Nerve palsies Flashcards
What are the spinal roots of the upper limbs
C5- elbow flexors C6- wrist extensors C7-elbow extensors C8- finger extensors T1- intirsic hand muscles
What are the spinal roots of the lower limbs
L2- Hip flexors L3- Knee extensors L4- Ankle dorsifelxors L5- Long toe extensors S1- Ankle plantar flexors
What is Erb’s palsy
Traction of C5/C6 (+7)
leads to waiters tip position (adducted shoulder, internally rotated, elboe extended and pronaed and flexed wrist
can happen if a baby is forced out of the womb adn the brachial plexusis strethced
What is Klumpe’s palsy
Traction of C8/T1
Very rare
Affects small muscles of hand (claw hand)
How does the badge patch have a reduced sensation?
Fractured neck of humerus, leads to deltoid atrophy due to damage of the posterior cord of the brachial plexus
What palsies can occur with radial nerve palsies
Saturday night palsy
Honeymoon palsy
Crutch palsy
What happens if their is radial nerve palsy at the axilla?
What happens if their is radial nerve palsy at the arm?
Loss of elbow extension, wrist extension and sensory changes forarm and hand
Loss of wrist extension and sensory loss
What happens if their is radial nerve palsy at the forearm?
What happens if their is radial nerve palsy at the wrist?
Loss of finger extension
Loss of sensation e.g. handcuffs
What is carpal tunnel syndrome
Nocturnal pain and parasthesia in part of the median nerve distribution. Causes wasting of the thenar muscles.
What causes carpal tunnel syndrome?
Trauma- distal radius fracture
Inflammatory- rheumatoid, gout, TB, amyloid
Swellings- ganglion, fibroma, lipoma
Metabolic- Pregnancy,, hypothyroidsim
How do you assess carpal tunnel syndrome?
Look- thenar wasting, deformity (previous fracture)
Feel- sensation
Move- abductor policus brevis power
Special tests- Tinnels- tap
Phalens- reverse prayer
What is cubital fossa syndrome?
Patient has numbness on ulnar side of hand due to compression of nerve in cubital fossa. This causes wasting of muscles of 1st webspace, guttering and hypothenar wasting
How does cubital fossa syndrome manifest
Ulnar claw hand- hyperextension at MCPJ, flexion at IPJ’s
Ulnar paradox- distal lesion has worse clw than proximal lesion
How do you test for ulnar palsy
Froments test- get them to gip something while you pull. Normal people will use flat of thumb but if ulnar paralysed then tip of thumb is also used to recruit FPL
What does common fibular nerve palsy cause
Foot drop as muscles in anterior compartment can no longer dorsiflex foot
