Blumenfeld Chapter 9: Plexuses and Nerves
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Questions and Answers

Which of the following clinical findings are associated with cubital tunnel entrapment (Ulnar Neuropathy) and NOT with Carpal Tunnel Syndrome?

  • Positive Tinel's sign, especially over the cubital tunnel
  • Sensory loss and paresthesia along the ulnar distribution (correct)
  • Positive Phalen's sign
  • Weakness of wrist flexion and adduction, finger adduction and abduction, and flexion of the 4th and 5th digits (correct)

    • Which of the following is a potential management option for both Carpal Tunnel Syndrome and Cubital Tunnel Entrapment?

  • Surgical decompression (correct)
  • Manipulation of the affected joint
  • Radio/ulnar articulation
  • Removable wrist splint at night (correct)

    • Which of the following scenarios is most likely to be a manifestation of Tunnel of Guyon syndrome?

  • Sensory loss and paresthesia along the ulnar distribution, especially with prolonged elbow resting
  • A combination of both, with significant pain and limited range of motion in the hand
  • Weakness in wrist flexion and adduction, finger adduction and abduction, and flexion of the 4th and 5th digits, with associated sensory loss
  • Weakness of abduction and adduction of fingers without sensory loss, often associated with repetitive cycling (correct)

    • Which of the following diagnostic tests would be most appropriate to differentiate between a C8 and T1 radiculopathy and Cubital Tunnel Entrapment?

    <p>NCV/EMG (D)</p> Signup and view all the answers

    Which of the following conditions shares a common differential diagnosis with both Carpal Tunnel Syndrome and Cubital Tunnel Entrapment?

    <p>All of the above (D)</p> Signup and view all the answers

    Which nerve is primarily responsible for the abduction of the thumb?

    <p>Radial Nerve (D)</p> Signup and view all the answers

    Which of the following statements accurately describes the brachial plexus?

    <p>The brachial plexus is formed by nerve roots arising from the cervical enlargement of the spinal cord. (C)</p> Signup and view all the answers

    Which of the following muscles is NOT innervated by the Ulnar Nerve?

    <p>Flexor pollicis brevis - superficial head (A)</p> Signup and view all the answers

    What is the name of the condition that affects only the terminal branches of a nerve?

    <p>Neuropathy (B)</p> Signup and view all the answers

    Which of the following statements is TRUE regarding the lumbricals?

    <p>They are primarily responsible for flexion at the PIP and DIP joints. (D)</p> Signup and view all the answers

    A patient presents with weakness of the deltoid muscle and numbness in the shoulder. Which of the following is the most likely diagnosis?

    <p>Axillary Neuropathy (C)</p> Signup and view all the answers

    Which statement accurately describes the relationship between the cords of the brachial plexus and the axillary artery?

    <p>The cords of the brachial plexus are named in relation to the axillary artery. (C)</p> Signup and view all the answers

    A patient presents with numbness and tingling in the arm, worse with overhead activity. The numbness is classically on the inside of the arm down to the pinky and ring finger. Which of the following is the most likely diagnosis?

    <p>Thoracic Outlet Syndrome (C)</p> Signup and view all the answers

    Which of the following statements is TRUE regarding the dorsal interossei?

    <p>They are primarily responsible for extension at the MCP joints. (B)</p> Signup and view all the answers

    Which of the following is NOT a typical sign or symptom of a brachial plexus injury?

    <p>Decreased sensation in the lower leg and foot. (A)</p> Signup and view all the answers

    Which of the following conditions is known to cause Horner's Syndrome?

    <p>Pancoast's Syndrome (A)</p> Signup and view all the answers

    The Musculocutaneous nerve innervates which of the following muscles?

    <p>Biceps, Brachialis, Coracobrachialis (D)</p> Signup and view all the answers

    Which condition is characterized by damage to the upper trunk of the brachial plexus, resulting in weakness of the deltoid, biceps, infraspinatus, and wrist extensors?

    <p>Erb-Duchenne Palsy (A)</p> Signup and view all the answers

    A patient presents with burning shoulder or lateral neck pain followed by weakness of the muscles innervated by the brachial plexus. Which of the following is the most likely diagnosis?

