Nerve Palsies in the Limbs Flashcards
What is erb’s palsy - CF and RF
Downward traction of C5/6
Waiters’ tip - shoulder adduction and internal rotation, elbow extension, forearm pronation and wrist flexion
Common in neonates during birth as head is pulled out
What is klumpke’s palsy - causes and features
Traction C8-T1
Falling out tree or pulled out hand first in birth
Claw hand - intrinsic muscles of hand
Causes of axillary nerve palsy
Shoulder dislocation
Fracture of surgical neck of humerus
Clinical features of axillary nerve palsy
Loss of shoulder abduction
Deltoid atrophy and regimental badge area numbness
Radial nerve palsy causes
Secondary to compression (i.e. Saturday night palsy) and entrapment (humerus fracture)
Symptoms of radial nerve palsy
Depend on site of lesion
- axilla –> loss of elbow and wrist extension and sensory changes in the forearm and hand
- arm –> loss of wrist extension (wrist drop) and sensory loss
- Forearm –> loss of finger extension n
- Wrist –> loss of sensation in 1st web space dorsally
Causes of median nerve palsy
Carpal tunnel syndrome
Wrist lacerations
Supracondylar #s
Causes of carpal tunnel syndrome
Idiopathic Trauma - distal radial # Swellings - ganglion, fibroma, lipoma Inflammatory - RA, gout, TB, amyloid Metabolic - pregnancy (fluid overload), mucopolysaccharides, hypothyroidism
Symptoms / signs of carpal tunnel
Nocturnal pain and paraesthesia in median nerve distribution
Wasting of thenar muscles (monkey hand)
Pointing finger
Examination for suspected carpal tunnel
Look - thenar wasting, previous scars, deformity
Feel - loss of sensation on volar aspect of thumb
Move - APB power
Tinnels - tap over carpal tunnel
Phalens - reverse prayer 1m
Treatment of carpal tunnel
Splint
Steroid injection
Carpal tunnel release surgery
Causes of ulnar nerve palsy
# humeral condyles Wrist lacteration
Clinical features of ulnar nerve palsy (cubital tunnel)
Numbness of ulnar side of hand Difficulty with fine tasks Wasting of 1st web space (dorsal interosseous), guttering, hypothenars Ulnar claw hand - hyperextension at MCPJ - Flexion at IPJs
What is the ulnar paradox
A distal lesion has worse clawing than a proximal lesion due to its intact long flexors with a distal lesion
Test for cubital tunnel syndrome
Froment’s test
- ask patient to grip paper between fist and thumb, if the ulnar nerve is not working, the patient will cheat and use flexor policies Longus instead of adductor pollicis