NMS 5

Question 1

Biceps Femoris function?

Answer 1

Both heads of the biceps femoris perform knee flexion.[4]

Since the long head originates in the pelvis it is also involved in hip extension.[4] The long head of the biceps femoris is a weaker knee flexor when the hip is extended (because of active insufficiency). For the same reason the long head is a weaker hip extender when the knee is flexed.

When the knee is semi-flexed, the biceps femoris in consequence of its oblique direction rotates the leg slightly outward.

Question 2

show how you would attempt to differentiate between damage to C8 spinal nerve and the Ulnar nerve.

Past history
Present complaint
Motor AND Sensory examination
Any ONE further diagnostic test of your choice

Answer 2

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Question 3

Describe an axillary nerve lesion. Include in your answer:

The axillary nerve’s usual nerve root and plexus-based origins
Its innervation of muscle and skin
The ‘points of weakness’ or ‘design faults’ that make it vulnerable to lesion
Two examples of causes of such a lesion
Four distinctive clinical features of such a lesion

Answer 3

It is characterized by trauma to the axillary nerve from either a compressive force or traction injury following anterior dislocation of the shoulder

it is a type of Peripheral neuropathy called mononeuropathy.

Symptoms include:

cannot bend arm at the elbow[4]
deficiency of deltoid muscle function[6]
different regions of skin around the deltoid area can lack sensation[6]
unable to raise arm at the shoulder[7]

axillary nerve palsy can occur after there is blunt trauma in the shoulder area without any sort of dislocation or fracture

Furthermore, a patient can also be tested for weakness when asked to raise the arm.[2] The deltoid extension lag sign test is one way to evaluate the severity of the muscle weakness

Question 4

Show how you would attempt to differentiate between damage to the L5 spinal nerve and the tibial nerve.

Include differentiating information in your answer under the following headings:

• Associated event/scenario
• Patient’s presenting complaint (symptoms)
• Motor examination (signs)
• Sensory examination (signs)

Answer 4

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Question 5

Outline the implications for spinal cord integrity of the following findings:

a) Following neck manipulation, the patient feels sharp, shooting pains into both of his arms when he flexes his head/neck
b) The patient was immediately ‘limp like a rag doll’ following a violent road traffic accident; he is the same 4 days later

Answer 5

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Question 6

Outline the differences between the neurological presentations of:

Syringomyelia from spinal cord central canal expansion
- and -
Spinal cord compression from chronic spondylosis

Include in your answer:

a. A brief account (prose or diagram as you prefer) of resulting neural structural changes.
b. Two key distinctive early symptoms that differentiate the two conditions.

Answer 6

Syringomyelia is a generic term referring to a disorder in which a cyst or cavity forms within the spinal cord. This cyst, called a syrinx, can expand and elongate over time, destroying the spinal cord. The damage may result in loss of pain, paralysis, weakness,[3] and stiffness in the back, shoulders, and extremities. Syringomyelia may also cause a loss of the ability to feel extremes of hot or cold, especially in the hands. It may also lead to a cape-like bilateral loss of pain and temperature sensation along the upper chest and arms. Each patient experiences a different combination of symptoms. These symptoms typically vary depending on the extent and, often more critically, to the location of the syrinx within the spinal cord.