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Musculoskeletal > Nerve Palsies in the Limb > Flashcards

Nerve Palsies in the Limb Flashcards

1
Q

What are the myotomes for the following spinal levels?

C5,6,7 and 8

T1

L2,3,4,5

S1

A

C5 = elbow flexors

C6 = Wrist extensors

C7 = Elbow extensors

C8 = Finger extensors

T1 = Intrinsic hand muscles

L2 = Hip flexors

L3 = Knee extensors

L4 = Ankle dorsiflexion

L5 = Long toe extensors

S1 = Ankle plantar flexors

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2
Q

What are the palsies of the upper limb?

A

Erb’s palsies

Klumpke’s palsy

Total brachial plexus palsy

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3
Q

What is the cause of palsy of the axillary nerve?

A

Secondary to trauma

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4
Q

What is the cause of palsy of the radial nerve?

A

Radial nerve palsy secondary to compression or entrapment

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5
Q

What is the cause of medial nerve palsy?

A

Carpal tunnel syndrome

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6
Q

What is the cause of ulnar nerve palsy?

A

Cubital tunnel syndrome

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7
Q

Here is the brachial plexus

A
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8
Q

What nerves are involved in erbs palsy, klumpke’s palsy and total brachial plexus palsy?

A
  • Upper Brachial Plexus (C5,6): Erb’s Palsy - sometimes involvement of C7
  • Lower Brachial Plexus (C8, T1): Klumpke’s (very rare!)
  • Total Brachial Plexus (C5- T1)
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9
Q

What is a common cause of erbs palsy?

A

Dystocia - an abnormal or difficult childbirth

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10
Q

What is the presentation of erbs palsy?

A

Arm is in waiter tip position

Loss of sensation of the arm

Atrophy of deltoid, biceps, and brachialis muscles.

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11
Q

What causes Klumpke’s palsy?

A

Risk of injury to the lower brachial plexus results from traction on an abducted arm, as with an infant being pulled from the birth canal by an extended arm above the head or with someone catching themselves by a branch as they fall from a tree.

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12
Q

Which muscle does the musculocutaneous nerve pierce?

A

Pierces the coracobrachialis

(It then runs between the biceps and brachialis to supply them both

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13
Q

Which nerve gives supply to the elbow joint?

A

Musculocutaneous nerve

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14
Q

What does the musculocutaneous nerve continue as?

A

The lateral cutaneous nerve to the forearm

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15
Q

What is Hilton’s law?

A

A sensory nerve supplying a JOINT also supplies the MUSCLES

moving the joint and the SKIN overlying the insertions of these muscles

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16
Q

Which cord is the axillary nerve?

A

Posterior cord

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17
Q

Which part of the humerus is the axillary nerve associated with?

A

It wraps around the surgical neck of the humerus

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18
Q

Which muscles are supplied by the axillary nerve?

A

Deltoid

Teres minor

(also supplies the skin over the regimental badge area)

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19
Q

What are the nerve values for the axillary nerve?

A

C5 and C6

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20
Q

What injuries can result in axillary nerve palsy?

A

Shoulder dislocation

Fracture of surgical neck of humerus

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21
Q

Which muscles does the radial nerve supply?

A

The triceps

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22
Q

Which part of the humerus is the radial nerve assocaited with?

A

Radial nerve runs in the radial groove of the humerus as it passes from medial to lateral.

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23
Q

What are the terminal branches of the radial nerve?

A

Posterior interossues nerve

Superficial radial nerve

25
Q

What are the two causes of radial nerve palsy?

A

Entrapment - fracture

Compression - falling asleep with arm over the back of a chair

26
Q

Radial nerve palsy features depend on which part of the radial nerve is affected, what are the features fi the lesion is in the axilla? Arm? Forearm? wrist?

A

Axilla - loww of elbow extensionm wrist extension and sensory changes in the forearm and the hand

Arm - Loss of wrist extensino and sensory loss

Forearm - loss of finger extension (PIN) from previously we said that figner extension was C8

At wrist - loss of sensation (superficial radial nerve)

27
Q

What are the muscles supplied by the median nerve?

