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Motor Weakness

Anatomy of Motor Weakness

The Descending Tracts of the Spinal Cord = ? * Lateral corticospinal, Rubrospinal, Lateral Vestibulospinal
Lateral corticospinal ? * projects to Lower Motor Neurons in ventral horn of spinal cord grey matter (willfully contract)
Rubrospinal ? * projects primarily to LMNs innervating flexor muscle groups.
Lateral Vestibulospinal ? * projects primarily to LMNs innervating extensor muscle groups, particularly in the lower limb
Where the Lateral Coticospinal tract decussates and what it means ? * Crosses at the inferior Medualla... * If injured above that point = Have Motor Weakness on CONTRALAT. Side..... * If injured BELOW = Motor Weakness on IPS. Side
Artery of the brain that has the largest watershed area and has major deficits when it is blocked ? * Middle Cerebral Artery
Artery Order from most inferior to superior on the Cerebellum ? * Vertebral A's (PICA comes off of this)-> Basilar A (AICA comes off of this)-> Sup. Cerebellar A -> Posterior Cerebral A
If Ant. Cerebral A is blocked, what areas are lost ? *lower limb areas
If middle cerebeal A is blocked ? * face and upper limbs
Lower Motor Neuron basics ? * Motor neurons in spinal cord’s anterior horn .....* They send axons along spinal nerves to reach skeletal muscle.
Signs of an Upper Motor Lesion ? * Weakness with NO Atrophy.... * See INCREASED tone and reflexes
Signs of a Lower Motor Lesion ? * Weakness WITH atrophy.... * See DECREASED tone and reflexes
rubrospinal tract basics ? * do not see it really used in humans bc it is overpowered by the lateral corticospinal tract
Vestibulospinal Tracts = ? * Medial vestibulospinal tract = control cervical movement to keep the head level during movement...... * Lateral vestibulospinal tract = inns. extensor muscles of the upper (little) and lower (lots) limbs. = balance w/o thinking
Loss of lateral corticospinal tract = ? * lesion between thalamus and midbrain that extends the legs, clinches the fists, and flexes the arms = Decorticate Rigidity Flexor posturing
Loss of lateral corticospinal and rubrospinal tracts = ? * extended hands, plantar flexed toes, everything is extended = Decerebrate Rigidity Extensor Posturing
3 nerves that have their own nuclei ? * Occulomotor, Trochlear, and Abducens
Muscles of Mastication and weakness issues ? * Mandibular branch of trigeminal nerve (CN V3) ...* Weakness will be due to the loss of the Trigeninal Nucleus and the chin will point to the lesioned side (Ips.)
Mastication things to not confuse ? * TMJ pain
Facial Musculature – Lesion of corticonuclear tract ? * Paralysis of one side of face sparing forehead. Forehead muscles receive bilateral corticonuclear input. Lower face receives only contralateral input. ... * If lose Left, we see RIGHT lower face impairment, with RIGHT forehead being ok
Facial (Bell’s) Palsy = ? * Peripheral nerve loss, effecting entire IPS. side of the face
Traps and SCM innervation = ? * SCM = ips innervation by CN XI and Traps = Contralat inn. by CNXI
CN XII testing ? * stick the tongue out... * If the tongue deviates, the side in which it is pointing, is the side that is lesioned
The tongue and lesions of the corticonuclear tract above the medualla results in ? * the tongue pointing to the contralat. side
Brachial Plexus Roots ? * C5 - T1
Trunks ? * Superior, Middle, Inferior
Cords ? * Lateral, Posterior, Medial
Terminal Branches ? * Musculocutaneous (C5,6,7).... *Axillary (C5-6) * Radial (all of them)... * Median (C6,7,8, T1).... * Ulnar (C8 - T1)
Musculo. sensory = ? * Lateral FOREARM
Axillary = ? * Lateral Shoulder
Radial Nerve = ? * Innervates post. arm and forearm.... * Sensory from the posterior arm, posterior forearm, and posterior hand
Median Nerve = ? * Inn the ant. forearm and some of the hand
Median nerves that does some of the hand and one that does some of the forearm ? * Hand = Recurrent branch of Median Nerve ( Abductor pollicis brevis, opponens pollicis, flexor, and 1 and 2 lumbricals).... * Anterior interosseous nerve ( flexor pollicis longus)
Median Nerve Sensory = ? * palmar aspect of digits 1-3 & the radial ½ of the 4th digit
