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MSK > Nerve Palsies in the Limbs > Flashcards

Nerve Palsies in the Limbs Flashcards

1
Q

Define dermatome

A

A sensory area of the skin supplied by a single spinal nerve

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2
Q

Can occurs at adjacent ?dermatomes/

A

Can be considerable overlap

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3
Q

Where is there no overlap?

A

Between adjacent pre and post axial dermatomes

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4
Q

What is the mnemonic to remember the sacral dermatomes?

A

Stand on S1
Sleep on S2
Sit on S3
Shit from S4

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5
Q

What is Hilton’s law?

A

The nerves supplying the joint capsule also supply the muscles regulating the movement over the joint and the skin over the joint

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6
Q

What supplies the hip and knee joint?

A

Both supplied by femoral, sciatic and obturator

This is why hip dx may give rise to knee pain

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7
Q

What nerve predominantly supplies the hip joint?

A

Obturator nerve (& femoral & lateral cutaneous)

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8
Q

Define myotome

A

Group of muscles supplied by one segment of the spinal cord

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9
Q

What is the brachial plexus?

A

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

NERVES C5-T1 (but variable - can be pre or postfixed)

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10
Q

What are the components of the brachial plexus?

A

Roots, trunks, divisions, cords, branches

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11
Q

What brachial plexus lesion causes a porter’s tip deformity?

A

Erb-Duchenne paralysis - injury to the UPPER brachial plexus (C5-C6)

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12
Q

What can cause Erb-Duchenne paralysis?

A

Downward traction, e.g. falling on head and shoulder

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13
Q

What are the clinical features of Erb-Duchenne paralysis?

A

Weakness in C5 and 6 muscles (deltoid, brachialis, triceps) –> flexed wrist, extended forearm, internally rotated and abducted arm

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14
Q

What brachial plexus injury can cause a clawed hand?

A

Klumpke paralysis - injury to the LOWER brachial plexus (C8-T1)

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15
Q

What causes Klumpke paralysis?

A

UPWARD traction e.g. hyperabduction of the arm, e.g. breaking a fall by grabbing a branch or breech delivery (excessive traction of arm) or compression of the lower trunk, e.g. by a Pancoast tumour

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16
Q

What are the signs and symptoms of Klumpke paralysis?

A

Weakness in the C8-T1 myotomes (intrinsic muscles of the hand) –> claw hand

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17
Q

What are the roots of the axillary nerve and where does it come off of the brachial plexus?

A

Direct continuation of posterior cord

C5 and C6

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18
Q

What muscles does the axillary nerve innervate?

A

Deltoid, teres minor and skin overlying the deltoid

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19
Q

When is someone at risk of axillary nerve palsy?

A

Where the axillary nerve spirals round the surgical neck of the humerus it is vulnerable to palsy –> therefore at risk during surgical neck fracture, shoulder dislocation

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20
Q

What are the clinical features of axillary nerve palsy?

A

Loss of shoulder abduction (by deltoid)

Loss of sensation over badge area

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21
Q

What are the roots of the radial nerve and where does it come off of the brachial plexus?

A

Continuation of posterior cord of brachial plexus

C5-T1

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22
Q

What does the radial nerve innervate?

A

Triceps, brachioradialis, supinator, muscles of extensor compartment of the forearm, skin of dorsal arm, forearm and hand

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23
Q

With what is the radial nerve closely associated in the arm?

A

Profunda brachii artery

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24
Q

How does the radial nerve enter the arm?

A

By passing between the brachioradialis and brachialis

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25
Q

Where is the radial nerve at risk of damage?

A

Where it spirals round the groove in the humerus and lateral intermuscular septum –> therefore at risk during humeral shaft fractures, Saturday night palsy, exposure of proximal radius

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26
Q

What is Saturday night palsy?

A

Compression of the posterior cord of the brachial plexus when sleeping with arm over chair, edge of bed etc.

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27
Q

What are the clinical features of radial nerve palsy?

A

Wrist drop

Sensory deficit in first webbed space dorsally

28
Q

What are the nerve roots for the median nerve and what cords does it come off of the brachial plexus?

A

C6-T1

Medial and lateral cords

29
Q

In the arm what structure is the median nerve closely associated with?

A

Brachial artery

30
Q

What does the median nerve innervate?

A

All muscles of flexor compartment (except flexor carpi ulnaris, medial half of flexor digitorum profundus), thenar muscles and lateral two lumbricals

31
Q

How does the median nerve enter the forearm?

A

Passing between two heads of pronator teres

32
Q

Where is the median nerve at risk of damage?

