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Y3 - Musculoskeletal > Peripheral nerve injuries and palsies > Flashcards

Peripheral nerve injuries and palsies Flashcards

1
Q

Give 6 examples of peripheral nerve injury conditions:

A

1) brachial plexus injury
2) peroneal foot drop
3) spinal accessory nerve injury
4) carpal tunnel syndrome
5) Charcot-Marie-Tooth Disease
6) Guillain-Barre syndrome

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2
Q

Give the ABCDE non-traumatic causes of peripheral neuropathy:

A

1) alcohol
2) B12 deficiency
3) cancer (myeloma) and CKD
4) diabetes and drugs
5) every vasculitis

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3
Q

Name 4 drugs that cause peripheral neuropathy:

A

1) isoniazid
2) amiodarone
3) leftunomide
4) cisplatin

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4
Q

Give 5 general symptoms of peripheral nerve injuries:

A

1) severe burning, pain
2) muscle weakness
3) reduced reflexes
4) reduced sensation/ paraethesia
5) muscle wasting

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5
Q

What is the same of the classification system for peripheral nerve injury?

A

Sunderland Classification System

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6
Q

Describe a first degree peripheral nerve injury:

A

a reversible conduction block at the site of injury (neuropraxia)

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7
Q

Describe second degree peripheral nerve injury:

A

the loss of the continuity of the axon and its covering myelin but preservation of the connection of the nerve (axonotmesis)

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8
Q

Describe third degree peripheral nerve injury:

A

damage to the axon and their supporting structures

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9
Q

Describe fourth degree peripheral nerve injury:

A

damage to the axons and the surrounding tissues sufficient to create scarring that prevents nerve regeneration

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10
Q

Describe fifth degree peripheral nerve injury:

A

complete transection of the next including the epineurium (neurotmesis)

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11
Q

What two muscles does the spinal accessory nerve innervate?

A

1) sternocleidomastoid
2) trapezius

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12
Q

Give two causes of spinal accessory nerve injury:

A

1) severing during neck surgery
2) trauma

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13
Q

Give 3 presentations associated with spinal accessory nerve injury:

A

1) shoulder pain
2) winging of the scapulae
3) weakness and atrophy of the trapezius muscle

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14
Q

Where is the carpal tunnel found?

A

between the carpal bones and flexor retinaculum in the wrist

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15
Q

What is carpal tunnel syndrome?

A

compression, swelling or narrowing of the carpal tunnel, compressing the median nerve

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16
Q

What structures pass through the carpal tunnel?

A

1) median nerve
2) flexor tendons

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17
Q

What is the motor function of the median nerve in the hand?

A

innervation to the thenar eminence

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18
Q

What three muscles make up the the thenar eminence?

A

1) abductor pollicis brevis
2) opponens pollicis
3) flexor pollicis brevis

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19
Q

What is the sensory function of the median nerve in the hand?

A

sensory innervation to the thumb, index and middle finger and lateral half of the ring finger

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20
Q

Give 7 risk factors for carpal tunnel syndrome:

A

1) acromegaly
2) rheumatoid arthritis
3) diabetes
4) hypothyroidism
5) repetitive strain
6) obesity
7) perimenopause

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21
Q

Are carpal tunnel syndrome symptoms worse in the day or night?

A

Night

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22
Q

Give 5 symptoms of carpal tunnel syndrome:

A

1) weakness of thumb movement and grip strength
2) wasting of the thenar muscles
3) numbness in distribution of the median nerve supply
4) burning sensations
5) paraesthesia (pins and needles)

23
Q

Name the 2 special tests for carpal tunnel syndrome:

A

1) Phalen’s test
2) Tinel’s test

24
Q

Describe Phalen’s test for carpal tunnel syndrome along with the positive result:

A

have the patient put the backs of their hands together with their wrists at 90 degrees - a positive result is numbness and paraesthesia in this position

25
Q

Describe Tinel’s test for carpal tunnel syndrome along with the positive result:

A

tapping the wrist in the location where the median nerve travels through the carpal tunnel - the positive result is numbness and paraesthesia during this

26
Q

What investigation is used to diagnose carpal tunnel syndrome?

