Nerve Injuries In The Uppe Limb r Flashcards
What is spinal cord injury
Myelopathy
What is spinal nerve root injury
Radiculopathy
What is peripheral nerve injury
Peripheral neuropathy
Nerves can be damaged by
Stretch
Compression
Laceration
Toxins
What is seddon classification 1
Neuropraxia
Axon in tact
Epineurium, perineurium and endoneurium in tact
What is seddon classification 2
Axonotmesis
Axons not in tact
Epineurium, perineurium and endoneurium in tact
What is seddon classification 3
Neurotmesis
Axon not in tact
Epineurium, perineurium and endoneurium not in tact
Parts of brachial plexus
Roots trunks divisions cords branches
What parts of brachial plexus can be damaged in clavicular fractures
Trunks and divisions
What parts of brachial plexus can be damaged in trauma to axilla
Divisions and cords
How can musculocutaneous nerve be damaged
Uncommon
Trauma to axilla
Iatrogenic
Sensory region of musculocutaneous nerve
Lateral forearm
Musculocutaneous nerve motor function
Anterior compartment of arm BBC
Arm and elbow flexion, supination
If musculocutaneous nerve damaged motor impact
Arm flexion, elbow flexion and supination weak but not absent
How can you damage axillary nerve
Surgical neck of humerus fracture
Anterior shoulder dislocation
Compression of quadrangular space
Upper brachial plexus injury C5-C6
Axillary nerve sensory function
Regimental badge
Upper lateral cutaneous nerve
Axillary nerve motor function
Shoulder flexion, extension and abduction 15-90 degrees
External rotation
Consequences if axillary nerve damaged
Abduction absent between 15-90 degrees
Shoulder flexion, external rotation and extension wekeaned not absent
How can radial nerve be damaged
Mid-shaft humeral fracture
Radial groove
Radial nerve sensory function
Posterior arm and forearm
1st webbed space
Radial nerve motor function
Posterior compartment
Elbow extension
Wrist and finger extension
Supination
Radial abduction
Consequence if radial nerve damaged
Injury at humerus = wrist drop
Elbow extension in tact
How can median nerve be damaged
High injury at elbow- supracondylar fractures
Low injury at wrist- carpal tunnel syndrome or wrist laceration
Median nerve sensory function
Lateral 3.5 digits
Palmar cutaneous branch
Median nerve motor function
Thenar muscles
LOAF
If median nerve damaged at high lesion
High lesion- complete sensory loss in all regions of median nerve territory
Hand of benediction - loss of function of anterior forearm and thenar muscles
If median nerve damaged at low lesion
Complete sensory loss in all regions of median nerve territory except palmar cutaneous branch
Thenar muscle wasting
Forearm flexors unaffected
How can ulnar nerve be damaged
High injury- at elbow medial epicondyle or in cubital tunnel
Low injury- at wrist, Guyon’s canal, wrist laceration
Low brachial plexus injury C8-T1
Ulnar nerve sensory function
Medial 1.5 digits
Palmar branch
Ulnar nerve motor function
Anterior forearm- flexor carpi ulnaris flexor digitorum profundus medial half
Intrinsic hand muscles- Interossei, lumbricals 3 and 4, Hypothenar eminence, adductor pollicis
Ulnar nerve damage low injury
Loss of sensation in anterior 1.5 fingers
Intrinsic hand muscles only
Ulnar claw at rest
Hyperextension of MCPs, flexion of PIP and DIP (FDS and FDP)
Ulnar nerve high injury
Loss of sensation in all areas of ulnar nerve territory
Involvement of anterior forearm and intrinsic hand muscles
Hyperextension of MCPS, flexion of PIPs not DIPS as FDP not innervated
Deformity less obvious as MORE loss of function
How can long thoracic nerve be damaged
Iatrogenic
Traction injury
Upper brachial plexus injury
Motor function of long thoracic nerve
Serratus anterior- protraction of scapula
If long thoracic nerve damaged
Winged scapula
