Nerve Injuries and Repair

Question 1

Give some examples of direct trauma

Answer 1

lacerations
gunshot wounds
penetrating injuries
burns

Question 2

Give some examples of indirect trauma

Answer 2

fracture fragments stretching or tearing a nerve

Question 3

Give an example of a chronic or acute entrapment of a nerve

Answer 3

the median nerve being trapped within the carpal tunnel as a result of fracture or disease of the wrist or tendon sheaths eg. RA

Question 4

Who is most commonly affected by Carpal tunnel syndrome

Answer 4

Young to middle aged women especially during pregnancy

Question 5

What are the clinical features of Carpal tunnel syndrome

Answer 5

Pain or paraesthesiae in the thumb, index and middle fingers often occurring at night and sometimes relieved by hanging the arm out of bed

Question 6

What do patients complain of with carpal tunnel syndrome

Answer 6

numbness or clumsiness when carrying out fine manipulations

Question 7

What might reproduce the symptoms of carpal tunnel syndrome

Answer 7

Pressure of the carpal tunnel

Question 8

What might be needed to confirm the diagnosis of carpal tunnel

Answer 8

Nerve conduction studies

Question 9

What test / investigation may be required in a patient who has sensory loss and presence or absence of reflexes

Answer 9

Electromyography or conduction studies

Question 10

Are nerves capable of recovery

Answer 10

Peripheral nerves are

Question 11

What is neurapraxia

Answer 11

nerve injury due to blunt trauma or compression What is axonotmesis

Question 12

What is axonotmesis

Answer 12

Involves damage to individual axons but within intact sheaths

Question 13

What might cause axonotmesis

Answer 13

direct trauma or stretching

Question 14

What is neuronotmesis

Answer 14

a condition in which the nerve is completely divided or irreparably damaged over part of its length

Question 15

When is primary suture possible for nerve repair

Answer 15

With clean wounds and cleanly divided nerves

Question 16

When is secondary suture possible for nerve repair

Answer 16

when the skin wound is healed and up to 6 months after the injury

Question 17

What does Erb’s palsy affect

Answer 17

the upper plexus during birth

Question 18

What is the prognosis of a plexus injury if it is proximal to the dorsal root ganglia

Answer 18

Poor

Question 19

What can be used to determine the extend of nerve damage

Answer 19

myelography or MRI scanning What is Horner’s syndrome characterised by

Question 20

What is Horner’s syndrome characterised by

Answer 20

pupillary constriction
enophthalmos
ptosis

Question 21

What is the treatment of birth palsies

Answer 21

maintaining passive joint movements by physio

Question 22

What is often a disabling feature of a brachial plexus injury

Answer 22

chronic pain

Question 23

What is the most commonly damaged nerve in the wrist

Answer 23

median nerve

Question 24

What is the main neurological loss in a median nerve injury

Answer 24

sensory, producing anaesthesia over the thumb, index,middle and occasionally ring fingers

Question 25

What is the main neurological loss in an ulnar nerve injury

Answer 25

Motor loss

Question 26

What happens to the thumb in an ulnar nerve injury

Answer 26

adduction is lost

Question 27

What is known as the ulnar nerve paradox

Answer 27

Long flexors to the ring and little fingers and the ulnar wrist flexors may be lost in high lesions in which case clowng does not occur

Question 28

Where is sensation lost in an ulnar nerve injury

Answer 28

Over the little and part of the ring fingers

Question 29

Where is the radial nerve usually damaged

Answer 29

at the level of the mid-humerus by fractures or pressure

Question 30

What does a radial nerve lesion result in

Answer 30

paralysis of wrist, finger and thumb extensors and a characteristic wrist drop

Question 31

What nerve is occasionally damaged in a hip dislocation

Answer 31

Sciatic nerve

Question 32

What can division of the sciatic nerve result in

Answer 32

complete loss of function and almost total anaesthesia below the knee

Question 33

What causes femoral nerve palsy

Answer 33

penetrating injuries

Question 34

What is the main effect of femoral nerve palsy

Answer 34

loss of quadriceps function - standing and walking are difficult and stairs are even worse

Question 35

Where is the common perennial nerve vulnerable

Answer 35

where it winds round the neck of the fibula

Question 36

What does damage to the common perennial nerve result in

Answer 36

drop foot with anaesthesia over the dorsum