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MSK > Nerve Palsies in the Limbs > Flashcards

Nerve Palsies in the Limbs Flashcards

1
Q

What is a dermatome?

A

A sensory area of skin supplied by a single spinal nerve

Adjacent dermatomes overlap considerably

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2
Q

What are axial lines?

A

Result of embryological development of limb buds growing out from body wall (anterior and posterior)

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3
Q

Is there any overlap between adjacent pre- and post-axial dermatomes?

A

No

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4
Q

STAND on?

A

S1

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5
Q

SLEEP on?

A

S2

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6
Q

SIT on?

A

S3

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7
Q

SHIT on?

A

S4

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8
Q

What is Hilton’s Law?

A 
The nerves crossing a joint supply the muscles acting on it and the joint itself
(The motor nerve to a 
muscle tends to give
a branch of supply to 
the joint that the 
muscle moves, and 
another to the skin 
over the joint)
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9
Q

Which nerves supply the hip joint (3)?

A
  • Obturator nerve (predominantly)
  • Femoral nerve
  • Lateral femoral cutaneous nerve
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10
Q

What is a myotome?

A

Group of muscles supplied by one segment of spinal cord

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11
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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12
Q

What is the brachial plexus divided into?

A

Roots -> trunks -> divisions -> cords -> branches

SAVED AS BRACHIAL NERVES

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13
Q

What is porter’s tip?

A

Erb-Duchenne paralysis

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14
Q

Brachial plexus lesions - what damage is caused by downward traction e.g. fall on side of neck?

A
  • C5, 6 damage (deltoid & shoulder muscles, brachialis & biceps)
  • Porter’s tip
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15
Q

Brachial plexus lesions - what damage is caused by upward traction e.g. breech delivery?

A
  • T1 damage (intrinsic muscles)

* Hand “clawed” (Klumpke’s paralysis)

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16
Q

Brachial plexus lesions - what damage is caused by upward traction e.g. breech delivery?

A
  • T1 damage (intrinsic muscles)

* Hand “clawed” (Klumpke’s paralysis)

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17
Q

What anatomical terms should be used to describe the forearm?

A

•Use “RADIAL” and “ULNAR”
(rather than lateral and medial)
•Use “VOLAR” or “PALMAR” and “DORSAL”
(rather than anterior and posterior)

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18
Q

How might the axillary nerve be damaged?

A

•Fracture of humeral neck
•Shoulder dislocation
•Saturday night palsy
(branch of brachial plexus)

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19
Q

What does motor deficit of the axillary nerve cause?

A

Loss of shoulder abduction - deltoid

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20
Q

What does sensory deficit of the axillary nerve cause?

A

Loss of sensation in badge area

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21
Q

What are the roots of the radial nerve?

A

C5-8, T1

SAME AS BRACHIAL PLEXUS

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22
Q

What artery is the radial nerve associated with?

A

Profunda brachii

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23
Q

How does the radial nerve enter the forearm?

A

By passing between the brachioradialis and brachialis

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24
Q

In which areas is the radial nerve at risk of damage?

A
  • Spiral groove of humerus

* Lat. intermuscular septum

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25
Q

How might the radial nerve become damaged?

A
  • Humeral shaft fracture
  • Saturday night palsy
  • Exposure of proximal radius
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26
Q

What does motor deficit of the radial nerve cause?

A

Wrist drop

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27
Q

What does sensory deficit of the radial nerve cause?

A

1st web space dorsally

28
Q

What are the roots of the median nerve?

A

C7-8, T1

29
Q

Which artery is the median nerve closely associated with?

A

Brachial artery

30
Q

How does the median nerve enter the forearm?

A

By passing between the two heads of the pronator teres

31
Q

In which areas is the median nerve at risk of damage?

A

Volar aspect wrist (& cubital fossa)

32
Q

How might the median nerve become damaged?

A
  • Complication of carpal tunnel syndrome

* Wrist lacerations

33
Q

What does motor deficit of the median nerve cause?

