Nerve Palsies in the Limbs

Question 1

Nerves of the limbs

Answer 1

Nerve roots
Brachial/sacral and lumbar plexus
Peripheral nerves

Question 2

Peripheral nerve of the upper limbs

Answer 2

Axillary
Radial
Musculocuteneous
Ulnar
Median

Question 3

Peripheral nerve of the lower limbs

Answer 3

Sciatic
Femoral
Common Peroneal
LFCN

Question 4

Upper limb nerve palsies

Answer 4

Brachial plexus

Peripheral nerves

Question 5

Brachial plexus palsies

Answer 5

Upper - Erb’s (C5,6)
Lower - Klumpke’s (C8, T1)
Total brachial plexus (C5, T1

Question 6

Peripheral nerve palsies

Answer 6

Musculocuteneous (none)
Axillary (nerve palsy secondary to trauma)
Radial (nerve palsy secondary to compression or entrapment)
Ulnar (cubital tunnel syndrome)
Median (carpal tunnel sundrome)

Question 7

Erb’s palsy

Answer 7

C5, 6 (+/-C7)
Waiter’s Tip position:
Shoulder is adducted and internally rotated
Elbow is extended and pronated
Wrist is flexed

Question 8

Klumpke’s palsy

Answer 8

Traction of C8, T1
Very rare
Affects small muscles of hand - claw hand

Question 9

Which nerve wraps around the surgical neck of the humerus?

Answer 9

Axillary nerve

Question 10

What does the axillary nerve innervate?

Answer 10

Deltoid and Teres Minor

Supplies skin over lateral arm- regimental badge area

Question 11

Causes of axillary nerve palsy

Answer 11

Shoulder dislocation

Fracture of surgical neck of humerus (more commonly in osteoporosis

Question 12

Which nerve runs in the radial groove of the humerus?

Answer 12

From medial to lateral

Radial nerve

Question 13

Presentation of radial nerve palsy in axilla

Answer 13

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

Question 14

Presentation of radial nerve palsy in arm

Answer 14

Loss of wrist extension and sensory loss

Question 15

Presentation of radial nerve palsy in forearm

Answer 15

Loss of finger extension (PIN)

Question 16

Presentation of radial nerve palsy at wrist

Answer 16

Loss of sensation (SRN)

Question 17

What are the components of the carpal tunnel?

Answer 17

Floor - carpal bones
Roof - flexor retinaculum
Contents - FDS x4, FDP x4, FPL and median nerve (ie 9 tendons and a nerve)

Question 18

Causes of carpal tunnel syndrome

Answer 18

Developmental
Trauma
Swellings
Inflammatory
Metabolic

Question 19

Trauma as a cause of carpal tunnel syndrome

Answer 19

Distal radius fracture

Question 20

Swellings as a cause of carpal tunnel syndrome

Answer 20

Ganglion
Fibroma
Lipoma

Question 21

Inflammatory causes of carpal tunnel syndrome

Answer 21

Rheumatoid
Gout
TB
Amyloid

Question 22

Metabolic causes of carpal tunnel syndrome

Answer 22

Pregnancy
Mucopolysaccharidoses
Hypothyroidism

Question 23

Carpal tunnel syndrome presentation

Answer 23

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

Question 24

Where is the cubital tunnel?

Answer 24

Between medial epicondyle and olecranon, with fascial bands from FCU as roof

Question 25

Presentation of cubital tunnel syndrome

Answer 25

Numbness on ulnar side of hand and difficulty with fine tasks

Question 26

Ulnar nerve palsy presentation

Answer 26

Muscle wasting => 1st webspace Guttering Hypothenar wasting Ulnar claw hand (distal lesion has worse clawing as long flexors are intact)

Question 27

Sacral plexus ventral rami

Answer 27

L4 to S4

Question 28

Sciatic nerve branches

Answer 28

L4-S3 | Tibial nerve and common peroneal nerve

Question 29

Which nerve wraps around neck of fibula?

Answer 29

Common peroneal nerve

Question 30

Common peroneal nerve palsy presentation

Answer 30

Foot drop

Question 31

Lumbar plexus branches

Answer 31

``` L1-5 Main branches => LFCN Femoral Obturator ```

Question 32

What is meralgia parasthetica?

Answer 32

Altered sensation and pain of the lateral thigh | Compression of LFCN as it travels under lateral border of inguinal ligament

Question 33

LFCN

Answer 33

Lateral femoral cutaneous nerve

Question 34

What does the musculocutaneous nerve innervate?

Answer 34

Biceps brachii Brachialis Coracobrachialis muscles Lateral cutaneous nerve of the forearm

Question 35

What does the median nerve innervate?

Answer 35

Flexor muscles in the forearm Thenar muscles Lateral two lumbricals

Question 36

What does the ulnar nerve innervate?

Answer 36

Flexor carpi ulnaris Flexor digitorum profundus Intrinsic muscles of the hand

Question 37

What are the intrinsic muscles of the hand?

Answer 37

Palmaris brevis Medial two lumbricals Hypothenar muscles Interossei muscles

Question 38

Which muscles does the radial nerve innervate?

Answer 38

Triceps brachii Anconæus Brachioradialis Extensor carpi radialis longus