Ulnar Nerve Inn. and Sensory = ? * 2 muscles in the forearm ( 1/2 flex dig. profundus and flexor carpi ulnaris) and hand muscles via the deep branch of the ulnar nerve..... * Sensory = palmar and dorsal aspects of the 5th digit and the ulnar ½ of the 4th digit
Median Nerve Damage = ? * inability to make a circle with thumb and 2nd digit and tingling/numbness along median sensory pathway... * If proximal lesion, have all the above plus "hand of benedict" (digits 1-3 in ext and 4-5 in flexion
Ulnar Nerve Damage = ? * atrophy of hand muscles, except the thenar eminence, weak grip strength, weak abd and abb against resistance of the digits... * If proximal damge = all + weak wrist flexion
If signs of lesions involve Radial and Axillary nerves = ? * Posterior Cord
Median and Musculocutaneous Nerves = ? * Lateral Cord
Median and Ulnar Nerves = ? * Medial Cord
Posterior Cord Damage things we see ? * weakness in abduction of shoulder and in extension of arm/forearm
Damage to the Lateral Cord = ? * weak forearm flexion at elbow, weak wrist flexors, palmar digit 1 -2 sensation loss and loss of sensory on lat. forearm
Damage to the Medial Cord = ? * weakness of ALL muscles of the hand, digital flexor muscles, and sensation loos on medial arm/forearm and palmar aspect of the hand
Signs involving distal muscles (particularly those innervated by ulnar, distal radial, distal median nerves) = ? * Inferior Trunk/C8 & T1 roots = Klumpke's Paralysis
Signs involving proximal muscles (particularly those innervated by axillary, musculocutaneous, suprascapular) = ? * Superior Trunk/C5 & C6 roots = Erb-Duchenne Palsy (waiters tip sign)
See a winged scapula = ? * long thoracic nerve lost (5,6,7) which loses serratus anterior muscle
Tennis Elbow = ? * Lateral epicondylitis = Affects common extensor origin
Golfers Elbow = ? * Medial epicondylitis = Affects common flexor origin
Femoral Nerve Basics = ? * innervates muscles of the anterior compartment of the thigh.... * Sensory = anterior thigh, leg, and heel
lateral cutaneous nerve of the thigh = ? * sensory only and palsy if common due to it passing through the ASIS
Obturator nerve = ? * muscles of the medial compartment of the thigh (Inn and Sensory)... * abductors and adductors of the thigh
Superior gluteal nerve = ? * gluteus medius, gluteus minimus, tensor fascia lata
Inferior gluteal nerve = ? * gluteus maximus... * extends hip at thigh
Sciatic nerve = ? * made up of the tibial and common fibular nerves and it innervates the muscles of the posterior compartment of the thigh
Tibial nerve = ? * muscles of the leg’s posterior compartments (leg and foot)
Superficial fibular nerve = ? * muscles of the leg’s lateral compartment which evert the foot at the ankle... * also innervates the muscles on the dorsum of the foot that assist in extending the toes. ... * sensation from the anterior-lateral leg and dorsum of the foot
What nerve is affected if you have a patient that was forcibly dorsiflexed ? * Common Fibular
Deep fibular nerve = ? * muscles in the anterior compartment of the leg.... * sensory input from a small patch of skin on the dorsum of the foot between the first and second digits
Weakness extending the leg against resistance is characteristic of ? * Femoral Nerve Palsy
Obturator Nerve Damage = ? * with weakness or inability to adduct the against resistance
Superior gluteal nerve palsy = ? * inability to abduct hip on the affected limb side and see hip swing their torso towards the affected limb when walking
(Inversion) Ligament strain order in the ankle = ? * anterior talofibular -> calcaneofibular -> posterior talofibular
Eversion sprain = ? * Force from the medial side of the foot can stress the deltoid ligament of the medial ankle. The deltoid ligament often remains intact but avulses the medial malleolus... * further = fracture the distal fibula (Pott’s fracture)
Extending knee (seated with leg dangling) = ? * quadriceps muscles --> femoral nerve
Ankle dorsiflexion = ? * anterior muscles of leg --> deep fibular nerve
Ankle Eversion = ? * fibularis muscles --> superficial fibular nerve
Ankle plantar flexion * triceps surae (soleus & gastrocnemius muscles) --> tibial nerve
Knee flexion (laying prone) = ? * hamstring muscles --> tibial division of sciatic (mostly)
Created by: thamrick800