NERVE-ous
Muscle Man
Injury city
BLOCK
what you didnt study
500

a patient comes into the clinic un able to relax his hand after having surgery two days ago on his back. he states he feels like the majority of the stiffness is in his 4th and 5th fingers. What do you think happened?

Injury to his ulnar nerve due to improper compression between the OR table. 

500

what 4 muscles make up the rotator cuff? what are their functions?

DOUBLE POINT BONUS: WHAT MUSCLE IS COMMONLY TORN

  • Supraspinatus: this is the most common muscle to be injury in the rotator cuff. This will cause pain superiorly to the deltoid that can radiate to the neck. When this muscle is injured, the patient will not be able to abduct the arm between 0-15 degrees.
  • Infraspinatus: Laterally rotates the arm
  • Teres minor: adducts and laterally rotates the arm.
  • Subscapularis’s: medially rotated and adducts the arm
500
While doing your pediatric rotation you are getting a pre op assessment on your patient you notice the pts arm is medially and internally rotated, his wrist is in a flexed position. when asking the parents about it they said they think he fell but they were unsure and said it was his special arm. What do you think happened. 

He fell (stretching his neck to far) and injured his superior trunk, C5 and C6, known as erb-douchanes palsy. Which is injury to the axillary, musculocutaneous, and suprascapular nerves. 

500

When examine the upper arm with ultrasound you can see four nerves in order from upper left, upper right, lower left, lower right what are they?

DOUBLE POINT BONUS: WHAT WILL YOU NOT SEE IF PROPERLY BLOCKING OF ULNAR NERVE

Musculocutaneous, Median, Radial, and ulnar

adduction of the thumb 

500

what is tic douloureux?

extreme facial pain causes by cranial nerves 5 and 9 

500

When preforming a ulnar block versus a median block what part of hand sensation will these two blocks effect? 

  • Medial nerve: sensation on the anterior surface of the hand include the areas of the first digit to half of the fourth digit. On the posterior side it includes the skin over the distal phalanx of digits one through half of the fourth digit.
  • Ulnar nerve: sensation on the anterior surface of the hand includes the fifth digit and half of the fourth digit. On the posterior side it is the same area of coverage.
500

What muscle is supplied by a CN and spinal accessory nerve?

trapezius 

500

A man comes into the ER complaining of sever pain near his hand and wrist area for the past several days. Each time he comes in the new ED resident writes him off as a drug seeker since his X-rays are all normal. What do you think happened?

DOUBLE POINT BONUS TO BE GIVEN IF THIS ANSWERED CORRECTLY

he fractured his scaphoid and is suffering from a vascular necrosis. 


DOUBLE POINT BONUS: what are all the bones in the wrist on the anterior view (must be in correct place)

500

you are doing your regional rotation with a pain fellow, he asks you what block can be done to reduce pain during IV neural anesthesia?

intercostobrachial block 

500

We get to educated the frats on injuries that could happen from drinking to much. What would you educate them about? 

Saturday night palsy: causes by compression of the radial nerve when falling asleep on one arm 

It can be reversed with steroid shots depending on the degree of damage

500
A GSW pt comes into the ER, he has been shot in the left chest, what muscle and nerve injury do you expect?

-long thoracic nerve

-serratus anterior 

500

If a patient comes into the Physical therapy office with a decreased muscle mass of one upper arm and problems with abduction, what muscle and nerve could be injuryed

deltoid, axillary 

500

A man is attempting to break the world record at tight roping, half way through the falls but catches him self. During that moment he felt nothing but several days later he is unable to flex his elbow and his hand is in a claw position. What did he injur?

inferior trunk C8, T1 or Klumpke paralysis 

500

A successful block of the common fibular nerve should display what?

foot droop
500

what is the difference between the shoulder joint and the hip joint 

they are both ball and socket but the shoulder provided a lot more complex movements. The shoulder is also less stable than the hip joint due to the size of the head of the humerus and the glenoid cavity.

500

A woman is undergoing a masectomy due to breast cancer diagnosis. What nerves are most commonly injured?

Thoracodorsal, medial and lateral pectoral, long thoracic 

500

what flexors are not supplied by the median nerve?

flexor carpi ulnaris 

flexor digitorum profundus 

500

Karen spends most of her day review bombing buisnesses where she felt like she was discriminated or treated poorly for "being a Karen". When she falls asleep her hands are always going numb and she has trouble typing every morning. What is Karens problem?

carpal tunnel syndrome, it traps the median nerve 

500

Where are caudal blocks done?

sacral hiatus 

500

the second most common postoperative cause of peripheral neuropathy is injury to what?

DOUBLE POINT BONUS: CAN YOU IDENTIFY AND LABEL IT?

brachial plexus 

500

Which two nerves supply the upper arm and what is the difference between the two?

musculocutaneous(biceps) and radial (triceps)
500

what muscle is responsible for major nerve pain in the leg?

piriformus 

500

parents are playing with their kid and are picking him up by hands and are swinging him forward and back. Suddenly he starts crying from pain and says it feels like someone is poking his hands a lot. What happened?

partial or full subluxation of radial head, causing radial nerve pain 

500

where can a radial nerve block be done?

Thumb side of hand near the wrist 

500

where does the median nerve run between?

FDS AND FDP