    <p>Brachial Plexitis (A)</p> Signup and view all the answers

    Based on the content provided, which of the following structures are directly involved in the formation of the brachial plexus?

    <p>Cervical enlargement of the spinal cord and peripheral nerves. (B)</p> Signup and view all the answers

    Identify the term used to describe the condition affecting the nerve roots, as depicted in the provided diagram.

    <p>Radiculopathy (C)</p> Signup and view all the answers

    Which of the following conditions is associated with a fracture of the proximal humerus?

    <p>Axillary Neuropathy (C), Radial Neuropathy (D)</p> Signup and view all the answers

    Which nerve is responsible for the adduction of the thumb?

    <p>Ulnar Nerve (C)</p> Signup and view all the answers

    A patient presents with wrist drop and weakness of all extensors of the arm, hand, and fingers. Which of the following is the most likely diagnosis?

    <p>Radial Neuropathy (C)</p> Signup and view all the answers

    Which of the following muscles is primarily responsible for flexion at the DIP joint?

    <p>Flexor digitorum profundus (D)</p> Signup and view all the answers

    What is the most likely diagnosis for a patient presenting with muscle weakness and atrophy in the arms, legs, hands, or feet, particularly affecting the intrinsic foot muscles and anterolateral leg muscles, also exhibiting pes cavus and hammer toes, and a lack of Achilles tendon reflex?

    <p>Charcot-Marie-Tooth Disease (D)</p> Signup and view all the answers

    Which of the following accurately reflects the order of structures in the brachial plexus, from the spinal cord to the peripheral nerves?

    <p>Nerve Roots, Trunks, Cords, Terminal Branches (D)</p> Signup and view all the answers

    Which of the following conditions is most commonly associated with a history of improper crutch use?

    <p>Radial Neuropathy (C)</p> Signup and view all the answers

    Based on the provided content, which of the following statements accurately describes the potential effect of a brachial plexus injury?

    <p>Loss of sensation and weakness in the arm and hand. (B)</p> Signup and view all the answers

    Which of the following conditions can be differentiated from primary muscle conditions using a combination of nerve conduction studies and electromyography?

    <p>All of the above (D)</p> Signup and view all the answers

    The degeneration of which type of nerve is primarily responsible for the motor symptoms seen in Charcot-Marie-Tooth Disease?

    <p>Motor nerves (D)</p> Signup and view all the answers

    Which of the following conditions is associated with a history of sleeping with the arm slung over a park bench?

    <p>Radial Neuropathy (A)</p> Signup and view all the answers

    What is the primary method used to assess the speed of an impulse through a nerve, aiding in the diagnosis of nerve damage?

    <p>Nerve Conduction Velocity (NCV) (C)</p> Signup and view all the answers

    Which of the following conditions can be diagnosed using Needle Electromyography (EMG) by recording activity from muscle fibers?

    <p>Myasthenia Gravis (B)</p> Signup and view all the answers

    Which of the following is NOT a characteristic symptom of Charcot-Marie-Tooth Disease?

    <p>Muscle hypertrophy (B)</p> Signup and view all the answers

    What type of neurological condition is typically characterized by a 'waiter's tip' posture, affecting the hand and arm?

    <p>Erb-Duchenne Palsy (C)</p> Signup and view all the answers

    Which of the following conditions is MOST likely to involve swelling in the right arm?

    <p>Thoracic Outlet Syndrome (TOS) (A)</p> Signup and view all the answers

    Based on the information provided, which of the following diagnoses is most likely to involve a sensory deficit in the lateral thigh?

    <p>Meralgia Paresthetica (B)</p> Signup and view all the answers

    In the context of the provided information, what is a key differentiating feature between Sciatic Neuropathy and Sciatic Radiculopathy?

    <p>The site of nerve involvement (B)</p> Signup and view all the answers

    Which of the following diagnoses would likely exhibit weakness in dorsiflexion and eversion of the foot?

    <p>Common Peroneal Neuropathy (C)</p> Signup and view all the answers

    Based on the provided information, which diagnosis could be differentiated through muscle testing?

