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Orthopaedics > Nerve Injuries > Flashcards

Nerve Injuries Flashcards

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1
Q

Seddon’s classification of Nerve injuries

A
  1. Neuropraxia
  2. Axonotmesis
  3. Neurotmesis
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2
Q

Mechanism of Neuropraxia

A

Nerve compression -> Temporary, reversible physiological conduction block

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3
Q

Mechanism of Axonotmesis

A

Axons injured with atleast one nerve sheath intact (Continuity intact)

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4
Q

Mechanism of Neurotmesis

A

Complete trasection of nerve (Continuity lost)

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5
Q

Examples of Neuropraxia

A
  1. Tourniquet palsy
  2. Saturday night palsy
  3. Crutch palsy
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6
Q

Examples of Axonotmesis

A
  1. Fracture
  2. Dislocations
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7
Q

Examples of Neurotmesis

A
  1. Lacerations
  2. Cut wound
  3. Incised wound
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8
Q

What is Tinel’s sign?

A

Percussion from distal to proximal direction -> Nerve stimulation -> Sensations distal to neuroma -> Tingling
Neuropraxia: -ve
Axonotmesis: Progressive +ve
Neurotmesis: Non- progressive +ve

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9
Q

What is Motor march?

A

Gradual recovery of muscle function from proximal -> distal foll axonotmesis
Neuropraxia: -ve
Axonotmesis: +ve
Neurotmesis: -ve

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10
Q

What does High vs Low nerve injury mean?

A

Higher/more proximal injuries have greater disability/deformities

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11
Q

Root value of Axillary nerve

A

C5, C6

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12
Q

Recovery of Nerve injuries

A

Neuropraxia: 100% recovery spontaneously
Axonotmesis: <100% recovery (1 mm/day)
Neurotmesis: No recovery -> Repair + Graft

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13
Q

Motor supply of Axillary nerve

A
  1. Deltoid (Abduction of shoulder)
  2. Teres minor (Ext rotation of shoulder)
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14
Q

Sensory supply of Axillary nerve

A

Lateral aspect of Proximal shoulder

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15
Q

Deformity in Motor supply of Axillary nerve

A

Adducted and internally rotated

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16
Q

Deformity in Sensory supply of Axillary nerve

A

Regimental badge sign

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17
Q

Mechanism of Axillary nerve injury

A
  1. Shoulder dislocation (M/C)
  2. Proximal humerus fracture
  3. Iatrogenic
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18
Q

Motor supply of Musculocutaneous nerve

A

Anterior compartment of arm:
1. Biceps brachii: Forearm supination > Elbow flexion
2. Coracobrachialis
3. Brachialis: Elbow flexion

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19
Q

Sensory supply of Musculocutaneous nerve

A

Lateral aspect of forearm

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20
Q

Deformity in Motor supply of Musculocutaneous nerve

A

Extende elbow with pronated forearm

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21
Q

Deformity in Sensory supply of Musculocutaneous nerve

A

Paraesthesia, tingling, numbness

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22
Q

Motor supply of Median nerve

A
  1. Forearm: Ant compartment muscles except flexor carpi ulnaris and med half of flexor digitorum profundus
  2. Hand: All thenar muscles except adductor pollicis and lumbricals 1,2
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23
Q

Sensory supply of Median nerve

A
  1. Lateral 3 1/2: Palmar
  2. Only tips: Dorsal
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24
Q

