Lower moLor neuron

naLomy and physlology

W LocaLlon anLerlor horn of Lhe splnal cord +
moLor nuclel of cranlal nerves
W Lach LMn ls connecLed (Lhrough arborlzaLlon
of Lhe Lermlnal parL of lLs efferenL flber) Lo a
group of muscle flbers (few Lo 100) MC1C8
unl1 (Mu)
W Mu cenLral concepL of perlpheral nervous
sysLem organlzaLlon and funcLlonr
Mu
W varlaLlons ln force range raLe and Lype of
movemenLs are relaLed Lo Lhe number and
slze of Lhe Mu recrulLed ln conLracLlon and Lo
Lhe sequence and frequency of flrlng lnLo each
Mu
W Muscles are lnnervaLed accordlng Lo Lhe
segmenLs of Lhe splnal cord ln a meLamerlc
dlsLrlbuLlon
W MoLor nerve flber of each venLral rooL
parLlclpaLe LogeLher wlLh Lhe nelghborlng
rooLs Lo Lhe plexuses formaLlon
W So each large muscle can be lnnervaLed by 2
or more rooLs
W 8uL a slngle perlpheral nerve lnnervaLes
compleLely a muscle or a group of musclesr
W rr
W 1endon reflex acLlvlLy and muscle Lone are
conLrolled by
large (alpha) moLor neurons
Muscle splndles
fferenL flbers of Lhe muscle splndles
Small anLerlor horn cell (gamma) moLor neurons
axons are connecLed wlLh Lhe splndles
MyoLaLlc sLreLch reflex
W 1ap on Lhe Lendon acLlvaLes nuclear bag
flbers lnslde Lhe splndles
W fferenL pro[ecLlons synapse wlLh Lhe alpha
moLor neurons (ln Lhe same and ad[acenL
segmenLs)
W lmpulses Lo skeleLal muscles monosynapLlc
muscle conLracLlon sLrech reflex
W nLagonlsL muscles are lnhlblLed Lhrough
dlsynapLlc connecLlons ln Lhe same Llmer
LMn leslon cllnlcal plcLure
W Motor def|c|t resLrlcLed Lo Lhe muscle flbers
LhaL are lnnervaLed by Lhe ln[ured LMns
W lmlnlshed or loss of muscle Lone oton|a
ln Lhe same LerrlLoryr
W Muscle flbers amyoLrophlc changes refers Lo
Lhe muscle flbers parL of Lhe affecLed Mu we
can have rou amotro#
W @endon and cutaneous ref|exes conLrolled by
Lhe ln[ured LMns d|m|n|sed or |ost
W asc|cu|at|ons lnvolunLary rlppllng of
muscles wlLhouL movlng segmenLs due Lo
perlcarlonal and axonal membrane lnsLablllLy
and generaLlon of sponLaneous aberranL
acLlon poLenLlals (very promlnenL ln
perlcarlonal and radlcular leslons)
8adlcular syndrome
W MoLor deflclL meLamerlc segmenLal
W sensory deflclL lf sensory rooL ls lnvolved
W Sensory deflclL and paln on a dermaLoma (rooL
LerrlLory
W Lendon reflexes conLrolled by Lhe rooL lnvolved
abollshed
W MulLlple rooLs lnvolvemenL change ln composlLlon
of CSl
W LlongaLlons maneuvers poslLlver
W lsorders affecLlng rooLs C8S dlsc hernlaLlon
Lumorsr
8rachlal plexus lnvolvemenL
Cllnlcal syndrome
W Monomellc moLor deflclL affecLlng Lhe uL
lpsllaLeral Lo Lhe ln[ury hangs uselessly aL
Lhe slde
W LosL Lendon reflexes affecLed uL unllaLeral
W 1oLal sensory loss below a llne exLendlng from
Lhe shoulder Lo Lhe mlddle Lhlrd of Lhe upper
arm
W Causes Lrauma lrradlaLlon neoplasLlc
lnvaslon vlral (arsonage1urner sy) alerglc
(vacclnaLlon) elecLrlcal ln[ury narrowed
Lhoraclc ouLleL
Medlan nerve
W Crlgln C311
W unlon of Lhe medlan and laLeral cords of Lhe
brachlal plexus
W Cllnlcal sy
lnnablllLy Lo pronaLe Lhe forearm and flex Lhe
hand ln radlal dlrecLlon
aralysls of Lhe flexlon of Lhe lndex flnger and
Lermlnal phalanx of Lhe Lhumb
weakness of flexlon of Lhe remalnlng flngers
W Jeakness of opposlLlon and abducLlon of Lhe
Lhumb ln Lhe plane aL Lhe rlghL angle Lo Lhe
palm
W Sensory lmpalrmenL over Lhe radlal Lwo Lhlrds
of Lhe palm and dorsum of Lhe dlsLal
phalanges of Lhe lndex and Lhlrd flngers
W Causes dlslocaLlon ln Lhe axlla wounds
occurlng on along Lhe nerve paravenous
lnfuslons aL Lhe blclplLal groove
W nerves of Lhe
upper llmb
medlan
ulnar
Carpal 1unel Syndrome
W Compresslon of Lhe nerve aL Lhe wrlsL
W 1he mosL frequenL nerve enLrapmenL
syndrome
W Cllnlcal syndrome
ysesLhesla and paln ln Lhe flngers
