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Musculoskeletal + Rheumatology > Nerve Palsies of the Limbs > Flashcards

Nerve Palsies of the Limbs Flashcards

1
Q

What is carpal tunnel syndrome?

A

Compression of the median nerve in the carpal tunnel due to inflammation of nearby tendons and tissues, resulting in oedema

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2
Q

What sex is more commonly affected by carpal tunnel syndrome?

A

F>M

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3
Q

What age group is most commonly affected by carpal tunnel syndrome?

A

40-60s

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4
Q

What causes carpal tunnel syndrome?

A

Idiopathic

High BMI

Smoking

Pregnancy

RA, most common association with carpal tunnel syndrome

Trauma/distal radial fracture

Lunate fracture

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5
Q

How does carpal tunnel syndrome present?

A

Paraesthesia, mainly in thumb, middle and index fingers, but can radiate up the forearm

Pain can worsen at night and shakes hand to obtain relief

Weakness in the hand of thumb abduction/abductor pollicis brevis

Wasting of thenar eminence

Bilateral symptoms as usually due to stressor such as typing

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6
Q

What tests can be used in carpal tunel diagnosis?

A

Phalen’s

Tinel’s

  • Tapping transverse carpal ligament to initiate symptoms
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7
Q

How is carpal tunnel syndrome managed?

A

Lifestyle modification

Wrist splints at night

Corticosteroid injection

Surgical decompression (flexor retinaculum division)

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8
Q

What is Erb’s palsy?

A

Compression of upper trunk (C5/C6)

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9
Q

What muscles are affected in Erbs palsy?

A

Biceps brachii, Brachialis, coracobrachialis (Musculocutaneous/C5-C7)

Deltoid (Axillary/C5-C6)

Brachioradialis (Radial/C5-T1)

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10
Q

How does Erbs palsy present?

A

Waiter’s Tip

  • Arm adducted and internally rotated
  • Elbow extended and pronated
  • Wrist flexed
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11
Q

What is Klumpke’s palsy?

A

Compression of lower trunk (C8/T1)

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12
Q

How does Klumpkes present?

A

Claw hand

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13
Q

What muscles are affected in Klumpkes?

A

Intrinsic muscles of hand

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14
Q

What causes axillary nerve damage?

A

Humeral neck fracture

Shoulder dislocation

Saturday night palsy (pressure on posterior cord of brachial plexus

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15
Q

How does axillary nerve damage present?

A

Loss of shoulder abduction/deltoid

Loss of sensation in badge area

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16
Q

What are the roots of the radial nerve?

A

C5,6,7,8,T1

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17
Q

What causes radial nerve damage?

A

Very high lesions, causing wrist drop and tricep lesion

  • Saturday night palsy
  • Crutches

High lesions, wrist drop and reduced sensation in snuffbox

  • Humeral shaft fracture

Low lesions, finger drop with no sensory loss

  • Forearm fracture
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18
Q

How does radial nerve damage present?

A

Wrist drop extensors

Sensory deficit in 1st web space dorsally

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19
Q

Give the roots of the median nerve

A

C7, C8 TI

20
Q

What causes median nerve damage?

A

Carpal tunnel syndrome

Wrist lacerations

21
Q

How does median nerve damage present?

A

Thenar wasting/monkey hand

Pointing finger

Sensory loss of volar aspect of thumb

22
Q

What are the roots of the ulnar nerve?

A

C7,8,T1

23
Q

What caues ulnar nerve damage?

A

Cubital tunnel syndrome

Fracture of humeral epicondyles

Wrist lacerations

24
Q

How does ulnar nerve damage present?

A

Claw hand

Hypothenar and 1st dorsal interosseous wasting

Sensory loss of little finger/ulnar border

Weak finger abduction and adduction

Ulnar paradox, proximal lesions produce less prominent deformity than distal

25
Q

What are the roots of the femoral nerve?

A

L2-4

26
Q

Give causes of femoral nerve damage

A

Hip and pelvic fractures

Stab/gunshot wounds

27
Q

Give features of femoral nerve damage

A

Weakness in knee extension

Loss of patella reflex

Numbness of thigh

28
Q

What are the roots of lateral femoral cutaneous nerve?

A

L2,3

29
Q

Give features of lateral femoral cutaneous nerve

A

Meralgia paraesthetica, characterised by pain, tingling and numbness in the distribution of the lateral cutaneous nerve

30
Q

What are the roots of the sciatic nerve?

A

L4-S3

31
Q

What causes sciatic nerve damage?

A

Posterior dislocation of hip

Intra-muscular injections

Surgery

32
Q

Give features of sciatic nerve damage

A

Weakness in knee flexion and foot movements

Pain and numbness from gluteal region to ankle

33
Q

What is the most commonly injured nerve of the lower limb?

A

Common fibular nerve, also known as common peroneal nerve

34
Q

What are the roots of the common fibular nerve?

A

L4-S2

35
Q

Give causes of common fibular nerve

A

Neck of fibula injury

Tightly applied lower limb plaster cast

36
Q

How does common fibular nerve damage present?

A

Foot drop

Slapping gait

37
Q

Give features of cubital tunnel syndrome

A

Tingling and numbness of 4th and 5th finger, which starts off as intermittent and becomes constant

Over time patients may develop weakness and muscle wasting

Pain worse on leaning on affected elbow

History of osteoarthritis or trauma to area

38
Q

How is cubital tunnel syndrome managed?

A

Avoid aggravating activity

Physiotherapy

Steroid injections

Surgery in resistant cases

39
Q

Give causes of obturator nerve damage

A

Anterior hip dislocation

40
Q

Give features of obturator nerve damage

A

Weakness in hip adduction

Numbness over medial thigh

41
Q

Give causes of tibial nerve damage

A

Popliteal lacerations

Posterior knee dislocation

42
Q

Give causes of superior gluteal nerve damage

A

Misplaced intramuscular injection

Hip surgery

Pelvic fracture

Posterior hip dislocation

43
Q

Give features of superior gluteal nerve damage

A

Trendelenburg sign

44
Q

Give causes of inferior gluteal nerve injury

A

Injured in association with sciatic nerve

45
Q

Give features of inferior gluteal nerve damage

A

Difficulty rising from seated position

Inability to jump and climb stairs

Musculoskeletal + Rheumatology (16 decks)

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