Peripheral Nerve

Question 1

Radial impingement sites

Answer 1

Triangular space
Radial groove
Elbow

Question 2

Radial Triangular space

Answer 2

Teres major, tricep (long head), humerus

Weakness of elbow extension, weakness of wrist extension
Loss of tricep reflex
Loss of sensation of entire posterior arma nd froearm (exceot lateral forearm- musculocutaneous)
Loss of sensation lateral 3 1/2 fingers to DIP Jt

Question 3

Radial groove

Answer 3

Often due to compression from humeral #, tourniquets or blood pressure cuff
Entrapment below triceps
Weakness of wrist extension
Loss of sensation to posterior lateral 3 1/2 fingers

Question 4

Radial Elbow

Answer 4

Deep branch of radial nerve compressed by # of proximal radius or as it passes through two planes of supinator muscle
Weakness of thumb and MCP extension

Question 5

Musculocutaneous impingement sites

Answer 5

Axillary fold or coracobrachialis belly

Question 6

Musculocutaneous impingement S+S

Answer 6

Weakness of elbow flexion
Loss of cutaneous sensation to ant/lat forearm
Loss of bicep reflex

Question 7

Axillary impingement sites

Answer 7

Quadrangular space- teres minor, major, triceps (long head), humerus

Question 8

Axillary impingement S+S

Answer 8

Weakness in deltoid + teres minor muscles- results in weak abduction of arm
Loss of cutaneous sensation to superior posterior/lateral arm

Question 9

Median impingement sites

Answer 9

Elbow
Passage of nerve through two heads of hypertonic pronator teres muscle
Wrist

Question 10

Median Elbow

Answer 10

Occasionally compression due to sleeping on elbow, or medial supracondylar #
Weakness of forearms + wrist pronation
Weakness of wrist flexion
Ape hand deformity (atrophy of thenar muscles)
Loss of sensation to palm and palmar surface of lat 3 1/2 fingers

Question 11

Median Pronator teres muscle

Answer 11

Throbbing/aching P in wrist and forearm
Weakness in gripping small objects
P with pronation
P with wrist flexion
Ape hand
Same loss of sensation

Question 12

Median Wrist

Answer 12

Most commonly CTS, maybe lacerations or puncture wounds
Ape hand deformity
Loss of sensation to 3 1/2 lateral fingers, NOT palm- helps differentiate CTS ti impingement further up

Question 13

Ulnar sites of impingement

Answer 13

Cubittal tunnel
Wrist

Question 14

Ulnar Cubittal tunnel

Answer 14

Cubittal tunnel syndrome
Compression due to # at medial epicondyle or sustained pressure in aconeus muscle

Weakness of wrist flexion (ulnar side)
Claw hand deformity
Loss of sensation to medial 1 1/2 finges

Question 15

The cubital tunnel

Answer 15

Tendinous arch joining humeral head and ulnar heads of flexor carpi ulnaris
Inflam to flexor carpi ulnaris may compress ulnar nerve

Question 16

Ulnar Wrist

Answer 16

Tunnel of Guyon (medial to carpal tunnel)
Wounds, cuts, other trauma, repetitive impact

Bishops (lateral three fingers curl) or claw hand deformity
Loss of sensation to medial 1 1/2 fingers, with normal PROM

Question 17

Femoral impingement sites

Answer 17

Can be compressed anywhere, mainly NRI

Question 18

Femoral S+S

Answer 18

Weak hip flexion, weak knee flexion
PF reduced or absent
P, tingling, loss of sensation to medial knee, leg and foot

Question 19

Lateral (external) femoral cutaneous nerve impingement sites

Answer 19

Near inguinal ligament, as nerve passes through ligament
Tight clothes, heavy work belts, obesity, pregnancy

Question 20

Lateral fem S+S

Answer 20

P, tingling or loss of sensation to lateral thigh

Question 21

Obturator impingement sites

Answer 21

Often NRI
An obturator hernia (typically elderly women)

Question 22

Obturator S+S

Answer 22

Weak adduction of thigh, Pt may have difficulty crossing legs
Isolated loss of sensation to medial thigh

Question 23

Genitofemoral impingement sites

Answer 23

Inguinal ligament by tight clothing

Question 24

Genitofemoral S+S

Answer 24

P or numbness over ant med thigh just below inguinal ligament
Pt may have previous Hx of appendectomy, psoas muscle infection or local trauma

Question 25

Sciatic impingement sites

Answer 25

Anywhere from greater sciatic notch to popliteal fossa NRI- disc herniation, facet dysfunction, spondylosis

Question 26

Sciatic S+S

Answer 26

P or loss of sensation along course of nerve from buttocks, post leg, and foot Weakness of hip extension + knee flexion

Question 27

Tibial impingement sites

Answer 27

Well-protected, so less likely Direct trauma NRI

Question 28

Tibial S+S

Answer 28

P or loss of symptoms to sole of foot Weakness in PF

Question 29

Common fibular (peroneal) impingement sites

Answer 29

Most often affected at head or neck of fibula Ant compartment syndrome (esp by extensor digitorum longus), #, dislocation of fibula tight cast, splint or bracing

Question 30

Common fibular S+S

Answer 30

Mild P or loss of sensation to anterolateral leg and dorsum of foot