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Module 204 MSK & Immune system > T2 L11 Upper limb nerve injuries > Flashcards

T2 L11 Upper limb nerve injuries Flashcards

1
Q

What are the 3 steps when approaching a neurological problem?

A

Anatomically localise lesion
Consider pathophysiology
Differential diagnosis

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2
Q

What are the signs of an UMN?

A 
Held in flexed posture if chronic
Increased tone
Pyramidal weakness (flexor muscles stronger than extensors)
Brisk reflexes
Sensory level
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3
Q

What are the signs of a LMN?

A

Wasting / fasciculations
Flaccid tone
Weakness in either a myotomal distribution or peripheral nerve distribution
Dermatomal or peripheral nerve distribution of sensory loss

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4
Q

What is a dermatome?

A

Area of skin suppled by nerve fibres originating from single dorsal nerve root

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5
Q

What myotome and muscle action does C5 root have?

A

Deltoid

Shoulder abduction

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6
Q

What myotome and muscle action does C6 root have?

A

Biceps, brachialis, brachioradialis

Elbow flexion

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7
Q

What myotome and muscle action does C7 root have?

A

Triceps, superficial forearm extensors and flexors

Elbow extension, wrist extension, wrist flexion

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8
Q

What myotome and muscle action does C8 root have?

A

Forearm extensors
Deep forearm flexors
Finger extension, finger flexion

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9
Q

What myotome and muscle action does T1 root have?

A

Intrinsic hand muscles

Finger abduction

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10
Q

What is the biceps reflex?

A

C5 reflex

Supplied by musculocutaneous nerve

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11
Q

What is the supinator jerk?

A

C6 reflex

Radial nerve

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12
Q

What is the triceps jerk?

A

C7 reflex

Radial nerve

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13
Q

What is the finger jerk?

A

C8 reflex

Median and ulnar nerve

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14
Q

What are the signs and symptoms of a nerve root impingement?

A 
Pain
 - can radiate
 - can be aggravated by neck movement
Sensory loss
Weakness
Reflex loss
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15
Q

What are the 4 types of nerve injury?

A

Avulsion
Rupture
Neuroma
Neurapraxia

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16
Q

What is avulsion?

A

Tearing of nerve from its attachment at the spinal cord

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17
Q

What is rupture?

A

Tearing of nerves but not from attachment to the spinal cord

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18
Q

What is neuroma?

A

Tumour or growth of nerve tissue

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19
Q

What is neurapraxia?

A

Axons remain intact but myelin damage causes interruption of impulse down nerve fibre

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20
Q

Give examples of causes of brachial plexus injuries

A 
Trauma
 - Erb-duchenne type paralysis
 - Klumpke paralysis 
Cancer 
 - lung cancer - pancoasts tumour
Inflammatory 
 - brachial neuritis 
Structural
 - thoracic outlet syndrome
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21
Q

What is Erb-duchenne type paralysis?

A

Avulsion of C5 and C6 roots

Upper plexus palsy

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22
Q

What are the causes of Erb-duchenne type paralysis?

A

Blow to shoulder or during delivery of the head

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23
Q

What muscles does Erbs palsy affect?

A 
Biceps
Brachioradialis
Deltoid
Supraspinatus
Supinator
24
Q

What is Klumpke’s palsy?

A

Avulsion of C8 and T1 roots

25
Q

What can cause Klumpke’s palsy?

A

Clutching for an object when falling from a height

26
Q

What are the signs and symptoms of Klumpke’s palsy?

A

Unable to flex wrist or fingers
Weakness of all small muscles of the hands
Sensory loss to hand and inner border of forearm
Claw hand

27
Q

How can you differentiate between Erb’s palsy and Klumpke’s palsy?

A

Erb’s palsy - arm doesn’t work, hand works

Klumpke’s palsy - arm works, hand doesn’t work

28
Q

What are the signs and symptoms of pancoast tumour?

A 
Pain in shoulder girdle and inner arm
Ipsilateral horners syndrome
 - miosis
 - ptosis
 - anhidrosis
29
Q

Describe radiation-induced brachial plexopathy

A

Occurs 6 years after radiation
Associated with treatment for breast, lung cancer and lymphoma
Pain isn’t a consistent feature
Predilection for upper brachial plexus

30
Q

What are the causes of idiopathic brachial neuritis?

