Neuro- Week 3

Front 1

**Segmental level of nervous system

Back 1

8 Cervical

12 thoracic

5 lumbar

5 sacral

1 cocygeal

Front 2

**number of pairs of spinal nerves

Back 2

31 pairs

Front 3

Number of vertebra

Back 3

26

Front 4

Where does the spinal cord start and end?

Back 4

From the foramen magnus to the level of L1-L2 vertebra

Front 5

names of the loginituninal "furrows" on the surface of the spinal cord

Back 5

Posterior or dorsal median sulcus

posterior median septum

anterior/ventral median fissure

dorolateral sulcus

ventrolateral sulcus

Front 6

Brachial plexus: which PN?

Back 6

C4-T1

Front 7

Lumbosacrial plexus: which PN?

Back 7

L2-S3

Front 8

**Internal Oranization: Gray Matter

Back 8

* H or butterfly shaped and divided into horn

- Anterior/ventral horns: contain cell bodies of motor (efferent) neurons

-Posterior/Dorsal horns: contain afferent (sensory) nerve fibers

- Lateral horns (only in the thoracic and upper lumbar segments): contain cell bodies of preganglionic sympathetic neurons

* Routes sensory and motor stimulus to interneurons of the CNS in order to create a response to the stimulus through chemical synapses

Front 9

**Gray matter: anterior/ventral horns

Back 9

Contain cell bodies of motor (efferent) neurons

Front 10

**Gray matter: posterior/dorsal horns

Back 10

Contain afferent (sensory) nerve fibers

Front 11

**Gray Matter: Lateral horns

Back 11

* only found in the thoracic and upper lumbar segments

*contain cell bodies of preganglionic sympathetic neurons

Front 12

**Internal Organization: White Matter

Back 12

Densely packed, longitudinally running myelinated fibers

* Myelin is found around almost all long nerve fibers: Acts as an electrical insulation, allows messages to pass quickly from place to place

*3 zones of white matter in the spinal cord known as funiculi: Dorsal, Lateral and ventral. Specific ascending and descending tracts run in the 3 funiculi

Front 13

**3 zones of white matter in the spinal cords are known as what?

Back 13

Funiculi: Dorsal, lateral and ventral

* specific ascending and descending tracts run in the 3 funiculi

Front 14

Internal Organization: Commissures

Back 14

Commissures: 1 gray and 2 white

* intermediate gray: between the dorsal and ventral horns; contains interneurons and fxns to link sensory and motor activity

Ventral white: contains axons and decussate from 1 side of the spinal cord to the other

- location where the spinothalamic tract (pain and temp. cross)

Front 15

Spinothalamic tract location

Back 15

Ventral white commissures

Front 16

Commissures: intermediate gray

Back 16

between the dorsal and ventral horns; contains interneurons and fxns to link sensory and motor activities

Front 17

Commissures: ventral white

Back 17

contains axons that decussate from one side of the spinal cord to the other

* spinothalamic tract located here

Front 18

Level variation in spinal cord structure

Back 18

Internal and external size and shape of cord vary at different levels

* more rostral the tract, the more white matter bc it contains all the ascending fibers from caudal regions and the descending fibers have not yet terminated in more caudal segments

Front 19

Ascending tracts

Back 19

**conduct impoulses to the brain

Nerve tracts w/in the spinal cord together with the spinal nerves provide two way communication system btw the brain and body parts outside the nervous systems

* composed of axons

Front 20

Ascending tracts: names

Back 20

*Fasciculus gracilis

*Faciculus cuneatus

*anterior spinothalamic

*lateral spinothalamic

*anterior spinocerebellar

*posterior spinocerebellar

Front 21

Ascending tracts: types of impulses

Back 21

Carry sensory impulses for

* pain

*temperature (thermal)

*touch(tactile)

*muscle and joint receptors (proprioception)

Front 22

**1st order neurons

Back 22

Primary afferent neurons

* enters the spinal cord thorugh the dorsal root ganglion, terminates in either the spinal gray matter or medulla on the ipsilateal side

Front 23

**2nd order neuron

Back 23

Cell body in the spinal cord or medulLa, axon crosses over to the contralateral side

