Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RLH MRCS > DrE: Upper limb nerves > Flashcards

DrE: Upper limb nerves Flashcards

1
Q

Radial nerve examination: inspection

A
  • Patient opposite, hanges resting on table/pillow/ Expose to above elbow/entire upper torso / Aids e.g. splint
  • Ask re pain
  • Inspect:
    • Scars - penetrating trauma of upper limb e.g. upper arm - #humerus, radial side of elbow - #radial head
    • Swelling - soft tissue/bony mass
    • Symmetry - symmetrical RA
    • Deformity ‘hold hands and arms out straight’ - wrist drop
    • Erythema - inflammation
    • Sinus - post op infection
    • muscle wasting - wrist extensors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Radial nerve examination: sensation

A

Feel - temperature changes dorsal/ventral - with back of hand

  • 1st dorsal web space - superficial radial nerve
  • Dorsal forearm - high lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Radial nerve examination: motor

A
  • triceps - extension - high lesion nerve br proximal to spiral groove
  • Brachioradialis - elbow flexion - nreve br above elbow distal to radial groove
  • supinator - posterior interosseous nerve - br at level of elbow, passes deep between 2 heads of supinator
  • MCPJ Extension - note R nerve supplies all long digital extensors
  • Extensor pollicis longus - palmar surface flat on table, lift thumb -> EPL visible and palpable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Radial nerve examination: Special test

A

Functional assessment

-Assess global and fine functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Radial nerve examination: completion

A
  • QoL Impingement and sleeep - ask patient about impact on life and in turn necessity for intervention
  • Help patient dress - functional limitation
  • Upper limb neurovascular status:
    • full examination
    • focus on pulses, dermatomes, myotomes
  • Neck examination - cervical spine pathology
  • Radiology - humerus # / cervical spine (MRI)
  • Nerve conduction studies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Median nerve examination: Inspection

A
  • Patient opposite, hanges resting on table/pillow/ Expose to above elbow/entire upper torso / Aids e.g. splint
  • Ask re pain
  • Inspect:
    • Scars - carpal tunnel decompression/previous trauma
    • swelling - soft tissue/bony mass
    • symmetry - symmetrical disease = RA
    • Deformity
      • Benediction sign - make a fist-> infability to flex thumb, index finger, AIN palsy, c.4-6cm below elbow, entire motor to FPL/FDP (radial), PQ. ?compression from tendinous band - accessory muscles, vascular pathology, pain/weakness of pinch
      • ape hand - loss of abduction of thumb
      • Simian thumb
    • Erythema - inflammation
    • sinus - post op, infective
    • Muscle wasting - thenar eminence/forearm flexors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Median nerve examination: sensation

A

Feel

  • temperature changes dorsal/ventral - with back of hand
  • reduced sweating
  • Thenar eminence - palmar cutaneous branch (over floor of retinaculum br proximal to carpal tunnel)
  • Digital nerves - ulnar and radial difital nerves, radial 31/1 digits after passing through carpal tunnel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Median nerve examination: motor

A
  • Pronator teres - affected with high lesion
  • Opponens pollicis - touch each finger in succession
  • Abductor pollicis brevis - palm up, point thumb to ceiling, stop pushing down
  • Flexor pollicis longus - pincer grip/paper pull - thumb flattens if FPL affected (adductor pollicis of ulnar nerve)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Median nerve examination: special tests

A
  • Tinel’s test - CTS
  • Phalen’s Test - CTS
  • Functional Assessment - global & fine function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Median nerve examination: completion

A
  • QoL Impingement and sleeep - ask patient about impact on life and in turn necessity for intervention
  • Help patient dress - functional limitation
  • Upper limb neurovascular status:
    • full examination
    • focus on pulses, dermatomes, myotomes
  • Neck examination - cervical spine pathology
  • Radiology - cervical spine (MRI)
  • Nerve conduction studies - degeneration/demyelination/conduction block
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ulnar nerve examination: inspection

