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Year 3: Block 1: MSK system > Nerve palsies in the limb > Flashcards

Nerve palsies in the limb Flashcards

1
Q

What is a dermatome

A

sensory area of skin supplied by a single spinal nerve

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2
Q

Define Myotome

A

group of muscles supplied by one segment of spinal cord

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3
Q

Hip joint is supplied by (3)

A

obturator nerve (predominately)
femoral nerve
lateral femoral cutaneous nerve

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4
Q

What is Hilton’s Law

A

The nerves crossing a joint supply the muscles acting on it and the joint itself.”

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5
Q

Hip disease may give rise to?

A

knee pain

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6
Q

Brachial Plexus Lesions (3 types - how may you get it?)

A

downward traction (eg. fall on side of neck)

C5, 6 damage (deltoid & shoulder muscles, brachialis & biceps)

arm “porter’s tip” (Erb-Duchenne paralysis)

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7
Q

What do C5, 6 supply

A

deltoid, shoulder muscles , brachial and biceps

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8
Q

C5,c6 issues ? what kind of posture

A

ERB’S - porters tip

  • elbow extended (biceps doesn’t wok)
  • wrist is flexed
  • adducted (deltoid doesn’t work)
  • forearm is pronated
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9
Q

Pull on the lower chords causes

what damage is done?

what Hand posture do you get?

A

upward traction - eg breech delivery, pulling of the arm

T1 damage (intrinsic muscles)

hand “clawed” (Klumpke’s paralysis

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10
Q

Klumpke’s palsy - what kind of damage

A

intrinsic damage

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11
Q

The axially nerve (C5 and C6) - where does it Come from?
what does it wrap around?

what does the axially nerve supply?

A

Posterior Cord

surgical neck of humerus

Supplies Deltoid and Teres Minor
Supplies skin over lateral arm- regimental badge area

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12
Q

When can axillary be damaged (2)

A

Shoulder Dislocation

Fracture Surgical Neck of Humerus

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13
Q

Axillary Nerve Palsy - how do we tell If we damaged it or if it was already damaged?

what does this lead on to?

A

test for reduced sensation on certain skin areas

deltoid atrophy

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14
Q

Upper nerve limb palsies include what nerves

A 
Nerve Roots
Brachial Plexus
Peripheral Nerves
Axillary
Radial
Musculocuteneous
Ulnar
Median
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15
Q

lower limb nerve palsies include what nerves

A 
Nerve Roots
Sacral and Lumbar Plexus
Peripheral Nerves
Sciatic
Femoral
Common Peroneal
LFCN
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16
Q

UPPER LIMB NERVE PALSIES - examples from brachial plexus

A

Erb’s Palsy
Klumpke’s Palsy
Total Brachial Plexus

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17
Q

UPPER LIMB NERVE PALSIES - examples from peripheral nerves

A 
Musculocutaneous (nil)
Axillary
Axillary nerve palsy secondary to trauma
Radial
Radial nerve palsy secondary to compression or entrapment
Median
Carpal tunnel syndrome
Ulnar
Cubital Tunnel Syndrome
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18
Q

The radial nerve is what nerve roots

A

c5,6,7,8,t1

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19
Q

Radial nerve is from what ?
supplies what muscle in arm?
where does it run?

A

Posterior Cord

Supplies Triceps in arm

Runs in radial groove of humerus as it passes from medial to lateral

Supplies BCR, ECRL and ECRB before dividing into PIN (motor) and SRN (sensory) branches

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20
Q

When do you get radial nerve palsies (2)

A

Entrapment
Compression

sat night palsy - pressure on arm (zone of reduced circulation) - neuropraxia

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21
Q

Radial nerve damage in the axilla symptoms

A
  • loss of elbow extension, wrist - extension and sensory changes forearm and hand
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22
Q

Radial nerve damage in the arm symptoms

A

loss of wrist extension and sensory loss

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23
Q

Radial nerve damage in the forearm symptoms

A

loss of finger extension (PIN)

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24
Q

Radial nerve damage in the WRIST symptoms

A

loss of sensation

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25
Q

test for radial

A

dorsal aspect of hand - pin prick

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26
Q

Median Nerve (C5,6,7,8,T1)

what chords are supplying?
What does it supply ?

A

Medial and Lateral Cords

Supplies Flexors of Forearm (Bar FCU and medial half of FDP), LOAF muscles

Supplies sensation to radial 3.5 digits

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27
Q

Median nerve supplies what fingers (4)

A

index finger
thumb
long finger
half of ring finger

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28
Q

Upper Brachial Plexus (C5,6) causes what palsy

A

ERB’s

29
Q

Lower Brachial Plexus (C8, T1) causes what palsy

A

Klumpke’s

30
Q

Erb’s palsy is due to traction of ?

A

C5,6 (+/-C7)

brachial plexus is stretched

31
Q

erb’s palsy - waiter’s tip position

A
  • Shoulder is adducted and IR
  • Elbow is extended and pronated
  • Wrist is flexed
32
Q

Klumpke’s Palsy is due to traction of

A

of C8/ T1
Very Rare
Affects small muscles of hand- claw hand

33
Q

Carpal Tunnel - floor is made up of?

what is the roof?

A

carpal bones

flexor - collagenous tissue

34
Q

What does carpal tunnel contain (4)

A

FDS x4, FDP x4, FPL and median nerve ie. 9 tendons and a nerve

35
Q

Causes of carpal tunnel syndrome

what fractures associated with?

examples of swellings?