A

nerve conduction studies

27
Q

Describe the nerve conduction studies used to test for carpal tunnel syndrome:

A

where a small electrical current is applied by an electrode to the median nerve - recording electrodes over the median nerve record the current that reaches them

28
Q

Give 3 treatment options for carpal tunnel syndrome:

A

1) wrist splints
2) steroid injections
3) surgery

29
Q

Describe carpal tunnel syndrome surgery:

A

under local anaesthetic, the flexor retinaculum is cut to release the pressure on the median nerve

30
Q

What structure is injured in Erb’s palsy?

A

the superior trunk of the brachial plexus (C5/C6)

31
Q

What is the most common cause of Erb’s palsy?

A

difficult childbirth (damage to neonate’s neck)

32
Q

What mechanism causes Erb’s palsy (damage to the superior trunk of the brachial plexus)?

A

excessive lateral neck flexion

33
Q

What 4 nerves are affected by Erb’s palsy?

A

1) musculocutaneous nerve
2) axillary nerve
3) suprascapular nerve
4) nerve to subclavius

34
Q

Give three areas where sensation is lost in Erb’s palsy:

A

1) sergeant’s patch
2) lateral arm
3) lateral forearm

35
Q

Give 4 muscles/ muscle groups that waste in Erb’s palsy:

A

1) deltoid
2) supraspinatus
3) infraspinatus
4) anterior compartment of the arm

36
Q

Give 4 movements that are difficult in Erb’s palsy:

A

1) shoulder abduction
2) shoulder external rotation
3) elbow flexion
4) forearm/ wrist supination

37
Q

What structure is injured in Klumpke’s palsy?

A

inferior trunk of the brachial plexus (C8/T1)

38
Q

What mechanism causes Klumpke’s palsy?

A

excessive force placed on an abducted shoulder

39
Q

What two nerves are injured in Klumpke’s palsy?

A

1) median
2) ulnar

40
Q

Give 4 areas that lose sensation in Klumpke’s palsy:

A

1) median distribution to the hand
2) ulnar distribution to the hand
3) medial forearm
4) medial arm

41
Q

Give 5 movements that are lost in Klumpke’s palsy:

A

1) metacarpophalangeal flexion
2) interphalangeal extension
3) finger abduction
4) finger adduction
5) opposition of the thumb

42
Q

What structure is injured in Horner’s syndrome?

A

T1 nerve root and sympathetic chain

43
Q

Give the 4 characteristic features of Horner’s syndrome:

A

1) ptosis (drooping eye lid)
2) anhidrosis (loss of sweating on the affected side of the face)
3) enophthalmos (eye appears sunken)
4) miosis (constricted pupil)

44
Q

What is Charcot-Marie-Tooth Disease?

A

an autosomal dominant inherited disease that affects peripheral nerves by causing myelin or axon dysfunction

45
Q

Give 4 classical features of Charcot-Marie-Tooth Disease:

A

1) pes cavus (high foot arch)
2) distal muscle wasting (causing inverted champagne bottle legs)
3) reduced reflexes
4) limb weakness and reduced muscle tone

46
Q

What is the name of the acute paralytic polyneuropathy characterised by ascending weakness following infection?

A

Guillain-Barre Syndrome

47
Q

Give 3 infective triggers of Guillain-Barre Syndrome:

A

1) Campylobacter jejuni
2) Ctyomegalovirus
3) Epstein-Barr virus

48
Q

Describe the pathogenesis of Guillain-Barre syndrome:

A

the body’s immune response to an infection produces antibodies, but due to biomimicry, these also attach to proteins on peripheral neurones

49
Q

Do symptoms progress upwards or downwards in Guillain-Barre syndrome?

A

Upwards

50
Q

Give two diagnostic investigations for Guillain-Barre syndrome and their positive results:

A

1) nerve conduction studies (reduced signal)
2) lumbar puncture (CSF will show raised protein but normal cell count and glucose)

51
Q

What is the first line management for Guillain-Barre syndrome?

A

IV immunoglobulins

52
Q

Give 3 general investigations for peripheral nerve injuries:

A

1) nerve conduction studies
2) electromyography
3) MRI cerograph/ CT scan

53
Q

What is the most common intervention for peripheral nerve injuries?

A

surgery

Y3 - Musculoskeletal (7 decks)

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