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Unilateral hand weakness/ parasthesia (Pathophysiology (Peripheral nerve …
Unilateral hand weakness/
parasthesia
Pathophysiology
Peripheral nerve
(radial, median, ulnar)
Plexus (brachial)
Radicular (root)
Spinal cord
Cerebral cortex
Aetiology
Carpal tunnel syndrome
Thoracic outlet syndrome
Ulnar neuropathy
Brachial neuritis
(Parsonage-Turner syndrome)
MS (cervical cord)
Diagnosis
History
Location of numbness
(peripheral nerve, root etc.)
Pins and needles
Pain in hand, arm, neck (SOCRATES)
Weakness
Examination
Wasting
Ulnar: hypothenars,
first dorsal interossei
Median: thenars,
abductor policis brevis
Weakness
Ulnar: first dorsal interossei, abductor digit minimi,
flexor digitorum profundus 4+5
Median: abductor policis brevis,
opponens pollicis brevis
Reflexes
C5/6: supinator, biceps
C7: triceps
Sensation
Median, ulnar, radial
Lateral and medial cutaneous nerves
Nerve roots (C5-T1)
Special tests
Investigations
Bloods
T3/T4
Glucose
Imaging
Cervical X-ray
(structural causes)
MRI spine
MRI brain
Special tests
NCS