Nerve Injuries of Upper Limb

Question 1

What is the cause of Erb’s Palsy?

Answer 1

Injury to the upper trunk of the brachial plexus from a wide separation between teh head and the shoulder

Results in tearing of C5 and C6 spinal nerves

Question 2

What are the most commonly involved muscles in Erb’s Palsy?

Answer 2

Infraspinatus and Supraspinatus

Teres minor

Biceps brachii

Brachialis

Deltoid

Question 3

What motor deficits are associtated with Erb’s Palsy?

Answer 3

Loss of Lateral rotation of arm

Abduction of arm

Supination of forearm

Flexion of forearm

Leads to waiters tip position

Question 4

What loss of senstation is experienced with Erb’s palsy?

Answer 4

Loss of sensations of lateral side of arm, forearm, and thrumb

C5 and C6 dermatomes

Question 5

What causes Klumpke palsy?

Answer 5

Injury to the lower brachial plexus resulting from hyperabduction of the arm

Results in tearing of T1 and some C8 spinal nerves

Question 6

What muscles are innervated mostly by T1?

Answer 6

Intrinsic muscles of the hand

Interosseous muscles and lumbricals

Question 7

What motor deficits are associated with Klumpke palsy?

Answer 7

Fingers hyperextended at MP joints due to loss of flexion

Fingers flexed at PIP and DIP joints due to loss of extension at PIP and DIP joints

Clinical presentation: Claw hand

Question 8

What sensory deficits are associated with Klumpke palsy?

Answer 8

Loss of sensation on medial side of arm and forearm

Question 9

What results from injury to the Long thoracic nerve?

Answer 9

Inability to rotate the scapulat for abduction of the arm above the horizontal plane

Winged scapula

Question 10

What results from injury to the axillary nerve?

Answer 10

Loss of function of deltoid - inability to abduct arm past 15 degrees

Loss of sensory innervation to upper lateral arm

Question 11

How can injury to the axillary nerve occur?

Answer 11

Inferior displacement of the head of the humerus in shoulder dislocation or from fracture of surgical neck of humerus

Question 12

What motor deficits result from radial nerve injury in the axilla?

Answer 12

Loss of extension of forearm at elbow - triceps deficit

Unopposed flexors of wrist - deficit of wrist and digit extensors

Wrist-drop - loss of wrist and digit extensors

Question 13

What motor deficits result from radial nerve injury in the humerus?

Answer 13

Wrist drop

*Triceps not affected

Question 14

What sensory loss occurs as a result of radial nerve injury in the humerus?

Answer 14

Dorsolateral hand and dorsum of proximal part of lateral 3.5 fingers

Question 15

What motor loss occurs as a result of injury to the median nerve at the elbow?

Answer 15

Very weak flexion and loss of pronation, may weaken abduction

Loss of flexion at MP, PIP and DIP joints of index and middle finger - Hand of Benediction

Loss of thenar muscles

Question 16

What sensory loss occurs as a result of injury to median nerve at the elbow?

Answer 16

Lateral 2/3 of palm of hand

Palmar side and nail beds of lateral 3.5 fingers

Question 17

What motor loss occurs as result of Injury of median nerve at wrist?

Answer 17

Loss of opposition of thumb an flattened thenar eminence

Question 18

What occurs from severance of the recurrent branch of median nerve?

Answer 18

Loss of opposition of thumb and atrophy of thenar muscles

No sensory loss

Question 19

What motor deficits result from carpal tunnel?

Answer 19

Progressive weakness of thenar muscles

Question 20

What sensory deficits result from carpal tunnel?

Answer 20

Anesthesia, Hypoesthesia, or paresthesia (abnormal) of distal lateral 2/3 of palm and palmar side and nail beds of lateral 3.5 fingers

Question 21

What is the treatment for carpal tunnel?

Answer 21

Reduce inflammation and limit repetitivie movements

Carpal tunnel release - surgical decompression of the nerve by severing the flexor retinaculum

Question 22

What muscle function is lost as a result to damage of the ulnar nerve at the elbow?

Answer 22

Loss of flexor carpi ulnaris

Medial half of flexor digitorum profundus

Interosseous muscles

Ulnar claw hand

Question 23

What sensory loss occurs as a result of damage to the ulnar nerve at the elbow?

Answer 23

Palmar side of proximal part of medial 1/3 of hand

Palmar side of distal part of medial 1/3 of palm and medial 1.5 digits

Dorsal 1/3 of hand and dorsal side of 1.5 digits

Question 24

What motor loss occurs as a result of damage to the ulnar nerve at the wrist?

Answer 24

Paralysis of most intrinsic muscles of han

Loss of adduction-abduction of fingers

Claw hand

Question 25

What sensory loss occurs as a result of damage to the ulnar nerve at the wrist?

Answer 25

Palmar side of medial 1/3 of hand and medial 1.5 digits