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Neurology > Peripheral Nerve Injury > Flashcards

Peripheral Nerve Injury Flashcards

1
Q

Wall layer that covers a nerve fascicles

A

Perineurium

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2
Q

Wall layer that covers a nerve fiber

A

Endoneurium

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3
Q

Wall layer that covers a spinal nerve

A

Epineurium

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4
Q

Three classifications under Seddon

A

Neuropraxia, Axonotmesis, Neurotmesis

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5
Q

Seddon: (+) Wallerian Degeneration

A

Axonotmesis and Neurotmesis

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6
Q

Seddon: (+) Complete transaction of neuron

A

Neurotmesis

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7
Q

Good rate of nerve regeneration

A

1-2 mm per day

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8
Q

Seddon: (+) Conduction block

A

Neuropraxia

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9
Q

Healing time of Neuropraxia

A

1-2 months (3-4 weeks)

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10
Q

Seddon: (+) Axonal injury

A

Axonotmesis

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11
Q

Seddon: (+) Compression

A

Neuropraxia

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12
Q

Sunderland V

A

Axon + Endo + Peri + Epi

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13
Q

Seddon: (+) Gunshot wound

A

Neurotmesis

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14
Q

Sunderland: Axon + Endoneurium

A

III

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15
Q

Sunderland: IV

A

Axon + Endo + Peri

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16
Q

Nerves commonly affected in Neuropraxia

A

Thick myelinated motor nerve

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17
Q

Sunderland: Conduction Block

A

I

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18
Q

Nerves commonly affected in Neurotmesis

A

Any

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19
Q

Seddon: (+) Severe compression

A

Axonotmesis

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20
Q

Prognosis of Axonotmesis

A

Good

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21
Q

True or False: There is a (+) atrophy with Neuropraxia injuries

A

False

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22
Q

Sunderland II

A

Axon

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23
Q

Nerves commonly affected in Axonotmesis

A

Myelinated motor and sensory nerve

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24
Q

True or False: Surrounding structures are affected in Axonotmesis

A

False

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25
Q

Brachial Plexus comes from what nerve roots?

A

ANTERIOR rami of C5-T1 (VEMDAS)

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26
Q

Nerve Innervation: Serratus Anterior

A

Long Thoracic Nerve (C5-7)

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27
Q

Nerve Innervation: Supraspinatus and Infraspinatus

A

Suprascapular Nerve (Upper Trunk)

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28
Q

Largest nerve in the brachial plexus

A

Radial Nerve

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29
Q

Medial Pectoral Nerve innervates what muscles?

A

Pectoralis Major and Minor

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30
Q

Nerve Innervation: Subscapularis Muscle

A

Upper and Lower Subscapular Nerve (Posterior Cord)

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31
Q

Lower Subscapular Nerve innervates what muscles?

A

Subscapularis and Teres Major

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32
Q

Nerve root of Axillary Nerve

A

C5-6

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33
Q

Nerve Innervation: Rhomboids

A

Dorsal Scapular Nerve

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34
Q

“External Respiratory Nerve of Bell”

A

Long Thoracic Nerve

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35
Q

Nerve Innervation: Pectoralis Major Muscle

A

Lateral Pectoral Nerve (Lateral Cord)

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36
Q

Musculocutaneous Nerve innervates what muscles?

A

BiCoBra: Biceps Brachii, Coracobrahialis, Brachioradialis

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37
Q

Nerve root of Levator Scapulae

A

C3-4

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38
Q

Sensory Innervation: Posterior forearm

A

Musculocutaneous, Radial and Medial Cutaneous of FA

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39
Q

Sensory Innervation: Superolateral Arm

A

Axillary Nerve

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40
Q

Sensory Innervation: Medial arm

A

Medial Cutaneous of Arm Nerve

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41
Q

Sensory Innervation: Lateral FA

A

Musculocutaneous Nerve

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42
Q

Sensory Innervation: Posterior Arm

A

Radial Nerve

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43
Q

Cause of Musculocutaneous nerve injury

A

Fracture and Dislocation

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44
Q

What atrophy happens if there is a (+) entrapment of the musculocutaneous nerve at the arm?