Front 24

**3rd order neuron

Back 24

Cell body terminates in either the brainstem, cerebellum or diencephalon

Front 25

**Brachial plexus

Back 25

Front 26

Brachial plexus: Origin- From Rami of the plexus : nerves/mm

Back 26

Nerves: dorsal scapular, long thoracic

Muscles: rhomboids, lavator scapulae

Front 27

Brachial plexus: Origin- From trunks of the plexus: nerves/mm

Back 27

N- Nerves of subclavious, suprascapular

MM- subclavius, infraspinatus, supraspinatus

Front 28

Brachial plexus: Origin- Fromlateral cord to the plexus: nerves/mm

Back 28

N: lateral pectoral, musculocutaenous, lateral root of the median nerve

MM- pectoralis major-clavicular head, biceps brachii, brachialis

Front 29

Brachial plexus: Origin- From medial cord to the plexus: nerves/mm

Back 29

N: Medial pectral, ulnar, medial root of the median

MM: pectoralis major/minor, flexor digitoram profundus, most of the mm of the hand, flexor mm of forearm( except FCU; the 5 muscle of the hand

Front 30

Brachial plexus: Origin- From the posteiror cord of the plexus : nerves/mm

Back 30

N: upper scapular, thoracodorsal, lower subsacpular, axillary, radial

M: subscapularis, lat, teres minor, deltoid, teres major, brachioradialis, triceps, supinator, anconeus mm.

Front 31

**Lumbar plexus

Back 31

Front 32

**Dermatomes

Back 32

Area of skin supplied by somatosensory fibers of the dorsal root ganglion

overlap w/ the dorsal root above and below each segment, therefore loss of one dermatomes results in virtually no loss of cutaneous sensation

Front 33

Peripheral nerves

Back 33

Spinal nerve lesion that can lead to extensive sensory loss

* comprised of the dorsal & ventral nerve roots after the exit the intervertebral foramen

*spinal nerves and mixed. They contain both afferent/efferent neorons

Front 34

**Myotomes

Back 34

* Groups of mm innervated via the ventral roots by a segment of the spinal cord

*most mm innervated by motor axons arising from multiple segments

*certain mm whose weakness or atrophy may indicated damage to a single nerve root

Front 35

**Myotome scan: C1 &2

Back 35

Neck flexors (SCM)

Front 36

**Myotome scan: C3

Back 36

Lateral neck flexors

Front 37

**Myotome scan: C4

Back 37

Trapezius, lavator scapula and diaphram

Front 38

**Myotome scan: C5

Back 38

Supraspinatus, intraspinatus, deltoid, biceps

Front 39

**Myotome scan: C6

Back 39

Biceps, supinator, wrist extensors

Front 40

**Myotome scan C7

Back 40

Triceps and finger flexors

Front 41

**Myotome scan: C8

Back 41

FInger flexors, thumb extensors and adductors

Front 42

**Myotome scan: T1

Back 42

Finger abduction and adduction

Front 43

**Myotome scan: upper body

Back 43

C1 and 2: Neck Flexors (SCM)

C3: Lateral Neck Flexors

C4: Trapezius, Levator Scapula and Diaphram

C5: Supraspinatus, Infraspinatus, Deltoid, Biceps

C6: Biceps, supinator, wrist extensors

C7: Tricep and Finger flexors

C8: Finger flexors, thumb extensors and adductors

T1: Finger Abduction and Adduction

Front 44

**Myotome: Respiration

Back 44

MM: diaphragm

Root: C3, C4, C5

Front 45

**Myotome: abduction of arm

Back 45

MM: Deltoid

Root: C5

Front 46

**Myotome: flexion of forearm

Back 46

MM: Biceps Root: C5

MM: Brachioradialis, root: C6

Front 47

**Myotome: Extension of forearm

Back 47

MM: Triceps

Root: C7

Front 48

**Myotome: Extension of Knee

Back 48

MM: quadriceps

root: L3, L4

Front 49

**Myotome: Dorsiflexion of great toe

Back 49

MM: extensor hallucis longus

Root: L5

Front 50

**Myotome: plantar fexion

Back 50

MM: gastrocnemius

Root: S1

Front 51

**Myotome Scan: L1-L3

Back 51

Iliopsoas

Front 52

**Myotome Scan : L2

Back 52

Psoas, Hip adductors

Front 53

**Myotome scan: L3

Back 53

Psoas, Quads

Front 54

**Myotome scan: L4

Back 54

Tibialis anterior, extensor hallucis

Front 55

**Myotome scan: L5

Back 55

Extensor Halluces, Peroneals, Glut Med

Front 56

**Myotome scan: S1

Back 56

Calf, Hamstring, Gluteals, Peroneals, Plantarflexors

Front 57

**Myotome Scan: S2

Back 57

Calf, Hamstring, Gluteals, Plantarflexors

Front 58

Action- Flexion of shoulder:

