Upper limb neurologic examination

Question 1

What nerve root is involved in elbow reflex ?

Answer 1

C5

Question 2

What nerve root is involved in wirst/brachioradialis reflex ?

Answer 2

C6

Question 3

What nerve root is involved in triceps reflex ?

Answer 3

C7

Question 4

What nerves root are involved in shoulder abduction and what muscle/s do they innervate?

Answer 4

C5- axillary nerve to DELTOID

C6- supraspinatus- SUPRASPINATUS

Question 5

What nerves root are involved in shoulder internal rotation and what muscle/s do they innervate?

Answer 5

C5- Subscapularis

Subscapularis

Question 6

What nerves root are involved in shoulder external rotation and what muscle/s do they innervate?

Answer 6

C5-Supraspinatus

infraspinatus muscle

Question 7

What nerves root are involved in elbow flexion with thumb up and what muscle/s do they innervate?

Answer 7

C5
musculocutanous N- lateral cord
biceps brachii and brachialis

Question 8

What nerves root are involved in elbow flexion with palm down and what muscle/s do they innervate?

Answer 8

C6
Radial N- post cord
brachioradialis

Question 9

What nerves root are involved in wrist extension and what muscle/s do they innervate?

Answer 9

C6
Radial N
ECRL, ECRB
( ecu supplied by ulna nerve involved in wrist extension)

Question 10

What nerves root are involved in wrist supination and what muscle/s do they innervate?

Answer 10

C6
Deep branch of radial n- PIN
Supinator

Question 11

What nerves root are involved in elbow extension and what muscle/s do they innervate?

Answer 11

C7
Radial N
Triceps

Question 12

What nerves root are involved in wrist flexion and what muscle/s do they innervate?

Answer 12

C7
Median N
FCR and PL

Question 13

What nerves root are involved in wrist pronation and what muscle/s do they innervate?

Answer 13

C7
Median nerve
Pronatpr quadratuas
Pronator teres

Question 14

What nerves root are involved in MCP and PIPJ finger flexion and what muscle/s do they innervate?

Answer 14

C8
Median n
FDS

Question 15

What nerves root are involved in DIPJ finger flexion and what muscle/s do they innervate?

Answer 15

C8
ULNA ( medial part) AND AIN ( MEDIAN n- lat part)
FDP

Question 16

What nerves root are involved in thumb extension and what muscle/s do they innervate?

Answer 16

C8
PIN of Radial nerve
EPL

Question 17

What nerves root are involved in finger abduction and what muscle/s do they innervate?

Answer 17

T1
Deep branch of ulna N
Interrossei

Question 18

Describe the dermatome of C5?

Answer 18

Lateral volar border of upper arm just crosses elbow

Question 19

Describe the dermatome of C6?

Answer 19

From distal elbow to include thumb and index finger

Question 20

Describe the dermatome of C7?

Answer 20

Middle finger only

Question 21

Describe the dermatome of C8?

Answer 21

ring and little finger extended proximally medial volar aspect of arm to just below elbow

Question 22

Describe the dermatome of T1?

Answer 22

crossing elbow and extending medial border of upper arm to half way up upper arm

Question 23

What is seen in isolation c5 root lesions?

Answer 23

loss of abduction of the arm- weak rather than absent

Sensory loss over lateral aspect of deltoid muscle

Question 24

What do you seen in isolated axillary nerve palsy?

Answer 24

Abduct able as some activity in supraspinatus to abduct arm

Sensation loss - outer lateral arm

Question 25

What is seen in C5/c6 root lesions?

Answer 25

Here the shoulder ABDUCTORS, INTERNAL ROTATORS, ELBOW FLEXORS ARE PARALYSED so the arm is held in - INTERNAL ROTATION, and the arm cannot be flexed at the elbow or abducted

Question 26

What is seen in isolated/ combined C8/T1 root lesions?

Answer 26

hand is clawed in all digits with weak flexion Good proximal muscle Often a HORNER's sydrome-sympathetic nervous system effected by avulsion of T1- eyelid ptosis, Pupil constriction, anhydroisis of face on same side as lesion

Question 27

What is erb's palsy? describe the features?

Answer 27

Paralysis of the upper arm caused by traction injury during birth with and injury to C5 and C6 nerve root. Head is turned opposite direction when shoulder is depressed and traction on brachial plexus Here the shoulder ABDUCTORS, INTERNAL ROTATORS, ELBOW FLEXORS ARE PARALYSED so the arm is held in - INTERNAL ROTATION, and the arm cannot be flexed at the elbow or abducted so held in extension with the forearm pronated - due to paralysis of biceps. sensation lost as well.

Question 28

What is ergs palsy asoociated with ?

Answer 28

``` Shoulder dystocia extended labour forceps delivery abnormal position breech presentation ```

Question 29

What is the prognosis of Erb's palsy?

Answer 29

90% resolve spontaneously though may take 2 years to resolve

Question 30

What are the favourable prognostic signs?

Answer 30

Recovery good if Biceps and deltoid are M1 at 2 months | Early biceps twitch

Question 31

What are the poor prognostic signs?

Answer 31

Lack of biceps function horner's syndrome- <10% chance of full recovery loss of rhomboid function Avulsion injuries- worse prognosis

Question 32

What nerves and their muscles are effected in erg's palsy?

Answer 32

Axillary- deltoid- no shoulder adbduction Supraspinatus- supraspinatus and infraspinatus- Musculocutaneous- biceps- no elbow flexion C6= Radial- brachioradialis- no supination

Question 33

What is Klumpke palsy?

Answer 33

Injury to C8/T1 Lower lesion

Question 34

How is Klumpke caused?

Answer 34

Mainly By avulsion of c8/t1 by excessive ABDUCTION person trying to save themselves when they fall. Cervical rib Lung mets

Question 35

What posiiton in the patients arm in klumpke's palsy?

Answer 35

upper limb to wirst fine WRIST IN EXTENSION- uppose action of extensors hand is clawed as all small muscles to hand paralysed- median and ulna nerve MCPJ in extension due to LOSS of INTRINSICS Flexion of IPJ due to loss of intrinsics Horner's syndrome

Question 36

What is the prognosis of Klumpke palsy?

Answer 36

poor especially if have hornet's syndrome- preganglionic injury

Question 37

What are the tx for erb's/klumpke's palsy?

Answer 37

non op- observation and daily passive exercises by parents- key to maintain passive motto while nerves recover

Question 38

what are the indications for surgery?

Answer 38

early surgery- microsurgical repair or nerve graft when complete fail arm at 1 month horner's syndrome at 1 month

Question 39

what late surgery is available?

Answer 39

correct contracture preventing External R of shoulder Subscapularis slide with lengthening ( young child) latismmus dorsi and teres major transfer to post rotator cuff ( aged 4) Proximal humeral rotational ostetomy Lack of elbow flexion Clerk's pectoral transfer and Steindler flexoplasty- tendon traansfer and allows for increased elbow flexion

Question 40

What is the late sequela of untreated brachial plexus injury?

Answer 40

Glenoid hypoplasia and retroversion due to post displacement of the humeral head on an increasing dysplastic and retroverted glenoid

Question 41

What supplies the trapezius? what does weakness cause?

Answer 41

Spinal accessory nerve - XI of the cranial nerves? Inabililty to shrug shoulders inability to sustain shoulder abduction at 90 degrees

Question 42

What muscles stabilise the shoulder?

Answer 42

Rhomboids Trapezius serratus anterior

Question 43

What can cause scapular winging?

Answer 43

Injury to the long thoracic nerve- serratus ant and rhomboids Injury to spinal accessory- XI n- trapzius ( rare!)