the adductor pollicis?
Deep branch of the ulnar nerve (C8, T1).
p.30
Radial Nerve Function Testing
What does the sensory test determine?
The integrity of the superficial branch of the radial nerve.
p.26
Radial Nerve Injuries and Symptoms
What is wrist drop?
A condition characterized by the inability to extend the wrist and fingers.
p.26
Radial Nerve Injuries and Symptoms
What muscle does the deep branch of the radial nerve pass between?
The deep and superficial heads of the supinator muscle.
p.15
Median Nerve Injuries and Symptoms
What is the 'hand of benediction' sign?
Inability to flex the lateral three fingers while flexing the medial two fingers due to median nerve injury.
p.15
Median Nerve Injuries and Symptoms
What is the 'ape hand deformity'?
Inability to oppose the thumb due to paralysis of thenar muscles from median nerve injury.
p.28
Radial Nerve Injuries and Clinical Presentations
Where does the radial nerve run in the cubital fossa?
Lateral to the biceps tendon and medial (or deep) to the brachioradialis.
p.13
Median Nerve Injuries and Symptoms
How does a lower plexus injury affect the median nerve?
It damages the medial cord (C8, T1), leading to significant functional deficit.
p.18
Median Nerve Injuries and Symptoms
What happens to finger positions when lumbricals are paralyzed?
The patient presents with extended MCP and flexed DIP and PIP joints.
p.19
Median Nerve Injuries and Symptoms
What is the 'Ape Hand' sign?
Inability to oppose the thumb, indicating median nerve injury.
p.22
Radial Nerve Injuries and Clinical Presentations
What does the radial nerve do after piercing the lateral intermuscular septum?
It enters the flexor compartment of the arm.
p.35
Ulnar Nerve Injuries and Clinical Presentations
What accompanies the ulnar nerve at the distal forearm?
The ulnar artery on its lateral side.
p.34
Ulnar Nerve Injuries and Clinical Presentations
At the elbow, where does the ulnar nerve pass in relation to the medial epicondyle?
Posterior to the medial epicondyle of the humerus.
p.36
Ulnar Nerve Injuries and Clinical Presentations
What is a less severe form of ulnar claw hand characterized by?
Flexion of PIP and DIP joints of the 4th and 5th fingers while the MCP joint is extended.
p.24
Radial Nerve Injuries and Clinical Presentations
What nerve supplies the inferolateral arm?
Inferior lateral cutaneous nerve of arm.
p.38
Ulnar Nerve Injuries and Clinical Presentations
What is the action of the extensor digitorium?
Extends the medial 4 fingers.
p.18
Median Nerve Injuries and Symptoms
What is the effect of a lower median nerve block?
Similar to level II median nerve injury, with sparing of lateral palmar sensation.
p.36
Ulnar Nerve Injuries and Clinical Presentations
What is the function of the flexor digitorum superficialis?
Flexes PIP (and MCP) joint of the medial 4 fingers.
p.9
Musculocutaneous Nerve Injury and Testing
Where does the musculocutaneous nerve penetrate?
It penetrates the coracobrachialis before descending between biceps brachii and brachialis.
p.1
Spinal Accessory Nerve Function Testing
What is the primary function of the spinal accessory nerve (CN XI)?
Motor innervation of the trapezius and sternocleidomastoid (SCM).
p.6
Long Thoracic Nerve Injury and Symptoms
What happens to the scapula when there is an injury to the long thoracic nerve?
Lack of protraction and severe retraction of the scapula.
p.7
Axillary Nerve Injury and Clinical Presentations
What are common clinical presentations of axillary nerve injury?
Shoulder pain and difficulty in abduction of the arm.
p.22
Radial Nerve Injuries and Clinical Presentations
What muscles does the radial nerve supply branches to?
The lateral head of triceps and the brachioradialis.
p.39
Ulnar Nerve Injuries and Clinical Presentations
What happens to the skin supplied by the dorsal and palmar branches if the injury is only to the main branch of the ulnar nerve?
It will not experience sensory loss.
p.4
Klumpke's Palsy and Its Causes
What are the clinical presentations of Klumpke's palsy?
Consistent with level I ulnar nerve injury and level I median nerve injury.
p.22
Radial Nerve Injuries and Clinical Presentations
Where does the superficial branch of the radial nerve pass down?
