Second most common postop peripheral neuropathy
Brachial plexus
Injured when arm abduction > 90 or improperly placed shoulder brace
Brachial plexus
Axillary innervates
deltoid and teres minor
Axillary injury causes
inability abduct arm
Musculocutaneous sends fibers to the
biceps brachii and brachialis ; ‘most superior nerve of brachial plexus’
Musculocutaneous Injury
inability to flex forearm
Median innervation
branches to most of the flexor muscles of wrist and fingers (also opponens pollicis)
Median injury
Pronation of forearm Flexion of wrist Opposition of thumb Flexion of lateral three fingers Injury-> Ape hand- “unable to oppose thumb”
Ulnar – supplies
the flexor carpi ulnaris and part of the flexor digitorum profundus
Ulnar injury
Most common postop peripheral neuropathy Flexion of wrist Adduction of fingers Flexion of medial two fingers (4,5) Injury-> Claw hand
Radial innervates
innervates essentially ALL extensor muscles of arm and forearm
Radial injury
Extension at elbow
Supination of forearm
Extension of wrist and fingers
Injury-> Wrist drop
Intercostobrachial nerve
Can be blocked to reduce pain from tourniquet inflation during IV regional neural anesthesia
___________ ______ provides innervation to lower limb
Lumbosacral plexus
Lumber plexus is formed by ventral rami of ___ -___. Occasional contribution of ___.
L1- L4, T12
Lumbosacral plexus Lies in ______muscle
psoas
Lumbosacral plexus Consists of three major nerves
Femoral nerve (L2-L4) Lateral femoral cutaneous nerve (L1- L3) Obturator nerve (L2- L4)
femoral nerve consists of __-__?
Femoral nerve (L2-L4)
Lateral femoral cutaneous nerve consists of __-__?
Lateral femoral cutaneous nerve (L1- L3)
Obturator nerve consists of __-__?
Obturator nerve (L2- L4)
Provides motor and sensory innervation to __________and sensory innervation to ________
anterior thigh, medial leg
Sacral plexus arise from ___-__ and __- __
L4-L5 and S1- S4
Posterior thigh and most of leg and foot are supplied by the _______ and ______.
tibial and common peroneal nerves (branches of sciatic nerve)
_____________ nerve provides sensory innervation to posterior thigh
Posterior femoral cutaneous
Femoral nerve supplies
Hip flexors
Knee extensors – Quads
Sensory innervation to hip and thigh
Saphenous nerve is the most medial branch of femoral nerve innervates
Skin of medial leg
Ankle joint
Sciatic Nerve injury caused by
Compression under piriformis
Improper lithotomy position
Sciatic Nerve injury
Weakness (below knee) and loss of sensation
Most frequent injury of lower limb
Common peroneal (fibular) Nerve
Common peroneal (fibular) Nerve injury
Injury = Foot drop
Tibial Nerve injury
Injury = Foot drop
Femoral Nerve injury
Injured by self retaining retractor
Absent knee reflex