Nerve palsies in the limb Flashcards
What is a dermatome
sensory area of skin supplied by a single spinal nerve
Define Myotome
group of muscles supplied by one segment of spinal cord
Hip joint is supplied by (3)
obturator nerve (predominately)
femoral nerve
lateral femoral cutaneous nerve
What is Hilton’s Law
The nerves crossing a joint supply the muscles acting on it and the joint itself.”
Hip disease may give rise to?
knee pain
Brachial Plexus Lesions (3 types - how may you get it?)
downward traction (eg. fall on side of neck)
C5, 6 damage (deltoid & shoulder muscles, brachialis & biceps)
arm “porter’s tip” (Erb-Duchenne paralysis)
What do C5, 6 supply
deltoid, shoulder muscles , brachial and biceps
C5,c6 issues ? what kind of posture
ERB’S - porters tip
- elbow extended (biceps doesn’t wok)
- wrist is flexed
- adducted (deltoid doesn’t work)
- forearm is pronated
Pull on the lower chords causes
what damage is done?
what Hand posture do you get?
upward traction - eg breech delivery, pulling of the arm
T1 damage (intrinsic muscles)
hand “clawed” (Klumpke’s paralysis
Klumpke’s palsy - what kind of damage
intrinsic damage
The axially nerve (C5 and C6) - where does it Come from?
what does it wrap around?
what does the axially nerve supply?
Posterior Cord
surgical neck of humerus
Supplies Deltoid and Teres Minor
Supplies skin over lateral arm- regimental badge area
When can axillary be damaged (2)
Shoulder Dislocation
Fracture Surgical Neck of Humerus
Axillary Nerve Palsy - how do we tell If we damaged it or if it was already damaged?
what does this lead on to?
test for reduced sensation on certain skin areas
deltoid atrophy
Upper nerve limb palsies include what nerves
Nerve Roots Brachial Plexus Peripheral Nerves Axillary Radial Musculocuteneous Ulnar Median
lower limb nerve palsies include what nerves
Nerve Roots Sacral and Lumbar Plexus Peripheral Nerves Sciatic Femoral Common Peroneal LFCN
UPPER LIMB NERVE PALSIES - examples from brachial plexus
Erb’s Palsy
Klumpke’s Palsy
Total Brachial Plexus
UPPER LIMB NERVE PALSIES - examples from peripheral nerves
Musculocutaneous (nil) Axillary Axillary nerve palsy secondary to trauma Radial Radial nerve palsy secondary to compression or entrapment Median Carpal tunnel syndrome Ulnar Cubital Tunnel Syndrome
The radial nerve is what nerve roots
c5,6,7,8,t1
Radial nerve is from what ?
supplies what muscle in arm?
where does it run?
Posterior Cord
Supplies Triceps in arm
Runs in radial groove of humerus as it passes from medial to lateral
Supplies BCR, ECRL and ECRB before dividing into PIN (motor) and SRN (sensory) branches
When do you get radial nerve palsies (2)
Entrapment
Compression
sat night palsy - pressure on arm (zone of reduced circulation) - neuropraxia
Radial nerve damage in the axilla symptoms
- loss of elbow extension, wrist - extension and sensory changes forearm and hand
Radial nerve damage in the arm symptoms
loss of wrist extension and sensory loss
Radial nerve damage in the forearm symptoms
loss of finger extension (PIN)
Radial nerve damage in the WRIST symptoms
loss of sensation
test for radial
dorsal aspect of hand - pin prick
Median Nerve (C5,6,7,8,T1)
what chords are supplying?
What does it supply ?
Medial and Lateral Cords
Supplies Flexors of Forearm (Bar FCU and medial half of FDP), LOAF muscles
Supplies sensation to radial 3.5 digits
Median nerve supplies what fingers (4)
index finger
thumb
long finger
half of ring finger
Upper Brachial Plexus (C5,6) causes what palsy
ERB’s
Lower Brachial Plexus (C8, T1) causes what palsy
Klumpke’s
Erb’s palsy is due to traction of ?
C5,6 (+/-C7)
brachial plexus is stretched
erb’s palsy - waiter’s tip position
- Shoulder is adducted and IR
- Elbow is extended and pronated
- Wrist is flexed
Klumpke’s Palsy is due to traction of
of C8/ T1
Very Rare
Affects small muscles of hand- claw hand
Carpal Tunnel - floor is made up of?
what is the roof?
carpal bones
flexor - collagenous tissue
What does carpal tunnel contain (4)
FDS x4, FDP x4, FPL and median nerve ie. 9 tendons and a nerve
Causes of carpal tunnel syndrome
what fractures associated with?
examples of swellings?
Inflammatory?