The anterolateral aspect of the forearm, deep to the brachioradialis muscle.
p.19
Median Nerve Injuries and Symptoms
Why are thenar muscles spared in anterior interosseous nerve injury?
Because the injury affects flexor digitorium profundus and flexor pollicis longus, but not the thenar muscles.
p.11
Median Nerve Injuries and Symptoms
Why is the median nerve prone to compression?
Because it travels within the carpal tunnel.
p.18
Median Nerve Injuries and Symptoms
Where is the lower median nerve block located?
Lateral to the palmaris longus tendon at the wrist.
p.14
Median Nerve Injuries and Symptoms
What is the function of the flexor pollicis longus?
Flexes interphalangeal and MCP joint of the thumb.
p.1
Brachial Plexus Anatomy and Injuries
What can excessive stretching of the neck cause?
Direct tearing of the C5 – C6 nerve roots from the spinal cord.
p.27
Radial Nerve Injuries and Clinical Presentations
How can the superficial branch of the radial nerve be compressed?
It may be compressed at the lateral aspect of the wrist due to its superficial location.
p.9
Axillary Nerve Injury and Clinical Presentations
How do you test the anterior part of the deltoid?
Ask the patient to flex the shoulder joint with the elbow joint extended.
p.26
Radial Nerve Injuries and Symptoms
What area does the superficial branch of the radial nerve supply?
Dorsum of lateral 2.5 digits (except tips).
p.22
Radial Nerve Injuries and Clinical Presentations
What is the condition known as Saturday night palsy associated with?
Compression of the radial nerve by hard objects between the arm and the trunk.
p.8
Axillary Nerve Injury and Clinical Presentations
Where does the axillary nerve run in relation to the GH joint?
It runs laterally, passing inferior to the GH joint.
p.21
Brachial Plexus Anatomy and Injuries
What does the radial nerve bifurcate into after crossing anterior to the lateral epicondyle of the humerus?
Deep and superficial branches.
p.31
Ulnar Nerve Injuries and Clinical Presentations
What are the clinical presentations of cubital tunnel syndrome?
They are the same as level I ulnar nerve injury.
p.28
Radial Nerve Injuries and Clinical Presentations
What happens when the radial nerve is blocked at the cubital fossa?
Causes finger drop and sensory loss over the dorsum of the lateral 2.5 digits.
p.21
Brachial Plexus Anatomy and Injuries
What does the deep branch of the radial nerve continue as in the extensor compartment of the forearm?
The posterior interosseous nerve.
p.15
Median Nerve Injuries and Symptoms
What happens to thumb abduction in median nerve injury?
Abduction is still possible to a lesser degree if the abductor pollicis longus is intact.
p.23
Radial Nerve Injuries and Symptoms
What happens to the triceps brachii muscle in a level I radial nerve injury?
It is completely paralyzed.
p.4
Brachial Plexus Block Techniques
What are the common sites for brachial plexus nerve block?
Interscalene block and supraclavicular block.
p.35
Ulnar Nerve Injuries and Clinical Presentations
What does the dorsal cutaneous branch of the ulnar nerve supply?
The dorsum of the medial 1.5 digits.
p.27
Radial Nerve Injuries and Clinical Presentations
What happens to the extensor carpi radialis brevis in radial nerve injury due to supinator entrapment?
It remains functional as it receives motor supply from the deep branch of the radial nerve before passing between the two heads of the supinator muscle.
p.19
Median Nerve Injuries and Symptoms
Which muscle is primarily responsible for PIP joint flexion of the index finger?
Flexor digitorium superficialis.
p.2
Brachial Plexus Anatomy and Injuries
What occurs with injury to the suprascapular and axillary nerves regarding lateral rotation?
Lack of lateral rotation.
p.37
Ulnar Nerve Injuries and Clinical Presentations
What is the main action of the interosseous muscles?
Abduct and adduct fingers at the MCP joint; aid in flexion of MCP joint while extending DIP and PIP joints.
p.36
Ulnar Nerve Injuries and Clinical Presentations
What causes the less severe claw hand in upper ulnar nerve injury?
Paralysis of the medial half of FDP, leading to unopposed action of FDS.
p.30
Radial Nerve Function Testing
What area is tested for sensory function in the radial nerve assessment?