A

Flexors of forearm (apart from the flexor carpi ulnaris and medial half of the flexor digitorum profundus)

LOAF muscles - (lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis)

28
Q

How many fingers does the median nerve supply innervation to?

A

3.5 radial digits

29
Q

What is the floor and the roof of the carpal tunnel

A

Floor = Carpal bones

Roof = Flexor retinaculum

30
Q

What are the contents of the carpal tunnel?

A

•Contents: FDS x4, FDP x4, FPL and median nerve ie. 9 tendons and a nerve

31
Q

What are the causes of carpal tunnel syndrome?

A

Developmental

Trauma (distal radius fracture)

Swellings (ganglion, fibroma, lipoma)

Inflammatory (rhuematoid, gout, TB, amyloid)

Swellings (ganglion, fibroma, lipoma)

Metabolic (pregnancy, mucopolysaccharidoses, hypothyroidism)

32
Q

What are the features of carpal tunnel syndrome?

A
  • Nocturnal pain and parasthesia in part or all of the median nerve distribution
  • Wasting of the thenar muscles
33
Q

Look feel move for carpal tunnel

A

•LOOK

–Thenar wasting

–Previous scars

–Deformity (previous fracture)

•FEEL

–Sensation

•MOVE

–APB power (abductor pollicis brevis)

•SPECIAL TESTS

–Tinnels

–Phalens

34
Q

What are the root values of the ulnar nerve?

35
Q

What muslces does the ulnar nerve supply?

A

Medial half of FDP, FCU and all intrinsic muscles in the hand except the LOAF muscles

36
Q

What digits does the ulnar nerve supply?

A

Supplies the ulnar 1.5 digits

37
Q

Where is the cubital tunnel?

A

Between medial epicondyle and olecranon with fascial bands from FCU as roof

38
Q

What are the clinical features of cubital tunnel syndrome?

A

NUmbness on ulnar side of hand and difficulty with fine tasks

39
Q

What are the features of ulnar nerve palsy?

A

Muscle wasting - wasting of muscles on first webspace (often most marked)

Guttering

Hypothenar wasting

Ulnar claw hand

40
Q

What are the features of ulnar claw hand?

A

Hyperextension of the MCPJ and flexion of the IPJ’s

41
Q

What is froment’s test? Which muscles can be used?

A

Key muscles are the adductor pollicis (ulnar nerve) and the flexor pollicis longus (median nerve)

If the ulnar nerve is not working then the patient will cheat and use the flexor pollicis longus instead of the adductor

42
Q

Which nerve is associated with the sacral plexus? the lumbar plexus?

A

Sacral - sciatic

Lumbar - femoral

43
Q

Which nerves are involved in the sciatic plexus?

A

•Ventral Rami of L4 to S4

44
Q

Which muscles are supplied by thhe superior gluteal nerve?

A

Gluteus medius and minimus and TFL (tensor fascia latae)

45
Q

What does the inferior gluteal nerve supply?

A

Gluteus maximus

46
Q

What muscles are supplied by the sciatic nerve?

A

Posterior thigh, leg and foot muscles

47
Q

What are the two divisions of the sciatic nerve?

A

Tibial nerve and common peroneal nerve

(supplies hamstrings in posterior compartment of thigh)

48
Q

What type of accident can damage the sciatic nerve?

A

Posterior dislocation - common in car accidents

49
Q

Which nerve wraps around the neck of the fibula?

A

Common peroneal nerve

50
Q

What supplies the anterior compartment of the leg and the lateral compartment of the leg?

A

The common peroneal nerve divides into Deep Peroneal Nerve which supplies anterior compartment of leg and superficial Peroneal nerve which supplies lateral compratment

Deep peroneal nerve = anterior compartment of the leg

Superficial peroneal nerve = lateral compartment of the leg

51
Q

What is the sign of peroneal nerve palsy?

A

Foot drop - impairment of dorsiflexion

52
Q

What are the nerve vaules for the lumabr plexus?

53
Q

What are the main branches of the lumbar plexus?

A

LFCN

Femoral
Obturator

54
Q

What does compression of the lateral femoral cutaneous nerve of thigh result in?

A

Meralgia parasthetica

Travels under the lateral border of the inguinal ligament

Musculoskeletal (28 decks)

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