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Year 3 > Peripheral nerve injuries/palsies (N) > Flashcards

Peripheral nerve injuries/palsies (N) Flashcards

1
Q

Define peripheral nerve injuries.

A

Result from systemic diseases (e.g. diabetes or autoimmune disease) or localised damage (e.g. trauma, compression, tumours) and manifest with neurological deficits distal to the level of the lesion

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2
Q

What are the types of causes of peripheral nerve injuries? (6)

A
  • injury - accidents can compress, crush or cut nerves
  • medical conditions - DM, GBS, carpal tunnel syndrome
  • autoimmune diseases - SLE, RA, Sjogren’s syndrome
  • infection - HIV
  • tumour/malignancy
  • toxic/metabolic causes - drugs, alcohol, B12, uraemia, amyloidosis
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3
Q

What is Guillain-Barre syndrome (cause of peripheral nerve injuries)?

A

Immune-mediated demyelination of peripheral nervous system often triggered weeks after an infection (Campylobacter jejuni)

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4
Q

What are the symptoms of Guillain-Barre syndrome? (4)

A
  • back/leg pain initially
  • progressive, symmetrical weakness of all limbs
  • classically ascending weakness of limbs (legs –> arms)
  • reflexes are absent
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5
Q

What would lumbar puncture show in Guillain-Barre syndrome?

A

Rise in protein with normal WCC

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6
Q

What would a nerve conduction study show in Guillain-Barre syndrome?

A

Decrease due to demyelination

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7
Q

What is carpal tunnel syndrome (cause of peripheral nerve injury)?

A

Compression of median nerve in carpal tunnel

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8
Q

What are some causes of carpal tunnel syndrome? (3)

A
  • pregnancy
  • rheumatoid arthritis
  • oedema
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9
Q

What are the symptoms of carpal tunnel syndrome? (5)

A
  • pins and needles in thumb, index and middle finger
  • weakness of thumb abduction
  • wasting of thenar eminence
  • Tinel’s sign - tapping causes paraesthesia
  • Phalen’s sign - flexion of wrist causes symptoms
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10
Q

What investigations do we do for carpal tunnel syndrome?

A

Nerve conduction studies or EMG

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11
Q

How do we treat carpal tunnel syndrome? (3)

A
  • steroid injections
  • wrist splints at night
  • severe - surgical decompression
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12
Q

What are the types of nerve damage? (4)

A
  • neuropraxia - compression injury causing temporary disruption of nerve conduction
  • axonotmesis - axon damaged but perineurium and epineurium remain intact
  • neurotmesis - complete nerve transection
  • traumatic neuroma - benign, painful nodular thickening caused by nerve regeneration at site of different forms of nerve injury
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13
Q

What are the clinical features of motor nerve injuries? (3)

A
  • muscle weakness
  • painful cramps
  • uncontrollable muscle twitching
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14
Q

What are the clinical features of sensory nerve injuries? (2)

A
  • paraesthesia in hands and feet (numbness and tingling)
  • trouble sensing pain or changes in temperature
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15
Q

What are the clinical features of autonomic nerve injuries? (4)

A
  • excessive sweating
  • changes in blood pressure
  • inability to tolerate heat
  • GI symptoms
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16
Q

What types of peripheral nerve palsies are there? (7)

A
  • median nerve injuries
  • ulnar nerve injuries
  • radial nerve injuries
  • Klumpske’s palsy
  • Erb’s palsy
  • common peroneal nerve injuries
  • tibial nerve injuries
  • (long thoracic, axillary, posterior interosseus, anterior interosseus, meralgia paraesthetica, obturator, sciatic, femoral, tarsal tunnel syndrome)
17
Q

What are the clinical features of median nerve injuries? (3)

A
  • loss of sensation in lateral palmar surface of 3.5 digits
  • weakness in abductor pollicis brevis (thumb abduction)
  • wasting of thenar eminence
18
Q

What signs are seen in median nerve injuries? (2)

A
  • Tinel’s sign - tapping causes paraesthesia
  • Phalen’s sign - flexion of wrist causes symptoms
19
Q

What condition is the median nerve commonly affected in?

A

Carpal tunnel syndrome

20
Q

What levels of the spinal cord are affected in median nerve injuries?

A

C6-T1

21
Q

What are the clinical features of ulnar nerve injuries? (4)

A
  • loss of sensation over medial 1.5 digits
  • weakness in abductor digiti minimi
  • wasting of hypothenar eminence
  • claw hand
22
Q

What levels of the spinal cord are affected in ulnar nerve injuries?

A

C8-T1

23
Q

What are the clinical features of radial nerve injuries? (2)

A
  • paraesthesia of first dorsal interosseus muscle
  • weakness of wrist extension –> wrist drop
24
Q

What levels of the spinal cord are affected in radial nerve injuries?

A

C5-T1

25
Q

What are the clinical features of Klumpke’s palsy? (3)

A
  • loss of sensation in ulnar distribution (medial 1.5 digits)
  • paralysis of intrinsic muscles of hand
  • Horner’s syndrome sometimes present
26
Q

What levels of the spinal cord are affected in Klumpke’s palsy?

A

C8-T1

27
Q

What are the clinical features of Erb’s palsy? (3)

A
  • loss of shoulder abduction and elbow flexion
  • arm held internally rotated
  • Waiter’s tip
28
Q

What levels of the spinal cord are affected in Erb’s palsy?

A

C5-C6

29
Q

What are the clinical features of common peroneal nerve injuries? (3)

A
  • sensory loss over dorsum of foot
  • weakness in dorsiflexion and eversion of foot –> foot drop
  • hit in side of knee
30
Q

What levels of the spinal cord are affected in common peroneal nerve injuries?

A

L4-S1

31
Q

What is a sign of L5 radiculopathy?

A

Weakness of hip abduction and loss of inversion of foot

32
Q

What are the clinical features of tibial nerve injuries? (2)

A
  • sensory loss on sole of foot
  • inability to invert foot or stand on tiptoe (plantarflexion)
33
Q

What levels of the spinal cord are affected in tibial nerve injuries?

A

L4-S3

34
Q

What are the main methods of investigating peripheral nerve injuries? (2)

A
  • EMG (electromyography)
  • nerve conduction studies
35
Q

What imaging can we do for peripheral nerve injuries?

A

Plain X-ray or CT/MRI

36
Q

What conservative treatment is there for peripheral nerve injuries? (6)

A
  • expectant management (allowing spontaneous recovery with close monitoring)
  • activity modification
  • splinting
  • electrical stimulation
  • physiotherapy
  • analgesia
37
Q

What surgical treatment is there for peripheral nerve injuries?

A

Nerve repair or nerve transfer - if injury not healing properly on its own/conservative Rx, or open injury

Year 3 (165 decks)

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