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Module 204 MSK & Immune system > T2 L11 Upper limb nerve injuries > Flashcards

T2 L11 Upper limb nerve injuries Flashcards

(55 cards)

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1
Q

What are the 3 steps when approaching a neurological problem?

A

Anatomically localise lesion
Consider pathophysiology
Differential diagnosis

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2
Q

What are the signs of an UMN?

A 
Held in flexed posture if chronic
Increased tone
Pyramidal weakness (flexor muscles stronger than extensors)
Brisk reflexes
Sensory level
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3
Q

What are the signs of a LMN?

A

Wasting / fasciculations
Flaccid tone
Weakness in either a myotomal distribution or peripheral nerve distribution
Dermatomal or peripheral nerve distribution of sensory loss

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4
Q

What is a dermatome?

A

Area of skin suppled by nerve fibres originating from single dorsal nerve root

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5
Q

What myotome and muscle action does C5 root have?

A

Deltoid

Shoulder abduction

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6
Q

What myotome and muscle action does C6 root have?

A

Biceps, brachialis, brachioradialis

Elbow flexion

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7
Q

What myotome and muscle action does C7 root have?

A

Triceps, superficial forearm extensors and flexors

Elbow extension, wrist extension, wrist flexion

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8
Q

What myotome and muscle action does C8 root have?

A

Forearm extensors
Deep forearm flexors
Finger extension, finger flexion

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9
Q

What myotome and muscle action does T1 root have?

A

Intrinsic hand muscles

Finger abduction

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10
Q

What is the biceps reflex?

A

C5 reflex

Supplied by musculocutaneous nerve

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11
Q

What is the supinator jerk?

A

C6 reflex

Radial nerve

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12
Q

What is the triceps jerk?

A

C7 reflex

Radial nerve

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13
Q

What is the finger jerk?

A

C8 reflex

Median and ulnar nerve

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14
Q

What are the signs and symptoms of a nerve root impingement?

A 
Pain
 - can radiate
 - can be aggravated by neck movement
Sensory loss
Weakness
Reflex loss
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15
Q

What are the 4 types of nerve injury?

A

Avulsion
Rupture
Neuroma
Neurapraxia

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16
Q

What is avulsion?

A

Tearing of nerve from its attachment at the spinal cord

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17
Q

What is rupture?

A

Tearing of nerves but not from attachment to the spinal cord

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18
Q

What is neuroma?

A

Tumour or growth of nerve tissue

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19
Q

What is neurapraxia?

A

Axons remain intact but myelin damage causes interruption of impulse down nerve fibre

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20
Q

Give examples of causes of brachial plexus injuries

A 
Trauma
 - Erb-duchenne type paralysis
 - Klumpke paralysis 
Cancer 
 - lung cancer - pancoasts tumour
Inflammatory 
 - brachial neuritis 
Structural
 - thoracic outlet syndrome
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21
Q

What is Erb-duchenne type paralysis?

A

Avulsion of C5 and C6 roots

Upper plexus palsy

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22
Q

What are the causes of Erb-duchenne type paralysis?

A

Blow to shoulder or during delivery of the head

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23
Q

What muscles does Erbs palsy affect?

Study These Flashcards
A 
Biceps
Brachioradialis
Deltoid
Supraspinatus
Supinator
24
Q

What is Klumpke’s palsy?