    <p>Common Peroneal Neuropathy (C)</p> Signup and view all the answers

    Which diagnosis is specifically mentioned as being associated with a potential 'tight belt' etiology?

    <p>Meralgia Paresthetica (A)</p> Signup and view all the answers

    Flashcards

    Brachial Plexus

    A network of nerves formed by roots C5, C6, C7, C8, and T1.

    Nerve Roots

    The origins of spinal nerves from the spinal cord, responsible for sensory and motor functions.

    Cervical Enlargement

    Thickened region of the spinal cord where nerve roots for the arms originate.

    Axillary Artery

    The major artery supplying blood to the upper limb, named as a reference point for the brachial plexus cords.

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    Plexopathy

    A disorder affecting a plexus of nerves, leading to pain or dysfunction.

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    Radiculopathy

    A condition caused by compression of spinal nerve roots leading to pain, weakness, or numbness.

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    Neuropathy

    A disorder resulting from damage to peripheral nerves, leading to weakness, numbness, or pain.

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    Terminal Branches

    Final branches of the brachial plexus that innervate specific muscles.

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    Extensors

    Muscles that extend joints, primarily in the arm.

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    Musculocutaneous Nerve (BBC)

    Innervates Biceps, Brachialis, and Coracobrachialis muscles.

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    Thumb Nerves (RUM)

    Radial, Ulnar, and Median nerves act on the thumb.

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    Radial Nerve Function

    Controls thumb abduction via Abductor pollicis longus.

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    Ulnar Nerve Function

    Controls thumb adduction via Adductor pollicis.

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    Median Nerve Functions

    Controls thumb flexion and opposition via specific muscles.

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    Intrinsic Hand Muscles

    Muscles within the hand, including thenar and hypothenar eminences.

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    Erb-Duchenne Palsy

    Upper trunk brachial plexus injury causing weakness in specific muscles.

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    Tinel's Sign

    A clinical test used to detect irritated nerves, often in carpal tunnel syndrome.

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    Phalen's Sign

    A test for carpal tunnel syndrome, involving wrist flexion for 60 seconds.

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    Ulnar Neuropathy

    A condition affecting the ulnar nerve, causing weakness and sensory loss in hand.

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    Cubital Tunnel Syndrome

    Compression of the ulnar nerve at the elbow, often from resting on hard surfaces.

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    Tunnel of Guyon Syndrome

    Compression of the ulnar nerve at the wrist, leading to finger weakness without sensory loss.

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    Numbness and Tingling in Arm

    Sensations in the arm, usually on the inner arm extending to pinky and ring finger.

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    Pancoast's Syndrome

    A tumor in the upper lung affecting the lower brachial plexus, possibly causing Horner's Syndrome.

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    Horner's Syndrome

    A condition marked by ptosis, miosis, and anhidrosis on one side of the face.

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    Brachial Plexitis

    Inflammatory condition affecting the brachial plexus, leading to shoulder pain and muscle weakness.

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    Axillary Neuropathy

    Weakness and numbness in the shoulder due to axillary nerve compression from injury.

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    Radial Neuropathy

    Disorder caused by compression of the radial nerve, leading to wrist drop and difficulty extending the arm.

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    Wrist Drop

    Inability to extend the wrist and fingers due to radial nerve damage.

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    Saturday Night Palsy

    Radial nerve palsy from arm compression over a bench or similar object, causing weakness.

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    Sciatic Neuropathy

    A condition resulting from damage to the sciatic nerve, causing pain or numbness.

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    Peroneal Neuropathy

    Damage to the peroneal nerve, leading to foot drop and sensory loss on the outer foot.

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    Tibial Neuropathy

    Injury to the tibial nerve causing loss of plantar flexion and sensation in the sole.

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    Diabetic Neuropathy

    Nerve damage due to diabetes, often affecting legs and feet with numbness and pain.

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    Meralgia Paresthetica

    Entrapment of the lateral femoral cutaneous nerve, causing thigh pain or numbness.

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    Charcot-Marie-Tooth Disease

    A genetic disorder causing nerve degeneration, leading to muscle weakness and atrophy, primarily affecting arms and legs.