A
  • Patient opposite, hanges resting on table/pillow/ Expose to above elbow/entire upper torso / Aids e.g. splint
  • Ask re pain
  • Inspect:
    • Scars - cubital tunnel decompressionscar posterior to medial epicondyle/previous trauma
    • swelling - soft tissue/bony mass
    • symmetry - symmetrical disease = RA
    • Deformity
      • Claw hand - when patient extends their fingers
    • Erythema - inflammation
    • Sinus - post op, infective
    • Muscle wasting - hypothenar eminence, interosseous muscles (intermetecarpal wasting)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ulnar nerve examination: sensation

A
  • Ask about pain
  • Feel temp changes/reduced sweating
  • Palpate ulnar nerve behind medial epicondyle
  • Sensation:
    • All digital nerves:
      • Ulnar and radial digital nerves
      • Superficial cutaneous branch of ulnar nerve classically supplies sensation to ulnar 1 1/2 digits via digital nerves after passing through guyon’s canal
    • Little finger
      • innervated by dorsal sensory branch, branches from ulnar nerve c.1 hand’s bredth proximal to wrist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ulnar nerve examination: motor

A
  • FDP (ulnar): ulnar 1/2 of FD{ (ring & little fingers) by testing distal interphalengeal joint flexion (DIPJ)
  • Palmar interossei - adduct fingers, placing sheet between PAD
  • Dorsal interossei - abduct fingers, against resistance DAB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ulnar nerve examination: special test

A
  • Froment’s test - fists with thumbs up, sheet between thumbs and fist, hold paper - weak adductor poll -> flex thumb to prevent pull (FPL supplied by median nerve)
  • Guyon’s canal percussion - reproduce ulnar nerve symptoms, if compression is within Guyon’s canal
  • Cubital tunnel syndrome - fully flex elow, tuck closely into sides, reproduce ulnar nerve symptoms, if compression is within ctubital tunnel (also percussion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ulnar nerve examination: completion

A
  • QoL Impingement and sleeep - ask patient about impact on life and in turn necessity for intervention
  • Help patient dress - functional limitation
  • Upper limb neurovascular status:
    • full examination
    • focus on pulses, dermatomes, myotomes
  • Neck examination - cervical spine pathology
  • Radiology - cervical spine (MRI)
  • Nerve conduction studies - degeneration/demyelination/conduction block
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the course of the radial nerve?

A
  • Roots C5-T1
  • Arise from posterior cord of brachial plexus
  • Pass through triangular space
  • Descends on posterior humerus in spiral groove between medial and lateral heads of triceps
  • Nerve br to triceps and anconeus
  • Nerve br to brachioradialis (above elbow)
  • At levels of lateral epicondyle:
    • Superficial radial nerve: superficial br
      • descends on dorsal radial aspect of forearm, beneath brachioradialis
      • Emerges to subcutaneous position at junction of middle and distral 3rds
      • Supplies sensation to dorsal 1st web space
    • Posterior interosseous nerve (PIN): deep br
      • Winds around neck of radius, passes between superficial and deep heads of supinator - arcade of frohse
      • Supplies wrist extensors and supinators, hand extensors and APL
      • Supplies ECRL and ECRB
        *
17
Q

What is the typical appearance of the hand in radial nerve palsy?

A

Dependent on level of nerve injury

  • High radial nerve injury:
    • Complete wrist drop due to loss of extensors
  • Lower radial nerve injury - afffecting e.g. PIN alone:
    • Loss of extension of all digits with preserved wrist extension - ERCL still functioning via ECRL via superficial radial nerve
    • Small patch of sensory loss on dorsal 1st web space
18
Q

What is the course of the median nerve?