MM, PN, NR, Plexus

Back 58

MM: Deltoid, coracobrachialis

PN: Axillary, Musculocutaneus

NR: C5-C6, C6-C7

Plexus: Brachial

Front 59

Action- Extension of shoulder: MM, PN, NR, Plexus

Back 59

MM PN NR

Lat's Thoracodorsal C6-C8

Teres Major Subscapular C5-C6

Deltoid (post) Axillary C5-C6

Plexus: Brachial

Front 60

Action- Abduction Arm:

MM, PN, NR, Plexus

Back 60

MM PN NR Supraspinatus Suprascapular C4-C6 Deltoid Axillary C5-C6

Plexus: Brachial

Front 61

Action- Elbow Flexion:

MM, PN, NR, Plexus

Back 61

MM PN NR Biceps Brachii Musculocutaneous C5-C6 Brachialis Musculocutaneous C5-C6 Brachioradialis Radial C5-C6

Plexus: Brachial

Front 62

Action- Elbow Extension:

MM, PN, NR, Plexus

Back 62

MM: Triceps Brachii

PN: Radial

NR: C5-C6

Plexus: Brachial

Front 63

Action- Wrist Flexion:

MM, PN, NR, Plexus

Back 63

M PN NR

F. Carpi Radialis Median C6-C7

F. Carpi Ulnaris Radial C8-T1

Plexus: Brachial

Front 64

Action- Wrist Extension:

MM, PN, NR, Plexus

Back 64

M/PN/ NR

E. Carpi Radialis Longus/ Radial/C6-C7

E. Carpi Radialis Brevis/ Radial / C6-C7(C8)

Extensor Carpi Ulnaris/ Radial/ C6-C8

Plexus: Brachial

Front 65

**Major Peripheral Nerves- UE:

Axillary

Back 65

MM & skin of ant., lat & post region of arm

Front 66

**Major Peripheral Nerves- UE:

Musculocutaneous

Back 66

MM of arm on the ant. side & skin of forearm

Front 67

**Major Peripheral Nerves- UE:

Median

Back 67

MM of forearms and MMs & skin of hands

Front 68

**Major Peripheral Nerves- UE:

Radial

Back 68

MM of arms on the post. sides/ skin forearms & hand

Front 69

**Major Peripheral Nerves- UE:

Ulnar

Back 69

MM of forearms & hands and skin of the hands

Front 70

Median Nerve: Injury

Back 70

Result in server disability (IE. Carpal tunnel Syndrome)

Front 71

High Median Nerve injury: causes

Back 71

Proximal forearm or above:

Loss of:

*Wrist flexion strength, ulnar deviation of wrist, thumb opposition, finger flexion of thumb, index and long finger IP joints

*When making a fist the ring &small fingers flex while the long & index tend to stay straight

Front 72

Low Median Nerve Injuries: causes

Back 72

Fingers are still able to flex, but thumb opposition is often lost

Front 73

Radial Nerve Injury: Results in

Back 73

* Loss of extension of the wrist, fingers and thumb (difficulty in grasping objects leads to significant disability_)

Front 74

Ulnar Nerve Injury: results in

Back 74

* hand and finger pain

* Weakness of hand

*Numbness, burning and decreased sensation

*Pain and tingling in the 4th and 5th fingers

Front 75

Action: Hip Flexion:

MM/PN/NR/P

Back 75

MM/PN/NR

Psoas Major/femoral/ L1-L3

Iliacus/ Femoral / L2-L3

Plexus: Lumbar

Front 76

Action: hip Extention

MM/PN/NR/P

Back 76

MM/Pn/NR

Gluteus Max/ inferior gluteal/ L5-S2

Semitendinosus/ Sciatic (tibial) L5-S2 (L4)

Plexus: Lumbosacral

Front 77

Action: hip abduction

MM/PN/NR/P

Back 77

MM/PN/NR

Gluteas Medius/ Superior gluteal/ L40S1

Plexus: Lumbosacral

Front 78

Action: Knee Flexion

MM/PN/NR/P

Back 78

Biceps femoris (long head)/ Sciatic (tibial)/ S1-S3

Biceps femoris (short head)/ Sciatic (common peroneal)/ L4- S2

Semitendinosis/ Sciatic (tibial)/ L4-S2

Plexus: Sacrial (LH), Lumbosacral (SH, SemiT)

