4 - Peripheral Nervous System (60-62)

What are the motor features of paralysis of deep fibular nerve

loss of DF and weak foot intrinsics

What are the motor features of paralysis of superficial fibular nerve

loss of eversion

damage to CN V

loss of facial sensation, weakness of muscles of mastication, ipsilateral deviation to side of jaw

What are motor features of paralysis of the sciatic nerve

loss of knee flexion weak hip adduction and loss of motor from the knee down

damage to CN IX

loss of posterior tongue dry mouth slight dysphagia

What are the nerve roots of the femoral nerve?

L2-L4

A physical therapist prepares to assess the blink reflex in a patient with suspected neurological involvement. Which cranial nerve components are assessed with this reflex? 1. afferent cranial nerve V; efferent cranial nerve VII 2. afferent cranial nerve VII; efferent cranial nerve V 3. afferent cranial nerve IX; efferent cranial nerve X 4. afferent cranial nerve X; efferent cranial nerve IX

1. afferent cranial nerve V; efferent cranial nerve VII *CN VII is associated with blinking, CN V is fascial sensation* CN III is raising the eyelid

What are the motor features of paralysis of radial nerve (4)?

1. elbow extension 2. wrist extension 3. finger extension 4. thumb extension *all extension*

What are the muscle innervated by superficial peroneal N (2)?

1. fibularis longus 2. fibularis brevis

A patient involved in a motor vehicle accident sustains an injury to the posterior cord of the brachial plexus. Which muscle would NOT be affected by the injury? 1. infraspinatus 2. subscapularis 3. latissimus dorsi 4. teres major

1. infraspinatus innervated by suprascapular nerve which extends from superior trunk of brachial plexus

what is function of CN III

1. moves the eye 2. elevates upper eyelid

What are the motor features of paralysis of median nerve (3)

1. pronation 2. wrist flexion and RD 3. thumb opposition, flexion, and ABD

damage to CN III

1. ptosis 2. dilation of pupil 3. loss of accomodation to light reflex

What are the muscle innervations of radial nerve (6)?

1. triceps 2. anconeus 3. brachioradialis 4. supinator 5. wrist extensors 6. finger and thumb extensors

What 3 nerves are formed by the posterior chord of the brachial plexus?

1. upper subscapular nerve 2. thoracodorsal nerve 3. lower subscapular nerve

A patient demonstrates a significant loss of strength when trying to grasp a cup. However, the patient has much less difficulty when holding onto a pencil. This type of clinical scenario is consistent with pathology affecting the: 1. median nerve 2. suprascapular nerve 3. musculocutaneous nerve 4. ulnar nerve

4. ulnar nerve *Ulnar nerve = power grip. Median nerve = precision grip*

**A PT and colleague are examining a patient who complains of numbness over the lateral aspect of the shoulder. The PT is convinced that the patient has a C5 radiculopathy, while the colleague believes the patient has an axillary nerve lesion. Weakness in which muscle would support the therapist's hypothesis of a C5 nerve root problem? A. teres minor B. biceps brachii C. middle deltoid D. triceps brachii

B. biceps brachii Dermatome at lateral shoulder is C5, and peripheral nerve field is axillary N (C5-C6). PT must test a C5 muscle that is not innervated by axillary N. Biceps brachii

what is the name of lesion to facial nerve

Bells Palsy

What are the nerve roots of radial nerve

C5-T1 Median: C6-T1 Ulnar: C7-T1

What are the nerve roots of axillary nerve

C5/6

What are the nerve roots of musculocutaneous nerve?

C5/6

What are the nerve roots of median nerve

C6-T1

What are the nerve roots of ulnar nerve

C7-T1 Radial: C5-T1 Median: C6-T1

A patient who has meralgia paresthetica has been referred to physical therapy. Which of the following clinical features is MOST likely to be assessed by the physical therapist during the examination? A. Strength of the adductor longus B. Strength of the quadriceps femoris C. Sensation of the superior medial aspect of the thigh D. Sensation of the lateral aspect of the thigh

D. Sensation of the lateral aspect of the thigh Meralgia paresthetica is an entrapment or injury to the lateral femoral cutaneous nerve, a purely sensory nerve

*A patient demonstrates a significant loss of strength when trying to grasp a cup. However, the patient has much less difficulty when holding onto a pencil. This type of clinical scenario is consistent with pathology affecting the:* A. median nerve B. suprascapular nerve C. musculocutaneous nerve D. ulnar nerve

D. ulnar nerve *Ulnar nerve controls flexion of digits 4-5, responsible for power grip*. Precision grip requires digits 1-3, controlled by median nerve

What are the muscle innervations of ulnar nerve

FCU, FDP (medial half), thumb ADD, interossei, 4th and 5th lumbricals

What are the nerve roots of deep fibular nerve

L4-S2

What are the nerve roots of the tibial nerve

L4-S3

What are the spinal nerve levels of sciatic nerve

L4-S3

What are the nerve roots of superficial peroneal nerve

L5-S2

*What nerve innervates the muscles necessary to squeeze therapy putty between the sides of the fingers?*

This movement isolates the *lumbricals and interossei, which are innervated by the ulnar nerve* and are affected when entrapment occurs at the tunnel of Guyon (at the level of the hamate)

What occurs when there is a lack of blood flow (ischemia) to the forearm. This occurs when there is increased pressure due to swelling, a condition called compartment syndrome?