Over the dorsum of the hand between the 1st and 2nd metacarpals.
p.37
Ulnar Nerve Injuries and Clinical Presentations
Which nerve affects the sensory loss in the medial palm over the hypothenar eminence?
Palmar branch of the ulnar nerve (from forearm).
p.26
Radial Nerve Injuries and Symptoms
What are the causes of level III radial nerve injury?
Radial head dislocation, proximal radius fracture, and radial nerve entrapment.
p.26
Radial Nerve Injuries and Symptoms
What is a common location for compression or injury of the deep branch of the radial nerve?
Around the head of the radius.
p.10
Median Nerve Injuries and Symptoms
What activities might lead to median nerve entrapment?
Prolonged hammering, cleaning dishes, playing tennis.
p.4
Klumpke's Palsy and Its Causes
What can excessive stretching of the arm above the head cause?
It may directly tear the C8-T1 nerve roots from the spinal cord.
p.29
Brachial Plexus Block Techniques
What anatomical structures are mentioned in relation to the radial nerve?
Superficial branch, deep branch, biceps tendon, and brachioradialis.
p.18
Median Nerve Injuries and Symptoms
What is the role of lumbricals in finger movement?
They flex the MCP while extending the PIP and DIP joints.
p.35
Ulnar Nerve Injuries and Clinical Presentations
What muscle does the ulnar nerve supply after branching off to the FCU?
The medial half of the flexor digitorum profundus (FDP) muscle.
p.38
Ulnar Nerve Injuries and Clinical Presentations
Which muscles are innervated by the deep branch of the ulnar nerve?
3rd and 4th lumbricals, interosseous muscles, and flexor digiti minimi brevis.
p.11
Median Nerve Injuries and Symptoms
Which bones form the base of the carpal arch medially and laterally?
Medially by the pisiform and hook of hamate; laterally by the tubercles of scaphoid and trapezium.
p.19
Median Nerve Injuries and Symptoms
What does the abnormal pinch sign test for?
Anterior interosseous nerve injury.
p.38
Ulnar Nerve Injuries and Clinical Presentations
What happens when the lumbricals and interossei are paralyzed due to ulnar nerve injury?
Cannot flex MCP while extending DIP and PIP joints.
p.14
Median Nerve Injuries and Symptoms
What branches does the median nerve give off upon termination?
Recurrent branch (to thenar muscles) and palmar digital branches (to lateral 2 lumbricals and tips of lateral 3.5 fingers).
p.17
Median Nerve Injuries and Symptoms
What happens to the lumbricals when they are paralyzed due to median nerve injury?
They cannot flex MCP while extending DIP and PIP.
p.24
Radial Nerve Injuries and Clinical Presentations
What nerve supplies sensation to the dorsum of the lateral 2.5 digits (except tips)?
Superficial branch of radial nerve.
p.35
Ulnar Nerve Injuries and Clinical Presentations
What is the primary function of the superficial branch of the ulnar nerve?
It is mostly sensory and supplies the skin over the palmar aspect of the medial 1.5 digits.
p.37
Ulnar Nerve Injuries and Clinical Presentations
What innervates the interosseous muscles?
Deep branch of the ulnar nerve (C8, T1).
p.30
Radial Nerve Function Testing
Where is the triceps tendon tapped during the reflex test?
At its insertion at the olecranon.
p.9
Musculocutaneous Nerve Injury and Testing
What are the common causes of musculocutaneous nerve injury?
Upper plexus injury and axillary trauma (rare).
p.37
Ulnar Nerve Injuries and Clinical Presentations
What sensory area is affected on the dorsal aspect due to ulnar nerve injury?
Dorsal aspect of medial 1.5 digits.
p.18
Median Nerve Injuries and Symptoms
What causes the pointer and middle fingers to appear clawed?
Paralysis of the first two lumbricals and unopposed actions of flexor digitorium and extensor digitorium.
p.1
Spinal Accessory Nerve Function Testing
How can you test the function of the spinal accessory nerve?
Ask the patient to shrug their shoulders and rotate their head against resistance.
p.2
Brachial Plexus Anatomy and Injuries
Which nerves experience the greatest degree of injury?
