Axillary

Roots C5, C6

Pain Shoulder tip

Distribution Sensory over deltoid Motor Teres minor Deltoid Artic GH joint

Upper Extremity Causative lesions Fractured neck of humerus Dislocated shoulder Deep i.m. injections Erbs palsy

Reflex Arc None

Tests Shoulder abduction (C5)

Musculocutaneous

C5, C7

Lat forearm

Radial

C5 T1

Dorsum Thumb & fore-finger

Median

C6, C7 & C8, T1

Thumb, index Middle finger (up fore-arm to elbow)

Sensory Lat forearm to wrist Motor Coracobrachialis x Biceps brachii Brachialis Sensory Lat dorsal forearm and back of thumb & index fi Motor Triceps brachii Brachioradialis Forearm supinator Wrist extensors Finger extensors Sensory Lat palm & index, middle & lat ring finger Motor Ant forearm muscle (not 1/2 FDP & FCU) Hand mm Wrist flexors Long finger flex Index & mid fing Abd poll brev

Erbs palsy

Biceps jerk C5

Elbow flexion (C5, C6)

Nerve vs Root Problem C5 pain/paresthesia around lateral aspect of arm from shoulder to elbow. Also all rotator cuff muscle and elbow flexion would be weak, biceps jerk reduced C6 - pain/paresthesia around lateral aspect of forearm from elbow to thumb and index finger. Weak elbow flexion when sem-pronated and wrist extensors, supinator reduced C6 - Cutaneous dist into hand musculocutaneous nerve is not C7 middle finger pain, weak elbow and finger extension, triceps jerk reduced Radial n. readily overlapped by other nerves sensory loss is quite unusual & symptoms may be confined to slight tingling over the dorsal aspect of thumb & index finger Pt presents with wrist drop

Crutch palsy Saturday night palsy Fractured humerus in spiral groove

Triceps jerk (C7) Supinator jerk (C6)

Elbow extension ((C6), C7, (C8)) Brachioradialis (C6)

Carpal tunnel syndrome Direct trauma to wrist Suicide attempt Falling on glass Palmar space infection

Finger jerks (C8) Brachioradi alis (C6)

2 point discrimination (thumb, index and middle) Finger flexion (C8) FDS & FDP Thumb abduction (T1) Abductor Pollicis Brevis

Pain from carpal tunnel can radiate up the central forearm to the elbow and th shoulder/ may be pain in 5 finger (sympathetic n. fibres almost all carried in median nerve) Pt presents with prob shaking hand (power shake)/holding a pan/wasting thenar eminence (Abd Pol Brov)

Ulnar

(C7), C8,

Occ. Along

Sensory Medial palm

Elbow

None

Tinels test / Phalens test 2 point discrimination

C8 pain/paresthesia around palmer

T1

course of n. up to elbow (can be confusing)

5 & medial ring Motor FCU Ulnar FDP Most intrinsic hand mm

th

Local trauma Bed rest (resting on it) Fractured olecranon Wrist Local trauma bicycling/martial arts Ganglion at wrist

Finger abduction (T1) st 1 dorsal interosseus Finger adduction (T1) nd 2 dorsal interosseus Hypothenar muscles Tinels /Phalens test?

and dorsal aspect of hand in the area of little and of ring finger. Weak finger flexion of ALL 4 fingers, finger jerk reduced T1 - pain/paresthesia around medial aspect of forearm from elbow to wrist, weak finger abduction including abductor pollicis brevis

Long thoracic Suprascapular Dorsal Scapular Subclavius Medial pectoral Lateral pectoral Thoracodorsal subscapular subscapular

C5-C7 C5-C6 C5 C5-C6 C6C8 C5-C6 C6-C8 C5-C6 C5-C6

Serratus anterior Infraspinatus and supraspinatus Rhomboid maj/min and levator scapulae Subclavius Pectoralis major sternocostal head and Pectoralis minor Pectoralis major clavicular head Latissimus dorsi Subscapularis Subscapularis and teres major

Breast surgery, blow to the ribs Erbs palsy Erbs palsy Erbs palsy Klumpkes palsy Erbs palsy Klumpkes palsy Erbs palsy Erbs palsy

Tinels test Percussion of a nerve at site of compression. Positive produces parasthesia in the distribution of nerve concerned Phalens test Wrist is palmar flexed and direct pressure is applied by the examiner's finger on the median nerve at the level of the carpal tunnel. More reliable method of reproducing symptoms than Tinel's test Nerve stretch test Adsons test. See Joint Exam pack