Nerve Injury

Question 1

How does a patient with long thoracic nerve damage present

Answer 1

Difficulty abducting

Winged scapula - medial border and inferior angle protrude

Question 2

What does the axillary nerve supply? Skin and muscles

Answer 2

Skin- regimental badge area

Muscles- deltoid and teres minor

Question 3

Give a cause of axillary nerve damage

Answer 3

Traction injuries in shoulder displacement.

Inferior displacement of numeral head

Question 4

What movement is impaired in axillary nerve damage

Answer 4

Abduction at shoulder (deltoid)

Question 5

Give causes of radial nerve injury

Answer 5

Falling asleep with one arm over back of chair (intoxication)
Fractures of dislocation of prox. Humerus
In groove at time of shaft fracture

Question 6

Give the sensory loss in radial nerve injury

Answer 6

Posterolateral surface of lower arm and forearm
Lateral surface of dorsum of hand
Dorsal surface of Roos of lateral 3.5 fingers

Question 7

Muscles lost in radial nerve injury at elbow

Answer 7

Posterior forearm muscles

Triceps intact

Question 8

Muscles lost in proximal radial nerve injury

Answer 8

All extensions of posterior upper limb

Question 9

What movements are impaired in radial nerve damage

Answer 9

Unable to extend elbow or wrist
Unopposed flexion of wrist = wrist drop
Unable to make grip

Question 10

Give the sensory loss in a musculocutaneous nerve injury

Answer 10

Lateral side of forearm

Question 11

Give the motor loss in a musculocutaneous nerve injury

Answer 11

Weakened flexion of arm (deltoid and pec. Major still in tact)
Weakened forearm flexion (loss of brachialis)

Question 12

Give causes of median nerve injury

Answer 12

Supra condylar fracture of humerus

Stab wounds proximal to flexor retinaculum between FCR and FDS

Question 13

Give sensory loss in median nerve lesion at elbow

Answer 13

Sensation lost of palmar aspect of lateral 3.5 fingers and corresponding palmar surface of the hand.

Question 14

Give the muscles paralysed in median nerve injury at elbow

Answer 14

PT FCR PL FDS radial half of FDP FPL PQ thenar eminence, lumbricals 1&2

Question 15

Give the position of the limb in median nerve injury at elbow

Answer 15

Forearm supinated
Weak wrist flexion, accompanied by adduction
No flexion of IP joints of 2 and 3
(4 & 5 = ulnar FDP) - hand of benediction when making a fist
No opposition - ape hand

Question 16

Sensory loss in median nerve damage at wrist

Answer 16

Distal part of dorsal 3.5 fingers

Palmar sparing due to branching earlier than carpal tunnel

Question 17

Motor loss in median nerve injury at wrist

Answer 17

LLOAF
thumb is laterally rotated and adducted
Weak flexion of MCP of 1&2

Question 18

Cause of ulnar injury at elbow

Answer 18

Fracture of medial humeral epicondyle

Question 19

Sensory loss in ulnar injury at elbow

Answer 19

Medial 1.5 fingers and hand

Question 20

Which muscles are paralysed in ulnar damage at elbow

Answer 20

FCU, ulnar half of FDP, intrinsically hand except LLOAF

Question 21

Clinical presentation of ulnar damage at elbow

Answer 21

Ulnar claw
Paralysed lumbricals 3&4 unopposed extension at MCP and unopposed flexion at PIP.
BUT no flexion at DIP due to paralysed FDP.
Can’t opposed FCR so flexion of wrist is accompanied by abduction.

Question 22

Causes of ulnar damage at wrist

Answer 22

Laceration of wrist

Question 23

Sensory loss in ulnar damage at wrist

Answer 23

Palmar Medial 1.5 digits and palmar surface of hand

Dorsal sparing.

Question 24

Motor loss and presentation of ulnar damage at wrist

Answer 24

Prominent claw hand
FDP is not lost so PIP of 3&4 are flexed
Abduction/adduction of fingers impossible

Question 25

Give the motor and sensory areas affected by injury to long thoracic nerve.

Answer 25

No sensory afferents

Serratus anterior is paralysed