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