Archive for April, 2007
Neck pain| Brachial Plexus| Upper Limb Pain| Medial Cord
April 30, 2007 9:53 amMonday, April 30, 2007
Nerves from the medial cord (5):
Medial pectoral nerve (C8, T1): Supplies the sternal head of the pectoralis major muscle. Sternal head is also supplied by the lateral pectoral nerve)
Medial cutaneous nerve of the arm (T1): supplies the medial arm
Medial cutaneous nerve of the forearm (T1): Supplies the medial forearm
Medial head of the median nerve (C8, T1): Supplies the flexor digitorum superficialis, abductor pollicis brevis, flexor pollicis brevis-superficial head, opponens pollicis and first two lumbrical muscles.
The anterior interosseous nerve supplies the flexor pollicis longus, flexor digitorum profundus slips to index and middle fingers and pronator quadratus.
There are no sensory branches from the anterior interosseous nerve.
Ulnar nerve (C8, T1): Supplies the flexor carpi ulnaris, flexor digitorum profundus slips to the ring and little fingers, palmaris brevis, abductor digiti minimi, flexor digiti minimi and opponens digiti minimi.
The sensory branches include dorsal ulnar cutaneous nerve of the forearm which supplies the skin over the dorsal aspect of the hand and medial two fingers; skin over the hypo-thenar eminence from the ulnar nerve and sensation to the medial half of the ring finger and the little fingers from the ulnar digital nerves.
The deep branch of the ulnar nerve supplies adductor pollicis, deep head of the flexor pollicis brevis , third and fourth lumbricals and dorsal and palmar interossei muscles.
© 2007 copyright all rights reserved www.stopmusclepain.com Neck pain| Brachial Plexus| Upper limb pain| medial cord
anterior interosseous nerve, arm pain, brachial plexus, medial cord, median nerve, neck pain, ulnar nerve, upper body topicsNeck pain| arm pain| brachial plexus| posterior cord
April 18, 2007 10:20 pmNeck pain | arm pain| lateral cord| brachial plexus
April 17, 2007 10:07 pmTuesday, April 17, 2007
Peripheral nerves from the lateral cord (3):
Lateral head of the median nerve (C5, C6, C7 supplies the pronator teres, flexor carpi radialis, palmaris longus).
The median nerve supplies sensation to the skin over the thenar eminence, lateral three and a half fingers including the dorsal aspect of these fingertips).
Lateral pectoral nerve (C5, C6, C7 supplies the clavicular head of the pectoralis major and the pectoralis minor muscle)
Musculocutaneous nerve (C5, C6 supplies the biceps brachii, coracobrachialis and brachialis muscles). The sensory branch includes the lateral cutaneous nerve of the forearm.
Neck pain| brachial plexus| upper limb pain
April 16, 2007 12:47 pmMonday, April 16, 2007
Neck pain| Brachial Plexus| Upper limb pain
Patients with neck pain often also have pain in the upper limb. In fact, they may present initially with upper limb pain and often, irritation of the brachial plexus is considered in the absence of complaints of neck pain.
Whether the patient's primary complaints are in the shoulder, arm, elbow, forearm, wrist, hand or fingers, cervical nerve root irritation must be considered.
It is important to be familiar with the anatomy of the brachial plexus so that you can decipher the nerve roots that may be involved or irritated.
The brachial plexus is formed from the contributions from the cervical nerve roots in the neck.
Roots (5 roots) in the neck: Anterior primary rami of the C5 - T1 nerve roots. A pre-fixed plexus has contributions from C4 and a post-fixed plexus has contributions from T2.
Dorsal scapular nerve arises from the anterior primary ramus of C5 nerve root. It supplies the rhomboideus major and minor, and also the levator scapulae muscle.
Other nerves arriving from the anterior primary ramus of C5 includes nerve to the subclavius and also twigs to the scalenes.
Long thoracic nerve arises from the anterior primary rami of C5, C6 and C7 nerve roots to supply the serratus anterior.
Trunks (3 Trunks), above the clavicle:
Upper trunk: Combination of anterior primary rami of C5 and C6 roots. Suprascapular nerve arises from the upper trunk to supply the supraspinatus and infraspinatus muscles.
Middle trunk: Anterior primary ramus of C7 root.
Lower trunk: Combination of anterior primary rami of C8 and T1 roots.
Divisions (6 divisions), behind the clavicle: All trunks divide into anterior and posterior divisions.
Cords (three cords), in the axilla surrounding the axillary artery:
Lateral cord: Formed from the anterior divisions of the upper trunk and middle trunk.
Medial cord: From the anterior division of the lower trunk.
Posterior cord: Formed from the posterior divisions of the upper, middle and lower trunks
Peripheral nerves from the lateral cord (3):
Lateral head of the median nerve
Lateral pectoral nerve
Musculocutaneous nerve
Nerves from the posterior cord (5):
Upper subscapular nerve
Lower subscapular nerve
Nerve to the Latissimus dorsi
Circumflex nerve (axillary nerve)
Radial nerve
Nerves from the medial cord (5):
Medial pectoral nerve
Medial cutaneous nerve of the arm
Medial cutaneous nerve of the forearm
Medial head of the median nerve
Ulnar nerve
© 2007 copyright all rights reserved www.stopmusclepain.com Neck pain| Brachial Plexus| upper limb pain
Dissection anatomy of the brachial plexus
Neck pain| fist tightening
April 15, 2007 8:04 amSaturday, April 14, 2007
Neck pain| fist tightening
Patients with neck pain have difficulty with making a fist, especially a tight fist secondary to pain in the wrists and fingers.
