Common Nerve Injuries

Question 1

musculocutaneous nerve injury @ Axilla

Answer 1

Injury @ axilla: paralysis of coracobrachialis, biceps brachii, brachialis muscles;

Sensation Loss: lateral antebrachium

Weakness in shoulder & elbow flexion;
Unable to supinate w/ the elbow flexed

Isolated injuries uncommon

Question 2

Common locations of musculocutaneous injury

Answer 2

axilla

Question 3

Common locations of median nerve injury

Answer 3

Recurrent branch
Wrist or in the carpal tunnel
Pronator terres compression
Injury at elbow or proximally

Question 4

Median, recurrent branch injury

Answer 4

Paralysis of thenar muscles –> inability to abduct/oppose thumbs

Thumb adducted permanently by unopposed adductor pollicis muscle –> called “ape hand”

Question 5

Median nerve, wrist or carpal tunnel compression

Answer 5

Capel tunne syndrome

Paralysis of thenar & thumb adducted by adductor pollicis muscle

Sensation loss: palmar digit 1-3 & radial surface of digit 4

Question 6

Median nerve, pronator teres compression

Answer 6

Pronator syndrome

Paralysis of thenar & thumb adducted by adductor pollicis muscle

Sensation loss: palmar digit 1-3 & radial surface of digit 4, over radial surface of the palm

Question 7

Median nerve, elbow or proximally

Answer 7

Hand of benediction (only present when asked to make fist)

Paralysis of thenar & thumb adducted by adductor pollicis muscle, loss of forearm pronation & flexion of digits 1, 2, 3;

Sensation loss: palmar digit 1-3 & radial surface of digit 4, over radial surface of the palm

Question 8

Common locations of ulnar nerve injury

Answer 8

Wrist
Cubital tunnel
Lower Branchial Plexus (C8,T1) injury

Question 9

Ulnar Nerve Injury, wrist

Answer 9

Ulnar claw hand w/ fingers flexed(1st digit ; extension of the metacarpophalangeal joints (unopposed contraction of digital extensor muscles) but flexion of interphalangeal joints (flexor digitorum produndus)

paralysis of all intrinsic muscles of the hand except those supplied by median nerve; inability to abduct or adduct digits 2-5, inability to adduct the thumb or oppose 5th digit

Loss of sensation: plamar 5th digit & ulnar 4th digit

Question 10

Ulnar nerve injury,compression in cubital tunnel or proximal injury

Answer 10

Cubital tunnel syndrome

Ulnar claw hand, fingers extended at DIPs:
extension of the metacarpophalangeal joints (unopposed contraction of digital extensor muscles) but paralysis of interphalangeal joints (flexor digitorum produndus)

paralysis of all intrinsic muscles of the hand except those supplied by median nerve; inability to abduct or adduct digits 2-5, inability to adduct the thumb or oppose 5th digit; paralysis of flexor digitorum profundus muscle to digits 4 & 5

Loss of sensation: plamar 5th digit & ulnar 4th digit

Pancoast tumor (apex lung) encroach on ulnar nerve/medial cord/branchial plexus

Question 11

Ulnar nerve injury, lower brachial plexus (C8,T1)

Answer 11

Klumke’s paralysis:
Paralysis of all ulnar muscles (abduction/flexion/opposition of digit 5, interosseus muscles, lumbricals to digit 4 & 5, flexor carpi ulnaris, flexor digitorum profundus to digits 4 & 5)

Arm supinated with wrist & fingers flexed

Etiology: upward traction of the upper limb;

Question 12

Musculocutaneous

Answer 12

C5, C6, C7

Question 13

Radial roots

Answer 13

C5, C6, C8, T1

Question 14

Ulnar roots

Answer 14

C8, T1

Question 15

Axillary roots

Answer 15

C5, C6

Question 16

Median roots

Answer 16

C5-T1

Question 17

Klumpke Paralysis

Answer 17

damage to C8 + T1

paralysis of intrinsic hand muscles (interossei, thenar, hypothenar), flexors of the wrist & fingers (flexor carpi ulnaris & flexor digitorum profundus to digit 4 & 5)

Forearm supinated & flex at elbow, extended at wrist;

Present: forearm supinated & write and fingers are flexed, if Horner’s –> miosis )

Question 18

Erbs Palsy

Answer 18

Waiter’s tip
C5, C6, C7

Arm adducted and extended @ elbow and wrist flexed;
Inability to supinate or flex