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Anatomy of upper and lower limb


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Shoulder Abduction
Deltoid C5 Axillary
Elbow Flexion
Biceps C5,6 Musculocutaneous
Brachioradialis C6 Radial
(+ reflex)
Elbow Extension
Triceps C7 Radial (+ reflex)
Radial wrist extension
Extensor carpi radialis longus and profundus C6 Radial (+reflex)
Finger extensors
Extensor digitorum C7 Radial (post. interosseus)
Finger flexors
Flexor digitorum longus and profundus C8 Median (ant. interossesus) (+reflex);
Flexor digitorum profundus C8 Ulnar
Finger abduction
dorsal interossei T1 Ulnar; abductor pollicus brevis T1 Median
Hip flexion
Iliopsosas L1/L2, Femoral
Hip adduction
adductors, L2/3, Obturator
Hip extension
gluteus maximus, L5/S1, inferior gluteal
Knee flexion
Hamstrings, S1, sciatic
Knee extension
quads, L3/4, (++reflex), femoral
Ankle dorsiflexion
tibialis anterior, L4, deep peroneal
Ankle eversion
peronei, L5/S1, superficial peroneal
Ankle inversion
tibialis posterior, L4/5, tibial
Ankle plantar flexion
gastrocnemius, soleus, S1/2, tibial (++reflex)
Big toe extension
Extensor hallucis longus, L5, deep peroneal (babinski)
Hip abduction
gluteus medius, L4/5, superior gluteal
Abdominal esophagus, stomach, superior part of duodenum, liver, pancreas, spleen
Celiac, Greater Splanchnic T5-9
Greater Splanchnic
descending duodenum-proximal 2/3 of transverse colon
Sup. Mesenteric, Lesser Splanchnic, T10-11
Lesser Splanchnic
distal 1/3 transverse colon-midway through anal canal
Inf. Mesenteric, Lumbar Splanchnic, L1-2
Lumbar Splanchnic
Renal Artery/Ganglion, Least Splanchnic, T11-T12
Least Splanchnic
Referred pain of appendicitis
via lesser splanchnic and sup. mesenteric ganglion to T10 (umbilicus)
Referred pain of angina
via sympathetics arising from T1-T5, and leaving symp chain from C1-T4. ischemia = pain at C1-T5 levels
Causalgia = pain from hyperstimulate nerves that travel w/blood vessels and follow sympathetics

Sympathetic Effects of anesthesia?
knock out sensory neurons in ganglion, but also knock out some of symp chain = 1)dilation (flushed skin), 2)sweat glands (dry skin), 3)erector pili muscles (no goosebumps); (sometimes constricted pupil and sunken eyeball = Horner's syndrome)
Innerv and fn of Serratus Anterior?
Long thoracic nerve (directly from C5,6,7 roots); scapular protraction, elevate glenoid; suscptible to injury--> winged scapula
Suprascapular nerve, roots, fn, injury?
C5,6 from upper trunk; infra- and supraspinatus (rotator cuff, abduction and lat rotation); compression = lat shoulder pain (C5,6 cutaneous territory), musc atrophy
Thoracodorsal nerve, roots, fn?
Lat. dorsi, from post cord C6,7,8 (susceptible in breast surgery), extension, medial rotation, adduction
Axillary nerve, roots, fn?
Deltoid, from post cord, C5,6, suscept to compression w/shoulder dislocation (abduction), sensory loss in patch of skin in upper lat arm
Snuff box tendons?
Abductor pollicus longus, extensor pollicus brevis, extensor pollicus longus; radial artery traverses it; point tenderness from scaphoid fracture or tenosynovitis of ext. poll. long. tend.
Wrist abduction
extensor (radial) and flexor (median) carpi radialis
Wrist extension
extensor carpi radialis and ulnaris, extensor digitorum
Wrist adduction
extensor (radial) and flexor (ulnar) qcarpi ulnaris
Radial nerve injury
suscept in radial groove and axilla (crutch paralysis); weak elbow extensors, paralysis of supinatory, wrist and thumb extensors = WRIST DROP; loss of triceps jerk, brachiorad tend reflex; sensory loss in post forearm and lat dorsum of hand
Musculocutaneous nerve injury
usu. in fractures of upper humerus; motor loss-elbow flexion weakness (esp when supinated), loss of biceps tend. reflex, sensory loss on anterolat. forearm
Median nerve in forearm
-pronation (pronator teres and quadratus),
-wrist flexion (flexor carpi radialis, palmaris longus, digital flexors)
-wrist abduction (flexor carpi radialis)
-digit flexion (flexor digitorum superficialis and profundus)
Median nerve, intrinsic hand muscles
-Thumb flexion, medial rotation, opposition (flexor pollicus brevis, opponens pollicus
-Thumb abduction (abductor pollicus brevis---abd.poll.longus is radial n.)
-Abduction of index/midd fingers (lumbricals 1,2)
-Flexion MP + Extension PIP/DIP (lumbricals 1,2)
Median nerve paralysis-above elbow (forearm effects)
motor paralysis of pronator teres = supinated forearm
Median nerve paralysis-wrist effects
weak flexion and abduction, causes hand extension and ulnar deviation (adduction)
Median nerve paralysis-MP,PIP,DIP joints
weak flexion, thus mid/index fingers extended
Median nerve paralysis-hand
thenar muscle paralysis (recurrent median nerve) = ape thumb (external rotation and adduction)
Carpel Tunnel Syndrome
paralysis of thenar muscles-ape thumb
sensory loss on 3.5 fingers, palmar surface, and dorsal surface from tips of finger to PIP joing
Ulnar nerve at forearm
Wrist flexion and adduction, and some finger flexion (flexor carpi ulnaris, flexor digitorm profundus)
Ulnar nerve at hand
Thumb adduction (adductor pollicus,
finger adduction (palmar interossei and 3,4 lumbricals)
finger abduction (dorsal interossei and 3,4 lumbricals)
MP flexion and PIP/DIP extension (same)
Ulnar nerve injury
susceptible to injury in medial epicondyle groove (funny bone) and olecronon
partial claw hand--paralysis of intrinsic hand muscles (except thenar), abducted and externally rotated thumb
sensory loss of medial 1.5 fingers and ulnar border of hand
Upper trunk lesion
C5,6 (separation of shoulder and neck, seen in breech delivery)
axillary, suprascapular, musculocutaneous, radial nerve(to supinator and brachiorad.)

=Erb's paralysis --> waiter's tip position, sensory loss along lat arm and forearm (C5/6 dermatomes)
Lower trunk lesion
trauma due to tug by outstretched arm
paralysis of intrinsic hand muscles--> claw hand (b/c long digital flexors (med) and long wrist extensors (rad) unopposed)
sensory loss of medial forearm and hand
Costoclavicular syndrome or Thoracic Outlet Syndrome (TOS)
where subclav v./a. and lower trunk enter axilla, between scalene anterior and medius, and 1st rib and clavicle
-compression = lower trunk palsy and vascular insufficiency
also can be compressed by pancoast tumor

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