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Year 3 - Musculoskeletal > Nerve palsies > Flashcards

Nerve palsies Flashcards

1
Q

Nerve palsies of the upper limb?

A 
> Nerve Roots
> Brachial Plexus
> Peripheral Nerves
- Axillary
- Radial
- Musculocuteneous
- Ulnar
- Median
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2
Q

Nerve palsies of the lower limb?

A

> Nerve Roots

> Sacral and Lumbar Plexus

> Peripheral Nerves

  • Sciatic
  • Femoral
  • Common Peroneal
  • LFCN
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3
Q

Which dermatome - Index finger?

A

C7

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4
Q

Which dermatome - little finger?

A

C8

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5
Q

Which dermatome - Lateral forearm?

A

C6

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6
Q

Which dermatome - thumb?

A

C6

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7
Q

Which dermatome - medial forearm?

A 
Proximally = T1
Distal = C8
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8
Q

Which dermatome - Medial upper arm?

A

T1

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9
Q

Which dermatome - axilla?

A

T2

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10
Q

Which dermatome - Outer upper arm?

A

C5

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11
Q

Which dermatome - Medial aspect of the upper arm, supinated?

A

C6

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12
Q

Which dermatome - Medial aspect of forearm, pronated?

A

C7

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13
Q

Which dermatome - big toe?

A

L4

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14
Q

Which dermatome - Middle foot?

A

L5

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15
Q

Which dermatome - Lateral aspect of heel?

A

S1

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16
Q

Which dermatome - Medial aspect heel?

A

L3

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17
Q

Which dermatome - Lateral aspect of lower leg, posterior?

A

S1

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18
Q

Which dermatome - medial aspect of lower leg, posterior?

A

L3

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19
Q

Which dermatome - Lateral aspect of lower leg, anterior?

A

L5

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20
Q

Which dermatome - Lateral aspect of lower leg, anterior?

A

L4

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21
Q

Which dermatome - Lateral aspect of upper leg, posterior?

A

L5

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22
Q

Which dermatome - middle aspect of upper leg, posterior?

A

S1

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23
Q

Which dermatome - medial aspect of upper leg, posterior?

A

L3

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24
Q

Which dermatome - Lateral aspect of upper leg, anterior?

A

L4

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25
Q

Which dermatome - medial aspect of upper leg, anterior?

A

L3

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26
Q

Which dermatome - groin area?

A

L2 distal

L1 proximal

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27
Q

Myotone patterns - Elbow flexors?

A

C5

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28
Q

Myotone patterns - Wrist flexors?

A

C6

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29
Q

Myotone patterns - elbow extensors?

A

C7

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30
Q

Myotone patterns - Finger extensors?

A

C8

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31
Q

Myotone patterns - intrinsic muscles of the hand ?

A

T1

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32
Q

Myotone patterns - hip flexors ?

A

L2

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33
Q

Myotone patterns - Knee extensors?

A

L3

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34
Q

Myotone patterns - ankle dorsiflexion?

A

L4

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35
Q

Myotone patterns - Long toe extensors?

A

L5

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36
Q

Myotone patterns - ankle plantar flexors?

A

S1

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37
Q

Upper limb nerve palsies - Brachial plexus?

A

Brachial Plexus
> Erb’s Palsy
> Klumpke’s Palsy
> Total Brachial Plexus

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38
Q

Upper limb nerve palsies - Peripheral nerves?

A

Peripheral Nerves
> Musculocutaneous (nil)

> Axillary
- Axillary nerve palsy secondary to trauma

> Radial
- Radial nerve palsy secondary to compression or entrapment

> Median
- Carpal tunnel syndrome

> Ulnar
- Cubital Tunnel Syndrome

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39
Q

Upper limb nerve palsies - Axillary nerve?

A

Usually secondary to trauma

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40
Q

Upper limb nerve palsies - radial nerve?

A

Usually die to compression or entrapment

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41
Q

Upper limb nerve palsies - Median nerve?

A

Carpal tunnel syndrome

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42
Q

Upper limb nerve palsies - Ulnar?

