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Systems: MSK AB > Nerve Palsies in Limbs > Flashcards

Nerve Palsies in Limbs Flashcards

1
Q

Where does each peripheral nerve start from?

A

Spinal cord

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2
Q

Dermatome

A

Sensory area of the skin supplied by a single spinal nerve

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3
Q

How do dermatomes develop?

A
  • Adjacent dermatomes overlap considerably
  • Embryological development of limb buds growing out from body wall results in axial lines (anterior and posterior) - there is no overlap between adjacent pre- and post-axial dermatomes
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4
Q

What are the dermatomes of the lower limb?

A
  • STAND on S1
  • SLEEP on S2
  • SIT on S3
  • ** on S4
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5
Q

Why are the dermatomes of the lower limb distorted?

A

Lower limb dermatomes distorted by rotation and extension, and “borrowing” of skin from trunk

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6
Q

What is Hilton’s law?

A

The nerve crossing a joint supply the muscles acting on it and joint itself

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7
Q

What are the implications of Hilton’s Law?

A

-May supply 2 joints, eg. hip and knee supplied by femoral, sciatic and obturator nerves
Therefore, HIP DISEASE MAY GIVE RISE TO KNEE PAIN

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8
Q

What is the hip joint supplied by?

A
  • Obturator nerve (predominantly)
  • Femoral nerve
  • Lateral femoral cutaneous nerve
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9
Q

Myotome

A

Group of muscles supplied by one segment of the spinal cord

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10
Q

What is the brachial plexus?

A

Large network of nerves supplying the upper limb, extending from the cervical spine to the axilla

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11
Q

How is the brachial plexus divided?

A
  • Roots
  • Trunks
  • Divisions
  • Cords
  • Branches
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12
Q

How does Erb’s palsy occur?

A

Downward traction such as a fall on the side of the neck

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13
Q

What happens if C5 and C6 are damaged?

A

Erbs palsy

-Deltoid and shoulder muscles, brachialis and biceps all affected

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14
Q

How does Klumpke’s paralysis occur?

A

Upward traction for example in a breech delivery

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15
Q

What happens if T1 is damaged?

A

Klumpke’s paralysis

  • Intrinsic muscles are damaged
  • Hand clawed
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16
Q

Give examples of brachial plexus injuries?

A
  • Erb’s palsy

- Klumpke’s paralysis

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17
Q

Where is the axillary nerve at most risk of injury?

A

Surgical neck of the humerus

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18
Q

What is Saturday night palsy?

A
  • Complication of humeral neck fracture, and shoulder dislocation
  • Caused by pressure on the posterior cord of the brachial plexus
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19
Q

What does axillary nerve injury result in?

A
  • Motor deficit: loss of shoulder abduction (deltoid)

- Sensory deficit over the badge area

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20
Q

What are the roots of the radial nerve?

A

C5-T1

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21
Q

What is the radial nerve closely associated with in the arm?

A

Profunda brachii artery

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22
Q

How does the radial nerve enter the forearm?

A

Enters forearm by passing between - brachioradialis & brachialis (and posterior interosseous branch of radial nerve passes between 2 planes of supinator)

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23
Q

Where is the radial nerve most at risk?

A

Spiral groove of humerus and lateral intermuscular septum (and posterior interosseous branch at radial neck)

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24
Q

How does radial nerve injury present?

A
  • Motor deficit: wrist drop (extensors)

- Sensory deficit in the 1st web space dorsally

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25
Q

What are the roots of the median nerve?

A

C7-T1

26
Q

What is the median nerve closely associated with in the arm?

A

Brachial artery

27
Q

How does the median nerve enter the forearm?

A

Enters forearm by passing between - two heads of pronator teres

28
Q

Where is the median nerve most at risk?

A

Volar aspect of wrsit (and cubital fossa)

29
Q

What can median nerve injury occur as a result of?

