AP13 - nerve trauma and MSK disease

Question 1

how might you analyse pain?

Answer 1

SOCRATES
sight
onset
character
radiation
associations
time
exacerbations
severity

Question 2

What pain is associated with a subarachnoid haemorrhage?

Answer 2

thunderclap

Question 3

How is pain experienced in a heart attack?

Answer 3

phrenic nerve transmits pain, dermatomes for spinal nerve of its’ origin experience the pain

Question 4

Where might someone with gallstones experience pain?

Answer 4

shoulder, as it irritates the phrenic nerve, with dermatomes here

Question 5

What are the 4 cardinal signs of inflamation?

Answer 5

rubor - redness
calor - heat
tumor - swelling
pain - dolor

Question 6

Why is it important that the patient is warm when conducting motor and sensory assessments?

Answer 6

there is a direct relationship between temperature and conductance velocity along sensory and motor fibres

Question 7

what is spastic gait?

Who might have it?

Answer 7

drags feet while walking

it is often observed in people with cerebral palsy or MS

Question 8

What is scissors gait?

who might have it?

Answer 8

legs bend inwards

spastic paraplegics

Question 9

What is steppage gait?

Answer 9

toes point towards the ground, may scrape the ground

problems with sciatic nerve

Question 10

What is waddling gait?

Answer 10

short steps, swinging body

Question 11

What is propulsive gait?

Answer 11

head and neck pushed forward

Question 12

name 2 common sites where the common peroneal nerve might be damaged

Answer 12

lateral ankle or the knee

Question 13

How might severe compression of the peroneal nerve present?

Answer 13

foot drop, unable to flex foot upwards at the ankle

often a distinctive gait where the knee is raised higher (steppage gait)

Question 14

What other injury might give the same symptoms as peroneal nerve damage?

what other symptoms might this injury present with?

Answer 14

sciatic nerve damage

posterior thigh and leg weakness
pain radiating down path of sciatic nerve

Question 15

What injuries might damage the radial nerve?

Answer 15

midshaft humeral fractures
Erb’s palsy or Klumpke’s palsy
radial tunnel syndrome

Question 16

How is radial tunnel syndrome characterised?

Answer 16

posterolaeral elbow pain

weakness of extention of wrist and 3rd digit

Question 17

What is supinator syndrome

Answer 17

radial tunnel syndrome really, moer specific for compression at the arcade of Frohse

Question 18

What is the arcade of Frohse and its’ relationship to the radial nerve?

Answer 18

formed by a fibrous band between 2 heads of supinator muscle

the deep branch of the radial nerve passes beneath the arcade with the vessels known as the leash of henry

Question 19

What are the roots of the long thoracic nerve?

Answer 19

C5-C7

Question 20

What might cause damage to the long thoracic nerve?

Answer 20

trauma (very long nerve)
direct blow to ribs
stretching
sustained weight bearing over shoulder

Question 21

How might damage to the long thoracic nerve be characterised?

Answer 21

winged scapula

Question 22

How would you test for long thoracic nerve damage?

Answer 22

serratus wall test
or resisted flexion with the arm below the horizontal will place the serratus under maximum resistance and will demonstrate winging

Question 23

How might proximal damage to radial nerve present?

Answer 23

hand of benediction

Question 24

How might distal damage to the radial nerve be characterised?

Answer 24

pinch sign (when doing the ok sign)