Front 79

Action: knee extension

MM/PN/NR/P

Back 79

Quadriceps Femoris/ femoral/ L2-L4

Plexus: Lumbar

Front 80

Action: Ankle plantar flexion

MM/PN/NR/P

Back 80

MM: Gastrocnemius, soleus

PN: Tibia

NR: S1-S2

Plexus: sacral

Front 81

Action: ankle Dorsiflexion

Back 81

MM: tibialis anterior

PN: deep peroneal

NR: L4-S1

P: Lumbosacral

Front 82

**Major PN of LE: Obturator

Back 82

Supplies the adductor mm of the thigh

**hernia surgery can cause injury**

Front 83

**Major PN of LE: Femoral

Back 83

Divides into many branches:

Supplies motor impulses to mm of the anterior thigh

receives sensory impulses from the skin of the thighs& legs

Front 84

**Major PN of LE: Sciatic

Back 84

* Largest and longest nerve in the body

*passes downward into the buttock &descends into the thigh

*divides into Tibial and common fibular N.

*supplies mm and skin in the thighs, legs and feet

** tibial nerve caused by ankle immobilization**

Front 85

Patents with obturator nerve injury have:

Back 85

Possible numbness and pain radiating into their inner thigh

adduction thigh weakness can occur, which causes gait and posture instability

Front 86

Femoral nerve injury: results in

Back 86

*loss of knee extension

*loss of cutaneous sensation on the medial side of the leg and foot

* pain felt over the femoral nerve distribution due to compression of L2-4 N. roots by an intervertebral disc

Front 87

Sciatic Nerve injury results in:

Back 87

*Sensation changes of the back of the calf or the sole of the foot

- Numbness, decr. sensation, tingling, burning sensation, pain (severe), abnormal sensations

* weakness of the knee or foot

- Difficulty walking, inability to move the foot, inability to bend the knee (in sever cases)

Front 88

**Neuropathies

Back 88

Disease of the PN system:

Segmental demyelination

Axonal degeneration

wallerian degeneration

Front 89

**Neuropathies: cause

Back 89

variety of diseases:

*Herpes zoster (shingles)

*Infection (GBS)

*malnutrition, vit. deficiency, toxic to meds, metabolic complication from DM, liver & kidney failure, hypothyroidism, hereditary

*Mechanical forces/trauma: cut or scratched, edema/ inflammation, compression

Front 90

Segmental demyelination

Back 90

Myelin degenerates by the axon is spared

Front 91

Axonal degeneration

Back 91

Distal degeneration of the axon

Front 92

Wallerian degeneration

Back 92

Both the distal axon and surrounding myelin degenerate

Front 93

Polyneuropathies

Back 93

*usually involve both sensory and motor impairments

*Sensory impairments are usually bilateral & in a grove like or stocking distribution

* affects the distal extremities first (dying back effect)

*affecting primary somatosensory neurons can cause sensory ataxia

**entire foot/hand vs. certain section

Front 94

Diabetic Neuropathy: etiology

Back 94

Prolonged exposure to high blood glucose levels

* involves sensory, motor and autonomic nerve fibers

Front 95

Diabetic neuropathy (polyneuropathies): Symptoms

Back 95

can be wide spread based on the diverse presentation: include weakness &sensory disturbances (numbness, tingling, or pain

* wasting of m. in feet/hands "stocking glove" sensory and distribution impairments, orthostatic hypotension, urinary impairment and significant pain

* usually involve decr. sensation in the distal LE

Front 96

Diabetic neuropathy (polyneuropathies): PT intervention

Back 96

Pain management, foot care and overall fitness

Front 97

Guillian-Barre syndrome: etiology

Back 97

Involves demyelination of PN resulting in axonal degeneration

Front 98

Guilian-Barre syndrome: symptoms

Back 98

*usually the legs are affected 1st & weakness ascending to the trunk. usually symmetrically

*motor loss is more predominant than sensory loss; absent DTR's

*progresses rapidly, can lead to total paralysis and death (2-5%)

* neurological signs totally or partially solves over weeks or months (peaks w/in 2-4 wks)

Front 99

Guillian-barre' syndrome: PT intervention

Back 99

Strengthening, mobility, WC or orthotic Rx, and/or assisted device training

Front 100

Charcot-marie-tooth disease

Back 100

*genetic PN disorder affecting both sensory and motor fibers

*presents w/ distal weakness and sensory loss

* onset in the teens or twenties and progresses gradually over a lifetime

Front 101

what type of roots are dorsal and ventral horns?

Back 101

Sensory roots: dorsal

Motor roots: ventral

Front 102

3 causes or brachial plexus injuries

Back 102

Erbs-palsy - causes paralysis in arm

Stinger- quick stretch to brachial plexus

anterior shoulder dislocation