Nerve Palsies in the Limbs

Question 1

RECAP- five terminal branches of the brachial plexus?

Answer 1

Musculocutaneous
Axillary
Radial
Median
Ulnar

Question 2

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

Answer 2

Childbirth- being pulled out through a tight space

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

Question 3

Which nerve roots may be damaged during childbirth?

Answer 3

C5-6

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

Question 4

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

Answer 4

Erb palsy/ Erb-Duchenne paralysis

Question 5

What happens to the arm in Erb-Duchenne paralysis?

Answer 5

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

Question 6

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

Answer 6

Klumpke’s palsy

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

Question 7

What is the sign of Klumpke’s palsy?

Answer 7

Claw hand

Question 8

Axillary nerve roots?

Answer 8

C5,6

Question 9

Where does the axillary nerve wrap around?

Answer 9

Surgical neck of humerus

Question 10

Which muscles does the axillary nerve supply?

Answer 10

Deltoid
Teres minor
Skin over lateral area- regimental badge area

Question 11

In which injury in the axillary nerve often damaged?

Answer 11

Shoulder dislocation

Question 12

What happens to the deltoid muscle in axillary nerve injury?

Answer 12

Deltoid atrophy

Question 13

Radial nerve roots?

Answer 13

C5-T1

Question 14

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

Answer 14

Posterior cord

Question 15

Which arm muscle does the radial nerve supply?

Answer 15

Triceps

Question 16

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

Answer 16

Radial groove

Question 17

Which muscles in the forearm does the radial nerve supply?

Answer 17

Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis

Question 18

When may there be radial nerve palsies?

Answer 18

Humerus fracture- can become entrapped

Question 19

The radial nerve can be compressed and cause which palsies?

Answer 19

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

Question 20

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?

Answer 20

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

->this is because loss of triceps

Question 21

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?

Answer 21

Loss of wrist extension
Sensory loss

Question 22

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?

Answer 22

Loss of finger extension

Question 23

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?

Answer 23

Loss of sensation

->can occur if wearing handcuffs

Question 24

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

Answer 24

First web space on the dorsal aspect

Question 25

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

Answer 25

Medial and lateral cords

Question 26

What dos the medial nerve supply in the forearm?

Answer 26

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)

Question 27

Which digits does the median nerve supply sensation to?

Answer 27

Radial 3.5 digits

Question 28

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

Answer 28

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

Question 29

RECAP- floor of carpal tunnel?

Answer 29

Carpal bones

Question 30

RECAP- roof of carpal tunnel?

Answer 30

Flexor retinaculum

Question 31

RECAP- contents of carpal tunnel?

Answer 31

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

Question 32

List some causes of Carpal Tunnel Syndrome.

Answer 32

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

Question 33

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

Answer 33

Hypothyroidism

Question 34

Symptoms of carpal tunnel syndrome?

Answer 34

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

Question 35

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

Answer 35

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

Question 36

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

Answer 36

Sensation

Question 37

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

Answer 37

Abductor pollicus brevis

Question 38

What are the two special tests for carpal tunnel syndrome?

Answer 38

Tinnels test Phalens test

Question 39

Tinnels test?

Answer 39

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

Question 40

Phalens test?

Answer 40

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

Question 41

How is Carpal Tunnel Syndrome treated?

Answer 41

Sometime splints Steroid injection Treat underlying cause e.g. hypothyroidism However, ultimately, carpal tunnel release in surgery

Question 42

Ulnar nerve roots?

Answer 42

C8-T1

Question 43

Where does the ulnar nerve enter the forearm?

Answer 43

Between the two heads of the flexor carpi ulnaris

Question 44

Which muscles does the ulnar nerve supply?

Answer 44

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

Question 45

Where does the ulnar nerve supply sensation to?

Answer 45

Ulnar 1.5 digits

Question 46

What is the second most common nerve entrapment?

Answer 46

Cubital tunnel syndrome ->cubital tunnel between medial epicondyle and olecranon

Question 47

What are the symptoms of cubital tunnel syndrome?

Answer 47

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

Question 48

RECAP- what nerve is compressed in carpal tunnel syndrome?

Answer 48

Medial nerve

Question 49

RECAP- which nerve is compressed in cubital tunnel syndrome?

Answer 49

Ulnar nerve

Question 50

What is seen in ulnar nerve palsies?

Answer 50

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

Question 51

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

Answer 51

Ulnar claw hand- hyperextension at MCPJ and flexion at IPJ

Question 52

Test for ulnar nerve power?

Answer 52

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

Question 53

Roots of lateral femoral cutaneous nerve?

Answer 53

L2-3

Question 54

Where does the lateral femoral cutaneous nerve lie?

Answer 54

Surface of iliacus muscle

Question 55

What is the supply of the lateral femoral cutaneous nerve?

Answer 55

Purely sensory to lateral aspect of the thigh

Question 56

Merlagia paraesthesia?

Answer 56

Compression of lateral femoral cutaneous nerve

Question 57

When is a typical scenario of meralgia paraesthesia to occur?

Answer 57

Pregnancy

Question 58

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

Answer 58

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

Question 59

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

Answer 59

Steroid injection

Question 60

Largest nerve in body?

Answer 60

Sciatic nerve

Question 61

Sciatic nerve roots?

Answer 61

L4-S3

Question 62

Where would you find sciatic nerve?

Answer 62

Exits pelvis through sciatic foramen below the piriformis muscle

Question 63

Which muscle does the sciatic nerve run deep to?

Answer 63

Gluteus maximus

Question 64

Which muscles does the sciatic nerve supply?>

Answer 64

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

Question 65

What can put the sciatic nerve at risk of damage?

Answer 65

Posterior dislocation of hip Intramuscular injections (injections in the buttock) Surgery ->significant injury to sciatic nerve is devestating

Question 66

Roots of common fibular nerve?

Answer 66

L4-S2 ->small branch of sciatic nerve

Question 67

Where does the common fibular nerve pass?

Answer 67

Around the lateral aspect of the neck of fibula