Positioning and Nerve Injuries

Question 1

What is the most most upper extremity postop nerve injury?

Answer 1

ulnar

d\t compression between medial epicondyle of humerus and sharp edge of the operating table

Question 2

The ulnar nerve is stretched when ______ the arm.

Answer 2

pronating

Question 3

Injury to the ulnar nerve causes the inability to ______ the fifth finger, ultimately leading to “________”.

Answer 3

abduct or oppose; claw hand

Question 4

What is the second most common postop neurologic injury?

Answer 4

brachial plexus injury

Question 5

What is the cause of a brachial plexus injury?

Answer 5

stretch injury when the neck is extended and the head is turned away, or the arm is abducted > 90 degrees
*compression injury between the clavicle and first rib with improperly placed shoulder braces or spreading of sternum

Question 6

This injury occurs if the arm slips off the surgical table or if pressure is applied to the nerve as it traverses the spiral groove of the humerus.

Answer 6

radial nerve injury

Question 7

What type of nerve injury results in wrist drop, inability to extend the metacarpophalangeal joints, weakness in abduction of the thumb, and decrease in sensation over dorsal surfaces of the lateral three and one half fingers (first, middle, and ring)?

Answer 7

radial

Question 8

Injury to this nerve is unlikely due to positioning, but can result in inability to oppose the first and fifth digits and decreased sensation on the palmar surface of the lateral three and one half fingers (first, ring, and middle).

Answer 8

medial

Question 9

What nerve is rarely injured d\t stretching or compression because of how deep it runs in the arm?

Answer 9

musculocutaneous

Question 10

What will be seen with musculocutaneous nerve injury?

Answer 10

inability to flex the arm and sensation is decreased over the ventral surface of the forearm.

Question 11

Match the nerve injury: “Ape Hand”

Answer 11

median nerve injury–> unable to oppose thumb

Question 12

Match the nerve injury: “Claw Hand”

Answer 12

ulnar nerve injury

Question 13

Match the nerve injury: “Wrist Drop”

Answer 13

radial nerve injury

Question 14

Match the nerve injury: “inability to flex forearm”

Answer 14

musculocutaneous nerve injury

Question 15

Match the nerve injury: “inability to abduct arm”

Answer 15

axillary nerve injury

Question 16

Match the nerve injury: “Foot drop”

Answer 16

sciatic, common peroneal, or anterior tibial

Question 17

Match the nerve injury: “absent knee jerk and loss of flexion of hip and extension of knee”

Answer 17

femoral

Question 18

Match the nerve injury: “paresthesias along the medial and anteromedial side of calf”

Answer 18

saphenous

Question 19

Match the nerve injury: “inability to adduct the leg and diminished sensation over medial side of the thigh”

Answer 19

obturator

Question 20

Match the nerve injury: “pain and dyesthesia over lateral thigh”

Answer 20

lateral femoral cutaneous

Question 21

Match the nerve injury: “pain or numbness of lower leg, thigh, or foot”

Answer 21

sciatic

Question 22

Match the nerve injury: “decreased sensation over superior aspect of thigh and medial and anteromedial side of leg”

Answer 22

femoral

Question 23

Match the nerve injury: “loss of dorsal extension of toes”

Answer 23

common peroneal

Question 24

Match the nerve injury: “most frequently damaged nerve of the lower extremity”

Answer 24

common peroneal

Question 25

Match the nerve injury: “damaged in sitting position with pressure on the ischial tuberosities or in lithotomy position when the nerves and thigh are externally rotated”.

Answer 25

sciatic

*also damaged with improper IM injection–> should be given in the upper, outer quadrant of the buttock

Question 26

Match the nerve injury: “damaged in lithotomy by extreme abduction of the thighs with external rotation of the hip”

Answer 26

femoral

Question 27

Match the nerve injury: “damaged during difficult forceps delivery or by excessive flexion of the thigh to the groin”

Answer 27

obturator

Question 28

Injury to this nerve eventually leads to claw hand.

Answer 28

ulnar

Question 29

Injury to this nerve prevents abduction and opposition of the fifth finger.

Answer 29

ulnar

Question 30

Spreading the sternum during heart surgery or abduction of the arm > 90 degrees or turning the head to the left can injury this structure.

Answer 30

brachial plexus

Question 31

Which nerve is compressed when pressure is applied to the spiral groove of the humerus?

Answer 31

radial

Question 32

This nerve may be damaged when an IV is started.

Answer 32

musculocuteneous

Question 33

Injury to this nerve results in decreased sensation over the dorsal surface of the lateral three and one-half fingers.

Answer 33

radial

Question 34

When this nerve is injured, opposition of the first and fifth digits is precluded (made impossible).

Answer 34

median

Question 35

The patient has weakened skeletal muscle function below the knee. Which nerve is injured?

Answer 35

sciatic

Question 36

What is the most frequently damaged nerve in the lower extremity?

Answer 36

common peroneal

Question 37

Which nerve may be compressed against the pelvic brim by a self-retaining retractor?

Answer 37

femoral

Question 38

What nerve is a terminal branch of the femoral nerve?

Answer 38

saphenous