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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

neurogenic symptoms of thoracic outlet syndrome

parasthesia, numbness, weakness