Template:Peripheral nerve syndromes: Difference between revisions

Latest revision as of 12:33, 30 July 2020

Peripheral nerve syndromes

Upper extremity
- Ulnar
  - Cause of Injury: Elbow injury.
  - Sensory changes in the 5th and medial half of 4th digits, weak wrist flexors, “claw hand”
- Radial
  - Cause of Injury: Distal humeral shaft fracture, anterior shoulder dislocation, supra-condylar fracture, Radial neuropathy at the spiral groove, Posterior interosseous neuropathy
  - “Wrist drop,” weakness of finger extensors. +/- sensory loss over the dorsum of the hand, weak thumb adduction
- Median, distal
  - Cause of Injury: Wrist dislocation, laceration, Carpal Tunnel Syndrome
  - Weak flexion of radial half of digits and thumb, loss of abduction and opposition of thumb. Ape hand deformity, benediction sign. Loss of sensation of lateral three and one-half digits and nail beds
- Median, proximal
  - Cause of Injury: Supracondylar humeral fracture, Pronator teres syndrome, Anterior interosseous neuropathy, tight cast
  - See Median, distal above, loss of forearm pronation, loss of radial half digits and thumb flexion
- Musculocutaneous
  - Cause of Injury: Anterior shoulder dislocation, entrapment due to hypertrophy
  - Elbow flexion and supination weakness, radial forearm sensory deficits
- Axillary
  - Cause of Injury: Anterior shoulder dislocation, inferior shoulder dislocation, proximal humerus fracture
  - Weak arm abduction (from 15 to 90 degrees), weak shoulder flexion, extension and rotation of shoulder, loss of sensation of upper lateral arm
- Suprascapular
  - Cause of Injury: Paralabral cyst, bone/soft tissue tumor, Scapular fracture, traction injury, Parsonage-Turner syndrome
  - Weak arm abduction to 90 degrees, weak shoulder flexion to 30 degrees, weak internal rotation
Lower extremity
- Femoral
  - Cause of Injury: Pubic rami fracture, pelvic fractures
  - Weak knee extension, anterior knee sensory deficits
- Obturator
  - Cause of Injury: Obturator ring fracture, obturator nerve entrapment
  - Weak hip adduction, medial thigh sensory deficit
- Posterior tibial
  - Cause of Injury: Knee dislocation
  - Weak toe flexion, plantar foot sensory deficit
- Superficial peroneal
  - Cause of Injury: Fibular neck fracture, knee dislocation
  - Weak ankle eversion, lateral dorsal foot sensory deficits
- Deep peroneal
  - Cause of Injury: Fibular neck fracture, compartment syndrome
  - Sensory deficit at dorsal 1st web space, weak ankle and toe dorsiflexion
- Sciatic
  - Cause of Injury: Posterior hip dislocation
  - Lower leg weakness, foot drop, leg sensory deficits
- Superior gluteal
  - Cause of Injury: Acetabular pelvic fracture
  - Trendelenburg’s gait, Trendelenburg’s sign
- Inferior gluteal
  - Cause of Injury: Acetabular pelvic fracture, s/p hip replacement
  - Abnormal gait, gluteus maximus weakness resulting in gluteus maximus lurch

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 ===[[Peripheral nerve syndromes]]===
-====Median Nerve Syndromes====
+*'''Upper extremity'''
-*[[Median Mononeuropathy (Carpal Tunnel Syndrome)|Carpal tunnel syndrome]]
+**'''Ulnar'''
-*[[Pronator teres syndrome]]
+***Cause of Injury: [[Elbow diagnoses | Elbow]] injury.
-*[[Anterior interosseous neuropathy]]
+***Sensory changes in the 5th and medial half of 4th digits, weak wrist flexors,  “claw hand”
+**'''Radial'''
-====Ulnar Nerve Syndromes====
+***Cause of Injury: Distal humeral shaft fracture, anterior shoulder dislocation, supra-condylar fracture, [[Radial neuropathy at the spiral groove]], [[Posterior interosseous neuropathy]]
-*[[Ulnar neuropathy at the elbow and wrist]]
+***“Wrist drop,” weakness of finger extensors. +/- sensory loss over the dorsum of the hand, weak thumb adduction
+**'''Median, distal'''
-====Radial Nerve Syndromes====
+***Cause of Injury: Wrist dislocation, laceration, [[Median Mononeuropathy (Carpal Tunnel Syndrome)|Carpal Tunnel Syndrome]]
-*[[Radial neuropathy at the spiral groove]] (ie. "Saturday night palsy")
+***Weak flexion of radial half of digits and thumb, loss of abduction and opposition of thumb. Ape hand deformity, benediction sign. Loss of sensation of lateral three and one-half digits and nail beds
-*[[Posterior interosseous neuropathy]]
+**'''Median, proximal'''
+***Cause of Injury:  Supracondylar humeral fracture, [[Pronator teres syndrome]], [[Anterior interosseous neuropathy]], tight cast
-====Proximal Neuropathies====
+***See Median, distal above, loss of forearm pronation, loss of radial half digits and thumb flexion
-*[[Suprascapular neuropathy]]
+**'''Musculocutaneous'''
-*[[Long thoracic neuropathy]]
+***Cause of Injury: [[Anterior shoulder dislocation]], entrapment due to hypertrophy
-*[[Axillary neuropathy]]
+***Elbow flexion and supination weakness, radial forearm sensory deficits
-*[[Spinal accessory neuropathy]]
+**'''Axillary'''
-*[[Musculocutaneous neuropathy]]
+***Cause of Injury: [[Anterior shoulder dislocation]], [[inferior shoulder dislocation]], [[proximal humerus fracture]]
+***Weak arm abduction (from 15 to 90 degrees), weak shoulder flexion, extension and rotation of shoulder, loss of sensation of upper lateral arm
-====Other====
+**'''Suprascapular'''
-*[[Brachial plexopathy]]
+***Cause of Injury: Paralabral cyst, bone/soft tissue tumor, [[Scapular fracture]], traction injury, [[Parsonage-Turner syndrome]]
-*[[Cervical rediculopathy]]
+***Weak arm abduction to 90 degrees, weak shoulder flexion to 30 degrees, weak internal rotation
+*'''Lower extremity'''
+**'''Femoral'''
+***Cause of Injury: Pubic rami fracture, [[pelvic fractures]]
+***Weak knee extension, anterior knee sensory deficits
+**'''Obturator'''
+***Cause of Injury:  Obturator ring fracture, [[obturator nerve entrapment]]
+***Weak hip adduction, medial thigh sensory deficit
+**'''Posterior tibial'''
+***Cause of Injury:  [[Knee dislocation]]
+***Weak toe flexion, plantar foot sensory deficit
+**'''Superficial peroneal'''
+***Cause of Injury:  Fibular neck fracture, [[knee dislocation]]
+***Weak ankle eversion, lateral dorsal foot sensory deficits
+**'''Deep peroneal'''
+***Cause of Injury:  Fibular neck fracture, [[compartment syndrome]]
+***Sensory deficit at dorsal 1st web space, weak ankle and toe dorsiflexion
+**'''Sciatic'''
+***Cause of Injury:  Posterior [[hip dislocation]]
+***Lower leg weakness, foot drop, leg sensory deficits
+**'''Superior gluteal'''
+***Cause of Injury: [[Acetabular pelvic fracture]]
+***Trendelenburg’s gait, Trendelenburg’s sign
+**'''Inferior gluteal'''
+***Cause of Injury: [[Acetabular pelvic fracture]], s/p hip replacement
+***Abnormal gait, gluteus maximus weakness resulting in gluteus maximus lurch