Gray's vs. Grey's
Nick Georgelos Random Trivia
"Don't Taze Me Bro"
Med Students and PGY-2's Only
WebMD told me...
100
These are two common sites that are atrophied with moderate-severe Ulnar Neuropathy at the Elbow.
What are the First Dorsal Web space and ADM/Ulnar edge of the hand.
100
This is the average distance from medial epicondyle to Cubital Tunnel.
What is approx 3 cm.
100
This key sensory finding can help distinguish between Neuropathy at the Elbow vs. the Wrist.
What is Abnormal SNAP at the Dorsal Ulnar Cutaneous. (Normal with UN at the Wrist).
100
These are the nerve roots that make up the Ulnar nerve.
What is (C7)-C8-T1.
100
Ulnar Neuropathy is the second most common entrapment neuropathy of the Upper extremity. This is the First.
What is Median Nerve entrapment?
200
The Ulnar nerve is derived from this cord and this trunk.
What is Medial Cord and Lower Trunk
200
These two bones make up the ulnar and radial borders of Guyon's Canal.
What are the Pisiform bone and the Hook of the Hamate bone.
200
Name the muscles that must be needled during EMG with suspect Ulnar Neuropathy at the Wrist.
What are the FDI, ADM, and either FCU/FDP. Additionally, would need to sample two non-ulnar C8 muscles (ABP, FPL, EIP).
200
This is the canal that the Ulnar nerve travels through at the level of the distal wrist crease.
What is Guyon's Canal.
200
In a C8-T1 radiculopathic lesion vs. UN at the Elbow, these findings would lean more to the Radicular lesion.
What are - Weakness of thumb ABduction (Median). - Weakness of Thumb Flexion (Radial). - Weakness of Index Finger Extension (Radial). - Sensory loss of medial Forearm (MAC). - Neck Pain.
300
These are the top two common sites of entrapment at the elbow. (Extra 100 points for any other site at the level of the elbow)
What are: 1) between the two heads of FCU and the humeral-ulnar aponeurosis (aka cubital tunnel) 2) more proximally through the Arcade of Struthers - between Osborne's Ligament and the MCL - Medial Head of the Triceps - Flexor Pronator Aponeurosis between FDP and FDS - Medial Epicondyle - Anconeus Epitrochlearis (accessory muscle in approx 15% of pop.)
300
Explain the setup of Dorsal Ulnar Cutaneous NCS
What is Active = between 4th and 5th webspace on dorsal surface. Reference = distally over the PIP Joint. Ground = between Active and Stimulation Site. Stimulation = 8-10cm distally, just proximal to ulnar styloid OR between Ulna and FCU.
300
In Ulnar Neuropathy of the Elbow, these are the EDX findings would you suspect to see.
What are - decrease in conduction velocity from BE to AE. - possibly reduced CMAP amplitudes. - prolongation of distal latencies.
300
These are the common presenting symptoms that patients with Ulnar Neuropathy report.
What are... - Numbness/Tingling/Paresthesias of the SF, RF and Ulnar Hand - Loss/Decrease of Grip/Pinch Strength - Pain near elbow/ulnar groove.
300
Name 3 of the common causes of Ulnar Neuropathy at the Wrist.
What are - Repetitive Trauma. - Ganglion Cyst (most common). - Ulnar artery thrombosis/aneurysm. - Hook of Hamate Fracture. - Pisiform Dislocation.
400
The Ulnar nerve has these three sensory branches (from Proximal to Distal).
What are the Dorsal Ulnar Cutaneous, the Palmar Cutaneous, and the Digital/Superficial Terminal Branches.
400
There are multiple physical exam "Sign's" that are associated with Ulnar Neuropathy. Explain the positive findings of these signs. - Wartenburg Sign - Froment Sign - Benediction Sign - Tinel's Sign
What are: * Wartenburgs = persistent SF abduction when attempting to adduct fingers due to weakness of interossei and lumbricals. * Froment Sign =using compensatory FPL (median n.) during key pinch/paper pinch resulting in thumb IP hyperflexion due to weakness of Adductor Pollicis. * Benediction Sign = unopposed flexion at IP and unopposed extension at MCP due to weakness in lumbricals. * Tinel's Sign = tingling/electric sensation when tapping over nerve commonly at the ulnar groove.
400
This internal comparison study between these two muscles of the hand can be used to tease out Ulnar Neuropathy of the Wrist
What are the 2nd Lumbrical (median) vs. Interossei (ulnar), stimulating over median nerve and ulnar nerve while recording over Index Finger.
400
Dr. Brian Kelly has been known to do this type of activity, which also has been known to cause Ulnar Neuropathy at the Wrist.
What is cycling.
400
Explain a Martin Gruber Anastomosis and also explain the EDX findings in a Proximal MGA.
What is MGA = the crossing over of median motor fibers to distal ulnar fibers most commonly through the forearm. A Proximal MGA would result in median fibers crossing to join ulnar fibers near where the BE stimulation site is located - resulting in a pseudo conduction block when comparing AE and BE CMAP amplitudes.
500
The Ulnar nerve branches in Guyon's canal to become the Deep and Superficial branches. The Superficial branch is known to be mainly sensory, but also has motor fibers to this muscle.
What is the Palmaris Brevis
500
Mock Oral Case!!! 29yo RHD male with no PMH that presents with L hand "numbness". Reports numbness in hand when laying awake at night scrolling through Facebook. Also reports waking up from sleep throughout night to have what seems to be the whole forearm and hand be "asleep". Occasionally is unable to extend 4th and 5th fingers of the Left hand. Describe the NCS and EMG study that you would do, and describe the responses you would expect.
What is Ulnar - motor and sensory over ADM Median - motor and sensory over APB Dorsal Ulnar Cutaneous - EMG - FDI, FCU/FDP, APB, EIP
500
In suspect UN at the Wrist, the motor study of this muscle is important in during the NCS and why.
What is the FDI - In Distal Deep Palmar Motor Branch UNW, the FDI will be more affected than the ADM (hypothenar muscles are spared).
500
Name at least five of the muscles supplied by the Ulnar nerve.
What is... *FCU *FDP (to RF and SF) *Palmaris Brevis *AbDM *ODM *FDM *3rd/4th Lumbricals *Interossei
500
These are the four types of lesions possible associated with Ulnar Neuropathy at the Wrist. Name the four and explain the corresponding findings.
What are - Distal Deep Palmar Motor = lesion affects lumbricals/interossei, spares the hypothenar muscles, and spares the sensory branch. - Proximal Deep Palmar Motor = lesion affects the lumbricals/interossei as well as the hypothenar muscles but spares the sensory superficial branch. - Proximal Canal lesion = affects the lumbricals/hypothenar and the superficial branch. - Superficial Branch Lesion = lesion affects the sensation only to digits (and Palmaris brevis), but spares Hypothenar and Lumbricals/Interossei. The Dorsal/Volar side of hand is spared.
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