Peripheral nerve injuries
Orthopedics · Topic 11
Source: NMC CBME Curriculum 2024 · Volume III · Orthopedics · Topic 11 · combined PDF page 449
Practice questions
- After a fracture of the humeral shaft, a patient has wrist and finger drop but can still extend the elbow. Which nerve is most likely injured?
- A patient has weak wrist and finger extension after trauma near the proximal forearm, but elbow extension is preserved. Which nerve is the best fit for this motor deficit?
- A patient with an ulnar nerve lesion has difficulty holding a sheet of paper between the thumb and index finger. Which examination sign is most directly relevant?
- A patient has an ulnar nerve lesion at the wrist and develops prominent clawing of the ring and little fingers. Which explanation best accounts for this pattern?
- Following a penetrating injury at the wrist, a patient cannot oppose the thumb and has reduced sensation over the palmar surface of the lateral three and a half digits. Which nerve is most likely affected?
- A patient cannot make a normal round “OK” sign because the thumb and index finger remain extended at the interphalangeal and distal interphalangeal joints. Sensation is intact. Which nerve branch is most likely affected?
- A patient develops foot drop after trauma at the fibular neck, with weak foot eversion and sensory change over the dorsum of the foot. Which nerve is most likely injured?
- A patient with foot drop after a suspected L5 lesion has weakness of both foot dorsiflexion and inversion. Compared with an isolated common fibular nerve injury, which finding is most useful in favoring the L5 lesion?
- A patient sustains a high-energy injury to the posterior thigh and develops weakness of knee flexion and most movements of the foot, with sensory loss below the knee. Which nerve is most likely involved?
- A patient presents after a traction injury with pain and weakness in an upper limb. Which approach is most appropriate for initial localization and characterization of the suspected peripheral nerve injury?
- A patient has persistent motor and sensory deficits after a traumatic nerve injury, and the clinical examination does not fully establish lesion extent. Which statement best describes the role of further investigations?
- A patient with a suspected traumatic nerve lesion is being considered for referral and treatment planning. Which general principle is best supported by current peripheral nerve injury guidance?
- After nerve injury, a gap prevents direct approximation of the nerve ends. Which statement best describes the choice of nerve replacement method according to the 2024 clinical practice guideline summary?
- A proximal nerve reconstruction is considered unlikely to restore elbow flexion adequately, and a nerve transfer is being discussed. Which statement best reflects the guideline summary of comparative evidence?
- A patient with an amputated limb has persistent neuroma-related stump pain despite conventional treatment. Which procedure was reported in the guideline summary to reduce stump pain compared with the classic approach?
- A patient with a peripheral nerve injury from a gunshot wound is being considered for surgery. Which conclusion is most consistent with the recent systematic review summary on operative timing?
- A patient with a gunshot-related peripheral nerve injury asks whether waiting more than three months is always preferable to earlier surgery. Which response best matches the recent evidence summary?
- A patient develops a new ulnar-distribution sensory and motor deficit during removal of a subdermal contraceptive implant. In the systematic review of reported implant-associated nerve injuries, which nerve was most frequently involved?
- A clinician is preparing to remove a subdermal contraceptive implant that cannot be palpated. Which approach is recommended in the systematic review summary?
- A patient asks about the course of recovery after a nerve injury associated with subdermal implant removal. Which outcome best reflects the systematic review of reported cases?
- A patient is undergoing postoperative rehabilitation after repair of a traumatic upper-limb nerve injury. Which statement best reflects the evidence on mirror therapy?
- A rehabilitation team proposes routine electrical muscle stimulation for every patient with a peripheral nerve injury. Which response best matches the current review of electrical modalities?
- A patient after nerve transfer is learning to recruit a reinnervated muscle. Which electrical rehabilitation modality was described as showing promise for facilitating motor relearning?
- A clinician is counseling a patient about the relative frequency of upper- and lower-extremity peripheral nerve injuries in the United States. Which conclusion is supported by the systematic review?
- A health-system committee wants to use existing US data to estimate the contemporary national cost burden of peripheral nerve injury, including outpatient therapy and medication. Which limitation should temper this estimate?
- A patient with a suspected traumatic peripheral nerve injury asks whether a severe mechanism alone determines the final deficit. Which approach best reflects contemporary assessment principles?
- A patient with a traumatic peripheral nerve lesion has neuropathic pain, sensory loss, and motor impairment. Which overarching goal best describes the purpose of surgical management?
- An athlete develops limb paresthesia and weakness after repetitive sport-specific loading. Which diagnostic strategy is most appropriate?
- A trauma service is deciding whether to defer every peripheral nerve injury operation because postoperative degeneration may progress over time. Which principle best reflects contemporary guidance?