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Upper Limb Neuro

Upper Limb Peripheral Mononeuropathy



  • Peripheral mononeuropathy is a type of peripheral neuropathy affecting a single peripheral nerve.
    • Causes of Peripheral Mononeuropathy

    • Compression (particularly carpal tunnel and ulnar tunnel) - prolonged pressure, hereditary neuropathy with liability to pressure palsies (HNPP)
    • Trauma - blunt trauma, penetrating injury (e.g. knife, gunshot, glass)
    • Nerve ischaemia - trauma, thromboembolism, diabetes, atherosclerosis, excessive tourniquet use
    • Radiation injury
    • Peripheral Nerves of the Upper Limb

    • NerveSensoryMotor
      RadialSnuff box
      Anterior forearm + AC fossa (proximal lesion)
      Wrist drop
      Wrist extension
      Finger extension
      Elbow extension (proximal lesion)
      MedianPalmar aspect of thumb, 2nd & 3rd fingers
      Thenar eminence (proximal lesion)
      Hand of benediction
      Thumb abduction
      Wrist flexion & pronation (proximal lesion)
      Ulnar5th finger + medial 4th finger
      Ulnar aspect of forearm (proximal lesion)
      Claw hand
      Finger abduction
      Ulnar deviation (proximal lesion)
      MusculocutaneousLateral forearmElbow flexion
      AxillaryLateral upper armShoulder abduction, flexion & extension
      Long ThoracicNilScapular winging
      Shoulder elevation
      SuprascapularNilShoulder abduction & external rotation
      Spinal AccessorySuperior shoulderShoulder elevation & abduction

Radial Nerve Palsy

    • Signs of Radial Nerve Palsy

    • Sensory

    • Sensory loss over the snuff box
    • Anterior forearm & AC fossa (proximal lesion)
    • Motor

    • Wrist drop - inability to extend the wrist
    • Weakness of wrist extension and finger extension
    • Weakness of elbow extension (proximal lesion)
    • Radial Nerve Syndromes

    • Radial neuropathy at the spiral groove
    • Posterior interosseous syndrome - palsy affecting the posterior interosseous nerve, a branch of the radial nerve
    • Crutch palsy - prolonged crutch use resulting in compression of the radial nerve in the axilla
    • Saturday night palsy - compression of the radial nerve during sleep, usually while intoxicated
    • Handcuff neuropathy - radial neuropathy at the wrist

Median Nerve Palsy

    • Signs of Median Nerve Palsy

    • Sensory

    • Sensory loss over the palmar aspect of the thumb, 2nd and 3rd fingers
    • Sensory loss over the thenar eminence (proximal lesion)
    • Tinel’s sign - percuss over the flexor retinaculum and ask about symptoms
    • Phalen’s sign - reverse prayer position and ask about symptoms
    • Motor

    • Weakness of thumb abduction
    • Hand of benediction (proximal lesion) - inability to flex the index and middle fingers
    • Thenar eminence wasting (proximal lesion)
    • Weakness of wrist pronation and flexion (proximal lesion)
    • Inability to maintain an O between the thumb and index finger (proximal lesion)
    • Median Nerve Syndromes

    • Carpal tunnel syndrome - compression of the median nerve beneath the flexor retinaculum at the wrist
    • Pronator teres syndrome - entrapment of the median nerve by the pronator teres
    • Anterior interosseous syndrome - palsy affecting the anterior interosseous nerve, a branch of the median nerve
    • Causes of Carpal Tunnel Syndrome

    • Idiopathic
    • Trauma - Colle’s fracture
    • Endocrine - hypothyroidism, acromegaly, diabetes
    • Rheumatoid arthritis
    • Amyloidosis
    • Gout
    • Pregnancy

Ulnar Nerve Palsy

    • Signs of Ulnar Nerve Palsy

    • Sensory

    • Sensory loss over the palmar and dorsal aspect of the 5th finger and medial half of the ring finger
    • Sensory loss of the ulnar aspect of the forearm (proximal lesion)
    • Motor

    • Claw hand - extension of the MCP joints and flexion of the IP joints of the ring and little fingers
    • Wasting of the small muscles of the hand (sparing the thenar eminance)
    • Weakness of finger abduction
    • Weakness of ulnar deviation of the wrist (proximal lesion)
    • Ulnar Nerve Syndromes

    • Cubital tunnel syndrome - trauma or compression of the ulnar nerve within the cubital tunnel at the elbow
    • Guyon’s canal palsy (cyclist’s palsy) - compression of the ulner nerve at the wrist
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