Common Nerve Syndromes - Upper/Lower Extremities

Question 1

Erb-Duchenne Palsy (upper trunk injury)

Answer 1

Traction of shoulder
Loss of C5-C6
- Deltoid, biceps, infraspinatus, and wrist extensors

Question 2

Klumpke’s Palsy (lower trunk injury)

Answer 2

Upward traction of shoulder
Loss of C8-T1
- Finger and hand weakness
- Weakness of the hypothenar muscles
- Sensory loss on the ulnar aspect of the hand and forearm
- Horner’s syndrome is possible (T1)

Question 3

Thoracic Outlet Syndrome (lower trunk injury)

Answer 3

• Compression between the clavicle and 1st rib
• Symptoms increase by raising and external rotation of arm

Question 4

Pancoast’s Syndrome (lower trunk injury)

Answer 4

• Apical lung tumor
  
  • malignant neoplasm of the superior sulcus of the lung
  • extends into the lower brachial plexus
• Lower plexus signs and voice hoarseness

Question 5

Axillary Neuropathy

Answer 5

Dislocation or fracture of proximal humerus -> compress axillary nerve

Question 6

Radial Neuropathy

Answer 6

Causes:
- Sleeping with the arm slung over a park bench “Saturday night palsy”
- Compression in the axilla “crutch palsy”
- Fracture of the humerus

• Weakness of all extensors (arm, hand, fingers), supinators, loss of the triceps reflex, and sensory loss
• Triceps may be spared (posterior interosseous nerve)
• Isolated sensory loss in the dorsal lateral hand (superficial branch of radial nerve)

Question 7

Median Neuropathy

Answer 7

Causes:
- Sleeping with a lover’s head resting on the upper arm “honeymooner’s palsy”
- Fractures of the humerus or distal radius
- Entrapment

Question 8

Carpal Tunnel Syndrome

Answer 8

• Women; > 30 years
  Causes:
• Repetitive activities that cause edema, e.g. typing
• Pregnancy, hypothyroidism, arthritis, wrist fractures, diabetes

Symptoms:
- Sensory loss in the 1st, 2nd, 3rd digits
- Paresthesia that can radiate into the UE
- Thenar atrophy

Question 9

Ulnar Neuropathies

Answer 9

Causes:
- Entrapment at elbow (cubital canal)
- Fractures

Symptoms:
- Weakness of wrist flexion and adduction, finger adduction and abduction, and flexion of the 4th and 5th digits (ulnar claw)
- Sensory loss and paresthesias in an ulnar distribution

Question 10

Femoral Neuropathies

Answer 10

Symptoms:
- Weakness of thigh flexion, knee extension
- Loss of patellar reflex
- Sensory loss in anterior thigh

Question 11

Sciatic Neuropathies

Answer 11

Symptoms:
- Weakness of knee flexors, all foot and ankle muscles
- Loss of the Achilles tendon reflex
- Sensory loss in the foot and lateral leg below the knee

Question 12

Peroneal Nerve Palsy

Answer 12

Symptoms:
- Foot drop
- Weakness of foot dorsiflexion and eversion
- Sensory loss over the dorsolateral foot and shin

Question 13

Obturator Nerve Palsy

Answer 13

Symptoms:
- Gait instability (weak adductors)
- Pain and numbness in the medial thigh

Question 13

Peroneal Nerve Palsy

Answer 13

Symptoms:
- Foot drop
- Weakness of foot dorsiflexion and eversion
- Sensory loss over the dorsolateral foot and shin