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Module 204 Theme 2 > Upper limb nerve injuries > Flashcards

Upper limb nerve injuries Flashcards

1
Q

Where does the lower motor neuron arise?

A

Anterior horn

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2
Q

Describe the characteristics of an upper motor neuron pathology

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

Describe the characteristics of a lower motor neuron pathology

A

Wasting/Fasciculations
Flaccid tone
Weakness in either a myotomal distribution or a peripheral nerve distribution
Reduced reflexes.
Dermatomal or peripheral nerve distribution of sensory loss.

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4
Q

Name the 3 anatomical regions for localizing a lesion

A

Roots
Brachial plexus
Peripheral nerves

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5
Q

What are myotomes

A

Relationship between spinal nerve and muscle

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6
Q

What are dermatomes?

A

Relationship between spinal nerve and skin

area of the skin supplied by nerve fibres originating from a single dorsal nerve root.

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7
Q

Where is there a lot of anatomical variation?

A

In dermatomes

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8
Q

What is the myotome of C5?

A

Deltoid

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9
Q

What is the myotome of C6?

A

Biceps
Brachialis
Brachioradialis

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10
Q

What is the myotome of C7?

A

Triceps
Superficial forearm extensors
Superficial forearm flexors

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11
Q

What is the myotome of C8?

A

Forearm extensors

Deep forearm flexors

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12
Q

What is the myotome of T1?

A

Intrinsic hand muscles

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13
Q

What muscle action does the C5 myotome perform?

A

Shoulder abduction

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14
Q

What muscle action does the C6 myotome perform?

A

Elbow flexion

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15
Q

What muscle action does the C7 myotome perform?

A

Elbow extension
Wrist extension
Wrist flexion

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16
Q

What muscle action does the C8 myotome form?

A

Finger extension

Finger flexion

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17
Q

What muscle action does T1 myotome form?

A

Finger abduction

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18
Q

What is the name of the C5 reflex?

A

Biceps reflex

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19
Q

Which nerve conveys the biceps reflex?

A

Musculocutaenous

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20
Q

What is the name of the C6 reflex?

A

Supinator jerk

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21
Q

Which nerve conveys the supinator jerk

A

Radial nerve

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22
Q

What is the name of the C7 reflex?

A

Triceps jerk

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23
Q

Which nerve conveys the triceps jerk?

A

Radial nerve

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24
Q

What is the name of the C8 reflex?

A

Finger jerk

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25
Q

Which nerve conveys the finger jerk?

A

Median and ulna nerve

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26
Q

What happens to reflexes in lower motor neuron lesions?

A

Reflex is depressed

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27
Q

What does nerve root impingement cause?

A

Pain which radiates or is aggravated by neck movement

Sensory loss

Weakness

Reflex loss

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28
Q

What causes nerve root impingement?

A

Hyperflexion and extension

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29
Q

What is an avulsion?

A

Tearing of the nerves from its attachment at the spinal cord.

30
Q

What is a rupture?

A

Tearing of the nerves but not from its attachment to the spinal cord

31
Q

What is a neuroma?

A

tumour or growth of the nerve tissue. Can arise from the axon or myeloma

32
Q

What is a neurapraxia?

A

Axons remain intact, but myelin damage cause an interruption of the impulse down the nerve fibre

33
Q

What is flail arm?

A

Cervical root avulsion

34
Q

Name some conditions as a result of trauma to the brachial plexus

A

Erb-Duchenne type paralysis: Avulsion of C5,C6 roots.

Klumpke paralysis: Avulsion of C8, T1 roots.

35
Q

Name a tumour affecting the brachial plexus

A

Pancoasts tumour - lung cancer

36
Q

Which cancer treatment may cause injury to the brachial plexus?

A

Radiotherapy

37
Q

Name an inflammatory injury of the brachial plexus

A

Brachial neuritis

38
Q

Name a structural injury to the brachial plexus

A

Thoracic outlet syndrome

39
Q

Name the muscles weakened in erbs palsy

A 
Biceps (flexes the arm)
Brachioradialis (flexes the arm in semi-prone position)
Deltoid (abducts the arm) 
Supraspinatus (abducts the arm)
Supinator (externally rotates the arm)
40
Q

What is erbs palsy?

A
  • upper plexus palsy
    C5/C6 innervated muscles
    Superior trunk of brachial plexus
41
Q

What causes erbs palsy?

A

Infants - birth and getting shoulder stuck

Adults - blow to the shoulder

42
Q

What is another name for erbs palsy lesion?

A

Waiters tip

43
Q

What actions can and cannot a person with erbs palsy perform?

A

Elevated
Abducted
External rotated
Flexed at elbow

But fingers unimpaired

44
Q

Describe Klumpke’s Palsy

A

Clutching for an object when falling from a height.
- Inferior trunk plexus injury involving C8/T1

Involves trunk that supplies median and ulnar nerves

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

May lead to a claw hand

Arm works but hand
does not!

