Flashcards in 11. upper limb nerve injuries Deck (25)
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1
approach to neurological problem
anatomically localise lesion
consider pathophysiology
differential diagnosis
2
UMN lesion in upper limb
held in flexed position if chronic
increased tone
pyramidal weakness (flexor muscles stronger than extensors)
brisk reflexes
sensory level
3
LMN lesion in upper limb
wasting/fasciculations
flaccid tone
weakness in myotomal or peripheral nerve distribution
reduced reflexes
4
regions for localising a lesion
roots
brachial plexus
peripheral nerve
5
myotome definition
relationship between spinal nerve and muscle
6
dermatome definition
relationship between spinal nerve and skin
area of skin supplied by nerve fibres from a single dorsal nerve root
7
roots and myotomes
c5 - deltoid
c6 - biceps, brachial, brachioradialis
c7 - triceps, superficial forearm flexors and extensors
c8 - forearm extensors, deep forearm flexors
t1 - intrinsic hand muscles
8
biceps reflex
c5 reflex - conveyed through musculocutaneous nerve
9
supinator jerk
c6 reflex - conveyed through radial nerve
10
triceps jerk
c7 reflex - conveyed through radial nerve
11
finger jerk
c8 reflex - conveyed through median and ulnar nerves
12
nerve root impingement
causes pain, radiating/aggravated by neck movement
sensory loss, weakness, reflex loss
cervical spine is flexible, protecting it from fractures/dislocation = injury may occur to neural structures, hyeprflexion/extension
13
avulsion
tearing of nerves from its attachment at spinal cord
14
rupture
tearing of nerves, nut from attachment to spinal cord
15
neuroma
tumour/growth of nerve tissue - axon or myeloma
16
neurapraxia
axons remain intact, myelin damage causes interruption of impulse down nerve fibres
17
flail arm
vertical root avulsion (C5-T1 lesions)
left shoulder subluxation
atrophy of deltoid, supraspinatus, infraspinatus
18
causes of brachial plexus injury
trauma (Klumpke paralysis - avulsion of C8,T1)
cancer (Pancoasts tumour of lung)
inflammatory (neuritis)
structural (thoracic outlet syndrome)
19
Erbs palsy
upper plexus palsy
superior trunk of brachial plexus, C5,C6 innervated muscles - biceps, brachioradialis, deltoid, supraspinatus, supinator
arm cannot be: elevated, abducted, externally rotated, flexed at elbow
fingers are unimpaired
20
Klumpke's palsy
clutching for object when falling from height
inferior trunk plexus injury, C8/T1 (median and ulnar nerves)
unable to flex wrist and fingers
weakness of small muscles in hand
sensory loss to hand/inner border of forearm
may lead to claw hand (ulnar nerve palsy)
21
metastatic brachial plexopathy
pancoast tumour in lung
infiltration off lower brachial plexus
pain in shoulder girdle and inner arm
ipsilateral horners syndrome
22
radiation induced brachial plexopathy
~6yrs post radiation
associated with treatment for breast, lung cancer and lymphoma
predilection for upper brachial plexus
23
idiopathic brachial neuritis
aetiology not clear
severe pain over days, pain followed by weakness and wasting
rarely bilateral
thickening and enhancement on MRI
treatment: analgesia, physio
24
thoracic outlet syndrome
variations in anatomy can cause compression sites
between anterior and middle scalene muscles
beneath clavicle in costoclavicular space
beneath tendon of pectoralis minor
25
