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MSK > Nerve Palsies in the Limbs > Flashcards

Nerve Palsies in the Limbs Flashcards

1
Q

Definition of a dermatome

A

Sensory area of skin supplied by a single spinal nerve

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2
Q

How to remember lower limb dermatomes

A

STAND on SI
SLEEP on S2
SIT on S3
SHIT on S4

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3
Q

What is Hiltons Law?

A

The nerves crossing a joint supply the muscles acting on it and the joint itself

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4
Q

Definition of myotome

A

Group of muscles supplied by one segment of the spinal cord

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5
Q

What is the component of a dorsal route?

A

Sensory

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6
Q

What is the component of a ventral route?

A

Motor

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7
Q

C5 myotome pattern

A

elbow flexors

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8
Q

C6 myotome pattern

A

wrist extensors

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9
Q

C7 myotome pattern

A

elbow extensors

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10
Q

C8 myotome pattern

A

finger extensors

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11
Q

T1 myotome pattern

A

intrinsic hand muscles

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12
Q

L2 myotome pattern

A

hip flexors

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13
Q

L3 myotome pattern

A

Knee extensors

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14
Q

L4 myotome pattern

A

ankle dorsiflexors

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15
Q

L5 myotome pattern

A

long toe extensors

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16
Q

S1 myotome pattern

A

ankle plantar flexors

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17
Q

What is the brachial plexus?

A

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

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18
Q

What is the prefixed plexus of the brachial plexus?

A

C4-8

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19
Q

What does the brachial plexus consist of? RUSSEL TAILOR DRINKS COLD BEER

A 
Roots
Trunks
Divisions
Cords
Branches
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20
Q

What do the cords of the brachial plexus lie in relation to?

A

The axillary artery

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21
Q

Roots and cord of the axillary nerve

A

C5, 6

Posterior cord

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22
Q

What does the axillary nerve wrap around?

A

The surgical neck of the humerus

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23
Q

What does the axillary nerve supply?

A

Deltoid and teres minor

Skin over lateral arm = regimental badge area

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24
Q

What results from axillary nerve palsy?

A

Deltoid atrophy
Loss of shoulder abduction (deltoid)
sensory deficit over badge area

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25
Q

When is the axillary nerve at risk?

A

Fracture of humeral neck
Shoulder dislocation
Saturday night palsy (pressure on posterior end of the brachial plexus)

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26
Q

Roots and cords of the radial nerve

A

C5,6,7,8, T1

Posterior cord

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27
Q

What does the radial nerve supply?

A

Triceps
BCR
ECRL
ECRB

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28
Q

What two muscles does the radial nerve pass through to get to the forearm?

A

Brachioradialis

Brachialis

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29
Q

When is the radial nerve at risk?

A

Fracture of the humeral shaft
Saturday night palsy
Exposure of the proximal radius

30
Q

Presentation of radial nerve palsy

A 
Wrist drop (extensors)
Sensory  deficit in 1st webspace dorsally 
Loss of elbow and wrist extension 
Sensory changes in forearm and hand
Loss of finger extension (PIN)
Loss of sensation at wrist (SRN)
31
Q

How could radial nerve entrapment occur?

A

Humerus fracture

32
Q

Roots and cords of the median nerve

A

C5,6,7,8, T1

Medial and lateral cords

33
Q

What does the median nerve supply?

A 
Flexor of forearm
- bar FCU
- medial half of FDP 
LOAF muscles
- L = lateral 2 lumbricals 
- O = opperves pollicus 
- A = adbuctor pollicus brevis 
- F = flexor pollicus brevis 
Sensation to radial 3.5 digits
34
Q

When is the median nerve at risk?

A

carpal tunnel syndrome
wrist lacerations
supracondylar fractures

35
Q

Presentation of medial nerve palsy

A 
Thenar wasting (monkey hand)
Pointing finger 
Sensory deficit to volar aspect of thumb
36
Q

Roots and cords of ulnar nerve

A

Roots C7,8, T1

Medial cord

37
Q

What does the ulnar nerve supply?

