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Hand Clinic (musculoskeletal) > Other things > Flashcards

Other things Flashcards

1
Q

How is a neurovascular assessment performed? (9)

A
  1. Clean hands
  2. Check pulses
  3. Note colour (pale/white)
  4. Swelling/oedema
  5. Temperature (cool)
  6. Capillary refill (normal = 1-3s)
  7. Pain with passive movement
  8. Sensation
  9. Motor = AROM/PROM/RISOM (aware of restrictions)
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2
Q

How do you assess the circumflex/axillary nerve?

A

Supplies the deltoid.

Sensory = touch deltoid

Motor = shoulder abduction

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3
Q

How do you assess the musculocutaneous nerve?

A

Supplies biceps and brachioradialis.

Sensory = touch radial forearm

Motor = elbow flexion

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4
Q

How do you assess the ulna nerve?

A

Supplies the ulna side flexors and hand intrinsics.

Sensory = touch pad of 5th finger

Motor = abduct (spread fingers)

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5
Q

How do you assess the radial nerve?

A

Supplies the extensors of the arm.

Sensory = touch back of the hand between thumb/index finger

Motor = dorsiflex hand/wrist (hyperextend thumb/fingers if in POP)

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6
Q

What is POP?

A

Plaster of Paris

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7
Q

How do you assess the median nerve?

A

Supplies forearm flexors, especially the thumb.

Sensory = touch index finger

Motor = opposition (thumb to 5th)

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8
Q

Why should the brachial plexus always be checked, and what for?

A

Can cause neurological deficits in the upper limb anywhere along the path.

Check for external pressure.

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9
Q

What constitutes an abnormal motor response and what should the next test be?

A

Unable to perform movements due to pain/numbness.

Check if PROM causes severe pain.

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10
Q

What does the sciatic nerve supply?

A

Supplies the hamstrings and their divisions below the knee.

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11
Q

How do you assess sensation of the sciatic nerve?

A

Injury type

  • Buttock +/or thigh = all surfaces of foot
  • Tibial = lateral calf, heel and foot
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12
Q

How do you assess motor function of the sciatic nerve?

A

Injury type

  • Buttock = move toes and foot
  • Thigh = knee flexion + move toes and foot
  • Tibial = ankle PF/DF and eversion
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13
Q

How do you assess the femoral nerve?

A

Supplies quadriceps femoris.

Sensory = medial aspect of foot

Motor = knee extn

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14
Q

How do you assess the peroneal nerve?

A

Supplies peroneal and anterior tibial mm.

Sensory = first webbed space between 1+2 toes.

Motor = ankle DF (if in POP, toe extn at MT and phalangeal jts)

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15
Q

How do you assess the tibial nerve?

A

Supplies gastrocnemius/soleus.

Sensory = medial/lateral sole of foot

Motor = PF ankles/toes (if in POP, just toes)

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16
Q

How should the lumbosacral plexus pathway be checked? (5)

A
  • regional block (when/where/how)
  • swelling/oedema in limb
  • plaster/dressings/traction/splints (not causing impairment?)
  • hip is not dislocated (limb shorter, ext rot of leg)
  • supports at knee to prevent ext rot.
17
Q

When testing temperature, what do the results mean?

A

Cold = inadequate arterial.

Hot = inadequate venous.

18
Q

When testing colour, what do the results mean?

A

White/pale = inadequate arterial

Blue = inadequate venous

19
Q

Is a pulse still present with Compartment Syndrome?

A

Sometimes.

20
Q

How should swelling be documented?

A
  • Slight
  • Moderate
  • Gross
21
Q

What should be considered if vascular deficit is detected?

A
  • Plaster/dressing/traction/splintage (PDTS) impingement
  • Environmental factors
    • Room temp
    • Limb exposure
    • Hot/cold pack use
  • If cap refil > 3s
    • MHx =
      • PVD
      • Raynard’s disease
  • Remember ~10% of the population don’t have a palpable dorsal pedal pulse
    • Palp post tib pulse if exposed.
22
Q

What are potential consequences of neurovascular compromise?

A
  • Nerve damage
    • Loss of sensation/ROM
      • Muscle tissue damage

4-12 hrs ischaemia may = permanent dysfunction/deformity (mm necrosis)

  • This may = loss of motor fn or amputation
23
Q

Before neurovascular obs, you should:

A
  1. Read notes
    1. Restriction on movement
    2. Relevant conditions (e.g. Reynaud’s)
  2. Nerve block?
  3. Explanation to pt
    1. Why Ax necessary
    2. IC
    3. Understands S/S to be reported
  4. Ensure nothing occludes skin before Ax (e.g. nail polish)

Hand Clinic (musculoskeletal) (3 decks)

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