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Axillary nerve lesion
Sensory supply
over deltoid
Sensory loss
small area over deltoid
Area of pain
across shoulder tip
Reflex arc
nil
Motor deficit
second 90° of shoulder abduction (deltoid)
(teres minor cannot be evaluated)
Causative lesions
# neck of humerus, dislocated shoulder
deep IM injection
Musculocutaneous nerve lesion
Sensory supply
lateral forearm to wrist
Sensory loss
lateral forearm
Area of pain
lateral forearm
Reflex arc
biceps jerk
Motor deficit
elbow flexion with elbow fully supinated (biceps & brachialis)
Causative lesions
very rarely damaged
Radial nerve lesion
Sensory supply
lateral dorsal forearm
back of thumb and index finger
Sensory loss
dorsum of thumb and index finger
may be none
Area of pain
dorsum of thumb and index finger
Reflex arc
triceps and supinator jerk
Motor deficit
elbow extension (triceps)
wrist extension
finger extension
elbow flexion, half supinated (brachioradialis)
forearm supination
Causative lesions
crutch palsy
Saturday night palsy
# humerus
in supinator muscle
Median nerve lesion
Sensory supply
lateral palm and lateral fingers
Sensory loss
as above
Area of pain
thumb, index and middle fingers
often spreads up forearm
Reflex arc
finger jerks
Motor deficit
wrist flexors
long finger flexors (thumb, index and middle)
pronators of forearm
abductor pollicis brevis
Causative lesions
carpal tunnel
direct trauma to wrist
Ulnar nerve lesion
Sensory supply
medial palm
5th finger and medial half of ring finger
Sensory loss
as above but often none at all
Area of pain
ulnar supplied fingers and palm distal to wrist
pain occasionally occurs along course of nerve
Reflex arc
nil
Motor deficit
all small hand muscles except APB. However injury at elbow seems to
preferentially affect first dorsal interosseus muscle
flexor carpi ulnaris (clinical evidence of involvement unusual)
finger flexors (medial 2 fingers). Again clinical involvement unusual
Causative lesions
elbow: trauma, bed rest, # olecranon
wrist: local trauma, ganglion of wrist joint
Obturator nerve lesion
Sensory supply
medial surface of thigh
Sensory loss
often none
Area of pain
medial thigh
Reflex arc
adductor reflex
Motor deficit
adduction of thigh
Causative lesions
pelvic neoplasm
pregnancy
Femoral nerve lesion
Sensory supply
antero-medial surface of thigh and leg to medial malleolus
Sensory loss
usually corresponds to distribution
Area of pain
anterior thigh and medial leg
Reflex arc
knee jerk
Motor deficit
extension of knee
Causative lesions
DM
femoral hernia
femoral artery aneurysm
posterior abdominal neoplasm
psoas abscess
trauma
Peroneal division of sciatic nerve
Sensory supply
anterior leg, dorsum of ankle and foot
Sensory loss
often only dorsum of foot
Area of pain
often painless
Reflex arc
none
Motor deficit
dorsiflexion, inversion and eversion of foot
lateral hamstrings
Causative lesions
pressure palsy at neck of fibula
hip #/dislocation
penetrating trauma to buttock
misplaced IM injection
Tibial division of sciatic nerve
Sensory supply
posterior leg
sole
lateral border of foot
Sensory loss
sole of foot
Area of pain
often painless
Reflex arc
ankle jerk
Motor deficit
plantar flexion, inversion of foot
medial hamstrings
Causative lesions
very rarely injured, even in buttock
peroneal division more sensitive to damage
Further reading
Patten J. Neurological differential diagnosis. Harold Starke, London, 1977
© Charles Gomersall December 1999
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