A

Cubital tunnel syndrome

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43
Q

How many nerve roots in the brachial plexus?

A

5 = C5 - T1

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44
Q

Which nerves form the superior trunk of the upper limb?

A

Roots C5 and C6

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45
Q

Which nerves form the middle trunk of the upper limb?

A

Root C7

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46
Q

Which nerves form the inferior trunk of the upper limb?

A

C8 and T1 Roots

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47
Q

Which nerves roots form the musculocutaneous nerve of the upper limb?

A

C5, C6 and C7

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48
Q

Which nerves roots form the radial nerve of the upper limb?

A

C5, C6, C7, C8, T1

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49
Q

Which nerves roots form the median nerve of the upper limb?

A

C5, C6, C7, C8, T1

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50
Q

Which nerves roots form the ulnar nerve of the upper limb?

A

C7, C8 and T1

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51
Q

What runs posterior to the median nerve immediately distal to the axilla?

A

The axillary artery

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52
Q

What is an upper brachial plexus palsy??

A

C5 and C6 = Erb-Duchenne palsy

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53
Q

What is an lower brachial plexus palsy??

A

> C8 and T1
Klumpke’s palsy
Very rare

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54
Q

What is an total brachial plexus palsy??

A

> C5 - T1

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55
Q

How does someone present with Erb-Duchenne palsy?

A

Waiter’s tip position:
> Shoulder is adducted
> Elbow is extended and pronated
> Wrist is flexed

C5, C6 damage (Deltoid, shoulder muscles, brachialis and biceps)

56
Q

What can cause Erb-Duchenne palsy?

A

> Brachial plexus is stretched leading to downward traction of C5 and C6 (+/- C7)

> Shoulder/arm pulled down as neck is pulled in opposite direction

57
Q

What can cause Klumpke’s palsy

A

> Upward Traction of C8/T1

> Shoulder/arm is pulled up, away from body e.g. hanging from a branch or arm pulled during childbirth

58
Q

How would one present with Klumpke’s palsy?

A

Affect small muscles of the hand = Claw hand

59
Q

What is the route of the muculocutaneous nerve (C5, 6, 7)?

A

1) Lateral cord
2) Pierce coracobrachialis
3) Runs inferiorly between biceps ad brachialis
4) Terminates as the lateral cutaneous nerve to the forearm

60
Q

What does the musclulocuatneous (C5, 6, 7) nerve supply?

A

> Biceps brachii
Brachialis
Elbow joint
Lateral cutaneous nerve

61
Q

What is Hilton’s Law? Give an example?

A

“ A sensory nerve supplying a JOINT also supplies the MUSCLES
moving the joint and the SKIN overlying the insertions of these muscles.”

Eg. Musculocutaneous Nerve gives sensory supply to anterior capsule of elbow, and supplies the BBC and skin overlying the insertions of these muscles, by way of the lateral cutaneous nerve of the forearm (which is the terminal branch of the MCC nerve)

62
Q

What is the route of the axillary nerve (C5, 6)?

A

1) Posterior cord

2) Wraps around the surgical neck of the humerus

63
Q

What does the axillary nerve (C5, 6) supply?

A

> Deltoid
Teres major
Skin over the lateral arm

64
Q

What can cause an axillary nerve (C5, 6) palsy?

A

> Dislocation of the shoulder

> Fracture of the surgical neck of the humerus

65
Q

If there is a nerve palsy and deltoid atrophy, what is likely to be the cause?

A

Axillary nerve (C5, 6) palsy

66
Q

What is the route of the radial nerve (C5, 6, 7, 8, T1)?

A

1) Posterior cord
2) Runs in radial groove of humerus as it passes from medial to lateral
3) PIN (motor) and SRN (sensory) branches

67
Q

What does the radial nerve (C5, 6, 7, 8, T1) supply?

A 
> Triceps brachii 
> Brachioradialis 
> Extensor carpi radialis brevis
> Extensor carpii brevis
> Extonsors
> Superficial radial nerve
68
Q

What can cause radial nerve palsy (C5, 6, 7, 8, T1)?