A
  • Carpal tunnel syndrome

- Wrist lacerations (and supracondylar fractures, Struther;s ligament)

30
Q

What does median nerve injury result in?

A
  • Motor deficit: thenar wasting (monkey’s hand) and pointing fingers
  • Sensory deficit of the volar aspect of the thumb
31
Q

What are the roots of the ulnar nerve?

A

C7-T1

32
Q

What is the ulnar nerve closely associated with in the arm?

A

Superior ulnar collateral artery ( and ulnar artery and nerve very closely interwoven at wrist)

33
Q

How does the ulnar nerve enter the forearm?

A

By passing between 2 heads of flexor carpi ulnaris

34
Q

Where is the ulnar nerve most at risk?

A

Behind medial epicondyle of humerus (and wrist, canal of GUyon)

35
Q

What can ulnar nerve injury occur as a result of?

A

Fracture of humeral condyles (and wrist lacerations)

36
Q

What does ulnar nerve injury result in?

A
  • Motor deficit: claw hand, hypothenar and 1st dorsal interosseous wasting
  • Sensory deficit in the little finger
37
Q

Where is the lumbar plexus found?

A

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

38
Q

How do the major nerve around the hip exit into the leg?

A

Most major nerves about the hip exit the pelvis by the sciatic foramen, except genitofemoral & ilioinguinal, femoral, lateral femoral cutaneous and obturator nerves

39
Q

What are the roots of the femoral nerve?

A

L2-L4

40
Q

What is the largest branch of the lumbar plexus?

A

;Femoral nerve

41
Q

How does the femoral nerve enter the leg?

A
  • Passes through psoas muscle
  • Exits pelvis under inguinal ligament, lateral to femoral artery, vein and lymphatic channels in femoral triangle (VAN with Vein next to “V” of legs)
42
Q

What does the femoral nerve supply?

A

Quadricep muscles in the anterior thigh

43
Q

What does the femoral nerve terminate as?

A

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)

44
Q

What are the roots of the lateral femoral cutaneous nerve?

A

L2,L3

45
Q

Where is the lateral femoral cutaneous nerve located?

A

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

46
Q

What does the lateral femoral cutaneous nerve supply?

A

Purely sensory to the lateral aspect of the thigh

47
Q

What does compression of the lateral femoral cutaneous nerve cause?

A

Meralgia paraesthetica

48
Q

What are the roots of the sciatic nerve?

A

L4-S3

49
Q

What is the largest nerve in the body?

A

Sciatic nerve

50
Q

What is the main branch of the sacral plexus?

A

Sciatic nerve

51
Q

What is the structure of the sciatic nerve?

A

Broad and flat with accompanying artery

52
Q

How does the sciatic nerve enter the leg?

A

Exits pelvis through sciatic foramen below piriformis muscle

53
Q

Where is the sciatic nerve located in the buttocks?

A

Deep to gluteus maximus

54
Q

What does the sciatic nerve supply?

A
  • Hamstring muscles in posterior thigh
  • Part of adductor magnus
  • All lower leg and foot muscles through terminal branches (tibial and commob fibular nerves), height of division is variable
55
Q

When is the sciatic nerve at risk of injury?

A
  • Posterior dislocation of the hip
  • Intra-muscular injections
  • During surgery
56
Q

What are the roots of the common fibular nerve?

A

L4-S2

57
Q

What are other names for the common fibular nerve?

A
  • Lateral popliteal nerve

- Common peroneal nerve

58
Q

What is the common fibular nerve a branch of?

A

Smaller and lateral branch of the sciatic nerve

59
Q

Where is the common fibular nerve at risk of injury?

A

As it passes around the lateral aspect of the neck of the fibula (deficit causes foot drop and slapping gait,)

60
Q

What is the most commonly injured nerve of the lower limb?

A

Common fibular nerve

61
Q

What does the common fibular nerve divide into?

A

Superficial and deep fibular nerves

Systems: MSK AB (43 decks)

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