Nerve Injuries during Positioning

Question 1

What causes damage to the supraorbital nerve?

Answer 1

compression from a tight facemask

Question 2

What causes damage to the axillary nerve?

Answer 2

during the prone position:

- when shoulders are extended & arms are placed above the head

Question 3

What causes damage to the radial nerve?

Answer 3

arm hanging over the table can produce pressure to the posterior cord of the axilla

Question 4

What causes damage to the median nerve?

Answer 4

direct needle trauma in the antecubital fossa

Question 5

What causes damage to the ulnar nerve?

Answer 5

lies superficially in groove behind medial epicondyle of the humorous

• internal compression between two heads of the flexor capri ulnaris
• full flexion at the elbow will cause compression where the nerve enters the cubital tunnel

Question 6

What causes damage to the sciatic nerve?

Answer 6

main source of direct trauma is from misplaced IM injections or pneumatic tourniquets

Question 7

What causes damage to the femoral nerve?

Answer 7

excessive leg flexion in lithotomy position can cause entrapment

Question 8

What causes damage to the common peroneal nerve?

Answer 8

compression from the lithotomy pole where the nerve passes around the head of the fibula

frames that support the anterior iliac spines when the patient is prone

Question 9

What causes damage to the pudendal nerve?

Answer 9

compression against a perineal post used during hip surgery

Question 10

What causes damage to the saphenous nerve?

Answer 10

compression between the medial tibial condyle & the lithotomy pole (leg lateral to the pole)

Question 11

The common peroneal nerve is also known as the:

Answer 11

lateral cutaneous nerve of the thigh

Question 12

What nerve lies in the groove behind the medial epicondyle of the humorous?

Answer 12

ulnar nerve

Question 13

Photophobia, pain in the eye, & numbness of the forehead is indicative of damage to which nerve?

Answer 13

supraorbital nerve

Question 14

↓ abduction of the arm & reduced skin sensation over the lateral aspect of the upper arm is indicative of damage to which nerve?

Answer 14

axillary nerve

Question 15

Hand weakness, tingling & pain is indicative of damage to which nerve?

Answer 15

ulnar nerve

Question 16

Loss of perineal sensation & fecal incontinence is indicative of damage to which nerve?

Answer 16

pudendal nerve

Question 17

Loss of hip & knee extension is indicative of damage to which nerve?

Answer 17

femoral nerve

Question 18

Loss of sensation over the anterior thigh and the anteromedial aspect of the calf is indicative of damage to which nerve?

Answer 18

femoral nerve

Question 19

Inability to oppose thumb & little fingers is indicative of damage to which nerve?

Answer 19

median nerve

Question 20

Wrist drop is a sign of damage to which nerve?

Answer 20

radial nerve

Question 21

Paralysis of all muscles and sensory loss below the knee is indicative of damage to which nerve?

Answer 21

sciatic nerve

Question 22

Meralgia paresthesia is what?

Answer 22

numbness & hyperalgesia of the upper lateral thigh

Question 23

Damage to the common peroneal nerve results in what?

Answer 23

meralgia paresthesia, foot drop, & loss of sensation over the lateral aspect of the leg and dorsum of the foot

Question 24

What nerve produces sensation over the lateral aspect of the leg & dorsum of the foot?

Answer 24

common peroneal nerve [aka: lateral cutaneous nerve of the thigh]

Question 25

Loss of sensation to the medial aspect of the calf results from damage to which nerve?

Answer 25

saphenous

Question 26

Rank muscles from LEAST sensitive to MOST sensitive:

Adductor pollicis
diaphragm
extraocular
masseter
vocal cord
pharyngeal
abdominal rectus
orbicularis occuli

Answer 26

Vocal cord
diaphragm
orbicularis oculi
abdominal rectus
adductor pollicis
masseter
pharyngeal
extraocular

Question 27

What site & modality is used to monitor fast onset/tracheal intubation
& what is the targeted response?

Answer 27

orbicularis oculi;
single twitch or TOF

0 twitches

Question 28

What site & modality is used to monitor profound blockade

& what is the targeted response?

Answer 28

adductor pollicis or orbicularis oculi;
Post tetanic count or TOF

NMB dependant

Question 29

What site & modality is used to monitor adequacy of relaxation for abdominal surgery
& what is the targeted response?

Answer 29

adductor pollicis;
TOF

1-2 twitches present

Question 30

What site & modality is used to monitor predicting reversible block when no TOF is present
& what is the targeted response?

Answer 30

adductor pollicis;;
post-tetanic count

NMB dependant

Question 31

What site & modality is used to detect reversible block

& what is the targeted response?

Answer 31

adductor pollicis;
TOF

at least 2 twitches

Question 32

What site & modality is used to detect adequate NM function

& what is the targeted response?

Answer 32

adductor pollicis;
double burst stimulation

no fade present