aresLheslas are characLerlsLlcally worsL durlng Lhe
nlghL
Sensory loss affecLlng Lhe Lhumb lndex and
mlddle flngers
W Causes
Lxceslve use of hands and occupaLlonal exposure
Lo repeaLed Lrauma
lnfllLraLlon of carpal llgamenL wlLh amylold (ln
mulLlple mleloma)
ConnecLlve Llssue dlsorders (reumaLold arLhrlLls)
PypoLhyroldlsm
ulnar nerve
W C811 orlgln
W Cllnlcal syndrome
Clawhand deformlLy
JasLlng of Lhe small hand muscles
eflclL of Lhe wrlsL flexors Lhe ulnar half of Lhe
deep flngers flexors
eflclL of abducLlon and adducLlon of Lhe flngers
Causes pressure ln axllla ln[ured aL Lhe elbow
fracLure dlslocaLlon delayed ulnar palsy" (years
afLer Lhe ln[ury aL Lhe elbow" ulnar Lunnel aL Lhe
wrlsL (prolonged pressure exon byclcle drlvlng)
8adlal nerve
W C6 C8 (malnly C7) posLerlor cord of Lhe
brachlal plexus
W Cllnlcal syndromearalysls of
W exLenslon of Lhe elbow
W llexlon of Lhe elbow wlLh Lhe hand perpendlcular Lo floor
(brachloradlalls muscle)
W SuplnaLlon of Lhe forearm
W LxLenslon of Lhe wrlsL and flngers
W LxLenslon and abducLlon of Lhe Lhumb ln Lhe plane of Lhe
palm
W Sensory lmpalremenL on radlal aspecL of Lhe dorsal hand
W 8adlal nerve
W Causes
Compresslon ln Lhe axllla cruLch palsy"
round Lhe humerus bone (fracLures pressure
palsles durlng alcohollc sLupor
Lead lnLoxlcaLlon
arL of Lhe cllnlcal plcLure of neuralglc
amyoLrophy
Lumbosacral plexus
W LxLends from Lhe upper lumbar area Lo Lhe
lower sacrum
W Cllnlcal syndrome
Jeaknes or paralysls of all leg muscles
mloLhrophy
reflexla
nesLhesla from Lhe Loes Lo Lhe perlanal reglon
uLonomlc loss wlLh warm dry skln edema of Lhe
leg
no sphlcLerlan lnvolvemenL
W Causes
1rauma
neoplasms ln Lhe pelvls
denopaLhy
lrradlaLlon
Surglcal leslons durlng hysLerecLomy of chlldblrLh
neuralglc amyoLrophy
lemoral nerve
W Crlgln L234 rooLs
W Cllnlcal syndrome
Jeaknes of Lhe exLenslon of Lhe lower leg
JasLlng of Lhe quadrlceps muscle
lallure of flxaLlon of Lhe knee
knee Lendon reflex abollshed
ln[ury ln Lhe lnlLlal parL before emerglng Lhe
braches for lllopsoas muscles assoclaLes weakness
of hlp flexlon
Femoral nerve and lumbar plexus
W Causes
CommonesL M
elvlc Lumors red flag for a process LhaL happens
lnslde Lhe pelvls and may compress Lhe nerve
dlrecLly or lndlrecLly
8leedlng lnLo Lhe lllacus muscle or Lhe
reLroperlLoneal ln paLlenLs recelvlng
anLlcoagulanLs and hemophlllacs
SclaLlc nerve
W Crlgln L43 and S12
W CompleLe paralysls
bollshed knee flexlon
Jeaknes of gluLeal muscles
ll Lhe muscles below Lhe knee
are paralysed
arLlal compresslons are more
common and Lend Lo lnvolve
peroneal lnnervaLed muscles
W Causes
lsc hernlaLlon compresslon aL Lhe rooL level
lracLures of Lhe pelvls or femural bone
ln[ecLlon ln Lhe lower gluLeal reglon
1oLal arLhroplasLy
1umors of Lhe pelvls
Lylng flaL on a hard surface ln sLupor sLaLe
neuroflbromas
lnfecLlons
lschemlc necrosls
M 8
crypLogenlc
Common peroneal nerve
W LaLeral or exLernal popllLeal nerve
W Cllnlcal syndrome
Jeakness of Lhe dorslflexlon of Lhe fooL
Jeakness of everslon
numbness of Lhe dorsum of Lhe fooL
Lhe fooL ln var equln" poslLlon
SLepage pecullar galL
W Causes
ressure palsy sponLaneous or assoclaLed Lo Pn
(heredlLary neuropaLhy wlLh pressure palsles)
labeLlc neuropaLhy
llbular bone fracLures
PemaLomas around Lhe flbular head
1lblal nerve
W 1he sclaLlc nerve Lermlnal dlvlslon LhaL
conLlnues lLs Lra[ecLory ln Lhe posLerlor
comparLmenL of Lhe calf muscles
W Cllnlcal syndrome
Calcaneovalgus deformlLy of Lhe fooL
Jeakness of planLar flexlon and lnverslon
Loss of sensaLlon over Lhe planLar aspecL of Lhe
fooL
Loss of achllean Lendon reflex
W Causes
lsc hernlaLlon aL Lhe rooL level
M
8aker CysL ln Lhe popllLeal fossa compresslon
1arsal Lunnel enLrapmenL