nerve palsies in limb

Question 1

what nerves are at risk upper limb

Answer 1

nerve roots
brachial plexus
peripheral nerves: axillary, radial, musculocutaneous, ulnar, medial

Question 2

what nerves are at risk lower limb

Answer 2

nerve roots
sacral and lumbar plexus
peripheral nerves: sciatic, femoral, common peroneal, LFCN

Question 3

classical brachial plexus lesions

Answer 3

downward traction e.g. fall on side of neck, being born

upward traction e.g. breech delivery

Question 4

downward traction of brachial plexus

Answer 4

C5,6 damage (deltoid and shoulder muscles, brachialis and biceps)

Erb-Duchenne paralysis (porters tip_

tends to rapidly resolve in infants/neonates

Question 5

upward traction of brachial plexus

Answer 5

T1 damage (intrinsic muscles)

Klumpke’s palsy: claw hand

Question 6

causes and signs axillary nerve palsy

Answer 6

shoulder dislocation, fracture surgical neck humerus

reduced sensation regimental badge area
deltoid atrophy

Question 7

axillary nerve roots

Answer 7

C5, 6

Question 8

what does axillary nerve supply

Answer 8

deltoid and teres minor

skin over lateral arm - regimental badge area

Question 9

radial nerve roots

Answer 9

C5, 6, 7, 8 and T1

Question 10

causes of radial nerve palsy

Answer 10

fractures
entrapment
compression - neurapraxia

Question 11

symptoms of radial nerve palsy - lesion at axilla

Answer 11

loss elbow extension, wrist extension

sensory changes forearm and hand

Question 12

symptoms of radial nerve palsy - lesion at arm

Answer 12

loss wrist extension and sensory loss

Question 13

symptoms of radial nerve palsy - lesion at forearm

Answer 13

loss finger extension

Question 14

symptoms of radial nerve palsy - lesion at wrist

Answer 14

loss sensation

Question 15

median nerve roots

Answer 15

C5, 6, 7, 8 and T1

Question 16

what does median nerve supply

Answer 16

flexors of forearm (minus flexor carpi ulnaris and medial half flexor digitorum profundus), LOAF muscles

sensation radial 3.5 fingers

Question 17

causes of carpal tunnel syndrome

Answer 17

developmental 
trauma - distal radius fracture
swelling - ganglion, fibroma
inflammatory - rheumatoid, gout, TB 
metabolic - pregnancy, hypothyroidism

Question 18

symptoms carpal tunnel syndrome

Answer 18

pain (worse night)

paraesthesia

Question 19

signs of carpal tunnel syndrome

Answer 19

thenar muscle wasting
dry skin

Tinnels
Phalens

Question 20

management carpal tunnel syndrome

Answer 20

splints
steroid injection
remove pressure - divide roof carpal tunnel

Question 21

ulnar nerve roots

Answer 21

C8, T1

Question 22

where does ulnar nerve provide sensation

Answer 22

ulnar 1.5 digits (little finger and half ring)

Question 23

cubital tunnel

Answer 23

between medial epicondyle and olecranon, fascial bands from flexor carpi ulnaris as oof

Question 24

cubital tunnel syndrome

Answer 24

patient numbness on ulnar side of hand and difficult fine tasks

treatment steroidal aor surgery to release tunnel

Question 25

ulnar nerve palsy - muscle wasting

Answer 25

1st web spaced
gutterng
hypothenar wasting

Question 26

ulnar claw hand

Answer 26

hyperextension at MCPJ and flexion at IPJs

ulnar paradox: distal lesion has worse clawing than a proixmal one due to intact long flexors with distal lesion

Question 27

lateral femoral cutaneous nerve supplies..

Answer 27

sensory to lateral aspect thigh

Question 28

what does compression of lateral femoral cutaneous nerve cause and what’s treatment

Answer 28

‘meralgia paraesthetica’
pain
abnormal sensation, tingling

steroid injection, surgery to release tunner

Question 29

what is sciatic nerve at risk from

Answer 29

posterior dislocation hip
IM injections
surgery mistakes

Question 30

common fibular nerve deficit features

Answer 30

foot drop

slapping gait