Nerve Palsies in the Limbs

Question 1

What is erb’s palsy - CF and RF

Answer 1

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

Question 2

What is klumpke’s palsy - causes and features

Answer 2

Traction C8-T1
Falling out tree or pulled out hand first in birth
Claw hand - intrinsic muscles of hand

Question 3

Causes of axillary nerve palsy

Answer 3

Shoulder dislocation

Fracture of surgical neck of humerus

Question 4

Clinical features of axillary nerve palsy

Answer 4

Loss of shoulder abduction

Deltoid atrophy and regimental badge area numbness

Question 5

Radial nerve palsy causes

Answer 5

Secondary to compression (i.e. Saturday night palsy) and entrapment (humerus fracture)

Question 6

Symptoms of radial nerve palsy

Answer 6

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

Question 7

Causes of median nerve palsy

Answer 7

Carpal tunnel syndrome
Wrist lacerations
Supracondylar #s

Question 8

Causes of carpal tunnel syndrome

Answer 8

Idiopathic 
Trauma - distal radial #
Swellings - ganglion, fibroma, lipoma
Inflammatory - RA, gout, TB, amyloid 
Metabolic - pregnancy (fluid overload), mucopolysaccharides, hypothyroidism

Question 9

Symptoms / signs of carpal tunnel

Answer 9

Nocturnal pain and paraesthesia in median nerve distribution
Wasting of thenar muscles (monkey hand)
Pointing finger

Question 10

Examination for suspected carpal tunnel

Answer 10

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

Question 11

Treatment of carpal tunnel

Answer 11

Splint
Steroid injection
Carpal tunnel release surgery

Question 12

Causes of ulnar nerve palsy

Answer 12

# humeral condyles 
Wrist lacteration

Question 13

Clinical features of ulnar nerve palsy (cubital tunnel)

Answer 13

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

Question 14

What is the ulnar paradox

Answer 14

A distal lesion has worse clawing than a proximal lesion due to its intact long flexors with a distal lesion

Question 15

Test for cubital tunnel syndrome

Answer 15

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

Question 16

Causes of sciatic nerve palsy

Answer 16

Posterior dislocation of hip
IM injections
Surgical procedures of leg

Question 17

What does palsy of the common peroneal (fibular) nerve cause

Answer 17

Foot drop and slapping gait

Question 18

What does compression of the lateral femoral cutaneous nerve cause

Answer 18

Lies on the surface of the iliac muscle and exits pelvis under lateral end of inguinal ligament
If compressed as it travels under IL causes MERALGIA PARASTHETICA - altered sensation in lateral thigh