A

At volar aspect of wrist and cubital fossa

Damage may occur as a result of carpal tunnel syndrome, wrist laterations, supracondylar fractures, Struther’s ligament

33
Q

What is carpal tunnel syndrome?

A

Compression of the medial nerve by the transverse carpal ligament –> disturbances, weakness and clumsiness of the hand

Commoner in those who repeatedly flex/extend the wrist

34
Q

What does damage to the median nerve lead to?

A

Thenar wasting, pointing finger motor deficit

Sensory deficit on volar aspect of thumb

35
Q

What are the roots of the ulnar nerve and what cord in the brachial plexus does it come off of?

A

C7-T1

Medial cord

36
Q

In the arm, what structure is the ulnar nerve closely related to?

A

Superior ulnar collateral artery (esp at wrist)

37
Q

What does the ulnar nerve innervate?

A

Flexor carpi ulnaris, medial 1/2 of flexor digitorum profundus and several hand muscles

38
Q

How does the ulnar nerve enter the forearm?

A

Passing between two heads of flexor carpi ulnaris

39
Q

When is the ulnar nerve at risk of damage?

A

Where it passes behind the medial epicondyle of the humerus and Canal of Guyon –> at wrist during humeral condyle fractures and wrist lacerations

40
Q

What is the Canal of Guyon?

A

Semi-rigid tunnel in wrist that allows passage of ulnar artery and nerve into the hand

41
Q

What are the clinical features of ulnar nerve damage?

A

Claw hand, hypothenar and 1st dorsal interosseous motor deficit
Sensory deficit over little finger

42
Q

Where does the lumbar plexus lie?

A

Surface of quadratus lumborum and within the body of the psoas

43
Q

Where do most major nerves about the hip exit?

A

Via the sciatic foramen - EXCEPT the genitofemoral, ilioinguinal, femoral, lateral femoral cutaneous and obturator nerves

44
Q

What are the roots of the femoral nerve?

A

L2-4

45
Q

What is the largest branch of the lumbar plexus?

A

Femoral nerve

46
Q

What is the pathway of the femoral nerve?

A

Goes through psoas muscle, exit pelvis via inguinal ligament (lat to femoral artery, vein and lymphatic channels in the femoral triangle)

47
Q

What does the femoral nerve innervate?

A

Quadriceps femoris, iliacus, sartorius, pectineus

48
Q

What does the femoral nerve terminate as?

A

Saphenous nerve (which accompanies femoral artery in the subsartorial canal of the thigh and long saphenous vein in the lower leg in front of the medial malleolus at ankle to supply the great toe)

49
Q

What are the roots of the lateral femoral cutaneous nerve?

A

L2 and L3

50
Q

Where does the lateral femoral cutaneous nerve lie?

A

On surface of iliacus muscle, usually exits pelvis under lateral end of inguinal ligament

51
Q

What does the lateral femoral cutaneous nerve innervate?

A

Sensory to lateral aspect of thigh

52
Q

What is meralgia paraesthetica?

A

Compression of the lateral femoral cutaneous nerve leads to pain/paraesthesia over the lateral surface of the anterior thigh

53
Q

What are the roots of the sciatic nerve?

A

L3-4

54
Q

What is the largest nerve in the body?

A

Sciatic

55
Q

How does the sciatic nerve exit the pelvis?

A

Via the sciatic foramen below the piriformis muscle

56
Q

What muscle does the sciatic nerve run deep to?

A

Gluteus maximus

57
Q

What does the sciatic nerve innervate?

A

Hamstrings, part of adductor magnus, all lower leg and foot muscles via terminal branches

58
Q

What are the two terminal branches of the sciatic nerve?

A

Common fibular and tibial nerve

59
Q

When is the sciatic nerve at risk of damage?

A

Posterior dislocation of hip, intra-muscular injections and surgery

60
Q

What are the nerve roots of the common fibular nerve?

A

L4-S2

61
Q

What is the pathway of the common fibular nerve?

A

Passes round lateral aspect of neck of fibula

62
Q

When is the common fibular nerve at risk of injury?

A

Fibular head fracture/compression, e.g. tight casts/sitting crossed legged

63
Q

What deficit results from damage to common fibular nerve?

A

Foot drop, slapping gait

64
Q

What does the common fibular nerve innervate?

A

Lateral surface of lower leg and back of feet, toes, foot, toe extensors and foot pronators

65
Q

What does the common fibular nerve divide into?

A

Deep and superficial fibular nerves

MSK (27 decks)

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