A

Flatness of Anterior arm

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45
Q

What weakness can be observed if there is a (+) entrapment of the musculocutaneous nerve at the arm?

A

BiCoBra: Weakness of Shoulder and Elbow flexion + FA supination

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46
Q

What area usually has a diminished sensation if there is a (+) entrapment of the musculocutaneous nerve at the arm?

A

Lateral FA sensory affectation

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47
Q

Two causes of musculocutaneous nerve entrapment in the forearm

A

Musculocutaneous nerve tunnel syndrome and Hyperextension of elbow

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48
Q

Musculocutaneous nerve tunnel syndrome is secondary to what structure?

A

Distal biceps tendon

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49
Q

What kind of sport causes musculocutaneous nerve entrapment in the forearm?

A

Backhand sports (hyperextension of the elbow)

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50
Q

What kind of neuropathy does musculocutaneous nerve entrapment in the forearm have?

A

Pure sensory neuropathy

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51
Q

Another name of Axillary Nerve

A

Circumflex Nerve

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52
Q

Two causes of axillary nerve entrapment

A

Anterior shoulder dislocation and Proximal Humeral Fracture

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53
Q

Site of Proximal Humeral Fracture

A

Quadrangular Space

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54
Q

3 clinical manifestations of axillary nerve entrapment

A

(+) Weakness of Teres Minor & Deltoids, (+) Atrophy, (+) Sensory loss of the superolateral arm

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55
Q

What atrophy happens if there is a (+) entrapment of the axillary nerve?

A

Square Shoulder Deformity

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56
Q

Two sites of Suprascapular nerve entrapment

A

Suprascapular ntoch and spinoglenoid notch

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57
Q

If there is a (+) suprascapular notch entrapment, what are the muscles affected?

A

Supraspinatus and Infraspinatus

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58
Q

If there is a (+) spinoglenoid notch entrapment, what are the muscles affected?

A

Infraspinatus

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59
Q

What area usually has a diminished sensation if there is a (+) entrapment of the suprascapular nerve?

A

AC and GH joint

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60
Q

If there is axillary nerve entrapment, what muscles would compensate for the weakness of shoulder ABER?

A

Supraspinatus and Infraspinatus

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61
Q

“Open Book” Winging

A

Medial Winging

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62
Q

Winging: Lesion of Dorsal Scapular Nerve

A

Posterior Winging

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63
Q

“Sliding Door” Winging

A

Lateral Winging

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64
Q

Synergistic action of SA and Traps

A

Upward Rotation of Scapula (lateral)

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65
Q

Winging: (+) Radial Neck Dissection

A

Lateral Winging

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66
Q

The same action of Traps and Rhomboids in the scapula

A

Retraction

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67
Q

Winging: Middle scalene hypertrophy

A

Posterior Winging

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68
Q

Winging: (+) Radial Mastectomy

A

Medial WInging

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69
Q

Winging: (+) Overhead activities

A

Posterior Winging

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70
Q

Winging: (+) Neck Surgery

A

Lateral Winging

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71
Q

Winging: (+) Back Pack Palsy

A

Medial WInging

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72
Q

9 muscles that are innervated by PIN

A

ECRB, Supinator, Extensor Digitiminimi, Extensor Indicis, Extensor Digitorum, Extensor Pollicis Brevis, Ext Pollicis Longus, Abductor Pollicis Longus

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73
Q

2 branches of radial nerve that branched out under spiral groove

A

Superficial and Deep Branch

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74
Q

4 sensory branches of radial nerve

A

Posterior arm, Lateral inferior arm, Posterior forearm and Superficial branch

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75
Q

Two muscles innervated by the radial nerve after its passes through the spiral groove

A

ECRL and Brachioradialis

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76
Q

The superficial branch of the radial nerve innervates what area of the arm?

A

Dorsum of the hand

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77
Q

What is the nerve palsy that occurs due to the entrapment of radial nerve in the level of axilla?

