Nerves / extremities

Question 1

What are 4 signs of compartment syndrome?

Answer 1

Pain out proportion, pain on passive stretch, pressure, pallor, paresthesia, paralysis, pulselessness

Question 2

What are 2 things that can be done to prevent rhabdomylalysis and renal damage?

Answer 2

IV 20% mannitol
-IV hydration
-Bicarbonate to alkalize urine
-Escharotomies/fasciotomies

Question 3

Sural nerve; what are the two nerves that contribute to the sural nerve; where do you find the sural nerve at the level of the ankle; describe the course of the sural nerve; list 2 methods for harvest of the sural nerve

Answer 3

1. Lateral sural (from fibular) and medial sural (from tibial)
2. Between achilles tendon and lateral malleolus
3. Pierces gastroc from deep to superficial about ½ down leg. Courses deep to superficial fascia laterally towards malleolus in the axis from the popliteal fossa to the lateral mal

The sural nerve originates high in the leg between the two heads of the gastrocnemius muscle (Fig. 6.86). It descends superficial to the belly of the gastrocnemius muscle and penetrates through the deep fascia approximately in the middle of the leg where it is joined by a sural communicating branch from the common fibular nerve. It passes down the leg, around the lateral malleolus, and into the foot. (Gray’s Anatomy for Students)

4. Open and endoscopic

Question 4

Patient is hit by a car; bumper hits lateral part of his leg just below knee and patient develops a nerve injury in his lower extremity; what is terms is given to describe this diagnosis; list 5 muscles affected in a patient with foot drop; list 3 sites in which a patient with foot drop would experience numbness

Answer 4

1. Neuropraxia
2. Deep and superficial peroneal nerve. Superficial = peroneus longus, brevis
   Deep = EHL, TA, EDL (also EDB, EHB)
3. First webspace (deep peroneal nerve), dorsum of foot (superficial fibular nerve), antero-lateral surface of leg (superficial peroneal nerve and lateral sural cutaneous nerve)

Question 5

Diabetics have peripheral neuropathy, list 3 broad classes of neuropathy and the affect

Answer 5

Somatic motor - deformations and wounds
Somatic sensory - loss of sensation, wounds
autonomic - loss of humidity, sweating, hair

Question 6

Patient with high ulnar nerve injury, list roots that contribute to ulnar nerve, list cord ulnar nerve comes from, list two branches that come off of this cord, with the MCPs blocked the patient can still extend the PIPs, why is this possible, list two benefits of splinting the patient post-injury, what is the best way to manage this patient surgically for maximal recovery

Answer 6

1. C7, T1
2. Medial cord
3. MABC, MBC, Medial pectoral
4. Radial nerve is intact and innervates the extensor apparatus
5. Prevent clawing, prevent intrinseque tightness, maintain ROM
6. Primary repair +/- AIN to UMN repair

Question 7

Draw the brachial plexus

Question 8

Draw the anatomy of the arm cross section

Question 9

What are three types of necrotizing fasciitis?
Two bedside manouvers to confirm diagnosis?
What are four factors which may increase mortality in patient with nec fasc?

Answer 9

Type 1 : polymicrobien
Type 2 : monomicrobien group A strep
Type 3 : aquatic micro-organisms vibrio

2 bedside manouevers
-Fascia biopsy
-Finger dissection

1. Age
2. Immunosuppression
3. Time to surgery
4. Obesity
5. Delayed antibiotics

Question 10

Other than triceps, what are three muscles innervated by radial nerve proper (not PIN)

Answer 10

Brachialis
Anconeos
ECRL

Question 11

4 Principles of nerve transfer

Answer 11

1. Motor to motor, sensory to sensory
2. Tension free
3. Synergistic movements
4. Donor site redundant
5. End to end
6. Similar number of axons