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    Motor Loss vs. Sensory Loss

    In Charcot-Marie-Tooth disease, motor nerve degeneration is much more severe than sensory loss.

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    Pes Cavus

    A foot deformity characterized by a high arch, commonly seen in Charcot-Marie-Tooth disease.

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    Nerve Conduction Velocity (NCV)

    A test measuring the speed of electrical impulses through nerves. Slow impulses indicate damage.

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    Electromyography (EMG)

    A technique that records electrical activity of muscles to assess motor unit integrity.

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    Klumpke's Palsy

    A lower trunk brachial plexus injury causing weakness in the hand and fingers.

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    Needle EMG vs. Nerve Conduction Studies

    Needle EMG assesses muscle activity, while NCV evaluates nerve transmission speeds.

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    Study Notes

    Major Plexuses and Peripheral Nerves

    • Blumenfeld Chapter 9 covers major plexuses and peripheral nerves.
    • The brachial plexus is formed by nerve roots at C5, C6, C7, C8, and T1.
    • Major functions include sensory and motor innervation to the upper extremities.
    • The lumbosacral plexus provides innervation to lower extremities and pelvis.
    • Roots of the brachial plexus connect to trunks, divisions, cords, and terminal branches.
    • Various nerves are associated with specific functions and areas supplied

    Brachial Plexus

    • The brachial plexus forms from nerve roots that connect to form trunks, divisions, and cords.
    • Three trunks formed are superior, middle, and inferior.
    • The three divisions form are anterior and posterior.
    • Three cords form are lateral, posterior, and medial.
    • Cords consist of various branches.
    • Plexus consists of the roots, trunks, divisions, cords, and terminal branches. Associated with motor and sensory.

    Branches of the Brachial Plexus

    • Specific nerves originate from the brachial plexus and innervate particular muscles and areas.
    • Some key branches are the musculocutaneous, axillary, radial, median, and ulnar nerves.
    • Specific spinal segments from C5 to T1 innervate and supply muscles.
    • These nerves control movement and sensation to varying portions of the upper limb.

    Plexus and Nerve Syndromes

    • Several conditions can affect plexuses and nerves, potentially causing pain or weakness.
    • Common conditions like Erb-Duchenne palsy (upper trunk), Klumpke's palsy (lower trunk), and thoracic outlet syndrome involve compression or injury to nerve structures.
    • Pancoast tumors, affecting the lower trunk, may cause Horner's syndrome (eye symptoms) and recurrent laryngeal nerve damage.
    • Additionally, brachial neuritis can present with pain and weakness.

    Peripheral Nerve Syndromes

    • Axillary nerve damage can occur due to humerus dislocations or fractures.
    • Radial nerve injury is sometimes due to improper crutch use, Saturday night palsy (arm trauma), or spiral groove/fracture.
    • Median nerve compression might cause carpal tunnel syndrome that includes pain, swelling, and numbness.
    • Ulnar nerve issues can present as cubital tunnel syndrome.
    • Symptoms and characteristics are common for these conditions.

    Other Conditions

    • Meralgia paresthetica involves entrapment of the lateral femoral cutaneous nerve, often with lateral thigh pain.
    • Charcot-Marie-Tooth disease is a genetic condition causing nerve degeneration, manifesting as progressive muscle weakness and atrophy.
    • Diabetic polyneuropathy is frequently due to blood sugar control issues, and involves both sensory and motor functions.
    • Alcoholic neuropathy can develop due to alcohol abuse and is often associated with pain and weakness in the extremities.
    • Post-viral Guillain-Barré syndrome is an immune-mediated polyneuropathy characterized by ascending muscle weakness.

    Tests and Diagnoses

    • Nerve conduction studies (NCS) and electromyography (EMG) help diagnose abnormalities.
    • These procedures assess the integrity of nerves and muscles.
    • Tests help determine the specific cause of symptoms.

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    Chapter 9 - Clinical Neuro PDF

    Description

    Explore the major plexuses and peripheral nerves covered in Blumenfeld Chapter 9. This quiz highlights the anatomy, functions, and relationships of the brachial and lumbosacral plexuses, along with their associated branches. Test your knowledge on sensory and motor innervation to the upper and lower extremities.

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