May 10, 2017
Francis Laudemir Libre
MUSCLE NERVE ROOTS UPPER EXTREMITY Muscle Group Shoulder Abductors Shoulder Adductors Elbow Flexors Elbow Flexors of the Semi-pronated arm Elbow Extensors Wrist Extensors
Wrist Flexors
Finger Finger Finger Finger
Abductors Adductors Extensors Flexors
Muscles Deltoid Pectoralis Major Brachialis and biceps Brachoradialis Triceps Flexor digitorum superficialis Flexor digitorum profundus Flexor Carpi Radialis Flexor Carpi Ulnaris Palmaris Longus Flexor Pollicis Longus Extensor digitorum Extensor carpi radialis longus Extensor carpi radialis brevis Extensor carpi ulnaris Extensor indicis Extensor digiti minimi Extensor pollicis longus Extensor pollicis brevis Dorsal interossei Palmar Interossei Similar to wrist extensors Similar to wrist flexors
Nerve Roots C5, C5, C6 C5, C5, C6 C5, C5, C6 C5, C6 C6, C7, C7, C8 C7, C8
C7, C8
Nerves Axillary nerve Lateral pectoral nerve Musculocutaneus Radial nerve Radial nerve Radial and ulnar nerve (Remember Dr. Leslie’s story)
Radial and ulnar nerve (Remember Dr. Leslie’s story)
C8, T1 C8, T1 C7, C7, C8, T1 C7, C8, C8, T1
How did you memorize in case you forgot: Sing the rhythmic upper ex song: C5! C6 (Abduct shoulder), C5! C6 (Adduct shoulder), C5!, C6 (Flex elbow). C5, C6 (semipronate elbow)! C6, C7!, C8 (Extend elbow), C7, C8 (extend wrist), C7 C8(extend wrist), C8, T1! (abduct fingers), C8 T1 (adduct fingers)!, C7, C8, T1 (flex and extend fingers) Clinical pearls Proximal weakness – weakness – suggestive suggestive of myopathy Distal weakness – weakness – suggestive suggestive of peripheral neuropathy Pyramidal weaknesss – weaknesss – UMN dysfunction. Think “like a pyramid” basta finger extension, elbow extension and shoulder abduction with preservation of the the elbow flexion and grip. -also characterized by upper limb extensor < flexor, reverse in lower limb
LOWER EXTREMITY Muscle Group Hip Flexors Hip Abductors
Hip Adductors
Muscles Iliopsoas Gluteus medius Gluteus minimus Sartorius TLF Adductor brevis Adductor Longus Adductor magnus Obturator externus
Nerve Roots L1, L2, L2, L3 L4, L5, S1
Nerves Femoral nerve
L2, L3, L4
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Hip Extensors Knee Extensors Knee Flexors Foot Dorsiflexors Foot Plantarflexors Foot Inverters Foot Everters Toe extensor
Pectineus Gracilis Gluteus maximus Quads femoris Hamstrings Several Gastrocnemus Soleus
Extensor halluces longus
L5, S1, S2 L2, L3, L4 L5, S1, S2 L4, L5 S1, S2
Inferior gluteal nerve Femoral nerve Sciatic nerve Deep peroneal nerve Sciatic nerve
L4, L5 L5, S1 S1
Posteriro Tibial Common peroneal Deep fibular nerve
Clinical pearls: Foot drop – damage to peroneal nerve (loss of ankle dorsiflexion)
REFLEXES Reflex Biceps Brachoradialis Triceps Patellar (Quadriceps femoris) Ankle (triceps surae)
Reflex Arc Roots C5, C6 C5, C6 C6, C7 L2, L3, L4 L5, S1, S2
If UMN – hypereflexic since no inhibition If LMN – hyporeflexic
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