A
  • Roots C6-T1
  • Arises from medial and lateral cords of brachial plexus
  • Passes with brachial artery
  • Passes through/under pronator teres and continues beneath FDS
  • Supplies: PT, Palmaris longus, FCR, FDS
  • Gives off:
    • Anterior interosseous nerve AID: FPL, Radial 1/2 FDP, PQ
    • Palmar cutaenous brach c.5cm proximal to wris: sensation to palm of hand (in line with radial 3.5 digits)

Enters the carpal tunnel and gives off…

  • Recurrent motor branch:
    • Lateral Lumbricals
    • Opponens pollicis
    • Abductor pollicis brevis
    • Flexor pollicis brevis
  • Digital cutaenous branches: sensation to radial 31/2 digits
19
Q

What is the appearance of the hand in a high median nerve palsy?

A
  • Thenar eminence wasting: lose innervation to abductor pollicis breevis, flexor pollicis brevis, opponens pollicis
  • Benediction sign: index and middle fingers remain extended when patient tries to make a fist
  • Ape hand deformity: wasting of thenar muscles results in thumb coming to lie in line with remaning digits and movement to become limitted to flexion, extension (LOSS of abduction and opposition)
20
Q

What is the course of the ulnar nerve?

A
  • Roots C8 and T1
  • medial cord
  • descends posterior- medial aspect of humerus
  • Pierces medial intermuscular septum
  • Passes posterior to medial epicondyle in cubital tunnel
  • Passes between 2 heads of FCU to enter anterior compartment of forearm, gives branch to FCU and FDP (ulnar 1/2)
  • Gives off
    • dorsal sensory branch at distal 1/3 of forearm, it perforates deep fascia and runs on ulnar side of dorcum of wrist and hand -> sensation to dorsal ulnar aspect of hand
  • Ulnar nerve continues through guyon’s canal (medial to ulnar artery) & gives off:
    • Deep motor branch:
      • all intrinsic hand muscles except LOAF (median)
    • Superficial sensory branch:
      • sensation to ulnar 1 1/2 digits
21
Q

What is the typical appearance of the hand in ulnar nerve palsy?

A
  • Ulnar clawing of ring and little finger
    • MCPJ hyper-extension (lumbrical paralysis) & flexion at PIPJ & DIPJ
    • Clawing -> more obvious when patient is asked to straighten their fingers
    • Middle and index fingers are not affected as those 2 lumbrical are supplies by medial nerve (LOAF)
22
Q

What is the ulnar paradox?

A

Clawing appears worse in lower less severe ulnar injury

  • clawing is due to ulnar 2 lumbrical paralysis
    • lumbrical flex the MCPJ and extend DIPJ & PIPJ
  • FDP and FPS flex the DIPJ and PIPJ in fingers
    • FDP to little and ring fingers = ulnar nerve (flexes DIPJ)
    • FPS - median nerve - flexes PIPJ
  • High ulnar nerve injury (e.g. at elbow) loss of FDP function so no flexion at DIPJ so less excentuated looking claw
  • Lower ulnar nerve injury e.g. at wrist FDP is spared, flexion at DIPJ, more excentuated looking claw
23
Q

What is the tardy ulnar nerve palsy?

A
  • Valgus deformity in the area of the medial epicondule
    • e.g. malnutrition/non-union of condylar #
    • e.g. epiphyseal injury to lateral side of elbow
  • -> chronic stretching of ulnar nerve
  • -> late/tardy ulnar nerve palsy
24
Q

What are the common sites of radial nerve compression?

A
  • Thoracic outlet
  • Axilla
  • Radial tunnel syndrome
  • Arcade of Frohse
  • ECRB
  • Supinator
25
Q

What are the cmmon sites of median nerve compression?

A
  • Medial intermuscular septum
  • Ligament of Struthers
  • Pronator teres
  • Anterior interosseous syndrome
  • Carpal tunnel syndrome
26
Q

What are the common sites of ulnar nerve compression?

A
  • Medial intermuscular septum
  • Cubital tunnel
  • Guyon’s canal
27
Q

what fractures may be associated with radial nerve injuries?

A

humeral shaft fractures

28
Q

What fractures may be associated with median nerve injury?

A

Wrist fractures

29
Q

What fractures may be associated with ulnar nerve injuries?

A

Supra-condylar humeral fractures

RLH MRCS (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions