Lim
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A patient comes to his physician with complaints of weakness in his arms,which has been getting worse over the past week. The physician orders an MRI,which whos a small-to-moderate C6-7 disc herniation that is pushing into the anterolateral part of the cord especially on the right. Weakness in which of the following muscles would most likely be found on physical exam?
A. distal upper extrimity flexors
B. distal upper extremity extensors
C. proximal upper extremity flexors
D. proximal upper extremity extensores
E. Trunk supportive muscles.
answer and explanation? 
How can you differentiate ant. post. med. and lateral in ongoing nerves?
Edited by Lim on 07/17/06 - 03:33 AM
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| robin082006
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This patient may have inferior flexus injury (C8-T1). Ulnar nerve is injured.
So I choose A
A. distal upper extrimity flexors : Ulnar and median
B. distal upper extremity extensors : radial
C. proximal upper extremity flexors :Musculocutaneous
D. proximal upper extremity extensores: radial
E. Trunk supportive muscles. not relevant
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| study_ing
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hmm intersting question
firstly anterolateral part of CORD , not nerve wud mean the medial areas are spared which wud rule out trunk muscles...
my anat isnt great so i need ur help robin...how did u figure out its the ulnar nerve they r asking abt, and not the myotomes ...i know herniation of a disc influences levels lower than it self...
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| Dr.Papez
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vague choices... very vague indeed...what does proximal UE means..shoulder ?Dital means wrist? ... elbow stands in between??
The C6-7 disc is likely to cacth C7 root and the adjacent part of cord....the choices does not favour cord pathology... hence look for C7 innervated muscles... Triceps, some long flexors... latissiumus dorsi... Look for preserved brachioradialis to differntiate from Radial nerve injury... wrist extension is often C6 than C 7.
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| Lim
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This is an answer and expl..
The correct answer is B.
The organization of lamina IX of the ventral horn of the spinal cord at the limb enlargements is such that alpha motor neuron to trunk and proximal muscles are located medially, cells to distal muscles are located laterally, cells to extensors are anterior, those to flexors are more posterior. The description of the herniated disc would impact those of distal extensors first.
Distal flexors(Choice A) are more posterior in the ventral horn.
Proximal flexors (Choice C) are relatively more medial and posterior in the ventral horn.
Proximal extensors (Choice D) are located relatively more medially in the ventral horn.
Trunk muscles(Choice E) are innervated by nerve cell bodies located medially, adjacent to the central canal of the spinal cord.
i also choiced A. but wrong. very interesting question. i think.
distribution of muscles in the lamina of the spinal cord is different from what we normally think.
flexors if posterior,that's the point. hm...
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| robin082006
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hahah, interesting question
But it is hard to understand and remember.
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| Cedrick
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Q & A
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| Dr.Papez
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I dont think this has any practical value... I have never seen any neurologist trying to localise within the cord based on weakness distribution. I think this is a hypothetical question at best.
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| study_ing
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well if first aid gives the above info( and it fuz) we'll heve to unfortunately know it
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| Lim
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study_ing~ funny comment~ haha...
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