A

Entrapment:
- Fracture of the distal humerus

Compression:

  • Saturday night palsy
  • Honeymoon palsy
  • Crutch palsy
69
Q

How would someone present with radial nerve palsy?

A

Symptoms depend on SITE of lesion
> In axilla: loss of elbow extension, wrist extension and sensory changes forearm and hand

> In arm: loss of wrist extension and sensory loss
In forearm: loss of finger extension (PIN)

> At wrist: loss of sensation (SRN) eg. handcuffs

70
Q

What does the median nerve (C5, 6, 7, 8, T1) supply?

A

> Flexors of the forearm (Bar FCU and medial half of FDP), LOAF muscles

> Supplies sensation to radial 3.5 digits

71
Q

Median nerve - sensory?

A

Supinated:

  • Thumb
  • 1st, 2nd and 1/2 3rd digits
  • 1/2 Palm of hand

Pronated:

  • Tip of thumb
  • Tips of 1st, 2nd and 1/2 3rd digits
72
Q

Radial nerve - sensory?

A

Supinated:
- Proximal aspect of lateral thumb

Pronated:

  • 1/2 hand thumb side
  • 1st, 2nd and 1/2 3rd digits not including tips
73
Q

Ulnar nerve - sensory?

A
  • Outer aspect of hand

- 1/2 3rd and 4th digits

74
Q

What makes up the floor of the carpal tunnel?

A

Carpal bones

75
Q

What makes up the roof of the carpal tunnel?

A

Flexor retinaculum

76
Q

What are the contents of the carpal tunnel?

A

> Flexor Digitum Superficialis x4 tendons
Flexor Digitorum Profundus x4 tendons
Flexor Pollicus Longus tendons
Median nerve

77
Q

Carpal tunnel syndrome - Causes?

A

Developmental

Trauma:
- Distal radius fracture

Swellings:

  • Ganglion
  • Fibroma
  • Lipoma

Inflammatory:

  • Rheumatoid
  • Gout
  • TB
  • Amyloid

Metabolic:

  • Pregnancy
  • Mucopolysaccharidoses
  • Hypothyroidism
78
Q

Carpal tunnel syndrome - Causes, trauma?

A

Trauma:

- Distal radius fracture

79
Q

Carpal tunnel syndrome - Causes, metabolic?

A

Metabolic:

  • Pregnancy
  • Mucopolysaccharidoses
  • Hypothyroidism
80
Q

Carpal tunnel syndrome - Causes, inflammatory?

A

Inflammatory:

  • Rheumatoid
  • Gout
  • TB
  • Amyloid
81
Q

Carpal tunnel syndrome - Causes, swellings?

A

Swellings:

  • Ganglion
  • Fibroma
  • Lipoma
82
Q

Carpal tunnel syndrome - Clinical presentation?

A

Nocturnal pain and parasthesia in part or all of the median nerve distribution

Wasting of the thenar muscles

83
Q

Carpal tunnel syndrome - diagnosis?

A

LOOK
> Thenar wasting
> Previous scars
> Deformity (previous fracture)

FEEL
> Sensation

MOVE
> APB power

SPECIAL TESTS
> Tinnels
> Phalens

84
Q

Carpal tunnel syndrome - Treatment?

A

Carpal tunnel release

85
Q

How many branches does the ulnar nerve (C8, T1) have in the arm?

A

None

86
Q

How does the ulnar nerve (C8, T1) enter the forearm?

A

Between the two heads of the flexor carpi ulnaris

87
Q

What does the ulnar nerve (C8, T1) supply?

A

> Medial half of the flexor digitorum profundus
Flexor carpi ulnaris
Intrinsic muscles in hand BAR LOAF
Sensation to 1/2 3rd and 4th digits

88
Q

Cubital tunnel syndrome - clinical presentation?

A

Patient has numbness on ulnar side of hand and difficulty with fine tasks.

89
Q

What is the cubital tunnel?