A

Crutch Palsy

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78
Q

The most common site of radial nerve entrapment

A

Spiral Groove

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79
Q

Site of radial entrapment: (+) Cheralgia Paresthetica

A

At the wrist

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80
Q

Site of radial entrapment: (+) Saturday night Palsy

A

Spiral Groove

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81
Q

Site of radial entrapment: (+) Supinator Syndrome

A

Radial Tunnel

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82
Q

Spared muscles in Spiral Groove Entrapment

A

Triceps and Anconeus

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83
Q

Pure motor neuropathy of radial nerve

A

Radial Tunnel Syndrome

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84
Q

Spared muscles in Radial Tunnel Syndrome

A

Triceps, Anconeus, ECRL, Brachioradialis

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85
Q

Two causes of Radial Tunnel Syndrome

A

Supinator Syndrome and Vascular Leash of Henry

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86
Q

The most common site of radial entrapment in the radial tunnel

A

Arcade of Froshe

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87
Q

Pure sensory neuropathy of radial nerve

A

Cheralgia Paresthetica / Wartenburg disease

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88
Q

Another name of Cheralgia Paresthetica

A

Wartenburg disease or syndrome

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89
Q

Four causes of Cheralgia Paresthetica

A

Tight bracelet, Tight wristwatch, scaphoid fracture, handcuff neuropathy

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90
Q

Three muscles innervated by AIN

A

FDP (lateral 2), Pronator Quadratus, FPL

91
Q

Four muscles innervated by the Median nerve at the elbow

A

Pronator Teres, FCR, Palmaris Longus, FDS

92
Q

Four muscles innervated by the Median nerve at the carpal tunnel

A

Lumbricals, Opponens Pollicis, Abductor Pollicis, Flexor Pollicis Brevis

93
Q

A sensory branch of Median Nerve

A

Superficial Palmar Branch

94
Q

Area innervated by Superficial Palmar Branch of Median Nerve

A

Thenar Area

95
Q

Ligament attached to the medial epicondyle to the supracondylar process of the humerus

A

Ligament of Struthers

96
Q

What is the specific site in the supracondylar process where the Ligament of Struthers is attached?

A

Avian Spur

97
Q

What is the name of the median entrapment above the elbow?

A

Supracondylar syndrome

98
Q

Three causes of median entrapment at the elbow?

A

Pronator teres syndrome, screwdrivers palsy and bicipital aponeurosis

99
Q

Does screwdrivers palsy occur due to repetitive movements?

A

Yes, because. of the repetitive pronation and supination

100
Q

Other two names of Bicipital Aponeurosis

A

Lacertus Fibrosus and Grace Dieu Fascia

101
Q

What is the spared muscle in the median entrapment at the elbow?

A

Pronator Teres (but weak if loaded)

102
Q

Pure motor neuropathy of median nerve

A

AIN/ Kiloh Nevin Syndrome

103
Q

What is the abnormal muscle formed by FPL?

A

Gantzer Muscle

104
Q

Two causes of AIN entrapment at the elbow?

A

Pronator Teres and Gantzer Muscle

105
Q

Sign of (+) Kiloh Nevin Syndrome

A

(-) Ok sign

106
Q

A special test of AIN neuropathy

A

Pinch Grip Test

107
Q

The most common entrapment of the nerve in the shoulder

A

Axillary Nerve

108
Q

The most common site of median nerve entrapment

A

Carpal Tunnel

109
Q

Four contents of carpal tunnel

A

4 tendons of FDP, 4 tendons of FDS, 1 tendon of FPL, and 1 median nerve

110
Q

What is the gender predominantly affected by CTS

A

Females

111
Q

True or False: Bilateral hand affectation is more prevalent than unilateral in patients with CTS

A

True

112
Q

Four systemic cause of CTS

A

Pregnancy, Obesity, Arthritis, Endocrine Problem

113
Q

Four traumatic cause of CTS

A

Lunate Dislocation, Repetitive Typing, Piano Playing, Usage of vibrating equipments

114
Q

What is spared in the CTS?

