Nerve palsies in the limb Flashcards by Sophie C

What is a dermatome

sensory area of skin supplied by a single spinal nerve

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Define Myotome

group of muscles supplied by one segment of spinal cord

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Hip joint is supplied by (3)

obturator nerve (predominately)
femoral nerve
lateral femoral cutaneous nerve

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What is Hilton’s Law

The nerves crossing a joint supply the muscles acting on it and the joint itself.”

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Hip disease may give rise to?

knee pain

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Brachial Plexus Lesions (3 types - how may you get it?)

downward traction (eg. fall on side of neck)

C5, 6 damage (deltoid & shoulder muscles, brachialis & biceps)

arm “porter’s tip” (Erb-Duchenne paralysis)

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What do C5, 6 supply

deltoid, shoulder muscles , brachial and biceps

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C5,c6 issues ? what kind of posture

ERB’S - porters tip

elbow extended (biceps doesn’t wok)
wrist is flexed
adducted (deltoid doesn’t work)
forearm is pronated

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Pull on the lower chords causes

what damage is done?

what Hand posture do you get?

upward traction - eg breech delivery, pulling of the arm

T1 damage (intrinsic muscles)

hand “clawed” (Klumpke’s paralysis

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Klumpke’s palsy - what kind of damage

intrinsic damage

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The axially nerve (C5 and C6) - where does it Come from?
what does it wrap around?

what does the axially nerve supply?

Posterior Cord

surgical neck of humerus

Supplies Deltoid and Teres Minor
Supplies skin over lateral arm- regimental badge area

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When can axillary be damaged (2)

Shoulder Dislocation

Fracture Surgical Neck of Humerus

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Axillary Nerve Palsy - how do we tell If we damaged it or if it was already damaged?

what does this lead on to?

test for reduced sensation on certain skin areas

deltoid atrophy

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Upper nerve limb palsies include what nerves

Nerve Roots
Brachial Plexus
Peripheral Nerves
Axillary
Radial
Musculocuteneous
Ulnar
Median

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lower limb nerve palsies include what nerves

Nerve Roots
Sacral and Lumbar Plexus
Peripheral Nerves
Sciatic
Femoral
Common Peroneal
LFCN

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UPPER LIMB NERVE PALSIES - examples from brachial plexus

Erb’s Palsy
Klumpke’s Palsy
Total Brachial Plexus

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UPPER LIMB NERVE PALSIES - examples from peripheral nerves

Musculocutaneous (nil)
Axillary
Axillary nerve palsy secondary to trauma
Radial
Radial nerve palsy secondary to compression or entrapment
Median
Carpal tunnel syndrome
Ulnar
Cubital Tunnel Syndrome

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The radial nerve is what nerve roots

c5,6,7,8,t1

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Radial nerve is from what ?
supplies what muscle in arm?
where does it run?

Posterior Cord

Supplies Triceps in arm

Runs in radial groove of humerus as it passes from medial to lateral

Supplies BCR, ECRL and ECRB before dividing into PIN (motor) and SRN (sensory) branches

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When do you get radial nerve palsies (2)

Entrapment
Compression

sat night palsy - pressure on arm (zone of reduced circulation) - neuropraxia

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Radial nerve damage in the axilla symptoms

loss of elbow extension, wrist - extension and sensory changes forearm and hand

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Radial nerve damage in the arm symptoms

loss of wrist extension and sensory loss

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Radial nerve damage in the forearm symptoms

loss of finger extension (PIN)

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Radial nerve damage in the WRIST symptoms

loss of sensation

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test for radial

dorsal aspect of hand - pin prick

Median Nerve (C5,6,7,8,T1) what chords are supplying? What does it supply ?

Medial and Lateral Cords Supplies Flexors of Forearm (Bar FCU and medial half of FDP), LOAF muscles Supplies sensation to radial 3.5 digits

Median nerve supplies what fingers (4)

index finger thumb long finger half of ring finger

Upper Brachial Plexus (C5,6) causes what palsy

ERB's

Lower Brachial Plexus (C8, T1) causes what palsy

Klumpke’s

Erb's palsy is due to traction of ?

C5,6 (+/-C7) | brachial plexus is stretched

erb's palsy - waiter's tip position

- Shoulder is adducted and IR - Elbow is extended and pronated - Wrist is flexed

Klumpke’s Palsy is due to traction of

of C8/ T1 Very Rare Affects small muscles of hand- claw hand

Carpal Tunnel - floor is made up of? | what is the roof?

carpal bones | flexor - collagenous tissue

What does carpal tunnel contain (4)

FDS x4, FDP x4, FPL and median nerve ie. 9 tendons and a nerve

Causes of carpal tunnel syndrome what fractures associated with? examples of swellings? Inflammatory? Metabolic

developmental - thickening Trauma Distal radius fracture Swellings Ganglion Fibroma Lipoma Rheumatoid Gout TB Amyloid Pregnancy Mucopolysaccharidoses Hyperthyroidism

bilateral carpal syndromes.....

hypothyroidism as potential cause

Carpal Tunnel Syndrome - patient symptoms wasting of what muscles?

