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Musculoskeletal 1 > Elbow, Hand Peripheral Nerve Injury > Flashcards

Elbow, Hand Peripheral Nerve Injury Flashcards

1
Q

What can a Nerve injury be due to?

A
  • traction
  • compression
  • crush injruy
  • fracture
  • laceration
  • entrapment in scar tissue healing
  • surgery
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2
Q

Peripheral Nerve Injury Signs and symptoms

A
  • Sensory changes in peripheral nerve pattern (paresthesia/anesthesia)
  • pain
  • Motor loss and weakness
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3
Q
  1. Paresthesia
  2. Anesthesia
A
  1. numbness/tingling/burning
  2. loss of sensation
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4
Q

What is compartment syndrome

A
  • volksmans ischemic contracture
  • rapid increase in pressure from bleeding and swelling
  • compression causes ischemia and damage to tissues
  • can cause muscle necrosis or peripheral nerve injury
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5
Q

How to determine Involved Nerve?

anatomy

A
  • nerve course
  • sensation altered (nerve pattern)
  • muscles nerve innervates (weakness)
  • site of nerve lesion
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6
Q

How can the site of nerve lesion be used to determin the involvment of a peripheral nerve?

A
  • adjacent structure involved (muscule/tendon, ligament, bone spur, fracutre, scar tissue, tumor)
  • mechanism of injury: compression caused by poor posture, hypertrophy and muscule contraction, traction injury, laceration, crush, post op/entrapment
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7
Q

What are the nerve injury classifications

A
  • neuropraxia
  • axonotmesis
  • nerotmesis
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8
Q

Nerve injury classifications:

neuropraxia

A
  • ischemia due to pressure or traction
  • decreased nerve conduction at the site (above/below are normal)
  • focal demyelination
  • minimal damage to nerve structure
  • no muscule atrophy
  • best prognosis - recover in 6 weeks
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9
Q

Nerve injury classifications

axonotmesis

A
  • compression or traction to nerve
  • extend of damage is axon
  • Ct is left intact
  • wallerian degneration
  • Muscule fiber atrophy - motor loss
  • sensory loss
  • nerve recovery - regenerates 1mm/ day or 1 inch per month
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10
Q

Wallerian degeneration

A
  • degeneration that goes distally from the point of damage
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11
Q
  • neurotmesis
A
  • complete disruption of both axon and CT
  • Wallerian degneration
  • muscule fiber trophy/motor loss
  • sensory loss
  • requires surgical repair (WORST prognosis)
  • healing = scar tissue can entrap the nerve
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12
Q

Axillary nerve:

  • course
  • MOI
  • Motor
  • Senory
  • functional loss
A

Course:
- off posterior cord, posterior through axilla
- quadrangular space
- behind surgical neck of humerus

MOI:
- dislocation of shoulder
- fracture - surgical neck of humerus

Motor:
- deltoid, teres minor

Sensory:
- deltoid region

Functional loss:
- weak shoulder abduction and ER (no affect at elbow or hand)

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13
Q

Radial nerve course

A
  • Posterior cord C5-T1
  • triangular interval
  • posterior humerus
  • radial grooe
  • anterior later epicondyle
  • supinator split (posterior interosseus n.)
  • Anterior lateral in forearm
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14
Q

Radial n. motor

A
  • tricpes
  • anconeus
  • supinator
  • brachioradalis
  • Wrist, finger and thumb extenors
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15
Q

Radial nerve Sensory

A
  • posterior cutaneous n. = arm and forearm
  • Superifical radial n. = dorsal radial hand
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16
Q

Radial N. Entrapment

midshaft of humerus facture

A
  • lose tricpes, all motor below
  • drop wrist
  • all sensory lost
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17
Q

Radial N. entrapment

saturday night palsy

A
  • Spared = triceps
  • lose all motor below = brachioradialis, supinator, wrist finger and thumb extenors
  • drop wrist
  • sensation: lose everything below level of injury
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18
Q

Radial nerve entrapment

  • Radial tunnel

- between brachialis and brachioradialis

A
  • also fx of lateral epicondyle
  • spared = supinator, brachioradialis
  • lose: ECRL and below = drop wrist
  • Sensory: below injury
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19
Q

Radial entrapment

  • in supinator split: Posterior interosseous N.
A
  • Spared: supinator, brachioradialis, ECRL, ECRB
  • Lose: extrinsic thumb, finger extensors and ECU
  • no drop wrist but will radially deviate
  • sensory: not affected as superficial radial n. branches proximally and above
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20
Q

Radial N. entrapment

Radial head fracture

A
  • Spared: supinator, brachioradialis, ECRL and ECRB
  • Lose: extrinsic thumb and finger extensors and ECU
  • Sensory: radial hand affected if superficial radial nerve is injured from dislocation or fracture
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21
Q

Medial Nerve Course

A
  • Medial and lateral cords
  • medial arm
  • ligament struthers
  • pronator teres heads
  • anterior forearm
  • carpal tunnel
22
Q

Median nerve motor

A
  • pronator teres
  • pronator quadratus
  • wrist and finger flexors except: FCU and ulnar 1/2 FDP and ulnar Lumbricals
  • Thenars
23
Q

