Practical - Nerve lesions table for upper limb PDF

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Nerve lesions table for upper limb...

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Nerve lesions table for upper limb Nerve Axillary

Site of Injury Axilla

Muscles Deltoid

Motor Loss Humeral abduction

Musculocutaneous Median

Axilla Elbow

Arm flexors Pronators, flexors except FCU and medial half of FDP. Thenar mm., lateral 2 lumbricals

Weak forearm flexion & supination Loss of pronation – PT, PQ

Thenar mm.

Sensory Loss Loss of sensation over “Sergeant’s Patch” Lateral forearm Decreased sensation on lateral 3 ½ digits

Reduction in flexion/abd of the hand/ fingers- PL, FCR, FDS, FDP// 1,2 lumbrical muscles

Wrist Opposition, abduction and flexion of the thumb are lost – thenar, FPL

Ulnar

Elbow, wrist

FCU, medial half of FDP, hypothenar mm, medial 2 lumbricals, interossei

Hand in Benedict position: damage to Median Nn. = inability to flex all fingers. However, the Ulnar Nn. flexes medial 2 fingers so get ulnar claw hand only when asked to make a fist. Reduced flexion/add of hand – FCU, medial half of FDP, 3+4 lumbricals, Reduced abd. of fingers: d interossei Reduced add of fingers: p interossei Reduced grip: palmar brevis Reduced add of thumb: add pollicis Loss of opp, abd and flexion of little finger – hypothenar group

Decreased sensation on palm & medial 1 ½ digits

Radial

Axilla, cubital fossa

What nerves might be damaged by: Dislocated shoulder Axillary Nerve # mid shaft humerus Radial Nerve Supracondylar # humerus Median Nerve Cut to volar aspect of wrist Median Nerve Dislocated hip Sciatic Nerve

Supinators & extensors of arm

Present with Ulnar claw hand: Ulnar Nn. controls the medial 2 lumbricals of hand. Since the lumbricals normally flex the MCP joints (aka the proximal knuckles), their denervation causes these joints to become extended by the newly unopposed action of the extensor muscles of the forearm (namely the extensor digitorum and the extensor digiti minimi). The lumbricals also extend the fingers at the IP joints, their paralysis results in unopposed flexion from the flexor digitorum profundus at IP joints. The combination of hyperextension at the MCP and flexion at the IP joints gives the hand its claw like appearance. Weal supination, loss of extension Lateral dorsum of hand

Tight below knee plaster of Paris Common Fibular Nerve

What signs on physical examination would suggest damage to: Median Nerve Decreased sensation radial 2/3 hand Weakness of thumb abduction If injured at elbow- Hand in Benedictin position Ulnar Nerve

Decreased sensation ulanr 1/3 hand, Ulnar claw hand Weakness of all interrossei. (Abduction/adduction of fingers)

Axillary Nerve

Loss of sensation over “Sergeant’s Patch” Weakness of deltoid

Radial Nerve

Variable loss of sensation over 1st web space dorsally, Wrist drop, Loss of finger extension

Sciatic Nerve

Decreased power and sensation of whole leg except thigh anteriorly and knee extension

Lateral Fibular Nerve Loss of sensation dorsum of foot Foot drop (Similar to radial nerve) Review the anatomy of the femoral nerve. How would you perform a femoral nerve block? Femoral nerve is lateral to femoral artery and deep to iliacus fascia. Inject 20 ml local anaesthetic lateral to femoral artery (palpable below inguinal ligament) Ensure that two “pops” are felt as superficial and deep (iliacus) fascia are penetrated Ideally use short bevel (Blunt) needle, or use ultrasound guidance...