A

Superficial Palmar Branch (thenar area)

115
Q

True or False: There is a weakness of finger flexors in CTS

A

False

116
Q

Three sensory branches of the ulnar nerve

A

Palmar Cutaneous, Dorsal Cutaneous, Superficial Branch

117
Q

What are the two muscles innervated by the ulnar nerve as it passes through the cubital tunnel?

A

FCU and FDP (median 2)

118
Q

What are the muscles innervated by the ulnar nerve as it passes through the tunnel of Guyon?

A

Palmaris Brevis

119
Q

Seven muscles innervated by a deep branch of the ulnar nerve

A

Interossei, Lumbricals, Flexor Digitiminimi, Abductor Digitiminimi, Opponens Digitiminimi, Adductor Pollics, Flexor Pollis Brevis

120
Q

Three dually innervated muscles of the hand

A

Lumbricals, FDP and Flexor Pollicis Brevis

121
Q

2 innervations of Flexor Digitorum Profundus

A

AIN and Deep branch of Ulnar Nerve

122
Q

The most common site of ulnar nerve entrapment

A

Cubital Tunnel (at elbow)

123
Q

Four causes of Cubital Tunnel Syndrome

A

Trauma on posterior elbow, cubitus valgus, Osborne ligament (FCU), anomalous epitrochelais anconeus muscle

124
Q

What is the gender predominantly affected by Cubital Tunnel Syndrome?

A

Male due to old age

125
Q

Three risk factors of Cubital Tunnel Syndrome

A

Tardy ulnar palsy, gripping activity, smoking

126
Q

What activity causes Tardy ulnar palsy?

A

Elbow Flexion

127
Q

What are the two muscles spared in the entrapment of the ulnar nerve in the tunnel of Guyon?

A

FCU and FDP

128
Q

The tunnel fo Guyon is formed by what structures?

A

Pisiform, Hamate, and Pisohamate Ligament

129
Q

Two causes of entrapment of the ulnar nerve in the tunnel of Guyon?

A

Handlebar’s Palsy and Jackhammer’s Palsy

130
Q

Who is most likely predisposed in Handlebar’s Palsy?

A

Bikers, Riders, Cyclist

131
Q

What area usually has a diminished sensation if there is a (+) entrapment of the ulnar nerve at the tunnel of Guyon?

A

Palmar Aspect of fingers

132
Q

Sensory innervation: Lateral palm of the hand

A

Median Nerve

133
Q

Sensory innervation: Lateral dorsum of the hand

A

Radial Nerve

134
Q

Sensory innervation: Medial aspect of the hand

A

Ulnar Nerve

135
Q

Sensory innervation: Lateral tips of the dorsum of the hand

A

Median Nerve

136
Q

Two special tests for interossei

A

Egawa and Wartenburg

137
Q

Special test for adductor pollicis

A

Froments

138
Q

Carpal bone affected in Radial Nerve Entrapment

A

Scaphoid

139
Q

Carpal bone affected in Median Nerve Entrapment

A

Lunate

140
Q

Carpal bone affected in Ulnar Nerve Entrapment

A

Pisiform and Hamate

141
Q

Hand Injury: (+) Active Papal Sign

A

Median Nerve

142
Q

Deformity present in Median Injury of the Hand

A

Ape Hand or Simian Hand

143
Q

Hand Injury: (+) Guttering stick palsy

A

Ulnar Nerve

144
Q

Deformity present in Ulnar Injury of the Hand

A

Bowler’s Thumb

145
Q

Hand Injury: (+) Hypothenar Muscle

A

Ulnar Nerve

146
Q

Hand Injury: (-) Precision Grips

A

Median Nerve

147
Q

Hand Injury: (-) Power Grips

A

Ulnar Nerve

148
Q

Hand Injury: (+) Thenar Muscle

A

Median Nerve

149
Q

Hand Injury: (+) Passive Papal Sign

A

Ulnar Nerve

150
Q

The ligament that causes Median Nerve Entrapment

A

Ligament of Struthers

151
Q

The ligament that causes Ulnar Nerve Entrapment

A

Osborne’s Ligament

152
Q

The abnormal muscle that causes Median Nerve Entrapment

A

Gantzer Muscle (FPL)

153
Q

The abnormal muscle that causes Ulnar Nerve Entrapment

A

Anomalous epitrochelais anconeus muscle

154
Q

“Anterior Crural Nerve”

A

Femoral Nerve

155
Q

Nerve that is activated during cremasteric reflex

A

Genitofemoral Nerve (L1-2)

156
Q

What is the continuation of the external oblique muscles to the inguinal ligament?