Ant interosseous nerve is a branch of

A

Median nerve

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25
Motor supply of Ant interosseous nerve
Purely motor 1. Flexor pollicis longus (Flexion of thumb IP joint) 2. Lat half of FDP (Flexion of DIP)
26
AIN injury leads to
Kiloh Nevin/Weak OK sign + D/t Supracondylar humerus # No sensory deficit
27
Median nerve injury at wrist leads to
1. Loss of sensation of lat 3 1/2 fingers 2. Wasting of thenar eminence 3. Loss of thumb: Ape hand/thumb deformity > Abduction > Flexion > Opposition
28
What is Pen test?
To assess abduction of thumb (Abductor pollicis brevis) Procedure: 1. With palm facing upwards, patient asked to touch pen with thumb 2. Positive if patient fails to do so
29
Median nerve injury at Elbow leads to
Manifestations of wrist lesion + loss of functions of FPL, FDS, FDP
30
What is Pointing index/ Benediction sign/Pope sign/Ochsner clasp sign?
Evaluates function of: 1. FDS: Flexion of PIP and MCP joints 2. FDP: Flexion of DIP, PIP, MCP joints Negative: Index finger doesn’t flex on making a fist in median nerve injury at elbow
31
Actions of thumb Just study
Abduction: Perpendicular to plane of palm Extension: Parallel to plane of palm
32
Motor supply of Ulnar/Musician’s nerve
Arm: No supply Forearm: Med half of FDP and Flexor carpi ulnaris Hand: 1. Hypothenar muscles 2. Adductor pollicis (Thenar muscle) 3. Interosseous group of muscles 4. Lumbricals 3.4
33
Sensory supply of Ulnar/Musician’s nerve
Medial 1.5 fingers (Volar and dorsal) Autonomous zone: Tip of little finger
34
Ulnar nerve injury at wrist leads to
1. Partial clawing of hand: D/t lumbricals 3,4 2. Hypothenar wasting 3. Loss of sensation in med 1.5 hand 4. Loss of palmar and dorsal interossei Site: Guyon’s canal behind pisohamate
35
Complete clawing means
Median + ulnar nerve palsy
36
Investigations of Median nerve injury at wrist
1. Card test 2. Egawa test 3. Book test 4. Fanning of finger
37
What is Card test?
To evaluate palmar interossei (Adduction of fingers)
38
What is Egawa test?
To evaluate dorsal interossei (Abduction of 2nd, 3rd, 4th, 5th fingers)
39
What is Fanning of fingers?
To evaluate dorsal interossei
40
What is Book test?
To evaluate Adductor pollicis
41
Procedure of Book test
Patient asked to hold an object between thumb and index finger | V Lack of Adduction compensated by flexor pollicis longus (Median nerve supply) | V Flexion of thumb (Froment sign)
42
Ulnar nerve injury at elbow leads to
Decrease in clawing/deformity Site: Cubital tunnel, behind medial condyle
43
Ulnar paradox Just study
High ulnar nerve palsy (Elbow): Dec in clawing/deformity Low ulnar nerve palsy (Wrist): Inc in clawing/deformity
44
Levels of Radial nerve injury
1. Very high radial nerve palsy 2. High radial nerve palsy (M/C) 3. Low radial nerve palsy 4. PIN palsy
45
Very high radial nerve palsy leads to
Location: Axilla 1. Finger drop 2. Thumb drop 3. Sensory loss 4. Wrist drop 5. Inability to extend elbow
46
High radial nerve palsy leads to
Location: Spiral groove 1. Finger drop 2. Thumb drop 3. Sensory loss 4. Wrist drop
47
Low radial nerve palsy leads to
Location: Lateral condyle 3. Sensory loss
48
PIN palsy leads to
Location: Radial head 1. Finger drop 2. Thumb drop
49
What is Holstein Lewis fracture?
Lower 1/3rd humerus #: Causes radial nerve entrapment -> Wrist drop, finger drop, thumb drop, sensory loss
50
Treatment of Holstein Lewis fracture
Cock up splint (Treatment for wrist drop): 1. Static (Extends wrist) 2. Dynamic (Extends wrist + allows flexion of fingers): Prevents contractures
