Mononeuropathies

Question 1

Where does damage to the peroneal nerve occur?

Answer 1

Compression of the nerve at the lateral border of the knee

Question 2

What is the clinical presentation of peroneal neuropathy?

Answer 2

Foot drop and weakness of foot eversion
Sensory loss of the dorsum of the foot and lateral border of the shin
Complete weakness around the ankle producing ‘flail foot’

Question 3

What muscles does the peroneal nerve innervate?

Answer 3

Tibialis anterior, extensor digitorum and hallucis, peroneus longus and brevis

Question 4

When is the sciatic nerve most commonly damaged?

Answer 4

As a complication of hip arthroplasty, prolonged lithotomy position, vasculitis and/or tumour

Question 5

What is the most common presentation of sciatic neuropathy?

Answer 5

Muscle weakness around the ankle and weakness of the toes
Sensory loss in the entire foor and distal lateral leg, ankle jerk+/- internal hamstring reflex is diminished or absent on the affected side

Question 6

When does femoral neuropathy arise?

Answer 6

As a complication of retroperitoneal haematoma, lithotomy positioning or hip dilocation. Surgeries around the hip area causes femoral neuropathy

Question 7

What are clinical symptoms of femoral neuropathy?

Answer 7

Difficult knee extension, difficult hip flexion, sensory loss around anterior +/- medial leg, patellar reflex diminished. Usually self limiting

Question 8

What is lateral femoral cutaneous neuropathy otherwise known as?

Answer 8

Meralgia paresthetica

Question 9

How does meralgia paresthetica present clinically?

Answer 9

Numbness and parasthesia along the lateral thigh. Symptoms increase on standing or walking and are relieved by sitting
Knee reflex intact
Strength and tone are normal

Question 10

How is lateral femoral cutaneous neuropathy diagnosed?

Answer 10

Electrodiagnosis is needed to rule out lumbar plexopathy, radiculopathy or femoral neuropathy

Question 11

What is the management of lateral femoral cutaneous neuropathy?

Answer 11

Analgesica (NSAIDS and/or lidocaine path), local nerve blood for pain relief, avoidance of tight belts around the waist

Question 12

How does radial nerve neuropathy arise?

Answer 12

Compression of the radial nerve along the spiral groove.

Most common cause is trauma, but rarely infections and inflammation cause radial nerve palsy

Question 13

How does radial nerve damage present clinically?

Answer 13

Wrist drop

Sensory loss over the dorsum of the hand, particularly 1st web space

Question 14

What muscles are affected in radial nerve neuropathy?

Answer 14

Weakness of brachioradialis, extensor carpi radialis, extensor carpi ulnaris, extensor digitorum or extensor pollicis

Question 15

How does ulnar radiopathy at the elbow arise?

Answer 15

Compression of the ulnar nerve around the elbow

Most commonly due to trauma

Question 16

What is the clinical syndrome of ulnar radiopathy at the elbow known as?

Answer 16

Cubital tunnel syndrome

Question 17

What are clinical symptoms of ulnar radiopathy at the elbow?

Answer 17

Weakness of the flexor carpi ulnaris, dorsal interossei and palmar interossei
Weakness of the hypothenar muscles,
Sensory loss along half of the 4th finger and little finger
Pain and weakness at the elbow
Parasthesia and numbness over medical hand, half of the 4th and entire little finger

Question 18

How does median neuropathy arise?

Answer 18

Compression of the medial nerve under transverse carpal ligament
Causes include pregnancy, obesity, hypothyroidism, RA or occupational disease (eg long typing hours, prolonged use of screwdrivers)

Question 19

What is medical neuropathy otherwise known as?

Answer 19

Carpal tunnel syndrome

Question 20

What are the clinical symptoms of medial neuropathy?

Answer 20

Weakness of the 1st and 2nd lumbricals, opponens pollicis brevis, abductor pollicis brevis and flexor pollicis brevis
Sensory loss in tumb, forefinger, middle finger or half of ring finger
Initial presentation includes weakness and or burning sensation over the wrist

Question 21

How does damage to the anterior interosseous nerve present?

Answer 21

Weakness of long flexors of the thumb and index finger. Unable to pronate foreaem. No sensory loss

Question 22

The anterior interosseous nerve is a branch of which nerve?

Answer 22

The median nerve