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Peripheral nerve injuries

Neuropraxia

  • Temporary loss of function caused by minor trauma or pressure
  • Recovery occurs within minutes

Axonotmesis

  • Loss of function due to severe ischaemia
  • Recovery occurs within weeks

Neurotmesis

  • Loss of function due to division of nerve
  • No recovery occurs unless nerve is repaired

Radial nerve

  • Often injured in radial groove of humerus
  • Motor paralysis results in typical 'wrist drop' due to loss of:
    • Extension of elbow, wrist, knuckles and all joints of thumb
    • Supinator and brachioradialis
  • Sensory loss involves dorsum of 1st, 2nd and 3rd metacarpals
  • May be as small as the anatomical snuffbox

Radial nerve palsy

Picture provided by Andrew Day, Royal Sussex County Hospital, Brighton, United Kingdom

Median nerve

  • Often injured by penetrating wounds of the forearm
  • Motor paralysis due to loss of:
    • The pronators
    • Radial flexor of the wrist
    • Flexors of all of the proximal interphalangeal joints
    • Flexors of the terminal joint of the thumb, index and middle finger
    • Abductor and opponens pollicis
  • Sensory loss over thumb, index, middle and half of ring fingers

Ulnar nerve

  • Often injured with fractures of the medial epicondyle of the elbow
  • Motor paralysis results in 'claw hand' and hypothenar wasting due to loss of:
    • Ulnar flexor of the wrist
    • Flexors of the terminal phalanx of the ring and little finger
    • Muscles of the hypothenar eminence
    • Adductor pollicis
    • Palmar brevis
  • All the interossei and the medial two lumbricals
  • Sensory loss over little and half of ring finger

ulnar nerve palsy

Picture provided by Loh Yin, International Medical University, Jolam Rasah. Malaysia

Ulnar nerve palsy

Picture provided by Alan Parbhoo, Barts and Royal London Hospital, United Kingdom

Brachial plexus injuries

  • Usually occur in two situations
    • Difficult vaginal deliveries associated with the use of forceps
    • Traction during a fall or road traffic accident

Erb's palsy

  • Due to damage to the upper nerve roots
  • Usually involves C5, C6, C7
  • Abductors and external rotators of the shoulder are affected
  • Loss of finger extension
  • Sensation is intact

Klumpke's palsy

  • Due to damage to the lower nerve roots
  • Usually involves C8, T1
  • All finger muscles are paralysed
  • Loss of sensation
  • Often associated with unilateral Horner's syndrome

Bibliography

Leffert R D.  Nerve lesions about the shoulder.  Orthop Clin North Am 2000;  31:  331-345.

Terzis J K,  Vekris M D,  Soucacos P N.  Brachial plexus root avulsions.  World J Surg 2001;  25:  1049-1061
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