Pheripheral nerves

Question 1

Pheripheral nerves of UL:

Brachial plexus consists of?

Answer 1

C5 to T1

Also C4 and T2

Question 2

Radial nerve:

1. Consists of?
2. Palsy presentation
3. Test

Answer 2

1. Consists of C5 to C8
2. Sensory: supply area to dorsum of hand between thumb and 1st finger
3. Motor supply to: Triceps, Brachioradialis, Supinator, Extensors of finger wrist
4. Palsy - Wrist drop
5. Test: Extension of elbow, wrist and fingers

Question 3

Ulner nerve

1. Consists of?
2. Palsy presentation
3. Test

Answer 3

1. C8 to T1
2. Sensory: Medial aspect of palm and litte / medial aspect of 4th finger
3. Motor: Innervates small muscles of hands except Abductor Pollicis
4. Palsy —> Wasting of Hypothenar muscles — Clawing of fingers (medial 3 fingers)
5. Common sites of injury: A) Wrist (just distal to it); B) Elbow - Medial Epicondyl; C) At the brachial plexus
6. Lesions of B and C - leads to wasting of forearm
7. Test: Adduction and Abduction of fingers; Adduction of thumb; Fingers flexion

Question 4

Median nerve

1. Consists of?
2. Palsy presentation
3. Test

Answer 4

1. Consists of C6 to C8 & T1
2. Sensory: Lateral aspect of palm and 3 & 1/2 fingers
3. Motor: Innervates the abductor pollis brevis, Flexor pollicis longus, Pronator Teres
4. Palsy results in wasting of thenar muscle & lateral forerm.
5. Common sites of injury: A) Wrist; B) Forearm; C) Elbow
6. Test: Thumb abduction & opposition; Forearm pronation; Sensory function

Question 5

Heading: Peripheral Nerve palsy of UL

Erbs Palsy (description, Cause and Mx)

Answer 5

1. Waiter tips hand - involved UL lies limpy at the side of body with forearm pronated, wrist slightly flexed. There is paralysis of deltoid, biceps, brachioradialis, supinator and extensor of wrist. Finger movement is normal.
   (beware of diaphragmatic paralysis)
2. Cause: Birth injury - damage C3 & 4
3. Mx - Keep UL with shoulder Abducted and elbow flexed. Recovery is expected within 2/52

Question 6

Klumpke’s Palsy (description, Cause and Mx)

Answer 6

1. Clawing of hand and wasting of muscle - beware of Horner’s syndrome associated
2. Cause: Birth injury - damage C7 & C8 & T1
   Feature: Clawing of hand and wasting of muscle

Question 7

Phrenic Nerve Palsy

Answer 7

1. Birth injury —> C3, C4 & C5 injury
2. Presents with SOB and recurrent chest infections. USG showed paradoxical movement of diaphragm
3. Mx- Chest physiotherapy; Plication of diaphragm
4. Course: Recovery within 1 - 3 months is expected

Question 8

Wrist drop
Causes
steps in examination

Answer 8

1. Cause: Radial nerve palsy - paralysis of extensor of finger, wrist, brachioradialis, supinator and triceps.
2. Steps in examination: Demonstrate wrist drop; Look for scars in spinal groove of Humerus / Elbow / Axilla

Question 9

Carpel Tunnel Syndrome

Answer 9

1. Hypothyroidism

2. Amyloidosis