Plexopathies

  1. Cervical plexus is formed from the ___________ rami from which spinal nerves?
    • Ventral
    • C1-C4
  2. Brachial plexus is formed from the ___________ rami from which spinal nerves?
    • Ventral
    • C5-T1
  3. Cervical nerve roots exit through the intervertebral foramen ______________ the corresponding vertebral body above
  4. Are the nerves in the cervical plexus sensory or motor?
    • C1 is motor only
    • C2-C4 are both sensory and motor
  5. Phrenic nerve is motor/sensory/both and is made up of which ventral roots?
    • Both motor and sensory
    • C3, C4, C5
  6. Which cranial nerve comes out superior to C1?
    CN XII – hypoglossal nerve
  7. What is the ansa cervicalis?
    Loop of nerves that are part of the cervical plexus
  8. Ansa cervicalis is made up of a superior root and inferior root. The superior root is aka __________________ and the inferior root is aka _________________
    • Descending hypoglossus
    • Descending cervicalis
  9. The ansa cervicalis is made up of fibers from the ________________
    Hypoglossal nerve and the cervical plexus nerves
  10. Cervical plexus can be damaged by any operation where?
    Posterior to the sternocleidomastoid muscle
  11. What structures does the ansa cervicalis innervate?
    All infrahyoid muscles except the thyrohyoid muscle
  12. What is the punctum nervosum?
    The area where the rami of C2, C3, and C4 emerge from posterior of SCM muscle
  13. What is Erb’s point?
    The point where C5 and C6 nerve roots join
  14. What does injury to Erb’s point do?
    Erb’s palsy or Erb’s palsy plus
  15. What determines whether a baby will have Erb’s palsy or Erb’s palsy plus?
    • Erb’s palsy is damage to C5 and C6
    • Erb’s palsy plus is damage to C5, C6, and C7
  16. Waiter’s tip arm is related to which condition?
    Erb’s palsy plus
  17. In _____________________, baby’s arm hangs at the side with hand rotated medially
    Erb’s palsy plus
  18. What causes Horner’s Syndrome?
    Damage to C5-T1
  19. What are the symptoms of Horner’s syndrome?
    • Partial ptosis of upper eyelid
    • Anhidrosis
    • Miosis
  20. What muscles does Erb’s palsy affect?
    • Biceps brachii
    • Brachialis
    • Coracobrachialis
    • Brachioradialis
    • Deltoid
  21. What is scalenus anticus syndrome?
    Compression of anterior scalene on brachial plexus
  22. Upper cervical spine does what movements?
    Rotational movements
  23. Lower cervical spine does what movements?
    Flexion/extension
  24. Spondylotic disease most commonly occurs where in the spine?
    Lower cervical spine
  25. What does this show?
    Image Upload 1
    Spondylolisthesis
  26. Radiculopathy vs plexopathy
    • Radiculopathy affects nerve root
    • Plexopathy affect nerves of a plexus distal to the root
  27. What is the most common type of radiculopathy?
    Compressive
  28. What are examples of compressive radiculopathies?
    • Cervical spondylosis
    • Disc herniation
  29. What are examples of non-compressive radiculopathies?
    • Diabetes
    • Autoimmune diseases
  30. What does this MRI show? 
    Image Upload 2
    Posteriorly herniated discs
  31. Cervical spine imaging is usually normal in ___________________ radiculopathy and abnormal in ___________________ radiculopathy
    • Non-compressive
    • Compressive
  32. What is the most frequently affected nerve root of a cervical radiculopathy?
    C7
  33. What is the spurling maneuver? What does a positive test look like?
    • Extend and rotate neck to the side of pain, then apply downward pressure on the head
