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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