A

Unclear

Could be infectious or post-infectious

31
Q

What are the signs and symptoms of idiopathic brachial neuritis?

A

Severe pain over days

As pain diminishes it is followed by weakness and wasting

32
Q

What investigations are done for idiopathic brachial neuritis?

A

MRI to look for thickening and enhancement

NCS / EMG for prognostication

33
Q

What is the treatment of idiopathic brachial neuritis?

A

Analgesia
Physiotherapy
Steroids (limited evidence)

34
Q

Where are the common compression sites in thoracic outlet syndrome?

A

Between anterior and middle scalene muscles
Between clavicle in costoclavicular space
Beneath tendon of pectoralis minor

35
Q

What are the signs and symptoms of neurogenic thoracic outlet syndrome?

A

Predominantly affects abductor policies brevis leading to thenar wasting
Paraesthesia
Numbness
Weakness
Not localised to specific nerve distribution
Aggravated by elevation or sustained use of arms or hands

36
Q

what are the signs and symptoms of vascular thoracic outlet syndrome?

A

Forearm fatigue within minutes
Swelling and cyanosis
Collateral venous patterning over ipsilateral shoulder, chest wall and neck
Rarely pain
Pallor and coldness
Lower BP on affected arm with diminished distal pulses

37
Q

Why does damage to long thoracic nerve cause winging of scapula?

A

Long thoracic nerve normally supplies serrates anterior which pulls medial border of scapula to posterior thoracic wall and stabilises it there

38
Q

What are the causes of damage to the long thoracic nerve?

A

Blows or pressure in posterior triangle of neck

Radical mastectomy

39
Q

What are the 2 common sites of compression of the median nerve?

A

Wrist - carpal tunnel syndrome

Elbow

40
Q

What hand muscles does the median nerve innervate?

A

Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

41
Q

What are the causes of carpal tunnel?

A 
Diabetes
Pregnancy
Hypothyroidism
Rheumatoid arthritis
Repetitive strain
42
Q

Where does the anterior interosseous nerve come from?

A

Median nerve just above elbow

43
Q

Where is the anterior interosseous nerve prone to compression?

A

Between 2 heads of pronator teres muscle

44
Q

What are the causes of anterior interosseous nerve compression?

A

Gripping tightly with forced pronation
Prolonged use of screwdriver
Damaged during blood-taking

45
Q

What does anterior interosseous nerve syndrome cause weakness of?

A

Flexors of interphalangeal joint of thumb - flexor pollicis longus
Distal interphalangeal joints of index and middle fingers - flexor digitorum profundus
Pronation

46
Q

Where is sensation lost if there is a lesion in the forearm which is proximal to palmar cutaneous sensory branch?

A 
Lateral palm
D1
D2
D3
1/2 D4
47
Q

What muscles will be paralysed if there is a higher lesion in the upper limb affecting the ulnar nerve?

A

Ulnar 1/2 flexor digitorum profundus
Interossei
Lumbricals

48
Q

Where does the superficial sensory branch come off the ulnar nerve?

A

In distal forearm above wrist

49
Q

What does the deep ulnar branch supply?

A

Motor innervation to intrinsic hand muscles

50
Q

What can cause Guyon’s canal to become inflammed?

A

Overuse such as occupation or cycling

Rheumatoid arthritis

51
Q

What nerve passes through Guyon’s canal?

A

Deep ulnar branch

52
Q

What does C8 supply?

A

All finger extensors via radial nerve

Flexor digitorum profundus of index / middle finger via median nerve

53
Q

What is the clinical sign of radial nerve palsy?

A

Wrist drop

54
Q

How is axonal differentiated from demyelinating in a nerve conduction study?

A

Axonal - decrease in amplitude

Demyelinating - decrease in velocity

55
Q

What does a needle EMG do?

A

Measures electrical activity of muscle during voluntary contraction
Pattern of electrical activity helps distinguish a lesion arising from a nerve vs a muscle

Module 204 MSK & Immune system (44 decks)

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