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Path of ulnar nerve

Inner/medial cord of brachial plexus
Posterior wall of axilla
Under pec minor (as do they all)
Coracobrachialis insertion
Medial triceps, posterior to medial epicondyle and Olecranon
Deep to FCU and above FDP
Over flex Ret and through Tunnel of Guyon (between hook of hamate and pisiform)

1

The ulnar nerve's relationship to forearm muscles.

Under FCU and over FDP

2

Ulnar claw hand

#5 hyperextended at MCP and abducted at MCP an flexed at IP

#4 hyperextended at MCP and flexed at IPs

Hypothenar mm wasting

Altered sensation in 5 and half of 4

Loss of lumbricals

3

Froment's Sign

Results from ulnar nerve lesion

Adductor pollicis doesn't work so can't hold paper between thumb and index finger. Has to recruit FPL to flex DIP instead.

4

Tardy ulnar palsy

Common complication after elbow fracture.

Associated with callus or valgus deformity at elbow, which produce gradual stretching of nerve in ulnar groove.

5

Where can the ulnar nerve become compressed?

Cubital tunnel (ulnar collateral ligament + FCU)
Between heads of FCU

6

What increased the chance of ulnar nerve compression?

Elbow Flexion
Valgus elbow

7

Thoracic outlet syndrome

Compression of brachial plexus from structures in thoracic outlet.

May also involve arteries and veins.

8

Thoracic outlet

Inter scalene triangle to inferior border of axilla.

9

Path of brachial plexus

Travels with subclavian artery
Btwn anterior and middle scalene
Then meets up with subclavian vein

Entire neurovascular bundle goes behind clavicle and under pec minor attachment and down arm.

10

Symptoms of TOS

Pain, numbness, weakness.
Tingling in arm, across upper thoracic area or over scapula
Trophic changes.

11

Causes of TOS

Cervical rib (C7)
Anterior scalene syndrome
Scalene triangle syndrome
Costoclavicular syndrome
Pec minor syndrome

12

Anterior scalene syndrome

TOS caused by brachial plexus being compressed between anterior and middle scalene

13

Scalene triangle syndrome

TOS caused by brachial plexus being caught in between anterior scalene (anterior), middle scalene (posterior) and R1 (inferior).

14

Costoclavicular syndrome

TOS caused by brachial plexus being compressed between clavicle and R1.

15

Pec Minor syndrome

TOS involving compression between the coracoid process and pec minor

Happens with hyperabduction with ER/extension

16

Lumbar plexus

Between heads of Psoas major, anterior to QL

Formed by anterior rami of spinal nerves L1-4

Supplies anterolateral abdominal wall, external genitals, part of lower limbs.

17

What nerves emerge from the lumbar plexus?

Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral cutaneous nerve of the thigh
Femoral
Obturator

18

Iliohypogastric nerve

L1
Anterior division of lumbar plexus

Ant-lat abdominal muscles
Skin of inferior abdomen and butt

19

Ilioinguinal nerve

L1
Anterior division of lumbar plexus

Ant-lateral muscles and skin of superior and medial thigh

Root of penis and scrotum

Labia majora and mons pubis

20

Genitofemoral nerve

L1-2
Anterior division of lumbar plexus

Cremaster muscle
Skin of middle anterior thigh
Scrotum and labia majora

21

Lateral cutaneous nerve of the thigh

L2-3
Posterior division of lumbar plexus

Skin of lateral, anterior and posterior thigh

22

Femoral nerve

Largest nerve in lumbar plexus

L2-4
Posterior division of lumbar plexus

Hip flexor muscles
Knee extensors
Skin of ant/med thigh and medial leg and foot

23

Obturator nerve

L2-4
Anterior division of lumbar plexus

Hip adductor muscles
Skin of medial thigh.

24

L1

Iliohypogastric nerve
Ilioinguinal nerve

25

L1-L2

Genitofemoral nerve

26

L2-L3

Lateral cutaneous nerve of the thigh

27

L2-L4

Femoral nerve
Obturator nerve

28

Injury to femoral nerve

Can't extend knee or flex hip
Wasting if quads
No sensation over ant/med thigh

29

Injury of obturator nerve

Paralysis of adductors
No sensation over medial thigh