Nerve Palsies of the Limbs

Question 1

What is carpal tunnel syndrome?

Answer 1

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

Question 2

What sex is more commonly affected by carpal tunnel syndrome?

Answer 2

F>M

Question 3

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

Answer 3

40-60s

Question 4

What causes carpal tunnel syndrome?

Answer 4

Idiopathic

High BMI

Smoking

Pregnancy

RA, most common association with carpal tunnel syndrome

Trauma/distal radial fracture

Lunate fracture

Question 5

How does carpal tunnel syndrome present?

Answer 5

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

Question 6

What tests can be used in carpal tunel diagnosis?

Answer 6

Phalen’s

Tinel’s

• Tapping transverse carpal ligament to initiate symptoms

Question 7

How is carpal tunnel syndrome managed?

Answer 7

Lifestyle modification

Wrist splints at night

Corticosteroid injection

Surgical decompression (flexor retinaculum division)

Question 8

What is Erb’s palsy?

Answer 8

Compression of upper trunk (C5/C6)

Question 9

What muscles are affected in Erbs palsy?

Answer 9

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

Deltoid (Axillary/C5-C6)

Brachioradialis (Radial/C5-T1)

Question 10

How does Erbs palsy present?

Answer 10

Waiter’s Tip

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

Question 11

What is Klumpke’s palsy?

Answer 11

Compression of lower trunk (C8/T1)

Question 12

How does Klumpkes present?

Answer 12

Claw hand

Question 13

What muscles are affected in Klumpkes?

Answer 13

Intrinsic muscles of hand

Question 14

What causes axillary nerve damage?

Answer 14

Humeral neck fracture

Shoulder dislocation

Saturday night palsy (pressure on posterior cord of brachial plexus

Question 15

How does axillary nerve damage present?

Answer 15

Loss of shoulder abduction/deltoid

Loss of sensation in badge area

Question 16

What are the roots of the radial nerve?

Answer 16

C5,6,7,8,T1

Question 17

What causes radial nerve damage?

Answer 17

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

Question 18

How does radial nerve damage present?

Answer 18

Wrist drop extensors

Sensory deficit in 1st web space dorsally

Question 19

Give the roots of the median nerve

Answer 19

C7, C8 TI

Question 20

What causes median nerve damage?

Answer 20

Carpal tunnel syndrome

Wrist lacerations

Question 21

How does median nerve damage present?

Answer 21

Thenar wasting/monkey hand

Pointing finger

Sensory loss of volar aspect of thumb

Question 22

What are the roots of the ulnar nerve?

Answer 22

C7,8,T1

Question 23

What caues ulnar nerve damage?

Answer 23

Cubital tunnel syndrome

Fracture of humeral epicondyles

Wrist lacerations

Question 24

How does ulnar nerve damage present?

Answer 24

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

Question 25

What are the roots of the femoral nerve?

Answer 25

L2-4

Question 26

Give causes of femoral nerve damage

Answer 26

Hip and pelvic fractures Stab/gunshot wounds

Question 27

Give features of femoral nerve damage

Answer 27

Weakness in knee extension Loss of patella reflex Numbness of thigh

Question 28

What are the roots of lateral femoral cutaneous nerve?

Answer 28

L2,3

Question 29

Give features of lateral femoral cutaneous nerve

Answer 29

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

Question 30

What are the roots of the sciatic nerve?

Answer 30

L4-S3

Question 31

What causes sciatic nerve damage?

Answer 31

Posterior dislocation of hip Intra-muscular injections Surgery

Question 32

Give features of sciatic nerve damage

Answer 32

Weakness in knee flexion and foot movements Pain and numbness from gluteal region to ankle

Question 33

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

Answer 33

Common fibular nerve, also known as common peroneal nerve

Question 34

What are the roots of the common fibular nerve?

Answer 34

L4-S2

Question 35

Give causes of common fibular nerve

Answer 35

Neck of fibula injury Tightly applied lower limb plaster cast

Question 36

How does common fibular nerve damage present?

Answer 36

Foot drop Slapping gait

Question 37

Give features of cubital tunnel syndrome

Answer 37

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

Question 38

How is cubital tunnel syndrome managed?

Answer 38

Avoid aggravating activity Physiotherapy Steroid injections Surgery in resistant cases

Question 39

Give causes of obturator nerve damage

Answer 39

Anterior hip dislocation

Question 40

Give features of obturator nerve damage

Answer 40

Weakness in hip adduction Numbness over medial thigh

Question 41

Give causes of tibial nerve damage

Answer 41

Popliteal lacerations Posterior knee dislocation

Question 42

Give causes of superior gluteal nerve damage

Answer 42

Misplaced intramuscular injection Hip surgery Pelvic fracture Posterior hip dislocation

Question 43

Give features of superior gluteal nerve damage

Answer 43

Trendelenburg sign

Question 44

Give causes of inferior gluteal nerve injury

Answer 44

Injured in association with sciatic nerve

Question 45

Give features of inferior gluteal nerve damage

Answer 45

Difficulty rising from seated position Inability to jump and climb stairs