    • Positive if there is limb pain or paresthesia produced
  34. What is the preferred initial test to diagnose cervical radiculopathy?
    MRI
  35. What is the gold standard for making the diagnosis of cervical radiculopathy, specifically foraminal compression?
    CT myelography
  36. What does this image show?
    Image Upload 3
    Spondylosis (lipping of vertebral bodies)
  37. Ulnar nerve is derived from branches of the ________________ cord in the brachial plexus
    Medial
  38. Radial nerve is derived from branches of the _________________ cord in the brachial plexus
    Posterior
  39. Median nerve is derived from branches of the _________________ cord in the brachial plexus
    Medial and lateral
  40. Musculocutaneous nerve is derived from branches of the _________________ cord in the brachial plexus
    Lateral
  41. Musculocutaneous nerve motor or sensory?
    • Motor above the elbow
    • Sensory below the elbow
  42. Axillary nerve is derived from branches of the ________________ cord in the brachial plexus
    Posterior
  43. Long thoracic nerve comes from which spinal nerves?
    C5-C7
  44. Which nerves are sometimes accidentally injured during a mastectomy?
    Long thoracic nerve and thoracodorsal nerve
  45. Thoracodorsal nerve is derived from branches of the ________________ cord in the brachial plexus
    Posterior
  46. Lower subscapular nerve is derived from branches of the ________________ cord in the brachial plexus
    Posterior
  47. Upper subscapular nerve is derived from branches of the ________________ cord in the brachial plexus
    Posterior
  48. Thoracodorsal nerve innervates _________________ muscle
    Latissimus dorsi
  49. Thoracodorsal nerve is aka __________________
    Middle subscapular nerve
  50. Axillary nerve is made of fibers from which spinal nerves?
    C5 and C6
  51. Musculocutaneous nerve is made of fibers from which spinal nerves?
    C5-C7
  52. Median nerve is made of fibers from which spinal nerves?
    C6-T1
  53. Radial nerve is made of fibers from which spinal nerves?
    C5-C8
  54. Ulnar nerve is made of fibers from which spinal nerves?
    C7-T1
  55. Image Upload 4
    • A: roots
    • B: trunks
    • C: divisions
    • D: cords
  56. Posterior dislocation of the shoulder affects which nerve?
    Axillary nerve
  57. The musculocutaneous nerve penetrates which muscle?
    Coracobrachialis
  58. Upper and lower subscapular nerves come from the _____________ cord of the brachial plexus
    Posterior
  59. Thoracodorsal nerve comes from the _______________ cord of the brachial plexus
    Posterior
  60. Explain why the thoracodorsal nerve is also known as the middle subscapular nerve
    Because it is in the middle between upper and lower subscapular nerves
  61. Brachial plexus is located between which muscles?
    Middle and anterior scalenes
  62. What are common plexopathies affecting brachial plexus? (5)
    • Scalene syndrome
    • Cervical rib syndrome
    • Costoclavicular syndrome
    • Hyperabduction syndrome
    • Backpack paralysis
  63. Define the risk factors for a brachial plexus palsy
    • A large maternal weight gain
    • Maternal diabetes (baby high birth weight)
    • Multiparity (twins/triplets)
    • Breech position
  64. Which nerves contribute to the waiter’s tip deformity in Erb’s palsy plus?
    • Suprascapular nerve
    • Musculocutaneous nerve
    • Axillary nerve
  65. Neonatal brachial plexus palsies are caused by…
    Baby’s shoulder getting stuck under mother’s pubic symphysis and this stretches the brachial plexus
  66. Klumpke palsy results from…
    Injury to C8 and T1
  67. Klumpke palsy affects mostly which muscles?
    Intrinsic muscles of the hand (thenar, hypothenar, and interossei muscles)
  68. True or false. Horner’s syndrome is sometimes seen with Klumpke palsy
    True
  69. In Klumpke palsy, if _______________ are severely affected, you can see a clawhand deformity
    Lumbricals
  70. Erb’s palsy and Klumpke palsy are both caused by injury to the brachial plexus, Erb’s is caused by injury to ______________ and Klumpke is caused by injury to ______________