To have a powerful grip while tightening the fist, the following conditions have to be present:
- the thumb must be able to bend across the fingers curled into the palm. The thumb must be able to oppose. These actions need the full function of the muscles supplied by the median and ulnar nerves.
- the strength of the wrist extensors to stabilize the wrist. This requires the full function of the dorsal forearm muscles supplied by the radial nerve.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| fist tightening
finger pain, fist tightening, median nerve, neck pain, radial nerve, ulnar nerve, upper body topics, wrist painNeck pain| fist-making| thumb flexion
April 13, 2007 10:13 pmNeck pain| finger flexion| thumb extension
April 12, 2007 10:35 pmThursday, April 12, 2007
Neck pain| finger flexion| thumb extension
Patients with neck pain can have pain in the fingers with difficulty in making a fist. The fingers need to be folded into the hand to make a fist.
This movement is performed by the flexor digitorum superficialis which bends the joints between the first and second phalanges. This muscle is supplied by the median nerve (C8,T1)
The flexor digitorum profundus muscle is responsible for bending the fingers at the knuckle joints and the joints between the phalanges. The flexor digitorum profundus slips to the index and middle fingers are supplied by the anterior interosseous branch of the median nerve (C7, C8). The flexor digitorum profundus slips to the ring and little fingers are supplied by the ulnar nerve (C8, T1).
When the fist making is not too tight, the thumb is extended through the action of the extensor pollicis longus and extensor pollicis brevis supplied by the radial nerve (C7, C8). The wrist has to be stabilized by the contraction of the wrist extensors supplied by the posterior interosseous branch of the radial nerve.
The wrist extensors are the extensor carpi radialis longus and brevis, extensor digitorum and the extensor carpi ulnaris muscles.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| finger flexion| thumb extension
upper body topicsNeck pain| hand pain| intrinsic hand muscles
April 11, 2007 1:11 pmWednesday, April 11, 2007
Neck pain| hand pain| intrinsic hand muscles
Patients with neck pain due to cervical nerve root irritation can have pain in the hands and difficulty with manipulation of fine objects such as turning a key, cutting meat, picking up small objects or holding onto flat and thin objects.
They may have difficulty picking up a piece of paper and holding onto it.
Palmar interossei muscles perform this type of motion that require bending the knuckle joints (metacarpophalangeal joints).
Dorsal interossei muscles and the lumbricals keep the interphalangeal joints straight.
The extensor digitorum can then be responsible for extension of the fingertips when the metacarpophalangeal joints are flexed.
Nerve supply:
- palmar and dorsal interossei muscles are supplied by the deep branch of the ulnar nerve (C8, T1).
- Extensor digitorum is supplied by the posterior i interosseous nerve from the radial nerve (C7, C8).
Photograph showing the action of the interossei muscles and lumbrical muscles and holding up a piece of paper.
© 2007 copyright all rights reserved www.stopmusclepain.com Neck pain|hand pain| intrinsic hand muscles.
cervical nerve root irritation, extensor digitorum, hand pain, interossei, intrinsic hand muscles, lumbricals, neck pain, upper body topics
Neck pain| fist-making| flexor digitorum superficialis
April 10, 2007 1:19 pmTuesday, April 10, 2007
Neck pain| fist-making| flexor digitorum superficialis
Patients with neck pain due to cervical nerve root irritation may have accompanying wrist, hand and finger pain.
Pain and spasm or stiffness in the flexor digitorum superficialis muscle will lead to difficulty in making a fist. Both the flexor digitorum superficialis and flexor digitorum profundus muscles must be able to contract well to make a fist.
Whenever there is difficulty in making a fist either due to stiffness, pain or spasm in the muscles that flex the fingers, it is essential to examine the muscles that must balance the action of the finger flexors.
The muscles on the dorsal aspect of the forearm and wrist, namely the wrist and finger extensors must undergo lengthening contractions to balance the action of the finger flexors.
The dorsal forearm muscles are needed to contract well to stabilize the wrist while making a fist. Therefore any problems in the function of the wrist and finger extensors, need to be worked on simultaneously to increase the function of the finger flexors.
You will note that when your wrist is bent down (flexed), you will have a hard time making a fist and your grip will be weak. Your wrist has to be bent-up (extended) for you to be able to make a fist with a strong grip.
The flexor digitorum superficialis is responsible for bending (flexing) the middle phalanx. The best way to test it is to hyperextend the knuckle (metacarpophalangeal) joint. With the metacarpophalangeal joint pushed back into hyperextension, the action of the flexor digitorum profundus is made silent. In this position, only the flexor digitorum superficialis can contract.
Flexor digitorum superficialis is supplied by the median nerve (C8, T1 roots).
Photograph of the location of the flexor digitorum superficialis belly and tendons.
© 2007 copyright all rights reserved www.stopmusclepain.com Neck pain| fist-making| flexor digitorum superficialis
fist making, flexor digitorum superficialis, hand pain, lengthening contractions, neck pain, nerve root irritation, upper body topicsNeck pain| hand pain| fist-making
April 9, 2007 10:44 pmMonday, April 09, 2007
Neck pain| hand pain| fist-making
Patients with neck pain due to cervical nerve root irritation may have hand pain significant enough that they may have difficulty making a fist.
The joints of the fingertips may have a hard time bending. This most peripheral joint of the fingertips is known as the distal interphalangeal joint. Bending of this joint is performed by the flexor digitorum profundus muscle.
The nerve supply to the flexor digitorum profundus:
- slips to the index and middle fingers are supplied by the anterior interosseous branch of the median nerve
- slips to the ring and fingers are supplied by the ulnar nerve.
Photograph showing flexor digitorum profundus
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| hand pain| fist-making
fingers, fist making, flexion, median nerve, neck pain, ulnar nerve, upper body topics
