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Nerve lesions

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Peripheral nerve lesions

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

 

©Charles Gomersall, February, 2015 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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