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Year 2- MSK > Nerve Palsies in the Limbs > Flashcards

Nerve Palsies in the Limbs Flashcards

1
Q

RECAP- five terminal branches of the brachial plexus?

A

Musculocutaneous
Axillary
Radial
Median
Ulnar

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2
Q

Which two parts of life are brachial plexus lesions most common?

A

Childbirth- being pulled out through a tight space

Falling onto shoulder (…this isn’t a part of life tho)

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3
Q

Which nerve roots may be damaged during childbirth?

A

C5-6

->supplying shoulder muscles, deltoid, brachialis and biceps)

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4
Q

What is the name of one of the most common neurological birth injuries affecting the brachial plexus?

A

Erb palsy/ Erb-Duchenne paralysis

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5
Q

What happens to the arm in Erb-Duchenne paralysis?

A

Arm is adduced as shoulder no longer works
Elbow is extended as biceps isn’t working
Forearm pronated
Wrist flexed

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6
Q

Which nerve palsy can occur due to upward traction e.g. birthing in breech position, pulling on arm?

A

Klumpke’s palsy

->pulling of arm is like if trying to hold onto a branch to prevent falling

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7
Q

What is the sign of Klumpke’s palsy?

A

Claw hand

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8
Q

Axillary nerve roots?

A

C5,6

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9
Q

Where does the axillary nerve wrap around?

A

Surgical neck of humerus

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10
Q

Which muscles does the axillary nerve supply?

A

Deltoid
Teres minor
Skin over lateral area- regimental badge area

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11
Q

In which injury in the axillary nerve often damaged?

A

Shoulder dislocation

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12
Q

What happens to the deltoid muscle in axillary nerve injury?

A

Deltoid atrophy

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13
Q

Radial nerve roots?

A

C5-T1

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14
Q

Which cord(s) does the radial nerve come from?

A

Posterior cord

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15
Q

Which arm muscle does the radial nerve supply?

A

Triceps

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16
Q

Which part of the humerus does the radial nerve run along?

A

Radial groove

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17
Q

Which muscles in the forearm does the radial nerve supply?

A

Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis

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18
Q

When may there be radial nerve palsies?

A

Humerus fracture- can become entrapped

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19
Q

The radial nerve can be compressed and cause which palsies?

A

Saturday night palsy
Honeymoon palsy
Crutch palsy

->commonly individual falls asleep on a Saturday night after having a few too many drinks with arm over back of chair, providing pressure on the radial nerve for a prolonged period

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20
Q

The symptoms of a radial nerve palsy depend on the site of the compression.
What would be the symptoms if the radial nerve was compressed in the axilla?

A

Loss of elbow extension
Loss of wrist extension
Sensory changes on forearm and hand

->this is because loss of triceps

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21
Q

The symptoms of a radial nerve palsy depend on the site of the compression.
What would be the symptoms if the radial nerve was compressed in the arm?

A

Loss of wrist extension
Sensory loss

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22
Q

The symptoms of a radial nerve palsy depend on the site of the compression.
What would be the symptoms if the radial nerve was compressed in the forearm?

A

Loss of finger extension

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23
Q

The symptoms of a radial nerve palsy depend on the site of the compression.
What would be the symptoms if the radial nerve was compressed in the wrist?

A

Loss of sensation

->can occur if wearing handcuffs

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24
Q

Which area of the hand is tested for fine touch and sensation of the radial nerve?

A

First web space on the dorsal aspect

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25
Q

Which cord(s) does the median nerve come from?

A

Medial and lateral cords

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26
Q

What dos the medial nerve supply in the forearm?

A

Flexors
LOAF muscles (lateral two lumbricals, opponens pollicus, abductor pollicus brevis, flexor pollicus brevis)

->except for flexor carpi ulnaris and medial half of flexor digitorum profundus)

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27
Q

Which digits does the median nerve supply sensation to?

A

Radial 3.5 digits

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28
Q

When suspecting carpal tunnel syndrome, if thenar sensation is retained, what does this suggest?

A

Suggests that the median nerve in injured proximal to the carpal tunnel

29
Q

RECAP- floor of carpal tunnel?

A

Carpal bones

30
Q

RECAP- roof of carpal tunnel?

A

Flexor retinaculum

31
Q

RECAP- contents of carpal tunnel?

A

Median nerve
4x tendons of FDS
4x tendons of FDP

32
Q

List some causes of Carpal Tunnel Syndrome.

A

Developmental
Trauma- distal radius fracture
Swellings
Inflammatory-rheumatoid, gout
Metabolic- pregnancy, hypothyroidism

33
Q

If you see bilateral carpal tunnel syndrome, what should you think of?