A

medial half of FDP and FCU
all instrinsic muscles of the hand BAR LOAF
Sensation to ulnar 1.5 digits

38
Q

When is the ulnar nerve at risk?

A

Fracture of humeral condyles

wrist lacerations

39
Q

Presentation of ulnar nerve palsy

A 
claw hand - hyperextension at MCPJ, flexion at IPJs
hypothenar and 1st dorsal IO webspace
sensory deficit of little finger 
Guttering
Ulnar paradox
40
Q

Roots and cords of musculotaneous nerve

A

C5,6,7

Lateral cord

41
Q

What does the musculotaneous nerve supply?

A

Elbow joint

42
Q

Causes of carpal tunnel syndrome

A 
Developmental 
Idiopathic
Trauma (distal radius fracture)
Swelling - ganglion, fibroma, lipoma 
Inflammatory 
- RA 
- gout
- TB
- amyloid
metabolic
- pregnancy 
- mucopolysaccharides
- hypothyroidism
43
Q

Symptoms of carpal tunnel syndrome

A

Nocturnal pain and paraesthesia in part or all the median nerve distribution
wasting of thenar muscles (once wasted, unlikely to return)
numbness on ulnar side of hand and difficulty doing fine tasks

44
Q

Investigations for carpal tunnel syndrome

A 
Look for 
- thenar wasting
- previous scars
- deformity (previous fracture)
Feel = sensation 
more - APB power
Special tests - Tinnels and phannels 
Froment's test
45
Q

Roots of the sciatic nerve

A

L4, 5, S1, 2, 3

46
Q

What does the sciatic nerve supply?

A

Posterior thigh muscles
Leg muscles
Foot muscles

47
Q

What does the inferior gluteal nerve supply?

A

Gleuteus maximus

48
Q

Roots of the lumbar plexus

A

L1-5

49
Q

Main branches of lumbar plexus

A

Femoral nerve
LFCN
Obturator

50
Q

What is the hip innervated by?

A

Predominately OBTURATOR NERVE
Femoral nerve
Lateral femoral cutaneous nerve

51
Q

Roots of the femoral nerve

A

L2-4

52
Q

What does the femoral nerve supply?

A

(anterior) quadriceps muscles in thigh

hip joint

53
Q

Roots of the lateral femoral cutaneous nerve

A

L2,3

54
Q

What does the lateral femoral cutaneous nerve supply?

A

Purely sensory to the lateral aspect of the thigh

55
Q

What does compression of the lateral femoral cutaneous nerve cause?

A

Meralgia paraesthesia

56
Q

What is largest nerve in the body?

A

The Sciatic nerve

57
Q

What does the sciatic nerve supply?

A

Hamstring muscles (posterior)
Part of the adductor magnus
All lower leg and foot muscles

58
Q

When is the sciatic nerve at risk?

A

Posterior dislocation of the hip
Intra-muscular infections
during surgery

59
Q

Roots of the common fibular nerve

A

L4-S2

60
Q

Presentation of common fibular nerve deficit

A

foot drop

slapping gait

61
Q

What does palsy of the common peroneal nerve cause?

A

Foot drop

62
Q

What is Erbs palsy?

A

Deficit of the upper brachial plexus (C5,6), traction of C5 + C6 (+/- 7)

63
Q

Presentation of erbs palsy

A

Waiters tip position

  • shoulder is adducted and internally rotated
  • elbow is extended
  • wrist is flexed
64
Q

What is Klumpe’s palsy?

A

Deficit of the lower brachial plexus (C8, T1), traction of C8/T1

65
Q

Presentation of klumpe’s palsy

A

claw hand

hyperextended wrist

66
Q

What syndrome is the median nerve affected?

A

Carpal tunnel syndrome

67
Q

What syndrome is the ulnar nerve affected?

A

cubital tunnel syndrome

68
Q

If someone develops winging of the scapula, what nerve is affected?

A

Long thoracic nerve

69
Q

When can the long thoracic nerve be damaged?

A

Masectomy

70
Q

How can nerve root pain be distinguished from other types of pain?

A

Pain by dermatomal distribution with associated neurological deficit

MSK (25 decks)

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