51
What is Erb’s point?
Confluence of: 1. C5 2. C6 3. Suprascapular nerve
52
Types of Brachial plexus injuries
1. Supraclavicular injury (Upper roots and trunks): Erb’s palsy (Best prognosis) 2. Infraclavicular injury (Lower roots and trunks): Klumpke’s palsy 3. Combined/mixed palsy (Worst prognosis)
53
Mechanism of Brachial plexus injury
Supraclavicular injury: Traction during birth or RTA/fall Infraclavicular injury: Traction during Hyperabduction injury or arm (Presenting part) during birth Hyperabduction injury: Fall from height while holding onto an object
54
Nerves injured in Erb’s palsy
1. Suprascapular N 2. Axillary N 3. Musculocutaneous N
55
Muscles affected in Erb’s palsy
D/t Suprascapular N: 1. Supraspinatus 2. Infraspinatus D/t Axillary N: 1. Deltoid 2. Teres minor D/t Musculocutaneous N: 1. Biceps brachii 2. Brachialis
56
Deformity in Erb’s palsy
1. Adduction 2. Int rotation 3. Elbow extension 4. Pronation
57
Erb’s palsy is AKA
Policeman’s/Waiter’s/Porter’s tip deformity
58
What is Klumpke’s palsy?
C8,T1 Injury
59
Klumpke’s palsy leads to
1. Combined ulnar + median nerve palsy 2. Loss of sympathetic supply to eye (T1)
60
What is Horner’s syndrome? Just study
Loss of sympathetic supply to eye (T1) -> Parasympathetic overactivity on eye -> Horner’s syndrome Horner’s syndrome: Ptosis, mitosis, anhidrosis, loss of ciliospinal reflex
61
Treatment of Erb’s palsy
Airplane splint
62
Treatment of Klumpke’s palsy
Plexus reconstruction
63
Causes of Common Peroneal nerve injury
1. Neck of fibula # 2. Lateral condyle of tibia # 3. Bumper fracture
64
Superficial branch of CPN Just study
1. Motor supply: Lat compartment of leg (Evertors of foot) 2. Sensory supply: Dorsum of foot
65
Deep branch of CPN Just study
1. Motor supply: Ant compartment of leg (Dorsiflexors of ankle/foot) 2. Sensory supply: 1st web space of foot
66
C/F of Common Peroneal nerve injury
1. Loss of ankle: Dorssiflexion and eversion Equinovarus deformity (Plantar flexion and inversion) 2. Gait: High stepping/foot-drop/steppage gait To overcome dragging of foot d/t foot drop)
67
Treatment of foot drop
Foot drop/Toe-raising splint/Ankle-foot orthosis
68
What is Carpal tunnel syndrome?
Median nerve entrapment in carpal tunnel (At wrist) under flexor retinaculum/transverse carpal ligament
69
Etiology of Carpal tunnel syndrome
1. Idiopathic (M/C) 2. Hypothyroidism (Myxedema) 3. Rheumatoid arthritis (Inflammation) 4. Pregnancy (Fluid retention) 5. Acromagaly (Excessive growth of bone and soft tissue) 6. Activity causing wrist compresssion (Writing) 7. Colle’s # (Hematoma -> Compression) 8. Gout 9. Amyloidosis 10. Diabetes mellitus
70
C/F of Carpal tunnel syndrome
C/o pain: 1. Type of pain: Burning, tingling and numbness 2. Distribution: Along lat 3 1/2 fingers 3. Max at night 4. Relieved on shaking her hand (Flick sign) Thenar muscle wasting and weakness
71
Investigation of Carpal tunnel syndrome
1. Phalen’s test 2. Reverse Phalen’s test 3. Durkan’s test 4. Tourniquet test
72
What is Phalen’s test and Reverse P’s test?
Position held for approx 1 minute (P: Hands pressed downward; R P’s: Hands pressed upwards praying) Positive: 1. Dull aching pain 2. Numbness 3. Paraesthesia 4. Tingling along median nerve distribution
73
Treatment of Carpal tunnel syndrome
Conservative: Rest, steroids, splints | No improvement V Surgery: Release of flexor retinaculum

Orthopaedics (12 decks)

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