Peripheral Nerve Injuries

Topics in this chapter

• Injury Classification and Regeneration
• Brachial Plexus Lesions and Palsies
• Radial and Axillary Nerve Injuries
• Median Nerve Injuries and Hand Deficits
• Ulnar Nerve Injuries and Cubital Tunnel
• Long Thoracic Nerve and Winged Scapula

Practice questions

1. Question 1Q-D0E1DD

   A 25-year-old male sustains a mid-shaft fracture of the humerus following a road traffic accident. On examination, he is unable to actively extend his wrist and fingers and has loss of sensation over the first dorsal interosseous space. Which of the following is the most appropriate initial management for this closed fracture with a primary radial nerve palsy?

   1. A.Immediate open reduction and internal fixation with radial nerve exploration
   2. B.Closed reduction, slab immobilization, and observation with serial clinical examinations
   3. C.Urgent nerve conduction studies followed by surgical exploration if absent within 48 hours
   4. D.Immediate tendon transfer of flexor carpi ulnaris to extensor digitorum communis
   See the answer and solution
2. Question 2Q-CDD995

   A 30-year-old construction worker falls from a height and presents with a flail upper limb. He has absence of the biceps reflex, loss of shoulder abduction and external rotation, and sensory loss over the lateral aspect of the arm and forearm. His hand intrinsics and finger movements are intact. What is the classic term for this type of brachial plexus injury?

   1. A.Klumpke palsy
   2. B.Erb-Duchenne palsy
   3. C.Total brachial plexus palsy
   4. D.Guyon canal syndrome
   See the answer and solution
3. Question 3Q-1F68C6

   According to the Seddon classification of peripheral nerve injuries, which type involves complete disruption of the axon while preserving the endoneurial tubes, resulting in Wallerian degeneration but a high likelihood of complete functional recovery through axonal regeneration?

   1. A.Neurapraxia
   2. B.Axonotmesis
   3. C.Neurotmesis
   4. D.Intermitmesis
   See the answer and solution
4. Question 4Q-D94DC7

   A patient presents with a deep laceration across the volar aspect of the wrist. Clinical examination reveals weakness in pinch grip (anterior interosseous-like presentation in the hand intrinsics), sensory loss over the radial three and a half digits on the palmar aspect, and flattening of the thenar eminence with inability to properly oppose the thumb. Which nerve is most likely injured?

   1. A.Ulnar nerve
   2. B.Median nerve
   3. C.Radial nerve
   4. D.Musculocutaneous nerve
   See the answer and solution
5. Question 5Q-CF9C34

   A young adult sustains a posterior dislocation of the elbow. Post-reduction, the patient complains of tingling and numbness along the medial border of the hand, little finger, and ulnar half of the ring finger, along with weakness in finger abduction and adduction (interosseous muscles). The site of nerve entrapment or injury is most classically at:

   1. A.Cubital tunnel
   2. B.Spiral groove
   3. C.Pronator teres muscle
   4. D.Guyon's canal
   See the answer and solution