Axillary nerve (C5 – C6), Musculocutaneous nerve (C5 – C7), Radial nerve (C5 – T1), Suprascapular nerve (C5 – C6).
p.34
Ulnar Nerve Injuries and Clinical Presentations
Where does the ulnar nerve first travel in the arm?
On the medial aspect of the brachial artery in the flexor compartment.
p.21
Brachial Plexus Anatomy and Injuries
What condition can lead to compression of the deep branch of the radial nerve?
Hypertrophy of the supinator muscle.
p.15
Median Nerve Injuries and Symptoms
What is the effect of median nerve injury on thenar muscles?
All three thenar muscles are paralyzed, severely affecting thumb opposition.
p.1
Erb's Palsy and Its Causes
What is a common cause of Erb's palsy?
Excessive increase in the angle between neck and shoulder, such as in motor vehicle accidents or during childbirth.
p.13
Median Nerve Injuries and Symptoms
What nerve does the median nerve give off as it travels between the heads of pronator teres?
The anterior interosseous nerve.
p.27
Radial Nerve Injuries and Clinical Presentations
What is a common cause of radial nerve injury?
Lateral wrist compression, such as wearing a very tight watch.
p.27
Radial Nerve Injuries and Clinical Presentations
Where does the superficial branch of the radial nerve emerge?
It emerges underneath the tendon of the brachioradialis muscle and passes over the anatomical snuffbox.
p.36
Ulnar Nerve Injuries and Clinical Presentations
What is the effect of median nerve palsy in lower plexus injury?
It complicates the presentation of claw hand.
p.30
Radial Nerve Function Testing
Why is the sensory test conducted over the dorsum of the hand?
It is the site with the least overlap of cutaneous innervation with other nerves.
p.7
Axillary Nerve Injury and Clinical Presentations
What can cause impingement of the axillary nerve?
Hypertrophy of the quadrangular space muscles.
p.40
Ulnar Nerve Injuries and Clinical Presentations
Where can the ulnar nerve be blocked at the wrist?
Lateral to the flexor carpi ulnaris tendon and medial to the ulnar artery.
p.39
Ulnar Nerve Injuries and Clinical Presentations
What is affected in wrist laceration regarding sensory loss?
Palmar branch of the ulnar nerve.
p.21
Brachial Plexus Anatomy and Injuries
Where does the deep branch of the radial nerve descend?
Between the superficial and deep heads of the supinator muscle.
p.14
Median Nerve Injuries and Symptoms
How does the median nerve enter the hand?
Through the carpal tunnel, deep and lateral to the palmaris longus tendon.
p.34
Ulnar Nerve Injuries and Clinical Presentations
What anatomical structure does the ulnar nerve penetrate at the level of the coracobrachialis?
The medial intermuscular septum.
p.2
Brachial Plexus Anatomy and Injuries
Which muscles are involved in arm adduction?
Supraspinatus, Deltoid, Pectoralis major, Latissimus dorsi.
p.13
Median Nerve Injuries and Symptoms
Where is the median nerve prone to entrapment?
Between the heads of the pronator teres (PT).
p.34
Ulnar Nerve Injuries and Clinical Presentations
Why is the ulnar nerve vulnerable to injury at the elbow?
Because it is located superficially and can be affected by fractures or dislocations.
p.35
Ulnar Nerve Injuries and Clinical Presentations
How does the ulnar nerve leave the forearm?
By traveling lateral to the FCU tendon and medial to the ulnar artery.
p.17
Median Nerve Injuries and Symptoms
What is the difference between median claw hand and ulnar claw hand?
Median claw hand is not introduced in the syllabus; ulnar claw hand is referred to by Prof. Shum.
p.14
Median Nerve Injuries and Symptoms
What happens when the median nerve is injured?
Flexion of the lateral 3 fingers is not possible.
p.9
Axillary Nerve Injury and Clinical Presentations
What are the symptoms of deltoid and teres minor atrophy?
Atrophy of deltoid and teres minor, along with sensory deficit over the lateral arm.
p.36
Ulnar Nerve Injuries and Clinical Presentations
Why are the 2nd and 3rd fingers unaffected in ulnar claw hand?
Because the lateral 2 lumbricals are supplied by the median nerve.
p.37
Median Nerve Injuries and Symptoms
What is the function of the abductor pollicis brevis?