Nocturnal pain and parasthesia in part or all of the median nerve distribution Wasting of the thenar muscles

Carpal Tunnel Syndrome - what to look for? (3)

Thenar wasting Previous scars Deformity (previous fracture)

Carpal Tunnel Syndrome - what to feel for? test for? SPECIAL TESTS (2) - how do you do them?

Sensation power ABD Tinnels - wrist dorsiflexed, tapped over with middle finger Phalens - palmar flex the wrists. both sides, back of hands together

how do we treat CTS?

night splints can treat hyperthyroidism steroids receive pressure - divide roof of CT at level of the wrist

Ulnar Nerve (C8,T1) - lower roots - doesn't supply anything in the? what does it supply? fingers it supplies?

arm Supplies medial half of FDP, FCU and all intrinsic muscles in hand BAR LOAF.( intrinsic muscles of the hand) little finger , ulnar Half of the ring finger

ulnar nerve | enters by

guyons cancel

Cubital Tunnel Syndrome where can you feel it?

Second most common nerve entrapment Medial epicondyle and olecranon, with fascial bands from FCU as roof

Cubital Tunnel Syndrome - where will patient have numbness?

ulnar side of hand and difficulty with fine tasks. - can affect motor function of intrinsic muscles

Ulnar Nerve Palsy- Muscle Wasting - where do you look first? what are you looking for (2)

first dorsal web space Guttering Hypothenar wasting

What causes ulnar claw hand

Hyperextension at MCPJ, flexion at IPJ’s | phalangeal joints

What is ulnar paradox?

the more distal the lesion , (elbow or wrist) = worst CLAWING due to intact long flexors with a distal lesion

ulnar nerve power test?

Froment’s Test

Key muscles tested in Froment’s Test

Key muscles: ADDUCTOR Pollicis (ULNAR NERVE) FLEXOR Pollicis Longus (MEDIAN NERVE) If Ulnar nerve not working, the patient will cheat and use FPL instead of Adductor Pollicis (thumb will flex/rise)

The lateral femoral cutaneous nerve of thick? supplies what area of skin? where does it lie? what does it supply

l2,l3 surface of iliac muscle - comes out Inguinal ligament sensory info to lateral aspect of the thigh

lateral femoral cutaneous nerve treatment

after pregnancy inject with steroid to shrink swelling - ultrasound operate on patient and release the tunnel

Cubital tunnel treatment

steriods | release the tunnel;

Sciatic Nerve - runs from it is the largest? where does it exit?

(L4,5,S1,2,3) nerve in the body Main Branch of Sacral Plexus pelvis - through sciatic foramen below piriformis muscle

Sciatic Nerve - what does it supply

Supplies Hamstring muscles in posterior compartment of thigh Made up of Tibial Nerve and Common Peroneal Nerve

Sciatic is at risk when?

post dislocation of the hip | IM injections

The common fibular nerve / Peroneal Nerve branches?

L4-S2 smaller and lateral branch of sciatic nerve

Where does the The common fibular nerve / Peroneal Nerve wrap around ?

neck of fibula | behind biceps tendon

What does the common fibular nerve / Peroneal Nerve divide into?

superficial peroneal /fibular - sensory deep fibular - dorsiflexors of foot and toes

common fibular nerve / Peroneal - risk / sign in patient?

risk of fractures around the fibula neck, long pressure foot drop, slapping gait (leg lifted higher as foot doesn't dorsiflex)

What causes Meralgia Parasthetica

Compression of Lateral Femoral Cutaneous Nerve of Thigh | as it travels under lateral border of inguinal ligament

What is Meralgia Parasthetica

Altered sensation and pain in thigh (lateral)

What are the 3 main branches of the lumbar plexus

LFCN Femoral Obturator L1-5

The sacral plexus is ventral rami from

l4 to s4

What nerve supplies the supplies Gluteus medius and minimus and TFL

Superior Gluteal N.

What nerve supplies gluteus maximus

Inferior Gluteal

The main branch of the sacral plexus is? what does it supply?

Sciatic N., which supplies posterior thigh, leg and foot muscles.

Lower limb - sacral plexus - what nerves come off?

Sciatic Common Peroneal Nerve Tibial Nerve

Lower limb - lumbar plexus - nerve?

Femoral Nerve

Nerve palsies in the limb Flashcards

(68 cards)