A

Cubital tunnel between Medial epicondyle and olecranon, with fascial bands from Flexor carpi ulnaris as roof

90
Q

Ulnar nerve palsy - Clinical presentation?

A

> Wasting of muscles of hand:

  • 1st webspace often most marked
  • Guttering
  • Hypothenar wasting

> Ulnar claw hand:
- Hyperextension at MCPJ, flexion at IPJ’s

91
Q

What is the ulnar paradox?

A

A distal lesion has worse clawing than a proximal lesion, due to intact long flexors with a distal lesion

92
Q

Which test is useful in diagnosis of ulnar nerve palsy?

A

Fronment’s test:

> Key muscles:

  • ADDUCTOR Pollicis (ULNAR NERVE)
  • FLEXOR Pollicis Longus (MEDIAN NERVE)

> If Ulnar nerve not working, the patient will cheat and use FPL instead of Adductor Pollicis

93
Q

Fronment’s test?

A

> Useful in diagnosis of ulnar nerve palsy

> Key muscles:

  • ADDUCTOR Pollicis (ULNAR NERVE)
  • FLEXOR Pollicis Longus (MEDIAN NERVE)

> If Ulnar nerve not working, the patient will cheat and use FPL instead of Adductor Pollicis

94
Q

Lower limb palsies?

A

Sacral Plexus
> Sciatic:
- Common Peroneal Nerve
- Tibial Nerve

Lumbar Plexus:
> Femoral Nerve

95
Q

Which nerve roots form the sacral plexus?

A

L4 to S4

96
Q

What does the superior gluteal nerve supply?

A

> Gluteus medius
Gluteus minimus
TFL

97
Q

What does the inferior gluteal nerve supply?

A

Gluteal maximus

98
Q

What is the main branch of the sacral plexus?

A

Sciatic nerve, supplies:

  • Posterior thigh
  • Leg
  • Foot muscles
99
Q

What are the branches of the sacral plexus?

A 
> Superior gluteal
> Inferior gluteal
> Sciatic 
> Posterior femoral 
> Pudendal
100
Q

Branches of the sciatic nerve?

A

> Tibial nerve

> Common fibular nerve

101
Q

What does the sciatic nerve supply?

A

Hamstring muscles in posterior compartment of thigh

102
Q

Route of the common fibular nerve?

A

1) Wraps around the neck of the fibula

2) Divides into deep fibular nerve and superficial fibular nerve

103
Q

What does the deep fibular nerve supply?

A

Anterior compartment of the leg

104
Q

What does the superficial fibular nerve supply?

A

Lateral compartment of the leg

105
Q

What is the mechanism of action of the muscles in which the common fibular nerve supply?

A

Muscles of the anterior leg which raise the foot, dorsiflexion

106
Q

If there is damage to the common fibular nerve what is the clinical outcome?

A

> There is loss of dorsiflexion = Foot drop

> Cannot raise foot

107
Q

In terms of the femoral plexus which nerve supplies the anterior compartment of the lower leg?

A

Deep fibular nerve

108
Q

In terms of the femoral plexus which nerve supplies the lateral compartment of the lower leg?

A

Superficial femoral nerve

109
Q

In terms of the femoral plexus which nerve supplies the posterior compartment of the lower leg?

A

Tibial nerve

110
Q

What are the branches of the lumbar plexus?

A 
> Iliohypogastric (T12, L1)
> Ilioinguinal (T12, L1)
> Genitofemoral (L1, L2)
> Lateral cutaneous (L2, L3)
> Femoral (L2, L3, L4)
> Obturator (L2, L3, L4)
111
Q

What are the main branches f the lumbar plexus?

A

> LFCN (L2, L3)
Femoral (L2, L3, L4)
Obturator (L2, L3, L4)

112
Q

Which nerve roots make up the lumbar plexus?

A

L1-L5

113
Q

Meralgia parasthetica - Clinical presentation?

A

Altered sensation and pain lateral thigh

114
Q

Meralgia parasthetica - Cause?

