Movement symposium 2: Peripheral nerve lesions Flashcards Preview

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Flashcards in Movement symposium 2: Peripheral nerve lesions Deck (29)
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1

What is Erb's palsy?

Common in newborn when there is excessive stretching of the neck during delivery causing damage to C5, C6 nerve roots.

2

What are the symptoms of Erb's palsy?

Paralysis of muscles of shoulder and arm supplied by C5, C6 e.g.

- Arm hangs limply by the side
- "waiter's tip" position
- Adducted shoulder
- Medially rotated arm
- Extended elbow
- Pronated forearm

3

What is the explanation for the muscular symptoms of Erb's palsy?

Loss of abductors e.g. Deltoid (axillary C5,6)

Loss of lateral rotators - infraspinatus (suprascapular C5,6) and teres minor (axillary C5,6)

Loss of flexion and supination by biceps (musculocutaneous nerve C5,C6,C7)

Loss of flexion by brachialis (musculocutaneous nerve C5,C6,C7)

4

How might Erb's palsy occur in an adult or child?

Child - brachial plexus stretched during birth
Adult - fall on the shoulder

Both result in extreme abduction at the neck

5

What is Klumpke's palsy?

Damage to inferior trunk of brachial plexus (C8, T1 – ulnar nerve)

Less common than Erb’s palsy

Occurs in newborns where the baby’s upper limb is pulled excessively during delivery

Paralysis of the majority of the intrinsic hand muscles (and ulnar flexors of the wrist and digits)

Imbalance of the intrinsic & extrinsic muscles leads to hand deformity - Claw hand

6

What might happen to the hand in Klumpke's palsy and why?

The extensors primarily extend the metacarpophalangeal joints whilst FDS and FDP inserting into the distal and middle phalanges, flex the interphalangeal joints

Thus in a claw hand there is hyperextension at the metacarpophalangeal joints and flexion at the interphalangeal joints - claw hand (not to be confused with hand of benediction)

Due to paralysed lumbricals of digits 4 and 5

7

How might Klumpke's palsy occur in adults and children?

Children - baby's upper limb is pulled excessively during birth.
Adult - upper limb is suddenly pulled superiorly e.g. grasping to prevent a fall

8

What is cubital tunnel syndrome?

- 2nd most common nerve entrapment syndrome

- Cubital tunnel - tendinous arch between the humeral and ulnar heads of flexor carpi ulnaris.

- May be caused by: constricting fascial bands, direct compression, occupational activities from repetitive elbow flexion and extension.

- Same symptoms as Klumpke’s palsy plus elbow pain

- Treatment initially anti-inflammatories then surgery if unresolved

9

What syndrome may Klumpke's palsy be associated with and why?

Horner's syndrome - ptosis, miosis, anhidrosis, vasodilation

Sympathetic neurons supplying the head originate from T1 and may also be damaged by traction

10

What is radial nerve palsy?

- Injury to radial nerve in spiral groove of humerus results in wrist drop
- Inability to extend the wrist and metacarpophalangeal joints due to paralysis of extensor muscles of the forearm.
- Triceps is usually weakened rather than paralysed

11

How might median nerve damage occur?

Supra condylar fractures or pronator teres syndrome.

12

What structures are supplied by the median nerve?

Supplies majority of forearm flexors EXCEPT flexor carpi ulnaris (ulnar) and medial half of flexor digitorum profundus (ulnar + median).

Also supplies thenar eminence and lateral 2 lumbricals of the hand

13

What might happen to the hand as a result of median nerve injury?

Inability to flex digits 1-3
-Flexor digitorum superficialis and profundus
-Lateral 2 lumbricals
-Flexor pollicis longus
-Thenar eminence

Flexion of digits 4 and 5 weakened but still able to flex including distal interphalangeal joint (ulnar nerve)

When trying to make a fist appear like hand of benediction

14

What name is given to the motor portion of the the radial nerve and what does it supply?

Posterior interosseous nerve - supplies wrist, finger and thumb extensors.

15

What name is given to the sensory portion of the radial nerve and what does it supply?

Dorsal sensory nerve - dorsum 1st web space

16

What are the symptoms of a high lesion of the radial nerve?

- Loss of active extension
- Altered sensation

17

What are the symptoms of a low lesion of the radial nerve?

- Altered sensation

18

What muscles are supplied by the recurrent motor branch of the median nerve?

Thenar muscles
Flexor pollicis longus
Flexor digitorum profundus (IF & MF)

19

What is supplied by the sensory branch of the median nerve?

Supplies sensation to the lateral half of the ventral palm up to the middle of the second digit. On the dorsal palm the split between radial/ulnar nerve is even down the third digit.

20

What might you see in a high lesion of the median nerve?

- Loss of wrist flexion
- Loss of ‘circle sign’
- Thumb weakness
- Loss of opposition
- Altered sensation

21

What might you see in a low lesion of the median nerve?

- Thumb weakness
- Loss of opposition
- Altered sensation
- Normal thenar sensation

22

What muscles are supplied by the motor branch of the ulnar nerve?

- Hypothenar muscles
- Interossei
- Ulnar 2 lumbricals
- Adductor Pollicis

23

What is supplied by the sensory branch of the ulnar nerve?

Ulnar half of palm & back of hand

24

What would you see in ulnar nerve paralysis?

Claw hand deformity - paralysis of lumbricals to ring and index finger only.

25

What is cubital tunnel syndrome?

Compression of the ulnar nerve within the cubital tunnel.

26

What might you see in a high lesion of the ulnar nerve?

- Hand weakness
- Weakness of FDP to RF & LF
- Altered sensation (front & back)

27

What might you see in a low lesion of the ulnar nerve?

- Hand weakness
- Normal FDP to RF & LF (= Claw hand)
- Altered sensation (palm only)

28

What is the distribution of peripheral nerve sensation across the dorsum of the hand?

Half radial half ulnar

29

What is the distribution of peripheral nerve sensation across the palm of the hand?

Ulnar only includes thumb and 1/2 of 2nd digit, rest supplied by the median