Nerve injuries and palsies in the limbs

Question 1

What are common causes of brachial plexus lesions

Answer 1

During birth when the child is pulled out of a tight space

During injuries - commonly driving accidents or falling onto the shoulder

Question 2

Describe porters tip and what causes it

Answer 2

Erb-duchenne paralysis Arm is adducted because deltoid is not working

Elbow is extended due to bicep not working correctly

Forearm is abducted and wrist is flexed

Question 3

What happens in upward traction brachial plexus lesions

Answer 3

Klumpke’s palsy

Question 4

What cord does the axillary nerve come from

Answer 4

posterior cord

Question 5

Why does the axillary nerve get damaged during dislocations and fractions of the surgical neck of the humerus

Answer 5

It wraps around the surgical neck of the humerus normally

Question 6

What does the axillary nerve supply

Answer 6

deltoid and teres minor

Question 7

What is the test on examination to see if there is damage to the axillary nerve

Answer 7

Feel the regimental badge area on the shoulder and if there is no sensation, the axillary nerve is damaged

Question 8

What are common causes of radial nerve palsy

Answer 8

entrapment and compression

Question 9

What is saturday night palsy and what does it cause

Answer 9

Sitting with arm over chair and chair compresses radial nerve

Question 10

What do the symptoms of the radial nerve palsy depend on

Answer 10

The site of the lesion

Question 10

If the radial nerve palsy is more proximal at the axilla what happens

Answer 10

Every function distal to that is compromised

Question 11

What happens if the radial nerve palsy is at the axilla

Answer 11

Loss of elbow extension, wrist extension and sensory changes inthe forearm and hand

Question 12

What happens if the radial nerve palsy is at the arm

Answer 12

Loss of wrist extension and sensory loss

Question 13

What happens if the radial nerve palsy is at the forearm

Answer 13

Loss of finger extension

Question 14

What happens if the radial nerve palsy is at the wrist

Answer 14

Loss of sensation - damaging superficial radial nerve

Question 15

What is the area that is normally checked for sensation in radial nerve injury

Answer 15

Dorsal aspect of first webbing between index finger and thumb

Question 16

What is the contents of the carpal tunnel

Answer 16

4 Flexor digitorum superficialis tendons
4 Flexor digitorum profundus tendons
1 flexor pollicis longus tendon
Median nerve

Question 17

What are the causes of carpal tunnel syndrome

Answer 17

Trauma, swelling, inflammation and metabolic conditions where there is swelling in the joint

Question 18

How does carpal tunnel syndrome present

Answer 18

Nocturnal pain and parasthesia in the median nerve distribution (index finger, thumb and half of middle finger )

Wasting of the thenar muscles

Question 19

What is checked in the movement for carpal tunnel syndrome

Answer 19

Movement - Abductor pollicis brevis power

Question 20

What are the tests done on examination for carpal tunnels syndrome

Answer 20

Tinnels
Phalens

Question 21

Describe tinnels test

Answer 21

tapping the middle of the carpal tunnel with the middle finger - this will cause shooting sensations into middle finger if the patient has carpal tunnel syndrome

Question 22

Describe phalens test

Answer 22

Putting the back of the hands together – the opposite of prayer sign – same pain and paresthesia as the night symptoms if they have carpal tunnel

Question 23

What is the treatment for carpal tunnel syndrome

Answer 23

Carpal tunnel release - removing the roof of the carpal tunnel to relieve the pressure on the median nerve

Question 24

What is the sensory supply of the ulnar nerve

Answer 24

hypothenar eminence, little finger and half of the ring finger

Question 25

Where is the normal place of compression for the ulnar nerve

Answer 25

cubital tunnel syndrome

Question 26

What is the cubital tunnel

Answer 26

Runs between the medial epicondyle and olecranon with fascial bands of flexor carpi ulnaris on top of it (the area which is thought to be the funny bone)

Question 27

How does cubital tunnel syndrome present

Answer 27

Numbness on the ulnar side of the hand

Question 28

How does ulnar nerve palsy present

Answer 28

Wasting of muscles - first web space first usually and the hypothenar Claw hand can occur in significant nerve compression

Question 29

What is ulnar claw hand

Answer 29

Flexion at the ulnar interphalangeal joints and hyper extension at the metacarpal phalangeal joints

Question 30

What is a test for ulnar nerve

Answer 30

Froment's test - checking adductor pollicis

Question 31

Describe froment's test

Answer 31

Ask patient to hold a piece of paper while their thumb is up and there other digits are in a fist - if there is ulnar nerve damage, the adductor pollicis won't be working so they will bend their thumb using flexor pollicis longus which is supplied by the median nerve

Question 32

What are the nerve roots of the lateral femoral cutaneous nerve

Answer 32

L2-3

Question 33

Describe location of lateral femoral cutaneous nerve

Answer 33

Lies on surface of iliacus muscle - exits pelvis under lateral end of inguinal ligament

Question 34

What does the lateraql femoral cutaneous nerve supply

Answer 34

Sensory innervation to lateral aspect of the thigh

Question 35

How does the lateral femoral cutaneous nerve compression occur

Answer 35

It runs through a tunnel so it can become compressed

Question 36

What is the treatment of lateral femoral cutaneous nerve compression

Answer 36

Injecting steroids into the tunnel to reduce the swelling Operation can be done if steroids do not work and to open up the tunnel and release the pressure

Question 37

What is the root of the sciatic nerve

Answer 37

L4-S3

Question 38

Where does the sciatic nerve leave the pelvis

Answer 38

Sciatic foramen below the priformis muscle

Question 39

What does the sciatic nerve supply

Answer 39

Hamstring muscles (posterior) - part of adductor magnus and all of the lower leg and foot muscles through terminal branches - tibial and common fibular nerves

Question 40

What is the roots of the common fibular nerve (commonly known as peroneal nerve)

Answer 40

L4-2 - small branch of the sciatic nerve

Question 41

What happens if there is damage to the common fibular nerve

Answer 41

Footdrop and slapping gait

Question 42

What is slapping gait - foot cant dorsiflex so patients have to lift legs higher and the foot slaps when they plant the foot down