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MSK > Nerve injuries and palsies in the limbs > Flashcards

Nerve injuries and palsies in the limbs Flashcards

1
Q

What are common causes of brachial plexus lesions

A

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

During injuries - commonly driving accidents or falling onto the shoulder

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2
Q

Describe porters tip and what causes it

A

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

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3
Q

What happens in upward traction brachial plexus lesions

A

Klumpke’s palsy

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4
Q

What cord does the axillary nerve come from

A

posterior cord

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5
Q

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

A

It wraps around the surgical neck of the humerus normally

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6
Q

What does the axillary nerve supply

A

deltoid and teres minor

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7
Q

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

A

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

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8
Q

What are common causes of radial nerve palsy

A

entrapment and compression

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9
Q

What is saturday night palsy and what does it cause

A

Sitting with arm over chair and chair compresses radial nerve

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10
Q

What do the symptoms of the radial nerve palsy depend on

A

The site of the lesion

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10
Q

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

A

Every function distal to that is compromised

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11
Q

What happens if the radial nerve palsy is at the axilla

A

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

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12
Q

What happens if the radial nerve palsy is at the arm

A

Loss of wrist extension and sensory loss

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13
Q

What happens if the radial nerve palsy is at the forearm

A

Loss of finger extension

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14
Q

What happens if the radial nerve palsy is at the wrist

A

Loss of sensation - damaging superficial radial nerve

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15
Q

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

A

Dorsal aspect of first webbing between index finger and thumb

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16
Q

What is the contents of the carpal tunnel

A

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

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17
Q

What are the causes of carpal tunnel syndrome

A

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

18
Q

How does carpal tunnel syndrome present

A

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

Wasting of the thenar muscles

19
Q

What is checked in the movement for carpal tunnel syndrome

A

Movement - Abductor pollicis brevis power

20
Q

What are the tests done on examination for carpal tunnels syndrome

A

Tinnels
Phalens

21
Q

Describe tinnels test

A

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

22
Q

Describe phalens test

A

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

23
Q

What is the treatment for carpal tunnel syndrome

A

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

24
Q

What is the sensory supply of the ulnar nerve

A

hypothenar eminence, little finger and half of the ring finger

25
Q

Where is the normal place of compression for the ulnar nerve

A

cubital tunnel syndrome

26
Q

What is the cubital tunnel

A

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)

27
Q

How does cubital tunnel syndrome present

A

Numbness on the ulnar side of the hand

28
Q

How does ulnar nerve palsy present

A

Wasting of muscles - first web space first usually and the hypothenar

Claw hand can occur in significant nerve compression

29
Q

What is ulnar claw hand

A

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

30
Q

What is a test for ulnar nerve

A

Froment’s test - checking adductor pollicis

31
Q

Describe froment’s test

A

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

32
Q

What are the nerve roots of the lateral femoral cutaneous nerve

A

L2-3

33
Q

Describe location of lateral femoral cutaneous nerve

A

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

34
Q

What does the lateraql femoral cutaneous nerve supply

A

Sensory innervation to lateral aspect of the thigh

35
Q

How does the lateral femoral cutaneous nerve compression occur

A

It runs through a tunnel so it can become compressed

36
Q

What is the treatment of lateral femoral cutaneous nerve compression

A

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

37
Q

What is the root of the sciatic nerve

A

L4-S3

38
Q

Where does the sciatic nerve leave the pelvis

A

Sciatic foramen below the priformis muscle

39
Q

What does the sciatic nerve supply

A

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

40
Q

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

A

L4-2 - small branch of the sciatic nerve

41
Q

What happens if there is damage to the common fibular nerve

A

Footdrop and slapping gait

42
Q

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

A

MSK (36 decks)

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