2: Peripheral Mononeuropathies Flashcards by Grace Poole

What is carpal tunnel syndrome

Compression Median.N within carpal tunnel

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What is the main risk factor for carpal tunnel syndrome

FH (Genetic)

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What fractures predispose to median nerve injury

Distal radius

Lunate

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What occupation predisposes to carpal tunnel syndrome

Jobs that involve repeated flexion and extension of the wrist

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What 5 conditions predispose to carpal tunnel syndrome

OA
RA
Diabetes
Pregnancy
Hypothyroidism 
Oedema - HF

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Where does median nerve arise

Lateral (C5-C7) and Median (C8-T1) trunk

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What is a branch of the median nerve

Anterior interosseous nerve

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What does damage to anterior interossus nerve cause

Loss of pronation of forearm and weakness of thumb and finger flexion

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How do mild symptoms of carpal tunnel syndrome present

Parasthesia over thumb, second finger and middle-finger which is worse at night
Symptoms may be improved by patient putting arm over bed

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How does severe carpal tunnel present

Weakness in pincer grip

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What are 4 signs of carpal tunnel syndrome

+ve Tinels
+ve Phalens
Weakness thumb abduction
Thenar wasting

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How may median nerve damage present

Pope blessing sign

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What is pope blessing sign

Inability to flex first three digits

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When does pope blessing sign occur

Damage to median nerve - not carpal tunnel syndrome

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What is ordered in carpal tunnel syndrome

NCS

EMG

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What is it called when ulna.N is compressed at the elbow

Cubital Tunnel Syndrome

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What is it called when ulna.N is compressed at the wrist

Guyon Canal Syndrome

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What can cause cubital tunnel syndrome

Trauma
Prolonged periods leaning on elbow
Tumour

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What causes guyon canal syndrome

Cycling - rest on edge of hand

Hook of hamate fracture

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What are motor signs of ulna nerve entrapment

Ulna Claw
Fromnent
Waterburg sign

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What is claw hand deformity

Extension at MCP and Flexion at PIP

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What is waternberg sign and what is it caused by

Permanent abduction little finger due to weak third interoessi

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What is froment sign

When pinching a piece of paper there is flexion at IP joint to compensate for weakness in adductor policies brevis

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What sensory loss occurs in ulna.N palsy

Hypothenar eminence

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What will be seen in cubital tunnel syndrome

Pain referred to fore-arm

Where does the ulna nerve arise from

Medial cord (C8-T1)

What is the ulna paradox

Close to the paw the worse the claw

Explain ulna paradox

Ulna nerve innervates medial half of the flexor digitorum profundus. If ulna nerve is damaged higher up this looses innervation and reduces flexion at the PIP = meaning hand only appears with extension at MCP

What is used to investigate ulna nerve palsy

NCS | EMG

What are two causes of radial nerve palsy

saturday night palsy humerus fracture

What is Saturday night palsy

draping arm over furniture for prolonged periods of time

What causes saturday night palsy

Intoxication | Anesthesia

why may a fractured humerus cause damage to radial nerve

As radial nerve runs in spiral groove

where does the radial nerve arise from

Posterior cord (C5-T1)

what is the main clinical feature of radial nerve palsy

Wrist drop

what are symptoms of radial nerve palsy

- Loss extension fingers and hand | - Loss extension at the wrist

where may sensory loss occur in radial nerve palsy

Anatomical snuffbox

if damaged in the arm what does radial nerve palsy cause

loss elbow extension

if damaged the fore-arm what does radial nerve palsy cause

weak supination

what is Erbs palsy

damage to upper brachial plexus

what nerve roots are damaged in erbs palsy

C5-C6

what are 3 causes of erbs palsy

- Excessive lateral traction when delivering shoulder dystocia - Excessive lateral neck flexion - Trauma: fall on head

what position will the arm be in in Erbs Palsy

Extended and internally rotated = waiter's tip

what is waiter's tip position

Extended and internally rotated

what is a sign of erbs palsy in infants

Asymmetrical morro reflex

what does loss of innervation to biceps and brachioradialis cause in erbs palsy

Loss supination and flexion

what does impaired innervation to infraspinatus in Erbs palsy cause

Impaired external rotation

what does impaired innervation to deltoid cause in erbs palsy

Impaired abduction

what is used to manage erbs palsy

Bracing - external rotation and flexion

what is Klumpke's paralysis

damage to lower brachial plexus

what nerve roots are affected in klumpke's palsy

C8-T1

what are the two causes of klumpke's paralysis

- Excessive abduction - Pancoast tumour - Cervical rib

what may cause hyperabduction of the arm

Holding onto branch when hanging from a tree

what may cause compression leading to klumphes paralysis

Pancoast tumour | Cervical rib

what is lost in Klumpke paralysis

Intrinsic muscles of the hand movement

what is foot drop

weakness in dorsiflexors of the foot

what can cause foot drop

- common perineal nerve injury - sciatic nerve injury - L5 radiculopathy

what causes common perineal nerve injury

- Fibular head fracture | - Compression = sitting cross-legged, cast

what gait does foot drop lead to

High-stepping

what movements are weak in common perineal nerve lesion

Dorsiflexion | Eversion

where is sensation lost in common perineal nerve injury

Dorsum of the foot and between first and second toe

what roots does common perineal nerve originate

L4-S2

what can cause axillary nerve palsy

- Fracture at surgical neck of humerus | - Anterior shoulder dislocation

how does axillary nerve palsy present

Impaired abduction and external rotation of the arm

where does axillary nerve arise

C5-C6

what does damage do musculcutaneous nerve cause

Loss flexion and supination

where does musculocutaneous nerve arise

C5-C7

what can damage long-thoracic nerve

Lymph node clearance in mastectomy

what does long thoracic nerve damage cause

Winged scapula

how will phrenic nerve damage present

Elevation diaphragm on that side

what nerve compression causes anaesthesia over lateral aspect of the thigh

lateral femoral cutaneous nerve

what can cause lateral femoral cutaneous nerve palsy

compression under ilioinguinal ligament due to increase in intra-abdominal pressure (pregnancy, tumour) external compression (belts, pants) local compression (tumour)

what nerve can be damaged in lymph node biopsy from posterior triangle of the neck

axillary nerve

what nerve can be damaged in thyroidectomy

recurrent laryngeal nerve

what nerve can be damaged when using Lloyd Davies stirrups

common perineal nerve

what nerve can be damaged in inguinal hernia repair

ilioinguinal nerve