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MSK > Nerve Palsies in Upper Limbs > Flashcards

Nerve Palsies in Upper Limbs Flashcards

1
Q

3 types of brachial plexus palsies

A
  • Erb’s palsy (upper brachial plexus C5,6)
  • Klumpke’s palsy (lower brachial plexus C8, T1)
  • Total brachial palsy (C5-T1)
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2
Q

Which type of brachial plexus palsy is very rare

A

Klumpke’s palsy (lower brachial plexus C8 T1)

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3
Q

Cause of Erb’s palsy

A
  • Traction of C5, 6 (+/- C7)

- Difficult birth

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4
Q

What does Erb’s palsy look like

A
  • Waiter’s tip position
  • Shoulder adducted + IR
  • Elbow is extended + pronated
  • Wrist is flexed
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5
Q

Causes of Klumpke’s palsy

A
  • Traction of C8, T1

- Difficult birth

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6
Q

What does Klumpke’s palsy look like

A

Affects small muscles of hand (claw hand)

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7
Q

5 types of peripheral nerve palsies

A
  • Musculocutaneous
  • Axillary
  • Radial
  • Median
  • Ulnar
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8
Q

From what cord does the musculocutaneous

A

Lateral

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9
Q

Define Hilton’s Law

A

A sensory nerve supplying a JOINT also supplies the MUSCLES moving the joint and the SKIN overlying the insertion these muscles

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10
Q

What area of skin + muscles does the axillary nerve innervate

A
  • Skin over lateral arm (army badge)

- Deltoid + Teres Minor

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11
Q

Causes of axillary nerve palsy

A
  • Shoulder dislocation

- Fractured surgical neck of humerus

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12
Q

Presentation of axillary nerve palsy

A
  • Deltoid atrophy

- “Army badge” paresthesia

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13
Q

What does the radial nerve supply

A
  • Triceps
  • Extensor carpi radialis brevis
  • Extensor carpi radialis longus
  • Brachioradialis
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14
Q

What sensory nerve and motor nerve does the radial nerve divide into

A
  • Superficial radial nerve (SRN) (sensory)

- Posterior interosseous nerve (PIN) (motor)

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15
Q

Causes of radial nerve palsy

A
  • Entrapment (fracture of distal humerus)

- Compression (Crutch palsy, Saturday night palsy)

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16
Q

Appearance of radial nerve palsy

A

Depend of site of lesion

  • In axilla = Loss of elbow extension, wrist extension and sensory changes in forearm + hand
  • In arm = Loss of wrist extension + sensory loss
  • In forearm = Loss of finger extension (PIN)
  • At wrist = Loss of sensation (SRN) e.g. handcuffs
17
Q

What cords make up the median nerve

A

Medial + Lateral cords

18
Q

What does the median nerve supply

A
  • LOAF muscles
  • Flexors of forearm (bar FCU + medial half of FDP)
  • Palmar aspect of thumb, index, middle + half of ring finger (sensation)
  • Radial half of palm (sensation)
19
Q

What makes up the floor + roof of the carpal tunnel

A
  • Floor = Carpal bones

- Roof = Flexor retinaculum

20
Q

Contents of the carpal tunnel

A

9 tendons + a nerve

  • Flexor digitorum superficialis tendon x4
  • Flexor digitorum profundus tendon x4
  • Flexor pollicis longus tendon
  • Median nerve
21
Q

5 causes of carpal tunnel syndrome

A
  • Developmental
  • Trauma
  • Swellings
  • Inflammatory
  • Metabolic
22
Q

Trauma cause of carpal tunnel syndrome

A

Distal radius fracture

23
Q

3 swellings causing carpal tunnel syndrome

A
  • Ganglion
  • Fibroma
  • Lipoma
24
Q

4 inflammatory causes of carpal tunnel syndrome

A
  • Rheumatoid
  • Gout
  • TB
  • Amyloid
25
Q

3 metabolic cause of carpal tunnel syndrome

A
  • Pregnancy
  • Hypothyroidism
  • Mucopolysaccharidoses
26
Q

Symptoms of carpal tunnel syndrome

A
  • Nocturnal pain + paraesthesia in part/all of median nerve distribution
  • Wasting of the thenar muscles
27
Q

3 things to LOOK for in carpal tunnel syndrome

A
  • Thenar wasting
  • Scars
  • Deformity (previous fracture)
28
Q

What to FEEL for in carpal tunnel syndrome

A

Sensation

29
Q

What to MOVE in carpal tunnel syndrome

A

APB power

30
Q

2 special tests for carpal tunnel syndrome

A
  • Tinel’s

- Phalen manoeuvre

31
Q

What cord makes up the ulnar nerve

A

Medial cord

32
Q

What does the ulnar nerve supply

A
  • Medial half of FDP
  • FCU
  • All intrinsic muscles in hand bar LOAF
  • Sensation to Pinkie and ulnar half of ring finger (palmar + dorsal aspects)
33
Q

Symptoms of CUBITAL tunnel syndrome

A
  • Numbness on ulnar side of hand

- Difficulty with fine task

34
Q

Wasting seen in ulnar nerve palsy

A
  • 1st webspace (often most marked)
  • Guttering
  • Hypothenar wasting
35
Q

Appearance of ulnar claw hand

A
  • Hyperextension at MCPJ

- Flexion at IPJs

36
Q

Describe the ulnar paradox

A
  • A distal lesion has worse clawing than a proximal lesion

- Due to intact long flexors with a distal lesion

37
Q

What two muscles does the Froment’s test

A
  • Adductor pollicis (ulnar nerve)

- Flexor pollicis longus (median nerve)

MSK (28 decks)

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