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14. Year 2: Musculoskeletal > Nerve Palsies in the Limbs > Flashcards

Nerve Palsies in the Limbs Flashcards

1
Q

Describe the brachial plexus?

A

From spinal roots C5-T1 > upper, middle and lower trunk > anterior/posterior divisions > medial/lateral cords > branches

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2
Q

Brachial lesions are common in what?

A

Childbirth

Upwards traction (such as fall onto side of neck - upper cord damage)

Downwards traction - lower cord damage

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3
Q

Damage to what spinal nerves is considered upper cord damage?

A

C5, C6

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4
Q

What muscles are supplied by the upper cords (C5, C6)?

A

Deltoid

Shoulder muscles

Brachialis

Biceps

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5
Q

What kind of paralysis does upper cord damage cause?

A
  • Causes Erb-Duchenne paralysis (arm “porters tip”)
    • Arm adducted, elbow extended, forearm pronated, wrist flexed
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6
Q

Describe Erb-Duchenne paralysis?

A
  • Causes Erb-Duchenne paralysis (arm “porters tip”)
    • Arm adducted, elbow extended, forearm pronated, wrist flexed
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7
Q

Damage to what spinal nerve is lower cord damage?

A

T1

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8
Q

What paralysis does lower cord damage cause?

A

Klumpke’s palsy

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9
Q

Axillary nerve is formed from what spinal nerves?

A

C5, C6

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10
Q

What cord forms axillary nerve?

A

Posterior cord

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11
Q

What does the axillary nerve supply?

A
  • Wraps around surgical neck of humerus supplying deltoid and teres minor, also regimental badge area of skin
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12
Q

Damage to axillary nerve causes what paralysis?

A
  • Axillary nerve palsy
    • Caused in shoulder dislocation or fracture of surgical neck of humerus
    • Presentation
      • Lack of sensation in badge area
      • Deltoid atrophy
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13
Q

What is the presentation of axillary nerve palsy?

A
  • Lack of sensation in badge area
  • Deltoid atrophy
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14
Q

What often causes axillary nerve palsy?

A
  • Caused in shoulder dislocation or fracture of surgical neck of humerus
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15
Q

Radial nerve is formed from what spinal nerves?

A

C5, C6, C7, C8, T1

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16
Q

Radial nerve comes from what cord?

A

Posterior cord

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17
Q

What does the radial nerve supply?

A
  • Tricep brachii
  • Supplies BCR, ECRL and ECRB before dividing into PIN (motor) and SRN (sensory) branches
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18
Q

Describe the course of the radial nerve?

A
  • Runs in radial groove of humerus as it passes from medial to lateral
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19
Q

Radial nerve damage causes what paralysis?

A
  • Radial nerve palsy
    • Occurs in entrapment (maybe in radial fracture) or compression (such as due to Saturday night palsy)
    • Presentation depends on site of lesion
      • In axilla – lose of elbow extension, wrist extension and sensory changes in forearm and hand
      • In arm – loss of wrist extension and sensory loss
      • In forearm – loss of finger extension (PIN)
      • At wrist – loss of sensation (SRN)
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20
Q

What is the presentation of radial nerve palsy?

A
  • In axilla – lose of elbow extension, wrist extension and sensory changes in forearm and hand
  • In arm – loss of wrist extension and sensory loss
  • In forearm – loss of finger extension (PIN)
  • At wrist – loss of sensation (SRN)
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21
Q

What often causes radial nerve palsy?

A
  • Occurs in entrapment (maybe in radial fracture) or compression (such as due to Saturday night palsy)
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22
Q

What nerve supplies snesation to this area?

A

Radial nerve

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23
Q

Median nerve is supplied from what spinal nerves?

A

C5, C6, C7, C8 and T1

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24
Q

What cords form the median nerve?

A

Medial and lateral cords

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25
Q

What does the median nerve supply?

A
  • Supplies flexors of forearm, LOAF muscles
  • Supplies sensation to radial 3.5 digits
26
Q

What nerve supplies this area?

A

Median nerve

27
Q

What forms the floor and the roof of the carpal tunnel?

A
  • Floor
    • Carpal bones
  • Roof
    • Flexor retinaculum
28
Q

What are the contents of the carpal tunnel?

A
  • FDS x 4
  • FDP x 4
  • FPL
  • Median nerve
  • Ie, above is 9 tendons and a nerve
29
Q

What are some causes of carpal tunnel syndrome?

