Positioning: Nerve Injury Flashcards
How is the brachial plexus injured?
2nd most common injury
- any position
- when arm abducted >90 degrees or head turned away
What happens when brachial plexus injured?
Thoracic outlet syndrome—> shoulder, neck, arm pain/numbness, impaired circulation
How do you prevent a brachial plexus injury?
- axillary roll DISTAL to axilla
- pre anesthetic screen- ask pt if they can clasp hand behind head or can comfortably sleep with arms elevated overhead
- SpO2 on dependent arm in lateral position
How is the ulnar nerve (brachial plexus) injured?
- most commonly injured **
- compression between medial epicondyle of humorous and sharp edge of bed
- increased risk to men > 50 yrs, preexisting ulnar neuropathy,extremes of body habitus, prolonged hospital stay
What does an ulnar injury present as?
Sensory loss to 4th and 5th digit
- claw hand- inability to abduct or oppose pinky
How do you prevent injury to ulnar nerve?
In supine position: palm up in abducted, neutral at side, NEVER PALMS DOWN
How is the radial nerve (brachial plexus) injured?
External compression of humoral head
- arms slip off table
- excessive cycling of BP cuff
- upper arm tourniquet
- sheets too tight around side tucked arms
What is the consequence of a radial nerve injury?
Wrist drop
What causes injury to the median nerve (brachial plexus)?
- IV in antecubital space
- carpal tunnel
- hyper extension of elbow
How does a median nerve injury present?
- reduced sensation of palm, index, middle, lateral ring finger
- “ape hand”: inability to oppose thumb
How is the femoral nerve (lumbar plexus) injured?
How can it be prevented?
Excessive traction during lower abdominal surgery
- avoid excess traction
How does a femoral nerve injury present?
- impaired knee extension/hip flex ion
- reduced sensation over anterior thigh and anteromedial leg
How is the saphenous nerve (lumbar plexus) injured?
How can this be prevented?
Compression of MEDIAL aspect of leg in lithotomy
-proper padding between TIBIA and stirrup
What are the symptoms of a saphenous nerve injury?
Reduced sensation over anteromedial side of calf
How is the obturator (lumbar plexus) nerve injured?
- excessive flexion of thigh toward groin
- excessive traction during abdominal surgery
How does an injury to the obturator nerve present?
- impaired leg ADDuction
- reduced sensation over medial thigh
How can an obturator nerve injury be prevented?
Minimize hip flexion
What causes injury to the sciatic nerve (sacral plexus)?
- sitting position- sitting with straight legs
- lithotomy: extreme hip flexion and/or external rotation
How does a sciatic nerve injury present?
- foot drop
- pain/numbness of leg, foot
- weakness of all skeletal muscle below knee
- diminished sensation over lateral half of leg and foot
How can a sciatic nerve injury be prevented?
- ample padding under buttocks
- avoid excessive external rotation of hips
- flex table at knees
What is the most frequently damaged nerve of the lower extremity?
- common peroneal nerve * (sacral plexus)
—> caused by compression of LATERAL aspect of leg in lithotomy
How does injury to the common peroneal nerve present?
How can this be prevented?
Foot drop
- proper padding under FIBULAR head
- knees flexed with minimum rotation
Crossing legs for extended periods increases risk of injury to which nerves?
- Sural nerve to top leg
- Superficial peroneal nerve to bottom leg
What are the different stages of the brachial plexus and how many nerves are in each?
Roots (5–> C5-T1 Trunks (3) Divisions (3) Cords (3) Branches (5)
