Peripheral N injuries Flashcards
Deep fibular Nueropathy
Signs and sxs:
- motor: weak EHL, tib ant, EDL
- present with drop foot
- sensory: dorsal web space btw first and second toes
Ulnar N
nerve roots and cord comes off of
C8-T1, medial cord
cubital tunnel syndrome
Nerve: Ulnar N
Site of compression: Cubital tunnel - between both heads of FCU
MOI: prolonged elbow flexion, fractures, spurs, arthritis
Signs and sxs:
- sensory ( first): sensory and pain of palmar and dorsal innervation of ulnar N - 4th/5th digits and hypothenar
- motor (later): weak hypothenars, FDP 3,4, addP, interossei
Special tests: +Froment’s, +Tinels, +elbow flexion test, +Wartenburgs sign
femoral neuropathy
Site of compression: Inguinal ligament, iliopsoas tendon
Signs/sxs
-motor: weak quads, psoas, iliacus, pectineus, sartorius
- sensory: anteromedial thigh
radiculopathy
- usually follows dermatomal pattern, sensory sxs are most reliable
- compression at N root
- motor, sensory, pain, altered reflexes
- possiblle neck pain with arm pain: arm pain>neck pain
Compression under Ligament of Struthers
- median N
- ligament of struthers: proximal to elbow (distal humerus)
- motor and sensory loss in whole distribution
- pronator teres IS AFFECTED
mononeuropathy
- disturbance of single nerve ex radial N
- doesntly follow derm pattern
- usually combo of motor, sensory, and reflex deficits
Tibial N neuropathy:
Site of compression: popliteal region
Signs and sxs:
-motor: weak PFs, weak inversion
- medial longitudinal arch cant be maintained- flat feet
- sensory: heel, plantar surface of foot (besides medial border), plantar surface of toes
- DTR affected: achilles
Common peroneal N neuropathy
Signs and sxs: see sxs of deep and superficial peroneal N neuropathies
High radial N injury
MOI: humerus spinal groove fx, fx of humerus shaft
Site of compression: mid- arm
Nerve: radial
Signs and sxs:
- motor: weak anconeus, wrist extensors (wrist drop), thumb extensor weakness, (triceps are spared)
- sensory: post forearm, post thumb, 2.5 digits
Wartenberg’s syndrome
Nerve: superficial sensory branch of Radial Nerve
Site of compression: chieralgia paresthetica - compression of superficial sensory branch under brachialis and ECRL tendons
MOI: trauma, handcuffs, right watch
Signs/ SXS:
-sensory only - lose sensory distribution and pain of dorsal 3.5 digits
- pain with wrist flexion and ulnar deviation
Special test: +Tinels at wrist
5 P’s of compartment syndrome
pain, pallor, paresthesia, pulselessness, paralysis
saphenous neuropathy
Site of compression: btw vastus medialis and adductor magnus
Signs and sxs:
- sensory only: from medial knee, medial leg, to medial malleolus
- pain with resisted knee flexion or resisted hip adduction
Radial N
N roots and where comes off brachial plexus
C5-T1
posterior cord
Guyon’s canal syndrome
nerve: Ulnar N
Site of compression: Guyon’s canal between hook of hamate and transverse carpal ligament
MOI: heavy gripping, twisting, activities involving pressure
Signs and SXS:
- decreased sensory of PALMAR Ulnar N distribution only, with pain
- weak interossei, weak AddP, weak hypothenars
Special tests:
+Froment’s, +Wartenburg sign, +Tinels sign at wrist
Carpal Tunnel Syndrome
Location of compression: Under transverse carpal ligament
Signs and Sxs: Weak OP, ABP, FPB, thenar m atrophy
- sensory: lateral 3.5 digits
- thenar eminence spared (innervated by palmar cutaneous branch)
Special tests: + phalens, +tinels at wrist, + reverse phalens, Flick sign+ (shaking hands reduces pain)
Radial tunnel syndrome
Site of compression: radial tunnel - 5cm distal to lat. epicondyle
Nerve: PIN from radial N
Signs and sxs: -no motor or sensory
- pain only - post proximal forearm, over radial tunnel, pain with finger extension, resisted supination, pronation with wrist flexion, elbow extension
- mimics lat epicondylitis (DD with no motor or sensory for radial tunnel)
lateral femoral cutaneous nerve neuropathy
Site of compression: inguinal ligament
MOI: pregnancy/trauma with surgery
Signs and sxs:
- sensory only: lateral thigh paresthesia and burning
Tarsal tunnel syndrome:
Nerve: posterior tibial
Sensory: pain and paresthesia in sole of foot, worse after long periods of standing/walking or at night
Motor: tib post and extrinsic toe flexor weakness,
Pronated feet
Superficial fibular N neuropathy
Signs and sxs:
-motor: weak peroneals
- sensory: dorsum of foot, ant-lat lower leg pain
- would present with inversion/supination - tight medial side
Sural nerve neuropathy
MOI: ankle sprains, trauma
Signs and sxs:
- sensory only: postero-lateral lower leg, pinky toe, lateral foot
- SID
what nerve supplies sensory to anatomical snuff box
radial N
pronator teres syndrome
Compression location: compressed btw both heads of PT
MOI: overuse repetitive activities involving pronation (tennis, hammering)
Signs and sxs: arm feels heavy, pain in forearm, minimal night pain, decreased motor and sensory median N distribution
Motor: FPL, APB, FDP (digits 2-3), OP, PQ, (PT is spared)
Sensory: lateral 3.5 digits, thenar eminence
Special tests: pronator teres test +, Tinel’s test at forearm +, (-) phalens
- pain reproduced with resisted flexion and pronation
PIN syndrome
Nerve: PIN coming off radial N
Site of compression: between 2 heads of supinator
Signs and sxs: MOTOR only
weak wrist extensors
- pain in deep forearm, lateral elbow
- drop fingers and thumb
- ECRL is preserved so wrist can still extend and radially deviate
Obturator neuropathy
Site of compression: obturator canal (in groin area), adductor m/
Signs and sxs:
motor: weak abductors
sensory: inner thigh
- pain with repetitive extension and abduction of leg
Tom Dick And Nervous Harry
tarsal tunnel
Tib post, flexor Digitorum longus, tibial Artery, tibial Nerve, flexor Hallucis longus
Crutch palsy
Nerve: radial
Site of compression: axilla injury, very high nerve palsy
MOI: stretch axilla ex sleep with armrest digging into axilla
Signs and Sxs: Motor and Sensory of all radial Nerve: Motor - loss of elbow extension, wrist and digit extension, weak supination
Sensory - paresthesia post lateral arm, forearm, wrist, post aspect of thumb and radial 3.5 digits
Anterior Interosseous Syndrome
- anterior interosseous N - comes off median N
Location of compression: distal to PT on forearm, near flexor group
Signs and sxs: MOTOR ONLY - weak PQ, FDP (digits 2,3), FPL,
- forearm pain
Special test: unable to make OK sign (Kiloh Nevin sign)
Median N
N roots and and where comes off brachial plexus
C5-T1
lateral and medial cords