Abducts the thumb at the MCP joint.
p.37
Ulnar Nerve Injuries and Clinical Presentations
What sensory area is affected by ulnar nerve injury?
Palmar aspect of medial 1.5 digits.
p.26
Radial Nerve Injuries and Symptoms
Which nerve is responsible for sensory loss in the inferolateral arm?
Inferior lateral cutaneous nerve of arm.
p.3
Musculocutaneous Nerve Injury and Testing
Which nerve innervates the biceps brachii?
Musculocutaneous nerve (C5, C6).
p.34
Ulnar Nerve Injuries and Clinical Presentations
From which part of the brachial plexus does the ulnar nerve arise?
As a continuation of the medial cord.
p.8
Axillary Nerve Injury and Clinical Presentations
What cutaneous branch does the axillary nerve give off?
The superior lateral cutaneous nerve of the arm.
p.23
Radial Nerve Injuries and Symptoms
What is a presentation of a level I radial nerve injury?
Elbow in a flexed position / unable to extend forearm.
p.24
Radial Nerve Injuries and Clinical Presentations
What is wrist drop and finger drop a result of?
Paralysis of all extensor muscles of the forearm due to radial nerve injury.
p.1
Spinal Accessory Nerve Function Testing
What movements are associated with the sternocleidomastoid (SCM) muscle?
Neck rotation to the contralateral side.
p.24
Radial Nerve Injuries and Clinical Presentations
Why do the wrist and fingers drop?
Due to the unopposed action of flexor muscles and the effect of gravity.
p.38
Ulnar Nerve Injuries and Clinical Presentations
What is the effect of unopposed action of flexor digitorium superficialis and profundus in ulnar nerve injury?
Flexion of PIP and DIP joints occurs.
p.1
Erb's Palsy and Its Causes
What can chronic compression, like carrying a heavy backpack, lead to?
Similar injuries to those caused by excessive stretching of the neck.
p.3
Musculocutaneous Nerve Injury and Testing
What sensory loss occurs with radial nerve injury?
Skin over deltoid and lateral part of arm.
p.21
Brachial Plexus Anatomy and Injuries
What can injure the radial nerve in the axilla?
Posterior dislocation of the GH joint or deltoid injection at a too posterior position.
p.36
Ulnar Nerve Injuries and Clinical Presentations
What is the role of interosseous muscles?
Abduct and adduct fingers at MCP joint; aid in flexion of MCP joint while extending DIP and PIP joints.
p.17
Median Nerve Injuries and Symptoms
Which muscle flexes the DIP joint of the 2nd and 3rd fingers?
Flexor digitorum profundus (lateral), innervated by the anterior interosseous nerve.
p.14
Median Nerve Injuries and Symptoms
What symptoms are present in a lower plexus injury involving C8 and T1 nerve roots?
Claw hand and inability to flex the lateral 3 fingers.
p.9
Axillary Nerve Injury and Clinical Presentations
How do you test the posterior part of the deltoid?
Ask the patient to extend the shoulder joint with the elbow joint flexed.
p.37
Radial Nerve Injuries and Symptoms
What is the role of the abductor pollicis longus?
Abducts the thumb at the carpometacarpal (CMC) joint.
p.15
Median Nerve Injuries and Symptoms
What is the role of the opponens pollicis?
It medially rotates the thumb for opposition.
p.28
Radial Nerve Injuries and Clinical Presentations
Where can the superficial branch of the radial nerve be blocked at the wrist?
Lateral to the flexor carpi radialis tendon and medial to the styloid process of the radius.
p.4
Brachial Plexus Block Techniques
Where is the anesthetic injected for a brachial plexus block?
Directly into or immediately adjacent to the axillary sheath surrounding the brachial plexus.
p.17
Median Nerve Injuries and Symptoms
What is the main action of the 1st and 2nd lumbricals innervated by the median nerve?
Flexes MCP joint while extending DIP and PIP joints of the 2nd and 3rd fingers.
p.19
Median Nerve Injuries and Symptoms
What does a 'pinch' posture during the 'OK' sign indicate?
Absence of flexion of the interphalangeal joint of the thumb and DIP joint of the index finger, indicative of isolated anterior interosseous nerve injury.
p.14
Median Nerve Injuries and Symptoms
What is the clinical presentation of median nerve injury?