Volkmann contracture

what is CN VI?

abducens

what is CN XI

accessory nerve

damage of CN VII

anterior 2/3 of tongue dry mouth ipsilateral facial paralysis

What is the sensory distribution of superficial peroneal

anterior/lateral ankle and dorsum of foot

Sensory innervation of musculocutaenous nerve

anterolateral surface of forearm

What are the muscle innervation of median nerve

pronators, wrist and finger flexors on radial side, most thumb muscles

what are the two parts of the accessory nerve?

carotid and spinal

*What is the deformity of the hand without ulnar nerve innervation?*

claw hand Permanent deformity with hyperextension of MCP and hyperflexion of IP 4-5

What is Anterior interosseous syndrome and how does it present?

condition in which damage to the anterior interosseous nerve (AIN), a motor branch of the median nerve, causes pain in the forearm and a characteristic weakness of the pincer movement of the thumb and index finger; *flexor digitorum profundus and flexor pollicis longus*

muscle innervated by musculocutaneous nerve (3)?

coracobrachialis biceps brachii brachialis

What is Kiloh-Nevin Syndrome?

damage to the anterior interosseous nerve (AIN), a motor branch of the median nerve, causes pain in the forearm and a characteristic weakness of the pincer movement of the thumb and index finger

What muscle can be affected by nerve damage with an antero-inferior dislocation of the shoulder?

deltoids via axillary nerve

How would a patient present with damage to hypoglossal nerve?

deviation to ipsilateral side with protrusion

damage to CN IV

diplopia, failure to rotate eye up and out

damage to CN VI

diplopia, inability to converge, paralysis of abduction

function of glossopharyngeal

elevate pharynx, salivary secretion, taste

function of CN VIII

equilibrium and hearing

function of CN VII

facial expression wink speech ingestion of food taste

what is CN VII

facial nerve

Lesion of musculocutaneous nerve

forearm supination loss of elbow flexion when supinated

What are the sensory innervation of ulnar nerve

fourth and fifth digit

What would an injury to the posterior interosseous nerve result in?

functional wrist drop

what is CN IX

glossopharyngeal

What are the muscle innervations of the sciatic nerve?

hamstrings and adductor magnus

what is CN XII

hypoglossal

what side does the jaw deviate with loss of CN V?

jaw deviates to ipsilateral side

Sensory innervation of axillary nerve

lateral arm over lower portion of deltoid

function of CN VI

lateral rectus SO4LR6

*What nerve innervates the muscles required to pinch between thumb (1st digit) and the tip of the index finger (2nd digit)?*

median nerve; impingement would occur at carpal tunnel

lesion of CN II

monocular blindness, loss of pupillary constriction, absence of blink reflex

function of trochlear nerve

motor nerve for the superior oblique muscle

What spinal and shoulder movements are innervated by accessory nerve?

move head and shoulders

What is the function of hypoglossal nerve?

movement of the tongue

what is CN III

oculomotor

CN I

olfactory nerve

CN II

optic

What is the sensory innervation of median nerve

palmar aspects of thumb, second, third, and fourth radial half of digits & finger tips

function of vagus

phonation visceral sensation and reflex cardiac depressor bronchoconstrictor GI tract

What motor functions would be lost with paralysis of tibial nerve?

plantarflexion and supination

What are the muscle innervations of the tibial nerve

popliteus soleus gastrocnemius plantaris tibialis posterior

What are the sensory innervation of radial nerve

posterior arm, posterior forearm, posterior aspect of hand on radial side

What is the sensory distribution of tibial nerve

posterior/lateral calf, ankle, and heel

*What nerve is affected with benediction hand?*

proximal median nerve injury Active deformity when asked to make a fist

What are the muscle innervations of femoral nerve

rectus femoris vastus medialis vastus lateralis vastus intermedius sartorius iliacus pectineus

What muscle can be affected by nerve damage with a medial and posterior dislocation of the shoulder?

rhomboids via dorsal scapular nerve

damage to accesory

shrugging ipsilateral and rotating opposite

function of CN II

sight, pupillary reflexes

function of CN 1

smell

What is Froment's sign?

special test of the wrist tests for palsy of the ulnar nerve - specifically the action of adductor pollicis -froment sign can refer to cogwheel effect (seen in essential tremor)

carotid function of accessory nerve

swallowing and phonation

How would patient present with damage to vagus nerve?

tachycardia vomiting slow respiration ipsilateral paralysis of soft palate and larynx, hoarseness

Muscle innervations of axillary nerve

teres minor and deltoid

What are the muscle innervation of deep fibular nerve

tibialis anterior extensor hallucis longus extensor digitorum longus fibularis tertius first and second dorsal interossei extensor digitorum brevis extensor hallucis brevis

what is CN V

trigeminal nerve

what is CN IV

trochlear nerve

What are the motor features of paralysis of ulnar nerve

ulnar deviation, weakened wrist and finger flexion, weakened 4th and 5th finger flexion, loss of thumb adduction, most intrinsics

What is handlebar palsy?

ulnar neuropathy, is a familiar affection of the long-distance cyclist, mostly due to overtraining. Typically the ulnar nerve becomes irritated and compressed in the wrist within or distal to Guyon's canal, due to the pressure exerted on the hands on the handlebars

What is a neuroma?

unorganized mass of nerve fibers resulting from a laceration (either surgical or accidental) or amputation in which the nerve regrows in unorganized bundles. Results in sharp, radiating pain.

what is CN X

vagus

damage to CN VIII

vertigo tinnitus dysequilibrium loss of hearing nystagmus

what is CN VIII

vestibulocochlear