A

Hypothyroidism

34
Q

Symptoms of carpal tunnel syndrome?

A

Nocturnal pain and paraesthesia in part or all of median nerve distribution
Wasting of thenar muscles

35
Q

Upon examination, what do you look for in carpal tunnel syndrome?

A

Thenar wasting
Previous scars (lack of sensation causing injuries)
Deformity

36
Q

Upon examination, what do you feel for in carpal tunnel syndrome?

A

Sensation

37
Q

Upon examination, what do you move for in carpal tunnel syndrome?

A

Abductor pollicus brevis

38
Q

What are the two special tests for carpal tunnel syndrome?

A

Tinnels test
Phalens test

39
Q

Tinnels test?

A

Area over carpal tunnel tapped repeatedly
If carpal tunnel syndrome, will be shooting sensations with each tap

40
Q

Phalens test?

A

Upside down prayer sign basically for a minute and will start to feel pain and tingling

41
Q

How is Carpal Tunnel Syndrome treated?

A

Sometime splints
Steroid injection
Treat underlying cause e.g. hypothyroidism

However, ultimately, carpal tunnel release in surgery

42
Q

Ulnar nerve roots?

A

C8-T1

43
Q

Where does the ulnar nerve enter the forearm?

A

Between the two heads of the flexor carpi ulnaris

44
Q

Which muscles does the ulnar nerve supply?

A

Medial half of FDP
Flexor carpi ulnaris
Intrinsic hand muscles except the LOAF muscles1!!

->LOAF
Lateral two lumbricals
Opponens pollicus
Abductor pollicus brevis
Flexor pollicus brevis

45
Q

Where does the ulnar nerve supply sensation to?

A

Ulnar 1.5 digits

46
Q

What is the second most common nerve entrapment?

A

Cubital tunnel syndrome

->cubital tunnel between medial epicondyle and olecranon

47
Q

What are the symptoms of cubital tunnel syndrome?

A

Patient has numbness on ulnar side of hand and has difficulty with fine tasks

48
Q

RECAP- what nerve is compressed in carpal tunnel syndrome?

A

Medial nerve

49
Q

RECAP- which nerve is compressed in cubital tunnel syndrome?

A

Ulnar nerve

50
Q

What is seen in ulnar nerve palsies?

A

Wasting of muscles:
-1st web space, often the most marked
-Guttering between digits
-Hypothenar wasting

51
Q

Which feature is only seen if the ulnar nerve is compressed significantly?

A

Ulnar claw hand- hyperextension at MCPJ and flexion at IPJ

52
Q

Test for ulnar nerve power?

A

Froment’s test

->patient holds paper in a certain way without flexing fingers but if flexed, ulnar nerve is damaged

53
Q

Roots of lateral femoral cutaneous nerve?

A

L2-3

54
Q

Where does the lateral femoral cutaneous nerve lie?

A

Surface of iliacus muscle

55
Q

What is the supply of the lateral femoral cutaneous nerve?

A

Purely sensory to lateral aspect of the thigh

56
Q

Merlagia paraesthesia?

A

Compression of lateral femoral cutaneous nerve

57
Q

When is a typical scenario of meralgia paraesthesia to occur?

A

Pregnancy

58
Q

If not pregnancy related, what is the treatment for meralgia paraesthesia?

A

Steroid injection

->after this if it settles but then comes back, operate on patient to release nerve like carpal tunnel release

59
Q

Sorry going back a minute, what is treatment for cubital tunnel syndrome?

A

Steroid injection

60
Q

Largest nerve in body?

A

Sciatic nerve

61
Q

Sciatic nerve roots?

A

L4-S3

62
Q

Where would you find sciatic nerve?

A

Exits pelvis through sciatic foramen below the piriformis muscle

63
Q

Which muscle does the sciatic nerve run deep to?

A

Gluteus maximus

64
Q

Which muscles does the sciatic nerve supply?>

A

Hamstring muscles
Part of adductor magnus
All lower leg and foot muscles via terminal branches

65
Q

What can put the sciatic nerve at risk of damage?

A

Posterior dislocation of hip
Intramuscular injections (injections in the buttock)
Surgery

->significant injury to sciatic nerve is devestating

66
Q

Roots of common fibular nerve?

A

L4-S2

->small branch of sciatic nerve

67
Q

Where does the common fibular nerve pass?

A

Around the lateral aspect of the neck of fibula

68
Q
A

Year 2- MSK (36 decks)

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