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1. Inherited HMSN-hereditary motor sensory neuropathy
Type I –distal limb weakness,wasting (mainly peroneal)
DTR depressed (ankle almost always)
some sensory loss in majority
peripheral nerve enlargement in 1/3
EP?demyelinating picture
SNB?onion-bulb demyelination
2. Acquired neuropathy Inflammatory
Connective tissue diseases
RA,SLE,PAN?vasa nervosa arteritis
symmetric distal sensory
multinuritis multiplex
mononeuropathy
SNB?fibrinoid arteritis
3. metabolic
Diabetic neuropathy (commonest)
symmetrical distal sensory (commonest)
?reduced V/P,DTR
distal pain,paresthesia,charcot joint
asymmetrical proximal motor
?thigh weakness/wasting
mono/multiple neuritis multiplex
autonomic neuropathy
Thyroid/parathyroid disorder
Renal/hepathic failure
Vitamin deficiency (B1,6,12)
4. Mononeuropathy entrapment Median nerve
carpal tunnel syndrome
patients have smaller canal
?nocturnal pain,numbness in fingers
sensory loss over lateral 3 ½
weakness/wasting of thenar
positive Tinel`s/Phalen`s sign
reduced SAP, distal motor latency
Proximal median lesion
Anterior interosseous br.entrapped at
pronator teres head?pain in forearm
Flexor and weak(FPL,FDP)?
weak grip/thumb,2nd ,3rd finger flexion
No sensory loss
5. Ulnar nerve
Cubital tunnel syndrome-entrapped by FCU
?pain from elbow to ulnar hand side
claw hand-due to weak 4th ,5th lumbricals
weakness/wasting of hypothenar,interossei,adductor policis
sensory loss of ulnar 1 ½
EP-slow motor CV across elbow
6. Radial nerve
saturday night palsy-
compressed around spiral groove
weak wrist,finger extensors
brachioradials,supinator(spare triceps)
slight sensory loss
posterior interosseous palsy
compressed through supinator
pain in elbow /forearm
weakness of wrist,finger extensor
radial deviation on wrist extension
(due to spared radial extensor)
7. Thoracic outlet syndrome
C8 orT1(lower trunk) compressed
by cervical rib (fibrous band)
?pain over ulnar forearm/hand,
weakness/wasting of thenar/ulnar muscles
wasting /sensory loss on medial forearm
symptoms worse by down arm traction
CXR-breaking C7 transverse process
SSER?reduced amplitude
increase latency of N9,N13
8. Brachial plexus lesions
damaged by irradiation,trauma,tumor
?pain in upper plexus distribution
global weakness/wasting of arm
may show Horner`s
Brachial plexopathy
(neuralgic amyotrophy)
induced by infection,trauma,surgery
?severe shoulder pain followed by
weakness/wasting of deltoid/spinati
winging scapula
9. Peroneal nerve
compressed around fibular neck
by trauma or prolonged immobility
?weakness/wasting of foot evetors and
foot/toes extensors (mainly EHL)
DTR spared
sensory over dorsal foot/lateral calf
Tibial nerve
Tursal tunnel syndrome
compressed post.tibial at tursal tunnel
?pain.pareesthesiae in sole
percussion behind med.malleolus triger the pain
EP-absent medial planter SAP
Digital neuropathy
compressed interdigital nerves between metatarsal
heads?pain at distal foot/toes