Neural Entrapments

Question 1

Erb-duchenne palsy

Answer 1

Upper brachial plexopathy
1. Clinical
  A. Xs angle between neck and shoulder
2. Physical exam: 
  A. Inspection: waiter’s tip
  B. Motor: muscle weakness (C5 and C6)
  C. Sensory: lateral arm and forearm

Question 2

Klumpke paralysis

Answer 2

Lower brachial plexopathy
1. Clinical
A. Inc angle between upper limb and trunk
2. Physical exam:
A. Inspection: finger clawing, atrophy
B. Motor: klumpke hand - atrophy digital flexors (C7-T1)
C. Sensory: ulnar surface forearm and hand
D. Other: horner’s syndrome - eyelid droops (T1 innervation)

Question 3

Long thoracic nerve injury

Answer 3

1. Clinical 
  A. Knife fight
  B. Mastectomy
2. Physical exam
  A. Inspection: atrophy, winged scapula
  B. Motor: abnormal scapular movement
  C. Special test: wall push up
3. No sensory fxn

Question 4

Musculocutaneous N. Injury

Answer 4

C5-C7
1. Clinical
  A. Gun shot/knife
2. Physical exam
  A. Inspection: atrophy
  B. Motor: trouble flexing arm
  C. Sensory: lateral antebrachial cutaneous n. -forearm

Question 5

Axillary n. Injury

Answer 5

1. Clinical
  A. Anterior glenohumeral joint dislocation
  B. Crutches
  C. Fracture surgical head of humerus
2. Physical exam
  A. Inspection: atrophy (deltoid)
  B. Motor: weakness abduction
  C. Sensory: sup. Lateral cutaneous n. - lateral arm

Question 6

Radial N. Injury

Answer 6

1. Clinical
   A. Wrist-posterior interosseous syndrome
   B. Axilla/proximal arm- “Saturday night palsy”
   
   1. Physical exam:
      A. Inspection: weakness, wrist drop/extension
      B. Motor: triceps involved
      C. Sensory: minimal effect, some in hand
      C. Distal (radial groove)
   2. Physical exam
      A. Inspect: wrist drop/extension
      B. Motor: triceps not involved
      C. Sensory: minimal, some in hand

Question 7

Median N. Injury

Answer 7

1. Clinical
  A. Elbow (supracondylar fx)
  B. Forearm (ant intersseous syndrome)
  C. Elbow (pronator syndrome
  D. Wrist (carpal tunnel syndrome)

Question 8

Pronator syndrome

Answer 8

Median N. Injury at elbow
1. Physical exam
A. Motor: flexion PIP 1-3 lost and weakened 4-5, flexion DIP 2-3 lost, flexion MCP 2-3 affected
1. Sign of benediction: 2-3 extended when making a fist
B. Sensory: median areas hand/wrist
C. Special test: make fist

Question 9

Carpal tunnel

Answer 9

Median n. Injury at wrist
1. Physical exam:
A. Inspection: weakness, Simeon (flat) hand
B. Motor: tingling, hypoesthesia, anesthesia lat 3.5 digits, loss of thumb strength w/ progression
C. Sensory: fingers 3.5 lateral and palm
D. Special tests:
1. Phalens
2. tines

Question 10

Ulnar n. Injury

Answer 10

1. Clinical
   A. Elbow (posterior to medial epicondyle of humerus)
   B. Hand (fracture hook of hamate or handlebar neuropathy)
   C. Cubical tunnel
   D. Ulnar (Guyon’s) canal syndrome

Question 11

Cubical tunnel

Answer 11

Ulnar n. Injury
1. Physical exam:
  A. Inspection: atrophy, hand position
  B. Sensory: 4-5 digit and medial forearm
  C. Motor: flexion 4-5 DIP
  D. Special tests
    1. Froment’s sign
    2. Tinels sign

Question 12

Ulnar (Guyon’s) canal syndrome

Answer 12

1. Physical exam
   A. Inspection: clawing 4-5th digits
   B. Sensory: hypoesthesia medial 1.5 fingers
   C. Motor: weakness intrinsic muscles of hand
   D. Special tests: tinels