Isolated nerve palsies - Non eye

Question 1

What are the common examination findings?

Answer 1

Inspection

• Median - Normal or thenar eminence wasting
• Radial - Wrist drop - Need to get hand in position to see it
• Ulnar - Claw hand, wasting of small muscles of hand

Tone

• Median - Reduced in thenar muscles
• Radial - Reduced in wrist and finger extensors
• Ulnar- Reduced in small muscles of hand

Reflexes

• Median - Normal
• Radial - Normal
• Ulnar - Normal

Sensation

• Median - Reduced over lateral 3.5 fingers and thenar eminence
• Radial - Reduced on dorsal aspect of hand
• Ulnar - Reduced on medial 1.5 fingers

Co-ordination - Normal

Question 2

What are the investigations?

Answer 2

• To finish the exam i would like to do - Upper/lower limb exam and cranial nerves
• By the bed - History, obs
• Bloods - FBC (b12), TFTS, Glucose, CRP, ANCA, ANA
• Other - Xray, nerve conduction studies

Question 3

What are the key investigation findings?

Answer 3

Depends on cause

Question 4

What is the treatment?

Answer 4

Conservative - Education and splints

Medical - Treat underlying cause

Surgical - Surgical decompression

Question 5

What are the common causes?

Answer 5

Median - Carpal tunnel (Pregnancy, RA, TB, COCP)

Radial - Trauma to nerve at humerus

Ulnar - Commonly elbow fracture

ALL CAN BE CAUSED BY THE CAUSES OF PERIPHERAL NEUROPATHY

ABCDEFGH

A - Alcohol/Amyloid

B - B12 deficiency

C - Connective tissue/ Cancer (Paraneoplastic)

D - Diabetes

E - Everything else sg sarcoid, lupus, drugs - amioderone

F - Friedrichs Ataxia

G - Guillian barre

H - Heriditary - CMT