Peripheral Nerves: Common Peroneal, Median, Ulnar, Radial, Axillary, Radiculopathy

Question 1

Common peroneal nerve
-presentation and why
How would this differ from a sciatic nerve lesion

Answer 1

Fibula neck => foot drop
-weak foot dorsiflex, eversion
-sensory loss of dorsum, lower lateral leg

Sciatic => common peroneal signs +
-weak knee flexion
-sensory loss below knee
-KNEE JERK PRESENT

Question 2

Median nerve patterns of damage
-wrist, pathology, diagnosis and management
-elbow
-AIN

Answer 2

Wrist - carpal tunnel
-motor LOAF weakness
-lateral 2.5 finger sensory loss
-Tinel’s, Phalen’s test => wrist splinting, SC CS, surgical decompression

Elbow
-ulnar deviation
-weak wrist flexion, pronation

AIN - branches off below elbow
-no thumb, index flexion, not ok

Question 3

Ulnar nerve patterns of damage
-distal and proximal lesions
-pathology, diagnosis, management

Answer 3

Claw hand
-wasting, paralysis of hypothenar, lat lumbricals
-medial 1.5 finger sensory loss

Claw hand more severe in distal ulnar lesions than proximal ulnar lesions
-higher lesions weaken FDP => less clawed appearance

Cubital tunnel
-Tinel
-Avoid compressing tunnel, splinting, NSAIDs/CS, surgery

Question 4

Radial nerve patterns of damage
-causes

Answer 4

Wrist drop
-Sunday night, Honeymoon, Crutch palsy, humeral shaft #
-sensory loss of dorsal lateral
-tricep paralysis

Question 5

Axillary nerve pattern of damage
-causes

Answer 5

Shoulder dislocation, clavicle fracture, humeral neck fracture
-sensory loss of regimental badge
-weak shoulder abduction

Question 6

Radiculopathy
-presentation
-based on site of compression in lower back pain
-diagnosis
-management

Answer 6

Symptoms caused by compression of nerve at spine root
-prolapsed disc
-disc degeneration
-spinal cord mets

Presentation
-sharp pain, myotome/dermatome/reflex in spinal root affected

Lumbar (sciatica) - lower limbs
-straight leg raise - recreate leg pain

Cervical - upper limbs
-Spurling test - neck mv to recreate pain

Pain relief - NSAIDs
Gentle mv
If they persist (4-6wks) => MRI referral

Question 7

Presentation in lower back based on site of compression
-L3
-L4
-L5
-S1

Answer 7

Intervertebral inbetween each vertebra

L3
-D - ant knee
-M - knee E
-reduced knee reflex
-+ve femoral stretch test

L4
-D - med leg
-M - ankle DF
-reduced knee reflex
-+ve femoral stretch test

L5
-D - dorsal foot
-M - hallux DF
-normal reflex
-+SLT

S1
- D - lat foot
-M - ankle PF
-reduced ankle reflex
-+SLT