A
  • Thenar wasting (monkey hand)

* Pointing finger

34
Q

What does sensory deficit of the median nerve cause?

A

Sensory loss in the volar aspect of the thumb

35
Q

What are the roots of the ulnar nerve?

A

C7-8, T1

36
Q

What artery is the ulnar nerve associated with?

A

Superior ulnar collateral artery

37
Q

How does the ulnar nerve enter the forearm

A

By passing between two heads of flexor carpi ulnaris

38
Q

Where is the ulnar nerve at risk?

A

Behind medial epicondyle of humerus

39
Q

What might cause damage to the ulnar nerve?

A

Fracture of humeral condyles

40
Q

What does motor deficit of the ulnar nerve cause?

A
  • Claw hand

* Hypothenar and 1st dorsal interosseous wasting

41
Q

What does sensory deficit of the ulnar nerve cause?

A

Little finger

42
Q

Where is the lumbar plexus?

A

Les in surface of quadrates lumborum and within body of psaos muscle

43
Q

Where do most of the major nerves around the hip exit the pelvis?

A

The sciatic foramen

44
Q

Which nerves around the hip do not exit the pelvis by the sciatic foramen?

A
  • Genitofemoral
  • Ilioinguinal
  • Femoral
  • Lateral femoral cutaneous
  • Obturator
45
Q

What are the roots of the femoral nerve?

A

L2-4

46
Q

What is the largest branch of the lumbar plexus?

A

Femoral nerve

47
Q

What is the route of the femoral nerve?

A
  • Passes through psoas muscle
  • Exits pelvis under inguinal ligament, lateral to femoral artery, vein and lymphatic channels in femoral triangle - VAN with Vein next to “V” of legs
48
Q

What does the femoral nerve supply?

A

Quadriceps muscles in thigh (anterior)

49
Q

How does the femoral nerve terminate?

A

Terminates in long fine sensory branch (Saphenous Nerve - accompanies femoral artery in subsartorial canal of thigh, and long saphenous vein in lower leg and in front of medial malleolus at ankle to supply great toe)

50
Q

What are the roots of the lateral femoral cutaneous nerve?

A

L2-3

51
Q

Where is the lateral femoral cutaneous nerve?

A

Lies on the surface of iliac muscle

52
Q

Where does the lateral femoral cutaneous nerve exit the pelvis?

A

Usually exits pelvis under lateral end of inguinal ligament, but variable

53
Q

What is the function of the LFCN?

A

Purely sensory to lateral aspect of thigh

54
Q

What does compression of the LFCN cause?

A

Meralgia paraesthetica

55
Q

What are the roots of the sciatic nerve?

A

L4-S3

56
Q

Describe the sciatic nerve

A
  • Largest nerve in body
  • Main branch of sacral plexus
  • Broad and flat with accompanying artery
57
Q

Where does the sciatic nerve exit the pelvis?

A

Sciatic foramen (below piriformis muscle)

58
Q

Where does the sciatic nerve run?

A

Deep to the gluteus maximus muscle

59
Q

What does the sciatic nerve supply?

A
  • Supplies hamstring muscles in thigh (posterior)
  • Part of adductor magnus
  • All lower leg and foot muscles via terminal branches (tibial and common fibular nerves) - height of division variable (really 2 nerves)
60
Q

What may cause damage to the sciatic nerve?

A
  • Posterior dislocation of hip
  • Intra-muscular injections
  • During surgery - division devastating
61
Q

What are the roots of the common fibular nerve?

A

L4-S2

previously called lateral popliteal nerve, then common peroneal nerve

62
Q

From what nerve does the common fibular nerve arise?

A

Sciatic - smaller and lateral branch

63
Q

What is the route of the common fibular nerve?

A

Passes around lateral aspect of neck of fibula

64
Q

What is the effect of deficit of the common fibular nerve?

A

Foot drop and slapping gait - most commonly injured nerve in lower limb

65
Q

Describe the common fibular nerve

A
  • Communicating branch to sural nerve

* Divides into superficial and deep fibular nerves

MSK (28 decks)

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