Flashcards in 9. Nerve Palsies in the Limbs Deck (51):
Why do Nerve Palsies in the Limbs arise?
The Nerve can be:
At any point along its course
Where can Nerve Palsies in the Upper Limb arise from?
1. Nerve Roots
2. Brachial Plexus
3. Peripheral Nerve
What Peripheral Nerves in the Upper Limb can get Nerve Palsy?
1. Axillary Nerve
2. Radial Nerve
3. Musculocutaneous Nerve
4. Ulnar Nerve
5. Median Nerve
Where can Nerve Palsies in the Lower Limb arise from?
1. Nerve Roots
2. Sacral Plexus
3. Lumbar Plexus
4. Peripheral Nerves
What Peripheral Nerves in the Lower Limb can get Nerve Palsy?
3. Common Peroneal
4. Lateral Femoral Cutaneous Nerve (LFCN)
What are the Nerve Root / Myotome Patterns in the Upper Limb?
C5 - Elbow Flexors
C6 - Wrist Extensors
C7 - Elbow Extensors
C8 - Finger Extensors
T1 - Intrinsic Hand Muscles
What are the Nerve Root / Myotome Patterns in the Lower Limb?
L2 - Hip Flexors
L3 - Knee Extensors
L4 - Ankle Dorsiflexors
L5 - Long Toe Extensors
S1 - Ankle Plantar Flexors
What Palsies can occur at the Brachial Plexus?
1. Erb's Palsy
2. Klumpke's Palsy
3. Total Brachial Plexus Palsy
Which Roots of the Brachial Plexus are compressed in Erb's Palsy?
3 +/- C7
Which Roots of the Brachial Plexus are compressed in Klumple's Palsy?
Which Roots of the Brachial Plexus are compressed in Total Brachial Plexus Palsy?
C5 - T1
How does Erb's Palsy present?
Waiter's Tip Position:
1. Shoulder is Adducted and Internally Rotated
2. Elbow is Extended and Pronated
3. Wrist is Flexed
1. What does Klumpke's Palsy affect?
2. How does this present?
1. Affects small muscles of the Hand
What Peripheral Nerve Palsies can occur in the Upper Limb?
1. Musculocutaneous Nerve
2. Axillary Nerve (Secondary to Trauma)
3. Raidal Nerve (Secondary to Compression / Entrapment)
4. Median Nerve (Carpal Tunnel Syndrome)
5. Ulnar Nerve (Cubital Tunnel Syndrome)
Where does the Musculocutaneous Nerve travel?
1. It is supplied from Nerve Roots C5-7
2. It Arises from the Lateral Cord of the Brachial Plexus
3. Pierces the Coracobrachialis
4. Runs inferiorly between Biceps and Brachialis
5. Runs to the Elbow
What does the Musculocutaneous Nerve supply?
1. Biceps Brachii
4. Elbow Joint
What does the Musculocutaneous Nerve continue as?
Lateral Cutaneous Nerve to the Forearm
What is Hilton's Law?
“A sensory nerve supplying a Joint also supplies the Muscles moving the joint and the Skin overlying the insertions of these muscles.”
Where does the Axillary Nerve travel?
1. It is supplied from Roots C5/6
2. It arises from the Posterior Cord of the Brachial Plexus
3. It Wraps around the Surgical Neck of the Humerus
What does the Axillary Nerve Supply?
2. Teres Minor
3. Skin over the Lateral Arm (Regimental Badge Area)
When might Axillary Nerve Palsy occur?
1. Shoulder Dislocation
2. Fracture of the Surgical Neck of the Humerus
Where does the Radial Nerve Travel?
1. It is Supplied by Nerve Roots C5-T1
2. It arises from the Posterior Cord of the Brachial Plexus
3. It runs in the Radial Groove of the Humerus as it passes from Medial to Lateral
What does the Radial Nerve Supply?
1. Triceps in the Arm
3. Extensor Carpi Radialis Longus
4. Extensor Carpi Radialis Brevis
What does the Radial Nerve divide into as it terminates?
1. Posterior Interosseous Nerve (Motor)
2. Superficial Branch of the Radial Nerve (Sensory)
Where does the Superficial Branch of the Radial Nerve supply Sensory innervation for?
Dorsal Surface of the lateral Three and Half Digits, and their associated Palm Area
When might Radial Nerve Palsy occur?
1. Entrapment: Broken Humerus
2. Compression: Saturday Night / Honeymoon / Crutch Palsy
What are the Symptoms of Radial Nerve Palsy?
1. At wrist - Loss of Sensation
2. In Forearm - 1 + Loss of Finger Extension
3. In Arm - 1+2 + Loss of Wrist Extension
4. In Axilla - 1+2+3 + Loss of Elbow Extension
Where does the Median Nerve Travel?