Study These Flashcards
A

Avulsion of C8 and T1 roots

25
What can cause Klumpke's palsy?
Clutching for an object when falling from a height
26
What are the signs and symptoms of Klumpke's palsy?
Unable to flex wrist or fingers Weakness of all small muscles of the hands Sensory loss to hand and inner border of forearm Claw hand
27
How can you differentiate between Erb's palsy and Klumpke's palsy?
Erb's palsy - arm doesn't work, hand works | Klumpke's palsy - arm works, hand doesn't work
28
What are the signs and symptoms of pancoast tumour?
``` Pain in shoulder girdle and inner arm Ipsilateral horners syndrome - miosis - ptosis - anhidrosis ```
29
Describe radiation-induced brachial plexopathy
Occurs 6 years after radiation Associated with treatment for breast, lung cancer and lymphoma Pain isn't a consistent feature Predilection for upper brachial plexus
30
What are the causes of idiopathic brachial neuritis?
Unclear | Could be infectious or post-infectious
31
What are the signs and symptoms of idiopathic brachial neuritis?
Severe pain over days | As pain diminishes it is followed by weakness and wasting
32
What investigations are done for idiopathic brachial neuritis?
MRI to look for thickening and enhancement | NCS / EMG for prognostication
33
What is the treatment of idiopathic brachial neuritis?
Analgesia Physiotherapy Steroids (limited evidence)
34
Where are the common compression sites in thoracic outlet syndrome?
Between anterior and middle scalene muscles Between clavicle in costoclavicular space Beneath tendon of pectoralis minor
35
What are the signs and symptoms of neurogenic thoracic outlet syndrome?
Predominantly affects abductor policies brevis leading to thenar wasting Paraesthesia Numbness Weakness Not localised to specific nerve distribution Aggravated by elevation or sustained use of arms or hands
36
what are the signs and symptoms of vascular thoracic outlet syndrome?
Forearm fatigue within minutes Swelling and cyanosis Collateral venous patterning over ipsilateral shoulder, chest wall and neck Rarely pain Pallor and coldness Lower BP on affected arm with diminished distal pulses
37
Why does damage to long thoracic nerve cause winging of scapula?
Long thoracic nerve normally supplies serrates anterior which pulls medial border of scapula to posterior thoracic wall and stabilises it there
38
What are the causes of damage to the long thoracic nerve?
Blows or pressure in posterior triangle of neck | Radical mastectomy
39
What are the 2 common sites of compression of the median nerve?
Wrist - carpal tunnel syndrome | Elbow
40
What hand muscles does the median nerve innervate?
Lateral 2 lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis
41
What are the causes of carpal tunnel?
``` Diabetes Pregnancy Hypothyroidism Rheumatoid arthritis Repetitive strain ```
42
Where does the anterior interosseous nerve come from?
Median nerve just above elbow
43
Where is the anterior interosseous nerve prone to compression?
Between 2 heads of pronator teres muscle
44
What are the causes of anterior interosseous nerve compression?
Gripping tightly with forced pronation Prolonged use of screwdriver Damaged during blood-taking
45
What does anterior interosseous nerve syndrome cause weakness of?
Flexors of interphalangeal joint of thumb - flexor pollicis longus Distal interphalangeal joints of index and middle fingers - flexor digitorum profundus Pronation
46
Where is sensation lost if there is a lesion in the forearm which is proximal to palmar cutaneous sensory branch?
``` Lateral palm D1 D2 D3 1/2 D4 ```
47
What muscles will be paralysed if there is a higher lesion in the upper limb affecting the ulnar nerve?
Ulnar 1/2 flexor digitorum profundus Interossei Lumbricals
48
Where does the superficial sensory branch come off the ulnar nerve?
In distal forearm above wrist
49
What does the deep ulnar branch supply?
Motor innervation to intrinsic hand muscles
50
What can cause Guyon's canal to become inflammed?
Overuse such as occupation or cycling | Rheumatoid arthritis
51
What nerve passes through Guyon's canal?
Deep ulnar branch
52
What does C8 supply?
All finger extensors via radial nerve | Flexor digitorum profundus of index / middle finger via median nerve
53
What is the clinical sign of radial nerve palsy?
Wrist drop
54
How is axonal differentiated from demyelinating in a nerve conduction study?
Axonal - decrease in amplitude | Demyelinating - decrease in velocity
55
What does a needle EMG do?
Measures electrical activity of muscle during voluntary contraction Pattern of electrical activity helps distinguish a lesion arising from a nerve vs a muscle

Module 204 MSK & Immune system (44 decks)

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