nerve palsies Flashcards
nerve roots myotone patterns
C5- elbow flexors C6- wrist extensors C7 elbow extensors C8- Finger extensors T1- Intrinsic hand muscles
L2- Hip flexors L3- Knee extensors L4- Ankle dorsiflexors L5- Long toe extensors S1- Ankle Plantar Flexors
Brachial plexus palsies
Erb’s palsy
Klumpke’s palsy
total brachial plexus
peripheral nerves
-axillary Secondary to trauma -Radial secondary to compression or entrapment -Median Carpal tunnel syndrome - Ulnar Cubital tunnel syndrome
Upper brachial plexus (C5,6)
Erb’s palsy
Lower Brachial plexus (C8,T1)
Klumpke’s (very rare)
Total brachial plexus
C5 to T1
Erb’s palsy
traction (during delivery) waiter's tip position shoulder is adducted and IR elbow extended wrist is flexed
klumpke
traction (C8,T1)
affects small muslces of hand-claw hand
hilton’s law
a sensory nerve supplying a joint also supplies the muscles moving the joint and skin overlying the insertions of these muscles
axillary nerve
wraps around surgical nexk of humerus
supplies deltoid and teres minor
supplies skin over lateral arm ( regimental badge area)
axillary nerve palsy
shoulder dislocation
fracture surgical neck of humerus
deltoid atrophy
radial nerve
posterior cord
supplies triceps
runs in radial groove
supplies BCR, ECRL,ECRB
Radial nerve palsy
radial nerve entrapment
saturday night palsy
honeymoon palsy
crutch palsy
median nerve
medial and lateral cords
C5679T1)
supplies flexors of forearm ( Bar FCU and medial half of FDP), LOF muscles
carpal tunnel
floor: carpal bones
roof: flexor retinaculum
contents: FDS,FDP, FPL and median nerve
causes of carpal tunnel
developmental trauma- distal radius fracture swellings- ganglion inflammatory metabolic- pregnancy -mucopolysaccharidoses -hypothyroidism
syndrome
noctural pain and parasthesia
wasting of thenar muscles
test
Look previous scars, deformity feel sensation Move APB power special tests tinels, phalens
ulnar
medial cord
enters forearm between two heads of FCU
supplies medial half of FDP, FCU and all intrinsic muscles in hand
cubital tunnel syndrome
second most common nerve entrapment
cubital tunnel between medial epicondyle and olecranon with fascial bands from FCU
numbness on ulnar side
difficulty fine tasks
ulnar nerve palsy
wasting of muscles 1st webspace guttering hypothenar wasting ulnar claw hand- hyper ext MCPJ and flex at IPJ
ulnar paradox
distal lesion has worse clawing than a proximal lesion due to intact long flexors with a distal lesion
froment’s test
key muscles Adductor pollicis (ulnar)
Flexor Pollicis longus (median)
if ulnar not working patient will try to use FPL
sacral plexus
sciatic common peroneal nerve, tibial nerve -ventral rami of L4 to S4 superior gluteal Gluteus medius/minimus and TFL inferior gluteal maximus main branch sciatic supplies posterior thigh, leg and foot muscles
lumbar plexus
femoral nerve
sciatic nerve
made up of tibial nerve and common peroneal nerve
suplies hamstring muscles in posterior compartment
common peroneal/fibular nerve
wraps around neck of fibula
divides into deep supplying anterior comparrment and superficial supplying lateral
palsy
footdrop
lumbar plexus
L1-L5
main branches
LFCN
femoral obturator
meralgia paraesthetica
altered sensation and pain lateral thigh
compression of lateral femoral cutaenous nerve of thigh as it travels under lateral border of inguinal ligament