45
Q

Describe a pancoast tumour

A

infiltration of the lower brachial plexus
Pain in shoulder girdle and inner arm.
Ipsilateral horners syndrome

46
Q

Describe radiation induced brachial plexopathy

A

Mean 6 yrs post radiation
Associated with treatment for breast, lung cancer and lymphoma
Pain is not a consistent feature
Predilection for upper brachial plexus

47
Q

Describe Idiopathic brachial neuritis (Parsonage – Turner Syndrome)

A

Aetiology not clear, infectious, post-infectious
Severe pain over days; as pain diminishes, it is followed by weakness and wasting (motor>sensory)
Typically monophasic
Rarely bilateral
MRI shows thickening and enhancement.
NCS/EMG is useful for prognostication.

48
Q

Give the treatment of Idiopathic brachial neuritis (Parsonage – Turner Syndrome)

A

Analgesia, physiotherapy

Limited evidence for the use of steroids

49
Q

Describe thoracic outlet syndrome

A

Variations in anatomy cause compression sites:
Between anterior and middle scalene muscles
Beneath clavicle in the costoclarvicular space
Beneath tendon of Pectorlis minor

50
Q

List some neurogenic symptoms of thoracic outlet syndrome

A

Paresthesia, numbness, weakness
Not localised to specific nerve distribution
Reproducibly aggravated by elevation or sustained use of arms or hands.

51
Q

List some vascular symptoms of thoracic outlet syndrome

A

Forearm fatigue within minutes of use.
Swelling and cynaosis
Collateral venous patterning over the ipsilateral shoulder, chest wall and neck.
Rarely pain, pallor and coldness (arterial involvement).
Lower BP on affected arm, diminished distal pulses.

52
Q

When may the long thoracic nerve be injured?

A

Long thoracic nerve
may be injured by blows or pressure
in the posterior triangle of the neck

or during a radical mastectomy.

53
Q

What can injury of the long thoracic nerve lead to?

A

‘winged scapula’

54
Q

Describe how injury to the long thoracic nerve results in winged scapula

A

Long thoracic nerve supplies the serratus anterior muscle.
The serratus anterior muscle pulls the medial border of the scapula
to the posterior thoracic wall and stabilises it there
Impairment of the long thoracic nerve leads to “winging” of the scapula

55
Q

List 2 common sites of nerve compression

A

Wrist (Carpel tunnel syndrome)

Elbow

56
Q

Which hand muscles does the median nerve innervate?

A

L ateral 2 lumbricals
O pponens pollicis
A bductor pollicis brevis
F lexor pollicis brevis

57
Q

List some causes of carpal tunnel syndrome

A 
Diabetes
Pregnancy
Hypothyroidism
Rheumatoid arthritis
Repetitive strain
58
Q

Where does the Anterior interosseous nerve arise?

A

from median nerve just above elbow.

59
Q

Describe how damage to the anterior interosseous nerve may occur

A

Prone to compression between 2 heads of
pronator teres muscle

Gripping tightly with forced pronation

Prolonged use of a screwdriver!

May also be damaged in careless blood taking

60
Q

Describe anterior interosseous nerve syndrome

A

Pure motor branch of the median nerve
weakness in flexors of ip joint of thumb (flexor policis longus)
& dip joints of index and middle fingers – (flexor digitorum profundus)
weakness of pronation

61
Q

Describe the ulnar claw of a higher lesion in the upper limb

A

Paralysis of the ulnar half of the flexor digitorum profundus (FDP), interossei and lumbricals. The ring and little fingers are not flexed and there is no claw.

62
Q

Describe the ulnar claw of a lower lesion in the upper limb

A

Flexion at the DIP (FDP is intact)
Flexion at the PIP (interossei are paralysed)
hyperextention at the MCP (lubricals are paralysed).

63
Q

Where is the deep ulnar nerve?

A

Guyon’s canal

64
Q

What does the deep ulnar nerve do?

A

motor only to intrinsic hand muscles

65
Q

How can the deep ulnar nerve be injured?

A

Occupation, cycling, rheumatoid arthritis

66
Q

What leads to the Froment’s sign?

A

Weakness of adductor pollicis

67
Q

Describe radial nerve palsy?

A

Radial nerve damage rarely causes extensive sensory loss

Extensive overlap with median/ulnar excepting anatomical snuff box

68
Q

What are nerve conduction studies useful for?

A

Useful in determining the amplitude and velocity of a peripheral nerve

69
Q

What does axonal loss lead to?

A

decrease in amplitude

70
Q

What does demyelinating lead to?

A

decrease in velocity

71
Q

What does needle EMG measure

A

electrical activity of the muscle during voluntary contraction. The pattern of the electrical activity can help distinguish a lesion arising from the nerve (neurogenic) vs muscle (myopathic)

Module 204 Theme 2 (31 decks)

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