Nerve Palsies in Upper Limbs

Question 1

3 types of brachial plexus palsies

Answer 1

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

Question 2

Which type of brachial plexus palsy is very rare

Answer 2

Klumpke’s palsy (lower brachial plexus C8 T1)

Question 3

Cause of Erb’s palsy

Answer 3

• Traction of C5, 6 (+/- C7)

- Difficult birth

Question 4

What does Erb’s palsy look like

Answer 4

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

Question 5

Causes of Klumpke’s palsy

Answer 5

• Traction of C8, T1

- Difficult birth

Question 6

What does Klumpke’s palsy look like

Answer 6

Affects small muscles of hand (claw hand)

Question 7

5 types of peripheral nerve palsies

Answer 7

• Musculocutaneous
• Axillary
• Radial
• Median
• Ulnar

Question 8

From what cord does the musculocutaneous

Answer 8

Lateral

Question 9

Define Hilton’s Law

Answer 9

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

Question 10

What area of skin + muscles does the axillary nerve innervate

Answer 10

• Skin over lateral arm (army badge)

- Deltoid + Teres Minor

Question 11

Causes of axillary nerve palsy

Answer 11

• Shoulder dislocation

- Fractured surgical neck of humerus

Question 12

Presentation of axillary nerve palsy

Answer 12

• Deltoid atrophy

- “Army badge” paresthesia

Question 13

What does the radial nerve supply

Answer 13

• Triceps
• Extensor carpi radialis brevis
• Extensor carpi radialis longus
• Brachioradialis

Question 14

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

Answer 14

• Superficial radial nerve (SRN) (sensory)

- Posterior interosseous nerve (PIN) (motor)

Question 15

Causes of radial nerve palsy

Answer 15

• Entrapment (fracture of distal humerus)

- Compression (Crutch palsy, Saturday night palsy)

Question 16

Appearance of radial nerve palsy

Answer 16

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

Question 17

What cords make up the median nerve

Answer 17

Medial + Lateral cords

Question 18

What does the median nerve supply

Answer 18

• 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)

Question 19

What makes up the floor + roof of the carpal tunnel

Answer 19

• Floor = Carpal bones

- Roof = Flexor retinaculum

Question 20

Contents of the carpal tunnel

Answer 20

9 tendons + a nerve

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

Question 21

5 causes of carpal tunnel syndrome

Answer 21

• Developmental
• Trauma
• Swellings
• Inflammatory
• Metabolic

Question 22

Trauma cause of carpal tunnel syndrome

Answer 22

Distal radius fracture

Question 23

3 swellings causing carpal tunnel syndrome

Answer 23

• Ganglion
• Fibroma
• Lipoma

Question 24

4 inflammatory causes of carpal tunnel syndrome

Answer 24

• Rheumatoid
• Gout
• TB
• Amyloid

Question 25

3 metabolic cause of carpal tunnel syndrome

Answer 25

- Pregnancy - Hypothyroidism - Mucopolysaccharidoses

Question 26

Symptoms of carpal tunnel syndrome

Answer 26

- Nocturnal pain + paraesthesia in part/all of median nerve distribution - Wasting of the thenar muscles

Question 27

3 things to LOOK for in carpal tunnel syndrome

Answer 27

- Thenar wasting - Scars - Deformity (previous fracture)

Question 28

What to FEEL for in carpal tunnel syndrome

Answer 28

Sensation

Question 29

What to MOVE in carpal tunnel syndrome

Answer 29

APB power

Question 30

2 special tests for carpal tunnel syndrome

Answer 30

- Tinel's | - Phalen manoeuvre

Question 31

What cord makes up the ulnar nerve

Answer 31

Medial cord

Question 32

What does the ulnar nerve supply

Answer 32

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

Question 33

Symptoms of CUBITAL tunnel syndrome

Answer 33

- Numbness on ulnar side of hand | - Difficulty with fine task

Question 34

Wasting seen in ulnar nerve palsy

Answer 34

- 1st webspace (often most marked) - Guttering - Hypothenar wasting

Question 35

Appearance of ulnar claw hand

Answer 35

- Hyperextension at MCPJ | - Flexion at IPJs

Question 36

Describe the ulnar paradox

Answer 36

- A distal lesion has worse clawing than a proximal lesion | - Due to intact long flexors with a distal lesion

Question 37

What two muscles does the Froment's test

Answer 37

- Adductor pollicis (ulnar nerve) | - Flexor pollicis longus (median nerve)