Peripheral nerve syndromes

Background

Clinical Features
Cutaneous innervation of the upper limb
Lower limb peripheral innervation

Peripheral nerve syndromes
  • Upper extremity
    • Ulnar
      • Cause of Injury: Elbow injury.
      • Sensory changes in the 5th and medial half of 4th digits, weak wrist flexors, “claw hand”
    • Radial
      • Cause of Injury: Distal humeral shaft fracture, anterior shoulder dislocation, supra-condylar fracture, Radial neuropathy at the spiral groove, Posterior interosseous neuropathy
      • “Wrist drop,” weakness of finger extensors. +/- sensory loss over the dorsum of the hand, weak thumb adduction
    • Median, distal
      • Cause of Injury: Wrist dislocation, laceration, Carpal Tunnel Syndrome
      • Weak flexion of radial half of digits and thumb, loss of abduction and opposition of thumb. Ape hand deformity, benediction sign. Loss of sensation of lateral three and one-half digits and nail beds
    • Median, proximal
      • Cause of Injury: Supracondylar humeral fracture, Pronator teres syndrome, Anterior interosseous neuropathy, tight cast
      • See Median, distal above, loss of forearm pronation, loss of radial half digits and thumb flexion
    • Musculocutaneous
      • Cause of Injury: Anterior shoulder dislocation, entrapment due to hypertrophy
      • Elbow flexion and supination weakness, radial forearm sensory deficits
    • Axillary
  • Lower extremity
    • Femoral
      • Cause of Injury: Pubic rami fracture, pelvic fractures
      • Weak knee extension, anterior knee sensory deficits
    • Obturator
    • Posterior tibial
      • Cause of Injury: Knee dislocation
      • Weak toe flexion, plantar foot sensory deficit
    • Superficial peroneal
      • Cause of Injury: Fibular neck fracture, knee dislocation
      • Weak ankle eversion, lateral dorsal foot sensory deficits
    • Deep peroneal
      • Cause of Injury: Fibular neck fracture, compartment syndrome
      • Sensory deficit at dorsal 1st web space, weak ankle and toe dorsiflexion
    • Sciatic
      • Cause of Injury: Posterior hip dislocation
      • Lower leg weakness, foot drop, leg sensory deficits
    • Superior gluteal
    • Inferior gluteal
      • Cause of Injury: Acetabular pelvic fracture, s/p hip replacement
      • Abnormal gait, gluteus maximus weakness resulting in gluteus maximus lurch

Differential Diagnosis

Upper extremity peripheral nerve syndromes

Median Nerve Syndromes

Ulnar Nerve Syndromes
  • Ulnar neuropathy at the elbow and wrist

Radial Nerve Syndromes

Proximal Neuropathies
  • Suprascapular neuropathy
  • Long thoracic neuropathy
  • Axillary neuropathy
  • Spinal accessory neuropathy
  • Musculocutaneous neuropathy

Other

Extremity trauma

Evaluation

Management

Disposition

See Also
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