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BSMS 204- Theme 2 > Lecture 7- Upper Limb Nerve Injuries > Flashcards

Lecture 7- Upper Limb Nerve Injuries Flashcards

1
Q

where do the lower motor nerve injuries arise from?

A

Anterior horn cell

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2
Q

Describe the upper motor neuron disease present?

A

-Held in flexed posture if chronic
-increased tone
-Pyriamidal weakness (flexor muscle stronger than extensors
-Brisk reflexes
Sensory level

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3
Q

Describe the lower motor neuron disease present?

A
  • muscle wasting/fasciculations
  • flaccid tone
  • Weakness in either a myotomal distribution or a peripheral nerve distribution
  • reduced flexes
  • dermatomal or peripheral nerve distribution of sensory loss
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4
Q

name the three anatomical localisation of the brachial plexus?

A

Roots
Brachial plexus
peripheral nerve

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5
Q

Describe a mytome?

A

relationship between the spinal nerve and the muscle

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6
Q

Describe a dermatome?

A

relationship between the spinal nerve and the skin

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7
Q

Which myotome is responsible for bicep reflex?

A

C5 reflex conveyed through musculocutanoeus nerve

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8
Q

Which myotome is responsible for supinator jerk?

A

C6 reflex conveyed through the radial nerve

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9
Q

Which myotome is responsible for Tricep jerk?

A

C7 reflex conveyed through the radial nerve

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10
Q

Which myotome is responsible for finger jerk?

A

C8 reflex conveyed through the median and ulnar nerve

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11
Q

What happens when nerve root is impinged?

A

caused by slipped disc
-Causes pain which radiates
-Aggravated by neck movement
-

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12
Q

what protects cervical spine from injuries?

A

flexibility of cervical spine protects it from fractures

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13
Q

Describe the types of nerve (plexus) injury?

A
  • Avulsion
  • Rupture
  • Neuroma
  • Neurapraxia
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14
Q

which of the following injuries will have a worse prognosis?

A

Avulsion/rupture- brachial plexus trauma, neurapraxia blunt injury

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15
Q

What is flail arm injury caused by?

A

C5-T1 lesions causes flail arm

  • cuases left shoulder subluxation
  • Atrophy of the left deltoid
  • supraspinatous and infraspinatous
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16
Q

What are causes the brachial plexus injury?

A

-Trauma:
-Erb-Duchenne type paralysis: Avulsion of C5,C6 roots.
-Klumpke paralysis: Avulsion of C8, T1 roots.
Cancer: Lung cancer: Pancoasts tumour
Radiotherapy
-Inflammatory
Brachial neuritis

  • Structural:
  • Thoracic outlet syndrome
17
Q

What is Erbs palsy and what is caused by?

A
  • Upper plexus palsy c5/c6 innervated muscle

- injury to the superior trunk of brachial plexus caused by blow to the shoulder

18
Q

What type of muscle weakness does Erbs Palsy cause?

A 
Biceps: flexes the arm
Brachioradialis: flexes the arm in semi prone position
Deltoid: abducts the arms
Supraspinatous: abducts the arm
Supinator: externally rotates the arm

Arm can not be:
elevated, abducted, externally rotated and is fixed at the elbow
But fingers are unimpaired- hands work but arms does not

19
Q

Describe what the Klumpke’s palsy caused by?

A

Caused by: clutching for an object when falling from a height causes inferior trunk plexus injury involving C8/T1:
Involves trunk that supplies median and ulnar nerve

20
Q

What happens to the muscles as a result of Klumpke’s palsy?

A
  • Unable to flex wrist or fingers
  • Weakness of all small muscles of the hand
  • sensory loss hand and inner border of forearm
  • May lead to claw hand
  • Arm works but the hand does not
21
Q

What is idiopathic brachial neuritis?

A
  • Aetiology not clear, infectious/post infectious
  • severe pain over days, followed by weakness and wasting
  • Typically monophasic/ rarely bilateral
  • MRI shows thickening and enhancement
  • NCS/EMG is useful for prognostication
  • Treatment: analgesia, physiotherapy
  • limited evidence for the use of steriods
22
Q

what is the thoracic outlet syndrome caused by?

A

variation in anatomy causes compression sites at following places:

1) Between anterior and middle scalene muscle
2) Beneath clavicle in the costoclavicular space
3) Beneath the tendon of pectoralis minor

23
Q

Neurogenic symptoms for thoracic outlet syndrome?

A
  • Paresthesia, numbness and weakness
  • Not localised to specific nerve distribution
  • reproducibly aggravated by elevation or sustained use of arms or hands
24
Q

Vascular symptoms of thoracic outlet syndrome?

A

Vascular:

  • forearm fatigue within minutes of use
  • swelling and cyanosis
  • collateral venous patterning over the ipsilateral shoulder, chest wall and neck
  • Rarely pain,pallor and coldness
  • Lower BP on affected arm, diminished distal pulses
25
Q

What can cause an injury to the long thoracic nerve?

A

-Blows or pressure in the posterior triangle of the neck
-Can be injured during radical mastectomy
Leading winged scapula

26
Q

What does the long thoracic nerve supply and what is the result of injury?

A
  • serratus anterior
  • Serratus anterior muscle pulls the medial border of the scapula to the posterior thoracic wall and stabilises it there
  • Impairment of the long thoracic nerve leads to winging of the scapula
27
Q

what are the two common sites of compression for the median nerve?

A

Wrist- carpal tunnel syndrome

-Elbow

28
Q

Which muscles in the hand is innervated by the median nerve?

A 
Remember LOAF
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
29
Q

what are the causes of the carpal tunnel syndrome?

A 
diabetes
Pregnancy
hypothyroidism
RA
repetitive strain
trauma
30
Q

where does the interosseous nerve arise from?

A

from median nerve- Just above the elbow

31
Q

what causes the compression of the interosseous nerve?

A

compression causes by two heads of pronator teres muscle which is caused by:

  • Gripping tightly with forced pronation
  • prolonged use of a screwdriver
  • may be damaged in careless blood taking
32
Q

what is the anterior interosseous nerve syndrome?

A
  • Pure motor branch of the median nerve
  • weakness of the flexors of ip joint of the thumb (flexor pollicis longus) and dip joints of index and middle fingers (flexor digitorum profundus) causing weakness of pronation
33
Q

Ulnar Vs C8

A

C8- all fingers extensors (radial nerve)

FDP of index/middle (median nerve)

34
Q

what is known as Saturday night palsy?

A

Radial nerve palsy

35
Q

what is the effect of the axonal loss?

A

results in decrease in amplitude

36
Q

What is the effect of demylinating?

A

results in decrease in velocity

BSMS 204- Theme 2 (5 decks)

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