Metabolic
developmental - thickening
Trauma
Distal radius fracture
Swellings
Ganglion
Fibroma
Lipoma
Rheumatoid
Gout
TB
Amyloid
Pregnancy
Mucopolysaccharidoses
Hyperthyroidism
bilateral carpal syndromes…..
hypothyroidism as potential cause
Carpal Tunnel Syndrome - patient symptoms
wasting of what muscles?
Nocturnal pain and parasthesia in part or all of the median nerve distribution
Wasting of the thenar muscles
Carpal Tunnel Syndrome - what to look for? (3)
Thenar wasting
Previous scars
Deformity (previous fracture)
Carpal Tunnel Syndrome - what to feel for?
test for?
SPECIAL TESTS (2) - how do you do them?
Sensation
power ABD
Tinnels - wrist dorsiflexed, tapped over with middle finger
Phalens
- palmar flex the wrists. both sides, back of hands together
how do we treat CTS?
night splints
can treat hyperthyroidism
steroids
receive pressure - divide roof of CT at level of the wrist
Ulnar Nerve (C8,T1) - lower roots - doesn’t supply anything in the?
what does it supply?
fingers it supplies?
arm
Supplies medial half of FDP, FCU and all intrinsic muscles in hand BAR LOAF.( intrinsic muscles of the hand)
little finger , ulnar Half of the ring finger
ulnar nerve
enters by
guyons cancel
Cubital Tunnel Syndrome
where can you feel it?
Second most common nerve entrapment
Medial epicondyle and olecranon, with fascial bands from FCU as roof
Cubital Tunnel Syndrome - where will patient have numbness?
ulnar side of hand and difficulty with fine tasks. - can affect motor function of intrinsic muscles
Ulnar Nerve Palsy- Muscle Wasting - where do you look first?
what are you looking for (2)
first dorsal web space
Guttering
Hypothenar wasting
What causes ulnar claw hand
Hyperextension at MCPJ, flexion at IPJ’s
phalangeal joints
What is ulnar paradox?
the more distal the lesion , (elbow or wrist) = worst CLAWING
due to intact long flexors with a distal lesion
ulnar nerve power test?
Froment’s Test
Key muscles tested in Froment’s Test
Key muscles:
ADDUCTOR Pollicis (ULNAR NERVE)
FLEXOR Pollicis Longus (MEDIAN NERVE)
If Ulnar nerve not working, the patient will cheat and use FPL instead of Adductor Pollicis (thumb will flex/rise)
The lateral femoral cutaneous nerve of thick?
supplies what area of skin?
where does it lie?
what does it supply
l2,l3
surface of iliac muscle - comes out Inguinal ligament
sensory info to lateral aspect of the thigh
lateral femoral cutaneous nerve treatment
after pregnancy
inject with steroid to shrink swelling -
ultrasound
operate on patient and release the tunnel
Cubital tunnel treatment
steriods
release the tunnel;
Sciatic Nerve - runs from
it is the largest?
where does it exit?
(L4,5,S1,2,3)
nerve in the body Main Branch of
Sacral Plexus
pelvis - through sciatic foramen below piriformis muscle
Sciatic Nerve - what does it supply
Supplies Hamstring muscles in posterior compartment of thigh
Made up of Tibial Nerve and Common Peroneal Nerve
Sciatic is at risk when?
post dislocation of the hip
IM injections
The common fibular nerve / Peroneal Nerve
branches?
L4-S2
smaller and lateral branch of sciatic nerve
Where does the The common fibular nerve / Peroneal Nerve wrap around ?
neck of fibula
behind biceps tendon
What does the common fibular nerve / Peroneal Nerve divide into?
superficial peroneal /fibular - sensory
deep fibular - dorsiflexors of foot and toes
common fibular nerve / Peroneal - risk / sign in patient?
risk of fractures around the fibula neck, long pressure
foot drop, slapping gait (leg lifted higher as foot doesn’t dorsiflex)
What causes Meralgia Parasthetica
Compression of Lateral Femoral Cutaneous Nerve of Thigh
as it travels under lateral border of inguinal ligament
What is Meralgia Parasthetica
Altered sensation and pain in thigh (lateral)
What are the 3 main branches of the lumbar plexus
LFCN
Femoral
Obturator
L1-5
The sacral plexus is ventral rami from
l4 to s4
What nerve supplies the supplies Gluteus medius and minimus and TFL
Superior Gluteal N.
What nerve supplies gluteus maximus
Inferior Gluteal
The main branch of the sacral plexus is?
what does it supply?
Sciatic N., which supplies posterior thigh, leg and foot muscles.
Lower limb - sacral plexus - what nerves come off?
Sciatic
Common Peroneal Nerve
Tibial Nerve
Lower limb - lumbar plexus - nerve?
Femoral Nerve