A
  • Development
  • Trauma
    • Distal radius fracture
  • Swellings
    • Ganglion
    • Fibroma
    • Lipoma
  • Inflammatory
    • Rheumatoid
    • Gout
    • TB
    • Amyloid
  • Metabolic
    • Pregnancy
    • Mucopolysaccharidoses
    • Hypothyroidism
30
Q

Carpal tunnel syndrome involves what nerve?

A

Median nerve

31
Q

What is the presentation of carpal tunnel syndrome?

A
  • Nocturnal pain
  • Parasthesia in part or all of median nerve distribution
  • Wasting of the thenar muscles
  • Lack of sensation
32
Q

What investigations are done for carpal tunnel syndrome?

A
  • Tinnels test
  • Phalens test
33
Q

Whats the treatment of carpal tunnel syndrome?

A
  • Splints
  • Treat metabolic cause
  • Steroid injection
  • Surgery
    • Divide roof of carpal tunnel to relieve pressure
34
Q

Ulnar nerve is formed from what cord?

A

Medial cord

35
Q

Does the ulnar nerve supply any muscles in the arm?

A
  • No branches in arm
36
Q

Ulnar nerve enters the forearm between what?

A
  • Enters forearm between two heads of FCU
37
Q

Ulnar nerve supplies what?

A
  • Supplies medial half of FDP, FCU and all intrinsic muscles in hand apart from LOAF
  • Sensation to ulnar 1.5 digits
38
Q

What nerve supplies this area?

A

Ulnar nerve

39
Q

Ulnar nerve runs through what tunnel?

A

Cubital tunnel

40
Q

Where is the cubital tunnel?

A
  • Cubital tunnel is between medial epicondyle and olecranon with fascial bands from FCU as roof
41
Q

Cubital tunnel syndrome involves what nerve?

A

Ulnar nerve

42
Q

What is the presentation of cubital tunnel syndrome?

A
  • Numbness on ulnar side
  • Difficulty with fine tasks
43
Q

What is the presentation of ulnar nerve palsy?

A
  • Wasting of muscles
    • 1st webspace
    • Guttering
    • Hypothenar wasting
  • Ulnar claw hand
    • Hyperextension at MCPJ and flexion at IPJ
    • Distal lesion has worse clawing than proximal lesion (known as Ulnar paradox)
44
Q

What investigation is done for ulnar nerve palsy?

A
  • Froment’s test
    • Tests adductor pollicis (ulnar nerve) and flexor pollicis longus (median nerve)
    • If ulnar nerve not working, patient will cheat and use FPL instead of adductor pollicis
45
Q

What does the Froment’s test test?

A
  • Tests adductor pollicis (ulnar nerve) and flexor pollicis longus (median nerve)
  • If ulnar nerve not working, patient will cheat and use FPL instead of adductor pollicis
46
Q

What are the roots of the lateral femoral cutaneous nerve?

A

L2, L3

47
Q

Describe the course of the lateral femoral cutaneous nerve?

A

Lies on surface of iliacus muscle, usually exits pelvis under lateral end of inguinal ligament but can vary

48
Q

What does the lateral femoral cutanoeus nerve supply?

A

Purely sensory to lateral aspect of thigh

49
Q

Compression of the lateral femoral cutaneous nerve causes what?

A

Compression causes “meralgia paraesthetica”:

  • Presentation
    • Pain
    • Paraesthesia’s
50
Q

What supplies this area?

A

Lateral femoral cutaneous nerve

51
Q

What is the treatment for lateral femoral cutanoeus nerve palsy?

A
  • Steroid injection guided by US
  • Operation to release tunnel
52
Q

What are the roots of the sciatic nerve?

A

L4-S3

53
Q

What is the largest nerve in the body?

A

Sciatic nerve

54
Q

Describe the course of sciatic nerve?

A
  • Exits through sciatic foramen below piriformis muscles
  • Runs deep to gluteus maximus muscle
55
Q

What does the sciatic nerve supply?

A
  • Hamstring (posterior)
  • Part of adductor magnus
  • All lower leg and foot muscles via terminal branches (tibial and common fibular nerves)
56
Q

What can damage to sciatic nerve occur due to?

A
  • Posterior dislocation of hip
  • Intra-muscular injections
  • During surgery or trauma
57
Q

What roots supply the common fibular nerve?

A

L4-S2

58
Q

What is the common fibular nerve a branch of?

A

Smaller and lateral branch of sciatic nerve:

  • Passes around lateral aspect of neck of fibula
  • Divides into superficial and deep fibular nerves
59
Q

Deficits to common fibular nerve causes what?

A

Deficit causes foot drop and slapping gait

60
Q

What is the most commonly injured nerve in the leg?

A

Common fibular nerve

14. Year 2: Musculoskeletal (40 decks)

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