A

External Oblique Aponeurosis

157
Q

What nerve is usually entrapement due to the External Oblique Aponeurosis?

A

Ilioinguinal Nerve

158
Q

What type of sports injury is predominantly causes the Ilioinguinal Nerve entrapment

A

Hockey Groin Injury

159
Q

What syndrome occurs due to the LFCN entrapment?

A

Meralgia Paresthetica

160
Q

Another name of Meralgia Paresthetica

A

Bernhardt-Roth Syndrome

161
Q

5 risk factors of Meralgia Paresthetica

A

Male, Obese, Tight Clothing, Seatbelt and Pregnancy

162
Q

What area usually has a diminished sensation if there is a (+) Meralgia Paresthetica?

A

Lateral Thigh

163
Q

The largest nerve in the lumbar plexus

A

Femoral Nerve

164
Q

The largest nerve in the sacral plexus

A

Sciatic Nerve

165
Q

Roots of nerve to piriformis

A

Posterior S1-2

166
Q

Sensory Innervation: Posterior Thigh

A

PFCN

167
Q

Femoral nerve supplies sensation in what area of the thigh?

A

Anterior and Inferior Medial part of the thigh

168
Q

Sensory Innervation: Superior Medial Thigh

A

Genitofemoral

169
Q

Sensory Innervation: Anterolateral of leg

A

SPN

170
Q

Deep peroneal nerve supplies sensation in what area of the for?

A

1st web space of the foot

171
Q

Sensory Innervation: Posteromedial of leg

A

Saphenous Nerve

172
Q

Sensory Innervation: Middle Medial Thigh

A

Obturator Nerve

173
Q

What are the nerves that provide sensory innervation in the sole of the foot?

A

Medial and Lateral Plantar Nerve, Sural Nerve, Saphenous Nerve, Calcaneal Nerve

174
Q

Sensory Innervation: Posterolateral of leg

A

Sural Nerve

175
Q

What nerve supplies the outstep of the foot?

A

Sural Nerve

176
Q

What nerve supplies the instep of the foot?

A

Saphenous Nerve

177
Q

Two pure sensory branches of the sciatic nerve

A

Sural Nerve and Calcaneal branch of tibial nerve

178
Q

Muscle innervated by Inferior Gluteal Nerve

A

Gluteus Maximus

179
Q

Cause of Inferior Gluteal Nerve entrapment

A

Posterior Hip Arthroplasty

180
Q

(+) Gluteus Maximus Gait

A

Posterior Leaning (Hyperextension)

181
Q

Muscles innervated by Superior Gluteal Nerve

A

Gluteus Minimus and Medius + TFL

182
Q

“Uncompensated” Trendelenburg

A

Trendelenburg Sign / Pelvic Drop

183
Q

“Compensated” Trendelenburg

A

Trendelenburg Gait / Leaning

184
Q

The direction of Trendelenburg Sign or Pelvic Drop

A

Contralateral

185
Q

The direction of Trendelenburg Gait or Leaning

A

Ipsilateral

186
Q

3 compensatory mechanism of (+) Trendelenburg

A

C/L Pelvic Drop, C/L Cane, I/L leaning

187
Q

Where would you put a briefcase if the patient has (+) Trendelenburg gait

A

Ipsilateral (not compensatory mechanism)

188
Q

(+) Right gmed and gmin weakness, where is the location of the pelvic drop?

A

Left pelvic drop

189
Q

(+) Right gmed and gmin weakness, where is the location of the trunk lean?