Median sensory

A
  • anterior thumb side to 1/2 ring finger
  • posterior tips of thumb-1/2 of ring DIP
24
Q

Median N. entrapment

ligament of struthers

A
  • Lose all median Muscules
  • lose all median sensation
25
Q

Median N. entrapment

  • pronator teres heads
A
  • Spared: Pronator teres, palmaris longus, FCR
  • lose: median wrist finger flexors, pronator quadratus and thenars
  • lose median sensation
26
Q

Median N. entrapment

pronator teres level but anterior interosseous nerve

A
  • lose motor only
  • cant do ok sign
  • weakness of FPL, FDP, and pronator quadratus
  • Sensation is intact only motor nerve
27
Q

Median nerve entrapment

carpal tunnel, tenosynovitis, colles fx, scaphoid fx, carpal dislocation, RA, pregnancy

A
  • Motor loss: thenars, lumbricals 1/2,
  • sensory: median N in hand but palm is spared
  • palmar cutaeus branch supplies and runs over carpal tunnel
28
Q

Ulnar nerve course

A
  • medial cord
  • medial arm
  • posterior elbow - cubtial tunnel
  • FCU heads
  • medial forearm
  • tunnel of guyan
29
Q

Ulnar motor

A
  • FCU
  • ulnar FDP 4&5
  • ulnar lumbricales 3,4
  • all interossei
  • hypothenars, Adductor pollicis
30
Q

Ulnar sensory

A
  • palmar/dorsal 1/2 ring to pinky
31
Q

Ulnar n. entrapment

  • cubital tunnel fracture or FCU hands
A
  • motor loss: (all ulnar): FCU, FDP 4/5, all interossei, hypothenars, adductor pollicis
  • sensory loss: ulnar hand dorsal and palmar
32
Q

Ulnar n. entrapment

tunnel of guyan/pisaform to hook of hamate

A
  • motor loss = ulnar intrinsics, lumbricals 3/4, all interossei, hypothenars and adductor pollicis
  • Sensory: ulnar hand
33
Q

Hand deformities related to n. injury

A
  • drop wrist: radial n.
  • ape hand: median
  • Benediction hand/partial claw: ulnar
  • Claw hand: both median and ulnar (intrinsic minus)
34
Q

Wrist drop deformity

A
  • radial n. injury in arm
  • lose: wrist and thumb extensor and MCP extension; IPs extension intact (lumbricals and interossei)
  • functional loss: wrist extesnors and active insufficiency of finger flexors
35
Q

Radial Palsy splint

A
  • cock up wrist
  • allows finger flexion and function to grip
  • aids in MCP extension function
36
Q

Ape hand/ape thumb

A
  • median nerve injry
  • proximal forearm from: pronator teres syndrom
  • at wrist from: carpal tunnel if chronic/severe, RA, carpal dislocation, colles fx
37
Q

Ape thumb: losses

A
  • thenars, thumb falls into plane of palm
  • difficulty grasping
  • losse lumbricals 1/2
  • still have weak IP extension
  • median n. sensation loss
  • loss of fine motor
38
Q

Ape thumb splint

A
  • places thumb into abducted position for function while awating median n. return
39
Q

Benediction hand or partial claw nerve and losses

A
  • ulnar nerve
  • lose: interossei, lumbricals 3,4
  • hypothenars lost/weakness
  • functional loss: power grip and key grip
  • weak ext o f2/3 IP due to lumbricals
  • MCP pulled into hyperextension due to dominance of ED
  • adductor pollicis loss and weak
40
Q

Claw hand deformity

A
  • Lose median and ulnar nerve
  • trauma, diabetes, alcoholic peripheral neuropathy
  • motor: loss IP extension due to all interossei/lumbrics
  • Guttering = intisic atrophy
  • ape thumb
  • MCP hyperextension intact
  • sensation: loss ulnar and median sensory
41
Q

claw hand deformity splinting

A
  • counterforce to prevent MCP hyperexnteion
  • position thumb in abduction
42
Q

Sensation testing

A
  • 2 point discrimination: alternate 1-2 points on one side of digit
  • monofilaments: C bend 1.5 sec and progress thickness
43
Q

2 point discrimination normal and what it is testing?

A
  • normal 5 mm, 6-10 is fair and 11-15 is poor
  • detecting protective sensation
44
Q

Monofilaments normal?

A
  • 2.44 - 2.83 is normal for hand
  • 3.61 = diminished
  • 4.31 = diminished; protective sensation still has pain and temperature safety but decreased manipulation of objects
  • 5.07 = protective sensation level
  • 6.65 = loss of protective sensation and little use of hand
45
Q

Median nerve special tests

A
  • anterior interosseous n. = motor only so ask if they can preform OK
46
Q

Ulnar nerve tests

Involvement

A
  • froment
  • ADM test
  • Wartenberg
47
Q

Froment test

A
  • ulnar nerve
  • pad to pad paper test
  • if they make the ok sign then they are compensating
48
Q

ADM test

A
  • active abduction of 5th digit
  • ulnar nerve
49
Q

Wartenberg

A
  • ulnar nerve
  • active adduction of 5th digit from ABDucted position
50
Q

Radial nerve test

A
  • thumb lift off test

Musculoskeletal 1 (42 decks)

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