    • C5 and C6
    • C8 and T1
  71. What are the most common neoplasms leading to brachial plexopathy?
    Breast and lung cancer
  72. The most common symptom of neuralgic amyotrophy is ________________
    Winging of the scapula
  73. Neuralgic amyotrophy is caused by…
    Damage to the long thoracic nerve
  74. Neuralgic amyotrophy is aka __________________
    Brachial plexus neuropathy
  75. Hereditary neuralgic amyotrophy mode of inheritance
    Autosomal dominant
  76. Hereditary neuralgic amyotrophy is characterized by ____________________
    Recurrent brachial plexopathies
  77. What are the symptoms of hereditary neuralgic amyotrophy?
    • Short stature
    • Small face
    • Hypotelorism (close eyes)
  78. What is paresthesia?
    Burning or prickling sensation
  79. What is a fasciculation?
    A muscle twitch
  80. What is thoracic outlet syndrome?
    Blood vessels or nerves in the space between clavicle and first rib (thoracic outlet) are compressed
  81. What are the two forms of thoracic outlet syndrome?
    • True neurogenic
    • True vascular
  82. What are the clinical findings in a patient with thoracic outlet syndrome?
    • Reduced ulnar and medial antebrachial cutaneous sensory response but normal median sensory response
    • Reduces ulnar and median motor response
  83. What plexus is most often involved in diabetic-related plexopathy?
    Lumbosacral plexus
  84. How is medial brachial fascial compartment syndrome caused?
    Puncture of axillary or brachial artery causing hematoma
  85. What nerves are most affected in median brachial fascial compartment syndrome?
    Median and ulnar nerve
  86. What is scalene syndrome?
    Neurovascular compression of interscalene space and brachial plexus
  87. What is cervical rib syndrome?
    Cervical rib compresses interscalene space and brachial plexus
  88. What is costoclavicular syndrome?
    Narrowing of space between first rib and clavicle causing compression of brachial plexus
  89. What is hyperabduction syndrome?
    Compression of brachial plexus by pectoralis minor muscle and coracoid process when arm is raised above head
  90. Lumbosacral plexus is formed by the ventral rami of which spinal nerves?
    L1-S4
  91. The lumbar plexus is formed by which spinal nerves?
    L1-L4
  92. The lumbar plexus divides into anterior and posterior branches within which muscle?
    Psoas major
  93. What happens to the lumbar plexus in the psoas major muscle?
    Divides into anterior and posterior branches
  94. What is the main difference between anterior and posterior branches of the lumbar plexus?
    • Anterior branches become the obturator nerve
    • Posterior branches become the femoral nerve
  95. The sciatic nerve is made from the ____________ segments of the lumbosacral plexus
    L4-S3
  96. What is piriformis syndrome?
    Sciatic nerve compressed by piriformis
  97. What is cauda equina syndrome?
    Damage to the cauda equina below the end of the spinal cord
  98. Sensory disturbance involving the anterior/medial thigh and medial leg typically represents ___________________ injury
    Lumbar plexus
  99. Lumbosacral trunk and upper sacral lesions result in ______________
    Drop foot
  100. Sensory disturbance involving the leg, dorsum of the foot, posterior thigh, and perineum suggests _________________ injury
    Lumbosacral trunk or sacral plexus
  101. How is Patrick’s test performed?
    Hip is externally rotated with knee flexed 90 degrees and placed on top of the opposite knee
  102. What diseases are being screened for with Patrick’s test?
    Hip or sacroiliac disease
  103. How is the straight leg test performed?
    Patient’s extended leg is passively raised with foot dorsiflexed (patient should not help)
  104. What diseases are being screened for with the straight leg test?
    Radiculopathy due to disc herniation
  105. What imaging is best to use for lumbosacral plexopathy?
    MRI and EMG (electromyography)
  106. What is radiation plexopathy?
    Lumbosacral plexopathy occurring months to years after pelvic irradiation
  107. What is myokymia?
    Quivering of a few muscles insufficient to move a joint
  108. What are the clinical findings in a patient with myokymia?
    • Tissue fibrosis
    • Microinfarction of axons
  109. Myokymia is common in which condition?
    Radiation plexopathy
  110. What are the most common types of peripartum plexopathies?
    Intrapartum and postpartum lumbosacral plexopathies
  111. Peripartum plexopathies present with which symptoms?
    • Numbness of lateral leg and dorsum of foot
    • Foot drop
Author
stepha998
ID
343424
Card Set
Plexopathies
Description
ATSU
Updated