A

Right trunk lean

190
Q

Cause of Obturator Nerve entrapment

A

Obstetric Palsy (Child Birth)

191
Q

3 causes of Femoral Nerve entrapment

A

Anterior Hip Dislocation, Hip Fracture, and Child Birth

192
Q

What muscle is the first to atrophy in femoral nerve entrapment?

A

Quadriceps muscle

193
Q

(+) Quadriceps Gait

A

Forward Lurch

194
Q

6 muscles innervated by DPN

A

Peroneus Tertius, TA, EHL, EDL, EHB, EDB

195
Q

2 muscles innervated by SPN

A

Peroneus Longus and Brevis

196
Q

Innervation of Shorthead of Hamstrings

A

CPN

197
Q

Innervation of true hamstrings

A

Tibial Nerve

198
Q

7 muscles innervated by the tibial nerve

A

Popliteus, TP, Gastrocs, Soleus, Plantaris, FHL, FDL

199
Q

4 muscles innervated by MPN

A

FAF1: Flexor Hallucis Brevis, Abductor Hallucis Brevis, FDB, 1st Lumbricals

200
Q

5 muscles innervated by LPN

A

FAIL AQ: Flexor DM, Abductor DM, Interossei, Lumbricals, Adductor Hallucis, Quadratus Plantae

201
Q

Most common entrapment in the hip region

A

Sciatic Nerve at Hip

202
Q

Most common tunnel syndrome in the body

A

CTS

203
Q

Most common entrapment in the LE

A

CPN at Fibular Head

204
Q

5 causes of sciatic entrapment in the hip

A

Posterior hip dislocation, Injection palsy, Fat wallet syndrome, toilet seat fracture, piriformis syndrome

205
Q

What atrophy is seen in sciatic entrapment in the hip?

A

Spindle Leg atrophy

206
Q

What are the 2 signs seen in sciatic entrapment in the hip?

A

Sign of pace and nagel and Sign of Freiberg

207
Q

Sign: (+) pain and weakness in active ABER of hip

A

Sign of pace and nagel

208
Q

Sign: (+) pain in passive IR of extended hip

A

Sign of Freiberg

209
Q

7 causes of CPN entrapment at Fibular Head

A

Crossed-leg sitting, side-lying, leg ER at supine, Indian sitting, Guitarist Posture, Prolonged squatting, Strawberry picker’s palsy

210
Q

4 gait deviations present in CPN entrapment at Fibular Head

A

Weak DF: (+) Foot drop (swing), (+) Foot slap (stance), (+) Steppage gait (increase hip and knee flexion), and (-) heel strike

211
Q

2 causes of DPN entrapment

A

Fracture or Trauma

212
Q

Sensory loss present in DPN entrapment

A

Sensory affectation in the 1st dorsal space

213
Q

3 syndrome that causes weakness of EDB and EHB

A

Anterior compartment syndrome, anterior tarsal tunnel, ski boots palsy

214
Q

Two sites of tibial nerve entrapment

A

Popliteal fossa and tarsal tunnel

215
Q

2 causes of tibial nerve entrapment at the popliteal fossa

A

Baker’s cyst and too long wheelchair seat depth

216
Q

3 gait deviations present in tibial nerve entrapment at popliteal fossa

A

Weak PF: (-) push-off, (+) decrease step length of the opposite foot, (+) calcaneal gait

217
Q

Cause of tibial nerve entrapment at the tarsal tunnel

A

Lesion at porta pedis

218
Q

What nerve is affected in tibial nerve entrapment at the tarsal tunnel?

A

MPN and LPN (foot intrinsics)

219
Q

2 causes of medial plantar nerve entrapment

A

Jogger’s foot and runners with flat feet (overpronation of the foot)

220
Q

The most common site of pain present in medial plantar nerve entrapment

A

Medial sole

221
Q

What is the pure sensory neuropathy occurs due to the entrapment of the 3rd-4th metatarsal?

A

Interdigital neuroma

222
Q

Other name of interdigital neuroma

A

Morton’s Neuroma

223
Q

What is the gender predominantly affected in interdigital neuroma?

A

Female

224
Q

Cause of interdigital neuroma

A

usage of poorly fitting high-heeled shoes

Neurology (14 decks)

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