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Examination > Upper limb neurologic examination > Flashcards

Upper limb neurologic examination Flashcards

1
Q

What nerve root is involved in elbow reflex ?

A

C5

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2
Q

What nerve root is involved in wirst/brachioradialis reflex ?

A

C6

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3
Q

What nerve root is involved in triceps reflex ?

A

C7

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4
Q

What nerves root are involved in shoulder abduction and what muscle/s do they innervate?

A

C5- axillary nerve to DELTOID

C6- supraspinatus- SUPRASPINATUS

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5
Q

What nerves root are involved in shoulder internal rotation and what muscle/s do they innervate?

A

C5- Subscapularis

Subscapularis

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6
Q

What nerves root are involved in shoulder external rotation and what muscle/s do they innervate?

A

C5-Supraspinatus

infraspinatus muscle

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7
Q

What nerves root are involved in elbow flexion with thumb up and what muscle/s do they innervate?

A

C5
musculocutanous N- lateral cord
biceps brachii and brachialis

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8
Q

What nerves root are involved in elbow flexion with palm down and what muscle/s do they innervate?

A

C6
Radial N- post cord
brachioradialis

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9
Q

What nerves root are involved in wrist extension and what muscle/s do they innervate?

A

C6
Radial N
ECRL, ECRB
( ecu supplied by ulna nerve involved in wrist extension)

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10
Q

What nerves root are involved in wrist supination and what muscle/s do they innervate?

A

C6
Deep branch of radial n- PIN
Supinator

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11
Q

What nerves root are involved in elbow extension and what muscle/s do they innervate?

A

C7
Radial N
Triceps

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12
Q

What nerves root are involved in wrist flexion and what muscle/s do they innervate?

A

C7
Median N
FCR and PL

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13
Q

What nerves root are involved in wrist pronation and what muscle/s do they innervate?

A

C7
Median nerve
Pronatpr quadratuas
Pronator teres

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14
Q

What nerves root are involved in MCP and PIPJ finger flexion and what muscle/s do they innervate?

A

C8
Median n
FDS

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15
Q

What nerves root are involved in DIPJ finger flexion and what muscle/s do they innervate?

A

C8
ULNA ( medial part) AND AIN ( MEDIAN n- lat part)
FDP

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16
Q

What nerves root are involved in thumb extension and what muscle/s do they innervate?

A

C8
PIN of Radial nerve
EPL

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17
Q

What nerves root are involved in finger abduction and what muscle/s do they innervate?

A

T1
Deep branch of ulna N
Interrossei

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18
Q

Describe the dermatome of C5?

A

Lateral volar border of upper arm just crosses elbow

19
Q

Describe the dermatome of C6?

A

From distal elbow to include thumb and index finger

20
Q

Describe the dermatome of C7?

A

Middle finger only

21
Q

Describe the dermatome of C8?

A

ring and little finger extended proximally medial volar aspect of arm to just below elbow

22
Q

Describe the dermatome of T1?

A

crossing elbow and extending medial border of upper arm to half way up upper arm

23
Q

What is seen in isolation c5 root lesions?

A

loss of abduction of the arm- weak rather than absent

Sensory loss over lateral aspect of deltoid muscle

24
Q

What do you seen in isolated axillary nerve palsy?

A

Abduct able as some activity in supraspinatus to abduct arm

Sensation loss - outer lateral arm

25
Q

What is seen in C5/c6 root lesions?

A

Here the shoulder ABDUCTORS, INTERNAL ROTATORS, ELBOW FLEXORS ARE PARALYSED
so the arm is held in - INTERNAL ROTATION, and the arm cannot be flexed at the elbow or abducted

26
Q

What is seen in isolated/ combined C8/T1 root lesions?

A

hand is clawed in all digits with weak flexion
Good proximal muscle
Often a HORNER’s sydrome-sympathetic nervous system effected by avulsion of T1- eyelid ptosis, Pupil constriction, anhydroisis of face on same side as lesion

27
Q

What is erb’s palsy? describe the features?

A

Paralysis of the upper arm caused by traction injury during birth with and injury to C5 and C6 nerve root. Head is turned opposite direction when shoulder is depressed and traction on brachial plexus

Here the shoulder ABDUCTORS, INTERNAL ROTATORS, ELBOW FLEXORS ARE PARALYSED
so the arm is held in - INTERNAL ROTATION, and the arm cannot be flexed at the elbow or abducted so held in extension with the forearm pronated - due to paralysis of biceps. sensation lost as well.

28
Q

What is ergs palsy asoociated with ?

A 
Shoulder dystocia
extended labour 
forceps delivery
abnormal position
breech presentation
29
Q

What is the prognosis of Erb’s palsy?

A

90% resolve spontaneously though may take 2 years to resolve

30
Q

What are the favourable prognostic signs?

A

Recovery good if Biceps and deltoid are M1 at 2 months

Early biceps twitch

31
Q

What are the poor prognostic signs?

A

Lack of biceps function
horner’s syndrome- <10% chance of full recovery
loss of rhomboid function
Avulsion injuries- worse prognosis

32
Q

What nerves and their muscles are effected in erg’s palsy?

A

Axillary- deltoid- no shoulder adbduction
Supraspinatus- supraspinatus and infraspinatus-
Musculocutaneous- biceps- no elbow flexion

C6= Radial- brachioradialis- no supination

33
Q

What is Klumpke palsy?

A

Injury to C8/T1 Lower lesion

34
Q

How is Klumpke caused?

A

Mainly By avulsion of c8/t1 by excessive ABDUCTION person trying to save themselves when they fall.
Cervical rib
Lung mets

35
Q

What posiiton in the patients arm in klumpke’s palsy?

A

upper limb to wirst fine
WRIST IN EXTENSION- uppose action of extensors
hand is clawed as all small muscles to hand paralysed- median and ulna nerve
MCPJ in extension due to LOSS of INTRINSICS
Flexion of IPJ due to loss of intrinsics
Horner’s syndrome

36
Q

What is the prognosis of Klumpke palsy?

A

poor especially if have hornet’s syndrome- preganglionic injury

37
Q

What are the tx for erb’s/klumpke’s palsy?

A

non op- observation and daily passive exercises by parents- key to maintain passive motto while nerves recover

38
Q

what are the indications for surgery?

A

early surgery- microsurgical repair or nerve graft when complete fail arm at 1 month
horner’s syndrome at 1 month

39
Q

what late surgery is available?

A

correct contracture preventing External R of shoulder
Subscapularis slide with lengthening ( young child)
latismmus dorsi and teres major transfer to post rotator cuff ( aged 4)
Proximal humeral rotational ostetomy

Lack of elbow flexion
Clerk’s pectoral transfer and Steindler flexoplasty- tendon traansfer and allows for increased elbow flexion

40
Q

What is the late sequela of untreated brachial plexus injury?

A

Glenoid hypoplasia and retroversion due to post displacement of the humeral head on an increasing dysplastic and retroverted glenoid

41
Q

What supplies the trapezius? what does weakness cause?

A

Spinal accessory nerve - XI of the cranial nerves?
Inabililty to shrug shoulders
inability to sustain shoulder abduction at 90 degrees

42
Q

What muscles stabilise the shoulder?

A

Rhomboids
Trapezius
serratus anterior

43
Q

What can cause scapular winging?

A

Injury to the long thoracic nerve- serratus ant and rhomboids
Injury to spinal accessory- XI n- trapzius ( rare!)

Examination (1 decks)

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