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Chapter: Medicine Study Notes : Neuro-sensory

Common Peripheral Nerve Lesions - Neurology

Unilateral defined areas of weakness/sensory loss in hand or foot

Common Peripheral Nerve Lesions

 

·        Patterns of presentations:

o  Unilateral defined areas of weakness/sensory loss in hand or foot

o  Peripheral neuropathy

o  Paraparesis: weakness of both legs.  Rare but critical.  Usually spinal chord lesion

 

o  Muscle disease (rare): initial proximal pattern of weakness – neck flexion, shoulder abduction, hip flexion

o  Hemiparesis due to stroke: 1/day in Wellington (this one is not peripheral)

·        Hand:

o  Common Lesions:

 

§  Ulnar neuropathy: Elbow compression ® weakness of finger but not thumb abduction. Thumb adduction weak (paper test). Weakness of long flexors of 4th and 5th fingers. Wasting of interossei. Sensory loss on little finger

 

§  Median nerve compression in Carpal Tunnel Syndrome: weakness and wasting of abductor pollicis brevis, with numbness of palmar surface of fingers 1,2,3 and lateral 4. Tingling/pain which wakes at night

 

§  C7 Radiculopathy: pain from neck, shoulder, arm and forearm. Weakness of elbow, wrist and finger extension

 

§  C6 Radiculopathy: Weakens elbow flexion and wrist extension. Sensory loss of dorsolateral forearm, thumb and index finger

 

§  Radial nerve (Saturday night Palsy): Unable to dorsiflex the wrist or extend fingers or thumb.


o  Less Common Lesions:

§  Peripheral neuropathy: weakens small muscles of the hand, glove sensory loss

§  T1 root lesion: Weakness of small hand muscles, sensory loss on medial arm and often

§  Horner‟s syndrome

·        Leg:

 

o  S1 Radiculopathy: Pain in back, buttock, thigh, leg, and foot, numbness of the lateral border of the foot. Mild weakness of eversion and dorsiflexion, depressed ankle jerk

 

o  L5 Radiculopathy: Pain in back, buttock, thigh, leg, and foot, numbness of medial border of the foot and big toe, weakness of inversion and dorsiflexion. No reflex change

 

o  Common peroneal nerve lesion from compression at the fibula head: Painless, severe weakness of dorsiflexion and eversion, with normal inversion, and numbness on the lateral foot and dorsum of the foot. Maybe sudden onset with severe footdrop. Ankle jerk normal. 80% of nerve palsies causing foot drop recover over 3 – 4 months. Differentiating foot drop:




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