nerve injury hand 1

Nerve Injury

1-Injury of the hand leads to median nerve injury:

a- claw hand

b- wrist drop

c- sensory defect only

- 20 years old male presented with volar wrist injury with median nerve involvement, what is the clinical picture:

a. Wrist drop.

b. Claw hand.

c. Sensory loss only.

d. Inability to oppose thumb towards fingers.

e. No metacarpophalangeal joint flexion.

- A 20-year-old man sustained a deep laceration on the anterior surface of the wrist. Median nerve injury would result in:

A. A claw hand defect.

B. A wrist drop.

C. A sensory deficit only.

D. An inability to oppose the thumb to other fingers.

E. The inability to flex the metacarpophalangeal joints.

2- a 20 year old patient had deep laceration in his right wrist.which of the following is the result from this injury

a)wrist drop

b)claw hand

c)sensory loss only

d)inability of thumb opponins to other fingers

e)inability of flexion of the interphalangeal joint

Nerve Injury at The Wrist

Radial nerve	Median nerve	Ulnar nerve
Sensory loss on the posterior hand (first dorsal web space).	Loss of function of the thenar muscles and lumbricals 1 and 2; “clawing” of digits 2 and 3. Sensory loss on palmar surface of digits 1, 2, and 3, and one-half of 4. Sign is “ape or simian hand” and “flattening of thenar eminence:’	Loss of abduction and adduction of the digits; loss of the hypothenar muscles and lumbricals 3 and 4. Sensory loss on digits 5 and one half of 4. Sign is “claw hand.”

3- The most important factor in the development of spinal headaches after spinal anesthesia is:

a) the level of the anesthesia

b) the gauge of the needle used

c) the closing pressure after the injection of tetracaine

d) its occurrence in the elderly

e) the selection of male patients

Headache. A characteristic headache may occur following spinal anaesthesia. It begins within a few hours and may last a week or more. It is postural, being made worse by standing or even raising the head and relieved by lying down. It is often occipital and may be associated with a stiff neck. Nausea, vomiting, dizziness and photophobia frequently accompany it. It is more common in the young, in females and especially in obstetric patients. It is thought to be caused by the continuing loss of CSF through the hole made in the dura by the spinal needle. This results in traction on the meninges and pain.

The incidence of headache is related directly to the size of the needle used. A 16 gauge needle will cause headache in about 75% of patients, a 20 gauge needle in about 15% and a 25 gauge needle in 1-3%. It is, therefore, sensible to use the smallest needle available especially in high-risk obstetric patients. As the fibres of the dura run parallel to the long axis of the spine, if the bevel of the needle is parallel to them, it will part rather than cut them and therefore, leave a smaller hole. Make a mental note of which way the bevel lies in relation to the notch on the hub and then align it appropriately. It is widely considered that pencil-point needles (Whiteacre or Sprotte) make a smaller hole in the dura and are associated with a lower incidence of headache (1%) than conventional cutting-edged needles (Quincke) (figure 7).

4- An old man undergoing brain surgery and on asprin. He needs prior to surgery:

a) vitamin K parenterally

b) vitamin K orally

c) delay surgery for 2 days

d) delay surgery for 2 weeks

e) none of the above

Radial nerve Injury

At the Axilla :

1. Loss of extensors at the elbow, wrist, and digits;
2. weakened extension at the shoulder;
3. weakened supination.
4. Sensory loss on posterior arm, forearm, and hand.
5. Sign is “wrist drop:’

Shoulder dislocation may injure the radial nerve. Also, pressure on the floor of axilla may injure nerve (Saturday night palsy).

At the Elbow :

1. Loss of extensors at the wrist and digits.
2. Sensory loss on the posterior forearm and hand.
3. Sign is “wrist drop”

Fracture of the shaft of the humerus could lacerate the radial nerve, and the deficits would be the same as if the nerve were damaged at the level of the elbow.

At the Wrist :

Sensory loss on the posterior hand (first dorsal web space).

Median nerve Injury

At the Elbow :

1. Loss of flexion of the digits, thenar muscles, and lumbricals 1 and 2;
2. weakened wrist flexion;
3. ulnar deviation upon flexion of the wrist;
4. loss of pronation.
5. Sensory loss on lateral palm and digits 1, 2, and 3, and one half of 4.
6. Sign is “ape or simian hand” and “flattening of the thenar eminence:’

At the Wrist :

5. Loss of function of the thenar muscles and lumbricals 1 and 2;
6. “clawing” of digits 2 and 3.
7. Sensory loss on palmar surface of digits 1, 2, and 3, and one-half of 4.
8. Sign is “ape or simian hand” and “flattening of thenar eminence:’

Carpal tunnel compression or wrist laceration.

Ulnar nerve Injury

At the Elbow (medial epicondyle)

1. Weakened wrist flexion;
2. radial deviation upon flexion of the wrist;
3. loss of abduction and adduction of the digits;
4. loss of hypothenar muscles and lumbricals 3 and 4.
5. Weakened flexion of digits 4 and 5.
6. Sensory loss on digits 5 and one half of 4.
7. Sign is “claw hand:’

At the Wrist

5. Loss of abduction and adduction of the digits;
6. loss of the hypothenar muscles and lumbricals 3 and 4.
7. Sensory loss on digits 5 and one half of 4.
8. Sign is “claw hand.”

Axillary nerve Injury

Loss of abduction of the arm to the horizontal plane.

The axillary nerve could be damaged with a fracture of the surgical neck of the humerus or dislocation of the shoulder.

Musculocutaneous nerve Injury

1. Loss of elbow flexion and weakness in supination;
2. loss of sensation on lateral aspect of the forearm.