Inflammatory?

Metabolic

A

developmental - thickening

Trauma
Distal radius fracture

Swellings
Ganglion
Fibroma
Lipoma

Rheumatoid
Gout
TB
Amyloid

Pregnancy
Mucopolysaccharidoses
Hyperthyroidism

36
Q

bilateral carpal syndromes…..

A

hypothyroidism as potential cause

37
Q

Carpal Tunnel Syndrome - patient symptoms

wasting of what muscles?

A

Nocturnal pain and parasthesia in part or all of the median nerve distribution

Wasting of the thenar muscles

38
Q

Carpal Tunnel Syndrome - what to look for? (3)

A

Thenar wasting
Previous scars
Deformity (previous fracture)

39
Q

Carpal Tunnel Syndrome - what to feel for?
test for?

SPECIAL TESTS (2) - how do you do them?

A

Sensation
power ABD

Tinnels - wrist dorsiflexed, tapped over with middle finger

Phalens
- palmar flex the wrists. both sides, back of hands together

40
Q

how do we treat CTS?

A

night splints
can treat hyperthyroidism
steroids
receive pressure - divide roof of CT at level of the wrist

41
Q

Ulnar Nerve (C8,T1) - lower roots - doesn’t supply anything in the?

what does it supply?

fingers it supplies?

A

arm

Supplies medial half of FDP, FCU and all intrinsic muscles in hand BAR LOAF.( intrinsic muscles of the hand)

little finger , ulnar Half of the ring finger

42
Q

ulnar nerve

enters by

A

guyons cancel

43
Q

Cubital Tunnel Syndrome

where can you feel it?

A

Second most common nerve entrapment

Medial epicondyle and olecranon, with fascial bands from FCU as roof

44
Q

Cubital Tunnel Syndrome - where will patient have numbness?

A

ulnar side of hand and difficulty with fine tasks. - can affect motor function of intrinsic muscles

45
Q

Ulnar Nerve Palsy- Muscle Wasting - where do you look first?

what are you looking for (2)

A

first dorsal web space

Guttering
Hypothenar wasting

46
Q

What causes ulnar claw hand

A

Hyperextension at MCPJ, flexion at IPJ’s

phalangeal joints

47
Q

What is ulnar paradox?

A

the more distal the lesion , (elbow or wrist) = worst CLAWING

due to intact long flexors with a distal lesion

48
Q

ulnar nerve power test?

A

Froment’s Test

49
Q

Key muscles tested in Froment’s Test

A

Key muscles:
ADDUCTOR Pollicis (ULNAR NERVE)
FLEXOR Pollicis Longus (MEDIAN NERVE)

If Ulnar nerve not working, the patient will cheat and use FPL instead of Adductor Pollicis (thumb will flex/rise)

50
Q

The lateral femoral cutaneous nerve of thick?

supplies what area of skin?
where does it lie?

what does it supply

A

l2,l3

surface of iliac muscle - comes out Inguinal ligament

sensory info to lateral aspect of the thigh

51
Q

lateral femoral cutaneous nerve treatment

A

after pregnancy

inject with steroid to shrink swelling -
ultrasound
operate on patient and release the tunnel

52
Q

Cubital tunnel treatment

A

steriods

release the tunnel;

53
Q

Sciatic Nerve - runs from

it is the largest?

where does it exit?

A

(L4,5,S1,2,3)

nerve in the body Main Branch of
Sacral Plexus

pelvis - through sciatic foramen below piriformis muscle

54
Q

Sciatic Nerve - what does it supply

A

Supplies Hamstring muscles in posterior compartment of thigh

Made up of Tibial Nerve and Common Peroneal Nerve

55
Q

Sciatic is at risk when?

A

post dislocation of the hip

IM injections

56
Q

The common fibular nerve / Peroneal Nerve

branches?

A

L4-S2

smaller and lateral branch of sciatic nerve

57
Q

Where does the The common fibular nerve / Peroneal Nerve wrap around ?

A

neck of fibula

behind biceps tendon

58
Q

What does the common fibular nerve / Peroneal Nerve divide into?

A

superficial peroneal /fibular - sensory

deep fibular - dorsiflexors of foot and toes

59
Q

common fibular nerve / Peroneal - risk / sign in patient?

A

risk of fractures around the fibula neck, long pressure

foot drop, slapping gait (leg lifted higher as foot doesn’t dorsiflex)

60
Q

What causes Meralgia Parasthetica

A

Compression of Lateral Femoral Cutaneous Nerve of Thigh

as it travels under lateral border of inguinal ligament

61
Q

What is Meralgia Parasthetica

A

Altered sensation and pain in thigh (lateral)

62
Q

What are the 3 main branches of the lumbar plexus

A

LFCN
Femoral
Obturator

L1-5

63
Q

The sacral plexus is ventral rami from

A

l4 to s4

64
Q

What nerve supplies the supplies Gluteus medius and minimus and TFL

A

Superior Gluteal N.

65
Q

What nerve supplies gluteus maximus

A

Inferior Gluteal

66
Q

The main branch of the sacral plexus is?

what does it supply?

A

Sciatic N., which supplies posterior thigh, leg and foot muscles.

67
Q

Lower limb - sacral plexus - what nerves come off?

A

Sciatic
Common Peroneal Nerve
Tibial Nerve

68
Q

Lower limb - lumbar plexus - nerve?

A

Femoral Nerve

Year 3: Block 1: MSK system (22 decks)

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