1. It is supplied by Nerve Roots C5-T1
2. It divides into Median and Lateral Cords
What does the Median Nerve Supply?
1. Flexors of the Forearm (Bar the Flexor Carpi Ulnaris, and the Medial Half of the Flexor Digitorum Profundus)
2. Sensation to the Radial Three and a Half Digits
How does Median Nerve Palsy often occur?
Carpal Tunnel Syndrome
What forms the Carpal Tunnel?
Floor - Carpal Bones
Roof - Flexor Retinaculum
What are the contents of the Carpal Tunnel?
1. 4 x Flexor Digitorum Superficialis Tendons
2. 4 x Flexor Digitorum Profundus Tendons
3. Flexor Pollicus Longus
4. Median Nerve
(9 x Tendons and 1 x Nerve)
What are the causes of Carpal Tunnel Syndrome?
2. Trauma - Distal Radius Fracture
3. Inflammatory - Rheumatoid / Gout / TB / Amyloid
4. Swellings - Ganglion / Fibroma / Lipoma
5. Metabolic - Pregnancy / Mucopolysaccharideosis / Hypothyroidism
What are the Symptoms of Carpal Tunnel Syndrome?
1. Nocturnal Pain in part / all of the Median Nerve Distribution
2. Parasthesia in part / all of the Median Nerve Distribution
3. Wasting of the Thenar Muscles
What is involved in Examination of Carpal Tunnel Syndrome?
1. Look - Thenar Muscle Wasting / Scars / Deformity
2. Feel - Sensation
3. Move - Adductor Pollicus Brevis power
4. Special Tests:
4. a) Tinnels Test
4. b) Phalens test
What is the treatment for Carpal Tunnel Syndrome?
1. Treat underlying cause
2. Carpal Tunnel Release (Surgery)
Where does the Ulnar Nerve Travel?
1. It is supplied by Nerve Roots C8/T1
2. It enters into the Forearm between the 2 heads of the Flexor Carpi Ulnaris
What does the Ulnar Nerve Supply?
1. Medial Half of the Flexor Digitoum Profundus
2. Flexor Carpi Ulnaris
3. Intrinsic Muscles of the Hand, Except:
3. a) Lateral 2 Lumbricals
3. b) Opponens Pollicis
3. c) Adductor Pollicis Brevis
3. d) Flexor Pollicis Brevis
4. Sensation to the Ulnar One and a Half Digits
What is the Second most common nerve entrapment?
Cubital Tunnel Syndrome
Where is the Cubital Tunnel located?
1. Between the Medial Epicondyle and Olecranon
2. Fascia Bands from the Flexor Carpi Ulnaris as a Roof
What are the Symptoms of Cubital Tunnel Syndrome, which can cause Ulnar Nerve Palsy?
1. Numbness on the Ulnar Side of the Hand
2. Difficulty with Fine Tasks
What are the Signs of Ulnar Nerve Palsy?
1. Wasting of Hypothenar Muscles
2. Guttering (1st webspace often marked)
3. Ulnar Claw-Hand (Hyperextension at MCPJ, Flexion at the IPJ's)
What is the Ulnar Paradox?
A Distal lesion has worse clawing than a proximal lesion, due to the intact long flexors with a distal lesion
What test is used to assess for Ulnar Nerve Palsy?
Froment's Test: Tests the Addoctor Pollicis (Ulnar Nerve), and the Flexor Pollicis Longus (Median Nerve)
If the Ulnar is not working, the patient will chat and use the FPL instead of the Adductor Pollicis
What are the 2 plexus's involved in the Lower Limb, and what are there most important Nerve?
1. Sacral Plexus - Sciatic Nerve (Common Peroneal Nerve / Tibial Nerve)
2. Lumbar Plexus - Femoral Nerve
Where does the Sacral Plexus arise from?
Ventral Rami of L4 to S4
What are the branches of the Sacral Plexus and what do they supply?
1. Superior Gluteal Nerve - Gluteus Medius, Gluteus Minimus and Tensor Fasciae Latae
2. Inferior Gluteal Nerve - Gluteus Maximus
3. Sciatic Nerve (L4-S3) - Posterior Thigh (Hamstring), Leg, and Foot Muscles
What does the Sciatic Nerve continue as?
1. Common Peroneal Nerve
2. Tibial Nerve
Where does the Common Peroneal Nerve travel?
1. It wraps around the Neck of the Fibula
2. It divides into the:
2. a) Deep Peroneal Nerve (Anterior Compartment of the Leg)
2. b) Superficial Peroneal Nerve (Lateral Compartment of the Leg)
What is a sign of Common Peroneal Nerve Palsy?