Inability to make a fist (hand of benediction).
p.17
Median Nerve Injuries and Symptoms
What is the result of unopposed action of the flexor digitorum due to median nerve injury?
Flexion of PIP and DIP joints.
p.35
Ulnar Nerve Injuries and Clinical Presentations
What is the function of the deep branch of the ulnar nerve?
It is purely motor and supplies most intrinsic muscles of the hand (except thenar muscles and first 2 lumbricals).
p.2
Brachial Plexus Anatomy and Injuries
What is the effect of the action of pectoralis major and latissimus dorsi on medial rotation?
Medial rotation occurs when not antagonized.
p.36
Ulnar Nerve Injuries and Clinical Presentations
What happens when lumbricals and interossei are paralyzed?
Cannot flex MCP while extending DIP and PIP joints, leading to claw hand.
p.37
Ulnar Nerve Injuries and Clinical Presentations
Which nerve innervates the adductor digiti minimi?
Deep branch of the ulnar nerve (C8, T1).
p.30
Radial Nerve Function Testing
Where is the brachioradialis tendon tapped during the reflex test?
At its insertion at the styloid process of the radius.
p.37
Ulnar Nerve Injuries and Clinical Presentations
Which nerve is responsible for sensory loss in the medial half of the dorsum of the hand?
Dorsal branch of the ulnar nerve (from forearm).
p.26
Radial Nerve Injuries and Symptoms
Which nerve supplies the posterior forearm?
Posterior cutaneous nerve of forearm.
p.24
Musculocutaneous Nerve Injury and Testing
What happens to arm extension at the shoulder when the triceps brachii is paralyzed?
Extension is compromised but not totally lost due to the unaffected deltoid.
p.2
Erb's Palsy and Its Causes
What is the Waiter’s tip sign?
Arm adducted and medially rotated; forearm pronated and extended.
p.13
Median Nerve Injuries and Symptoms
What condition can lead to compression of the median nerve near the cubital fossa?
Compartment syndrome due to a torn brachial artery from a supracondylar fracture.
p.18
Median Nerve Injuries and Symptoms
How does carpal tunnel syndrome affect sensation in the palm?
The sensation over the lateral 2/3 of the palm is unaffected.
p.27
Radial Nerve Injuries and Clinical Presentations
Why is there no wrist drop in this radial nerve injury?
The extensor carpi radialis longus has already received innervation from the radial nerve near the cubital fossa before the nerve bifurcates.
p.24
Radial Nerve Injuries and Clinical Presentations
Which nerve is responsible for sensory loss in the posterior arm?
Posterior cutaneous nerve of arm.
p.34
Ulnar Nerve Injuries and Clinical Presentations
How does the ulnar nerve enter the forearm?
By passing between the humeral and ulnar heads of the flexor carpi ulnaris muscle.
p.27
Radial Nerve Injuries and Clinical Presentations
What causes finger drop in radial nerve injury?
Finger drop occurs because the extensor muscles of the fingers receive their nerve supplies from the posterior interosseous nerve, which is distal to the site of injury.
p.3
Musculocutaneous Nerve Injury and Testing
Which areas are supplied by the radial nerve?
Lateral and posterior aspect of arm and forearm.
p.9
Axillary Nerve Injury and Clinical Presentations
What initial degree of abduction can a patient achieve despite deltoid dysfunction?
The patient may still initiate abduction for the first 15° by the action of supraspinatus.
p.14
Median Nerve Injuries and Symptoms
What can still flex when the median nerve is injured?
The medial 2 fingers, since the medial half of flexor digitorium profundus is innervated by the ulnar nerve.
p.30
Radial Nerve Function Testing
What indicates a normal response in the triceps tendon reflex?
Involuntary contraction of the biceps (extension of elbow).
p.9
Axillary Nerve Injury and Clinical Presentations
What is the test for the superior lateral cutaneous nerve of the arm?
Check for sensory function of skin over the inferior part of the deltoid.
p.9
Musculocutaneous Nerve Injury and Testing
What does the musculocutaneous nerve become as it emerges?
It emerges as the lateral cutaneous nerve of the forearm, accompanying the cephalic vein.
