neuro pathologies UE

Question 0

Traction injury of lower brachial plexus

Answer 0

Klumpke’s paralysis

Claw hand - thumb on the same plane as palm, whole hand, both median and ulnar (C8-T1)

Question 1

Injury to the superior roots of brachial plexus

Answer 1

Erb-Duchenne palsy (C5-C6)

Waiter’s tip postion

Question 2

Radial nerve leisions

Answer 2

Clavicle, axillary, radial groove, supinator
Posterior motor brach “Posterior interosseus nerve”: it enters supinator and travels down the lateral Radius to the wrist
Superficial branch: travels down the posterior forearm to the hand

Question 3

Radial nerve lesions causes

Answer 3

Fractures at spiral radial groove

• dislocations of head of radius, humeroradial or radioulnar joint
• Post surgical complications
• compression

Question 4

Radial nerve related pathologies

Answer 4

Crutch palsy at axilla
Saturday night palsy at spiral groove of humerus from direct pressure against a firm object
Posterior interosseuous syndrome: comes off in front of the lateral epicondyle of humerus
compression in arcade/canal of Frohse, motor nerve, get wrist drop
Cheiralgia parasthetica: compression of superficial branch of radial nerve as it passes under tendon of brachioradialis

Question 5

If injury is proximal to elbow….

Answer 5

both sensory and motor affected,

Question 6

if injury is distal to elbow…

Answer 6

Only sensory or motor is affected

Question 7

what causes cheiralgia paresthetica

Answer 7

Cast, hand cuffed compression swelling

Question 8

Median Nerve lesions

Answer 8

Path Under pronator teres, under carpal tunnel and end between 2nd and third fingers

Question 9

Median nerve lesions causes

Answer 9

Fractures at elbow, wrist and carpals
Dislocations at elbow, wrist, carpals
Compressions
Trauma

Question 10

Symptoms of Median nerve lesions

Answer 10

Ape hand - thumb in same plane as rest of hand since there is no opposition (wasting of thenar eminence)

• oath hand - you see when you make a fist only digit 4 & 5 can be flexed
• can’t grasp objects (keep dropping things)
• can’t pronate forearm, flex PIPs, flex DIPs of digit #2, 3
• Weak wrist flexion weak thumb movements
• altered sensation on digit 1, 2, 3, and half of 4

Question 11

Median legion pathologies

Answer 11

Ligament of struthers
Pronator Teres Syndrome
Anterior interosseus syndrome
Carpal tunnel syndrome

Question 12

Where is ligament of struthers

Answer 12

Runs from an abnormal supr on shaft of humerus to medial epicondyle. Median nerve can be pinched/compressed above elbow as it passes under - only 1% of populaton

Question 13

What is pronator teres syndrome

Answer 13

Compressed at proximal attachment of pronator teres
Aching in forearm
numbness in thumb and index - some weakness in thenar mm

Question 14

What is anterior interosseous syndrome

Answer 14

Branch of median nerve
Motor nerve - motor loss of FPL, lat 11/2 of FDP, pronator quadratus
Paralysis of flexors in index finger and thumb at tip, so reverse froment’s sign, can’t touch them together at tip, touch at distal knacles.
Can be entrapped it passes between 2 heads of pronator teres.

Question 15

What is carpal tunnel syndrom

Answer 15

Most common entrapment condition in the arm
compression through carpal tunnel at wrist
Numbness and tingling in digit #1,2,3 and half of 4
Distinguishing feature = presence of nocturnal symptoms that wake person up
Muscle weakness and clumsiness of thumb and fingers
later get thenar muscle wasting

Question 16

How the compression of median nerve in carpal tunnel occurs?

Answer 16

size of the tunnel decrease

Size of the contents passing through increases

Question 17

Carpal tunnel structures and tendons

Answer 17

Flexor retinaculum forms roof
Fexor retinaculum attaches to scaphoid tubercle and trapezium
Carpal bones form floor
Median nerve, Flextor digitorum superficialis, profundus and flexor pollicis longus (9 tendons and 1 nerve)

Question 18

Ulnar nerve leisons

Answer 18

path

Question 19

Ulnar nerve lesions causes

Answer 19

fractures at medial epicondyle, mid-forearm, wrist dislocations of elbow
Post surgical complications (badly positioned arm while under anesthetics)
Compression -resting elbow on hard surface
- wearing tight wrist band
-cycling
-repetitive actions, trauma

Question 20

Ulnar nerve lesions symptoms

Answer 20

Ulnar claw hand - baby finger hyper extended and abducted at MCP and flexed at iP

• ring finger is hyper extended at MCP and flexed at IP (loss of lumbricals)
• atropy of interosseous mm
• muscle wasting of hypothenar
• Altered sensation in little finger and medial half of ring ringer (palmar and dorsal)
• Froment’s sign is positive

Question 21

Froment’s sign

Answer 21

Hold paper between thum and index finger
can’t do it without using adductor pollicis
a patient flex thumb to use flex pollicis longus

Question 22

tardy ulnar palsy

Answer 22

ulnar palsy is common complication of fractures of elbow

• a late tardy ulnar palsy can occur years after a fracture
• it’s associated with callus formation or a valgus deformity of the elbow
• these produce a gradual stretching of nerve in ulnar groove of medial epicondyle

Question 23

Thoracic outlet syndrome

Answer 23

Compression of brachal plexus from structures in the thracic outlet (from interscalene triangle to inferior border of axilla)
-subclavian aa and vv may also be compressed

Question 24

Thoracic outlet syndrome path

Answer 24

Brachial plexus travels with the subclavian aa between anterior and medial scalene
subclavian vv joins and neurovascular bundle goes below clavicle and under pec minor insertion and down arm

Question 25

TOS causes

Answer 25

poor posture
c spine /clavicle dislocation
cervical rib
pec minor 
scalens
whiplash
systemic disease - RA, DM, hyothyroid
pregnancy

Question 26

TOS symptoms

Answer 26

Pain, numbness, weakness, tingling in arm or across upper thoracic area or over scapula
Trophic changes in tissue with blood vessel compression

Question 27

TOS locations (5)

Answer 27

1 Presence of cervical rib - additional rib at C7
2 Anterior scalene syndrome - compression btw ant & middle scalene
3 Interscalene triangle - ant, middle scalanes, rib 1, brachial plexus and subclavian artery pass through only (subclavian vein is anterior)
4 Costoclavicular syndrome- compression btw coracoid process and pec minor
5 Pectoralis minor syndrome

Question 28

Travell’s test and Addison’s test

Answer 28

Travell’s test (middle scalene) Extend, rotate arm, turn head away from the arm - check radial pulse

Addision’s test (anterior scalene) Extend, rotate arm, turn head toward the arm - check radial pulse