A

Compression of Lateral femoral cutaneous nerve of thigh as it travels under lateral border of inguinal ligament

115
Q

What is a dermatome?

A

> Sensory area of skin supplied by a single spinal nerve

> Adjacent dermatome overlap considerably

116
Q

Good pneumonic for sacral dermatomes, the 4 S’s.

A

STAND on S1
SLEEP on S2
SIT on S3
SHIT on S4 !

117
Q

Why could hip disease give rise to knee pain?

A 
Due to Hilton's law: 
“The motor nerve to a 
muscle tends to give
a branch of supply to 
the joint that the 
muscle moves, and 
another to the skin 
over the joint.”
118
Q

Which nerves supply the hip joint?

A

Hip joint is supplied by:
> Obturator nerve (predominately)
> Femoral nerve
> Lateral femoral cutaneous nerve

119
Q

What is a myotome?

A

A group of muscles supplied by one segment of spinal cord

120
Q

How does axillary nerve palsy clinically present?

A

Motor deficit = Loss of shoulder abduction (Deltoid)

Sensory deficit = Badge area

121
Q

How does radial nerve palsy clinically present?

A

> Motor deficit - wrist drop (extensors)

> Sensory deficit - 1st web space dorsally

122
Q

How does median nerve palsy clinically present?

A

> Complication of - carpal tunnel syndrome, wrist lacerations (& supracondylar #’s, Struther’s ligament)

> Motor deficit - thenar wasting (monkey hand), pointing finger

> Sensory deficit - volar aspect thumb

123
Q

How does ulnar nerve palsy clinically present?

A

> Complication of - humeral condyles (& wrist lacerations)

> Motor deficit - claw hand, hypothenar & 1st dorsal interosseous wasting

> Sensory deficit - little finger

124
Q

Where is the lumbar plexus located?

A

Lies on surface of quadratus lumborum and within body of psoas muscle

125
Q

Nerve supply of the femoral nerve?

A

L2-L4

126
Q

Which of the branches of the lumbar plexus are the larger?

A

Femoral nerve

127
Q

What is the route of the femoral nerve?

A

1) Passes through psoas muscle
2) Exits pelvis under inguinal ligament, lateral to femoral artery, vein and lymphatic channels in femoral triangle - VAN with Vein next to “V” of legs
3) Terminates in long fine sensory branch (Saphenous Nerve - accompanies femoral artery in subsartorial canal of thigh, and long saphenous vein in lower leg and in front of medial malleolus at ankle to supply great toe)

128
Q

Saphenous nerve?

A

Saphenous Nerve - accompanies femoral artery in subsartorial canal of thigh, and long saphenous vein in lower leg and in front of medial malleolus at ankle to supply great toe

129
Q

What is the route of the Lateral femoral cutaneous nerve?

A

Lies on surface of iliacus muscle; usually exits pelvis under lateral end of inguinal ligament, but variable

130
Q

What does the lateral femoral cutaneous nerve supply?

A

Purely sensory to lateral aspect thigh

131
Q

What is the largest nerve in the body? What is it a branch of?

A

> The Sciatic nerve
The main branch of sacral plexus
Broad and flat with accompanying artery

132
Q

How does the sciatic nerve exit the pelvis?

A

Through the sciatic foramen below piriformis muscle

133
Q

Which muscle does the sciatic nerve run deep to?

A

The gluteus maximus muscle

134
Q

When is the sciatic nerve at risk of damage?

A

> Posterior dislocation of hip
Intra-muscular injections
During surgery (division devastating)

135
Q

The sciatic nerve supplies what?

A

Supplies hamstring muscles in thigh (posterior) and part of adductor magnus, and all lower leg and foot muscles via terminal branches (tibial and common fibular nerves) - height of division variable (really 2 nerves)

136
Q

What are other names for the common fibular nerve?

A

It was previously called lateral popliteal nerve, then common peroneal nerve

137
Q

There are communicating branches of the common fibular nerve to which nerve?

A

The sural nerve

Year 3 - Musculoskeletal (30 decks)

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