Aids to the Examination of the Peripheral Nervous System

83 Pages·2022·25.582 MB·English

by  Michael O'Brien

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2020_ME
AIDS TO THE
EXAMINATION
OF THE PERIPHERAL
NERVOUS SYSTEM

SIXTH EDITION
AIDS TO THE
EXAMINATION
OF THE
PERIPHERAL
NERVOUS SYSTEM
First edition © 1942 Medical Research Council. Published by HM Stationary Office
Second edition © 1976 Medical Research Council. Published by HM Stationary Office
Third edition © 1986 The Guarantors of Brain. Published by Bailliere Tindall
Fourth edition © 2000 The Guarantors of Brain. Published by WB Saunders
Fifth edition © 2010 The Guarantors of Brain. Published by Elsevier Ltd
Sixth edition © 2023 The Guarantors of Brain. Published by Elsevier Ltd. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Details on how to seek
permission, further information about the Publisher’s permissions policies and our arrangements
with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency,
can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).
Some of the material in this work is © Crown copyright 1976. Reprinted by permission of the
Controller of Her Majesty’s Stationery Office.
Notices
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds or experiments described
herein. Because of rapid advances in the medical sciences, in particular, independent
verification of diagnoses and drug dosages should be made. To the fullest extent of the
law, no responsibility is assumed by Elsevier, authors, editors or contributors for any
injury and/or damage to persons or property as a matter of products liability, negligence
or otherwise, or from any use or operation of any methods, products, instructions, or
ideas contained in the material herein.
ISBN: 978-0-3238-7110-5
Publisher: Jeremy Bowes
Content Project Manager: Shubham Dixit
Design: Brian Salisbury
Illustration Coordinator: Narayanan Ramakrishnan
Marketing Manager: Deborah Watkins
Printed in India
Last digit is the print number: 9 8 7 6 5 4 3 2 1
PREFACE v
In 1940 Dr George Riddoch was Consultant Neurologist to the Army. He realised the
necessity of providing centres to deal with peripheral nerve injuries during the war. In
collaboration with Professor J. R. Learmonth, Professor of Surgery at the University of
Edinburgh, peripheral nerve injury centres were established in the neurosurgical units
at Gogarburn near Edinburgh and at Killearn near Glasgow. Professor Learmonth
suggested an illustrated guide on peripheral nerve injuries for the use of surgeons
working in general hospitals. In collaboration with Dr Ritchie Russell, a few photographs
demonstrating the testing of individual muscles were taken in 1941. Dr Russell returned
to Oxford in 1942 and was replaced by Dr M. J. McArdle as Neurologist to Scottish
Command. The photographs were completed by Dr McArdle at Gogarburn with the
help of the Department of Medical Illustration at the University of Edinburgh. About
20 copies in loose-leaf form were circulated to surgeons in Scotland.
In 1942 Professor Learmonth and Dr Riddoch added the diagrams illustrating the
innervation of muscles by various peripheral nerves modified from Pitres and Testut
(Les Neufs en Schemas, Doin, Paris, 1925) and the diagrams of cutaneous sensory
distributions and dermatomes. This was first published by the Medical Research Council
in 1942 as Aids to the Investigation of Peripheral Nerve Injuries (War Memorandum
No. 7) and revised in 1943. It became a standard work, and over the next 30 years
many thousands of copies were printed.
It was thoroughly revised between 1972 and 1975 with new photographs and many
new diagrams, including a coloured drawing of the brachial plexus, and was republished
under the title Aids to the Examination of the Peripheral Nervous System (Memorandum
No. 45), reflecting the wide use made of this booklet by students and practitioners and
its more extensive use in clinical neurology, which was rather different from the wartime
emphasis on nerve injuries.
In 1984 the Medical Research Council transferred responsibility for this publication to
the Guarantors of Brain for whom a new edition was prepared. Modifications were made
to some of the diagrams, and a new drawing of the lumbosacral plexus was included.
Most of the photographs for the 1943, 1976 and 1986 editions show Dr. McArdle,
who died in 1989, as the examining physician. A new set of colour photographs was
prepared for the fourth edition published in 2000 with Dr. M. D. O’Brien as the examining
physician. The diagrams of the brachial plexus and lumbosacral plexus were retained, but
all other diagrams were redrawn, including the cutaneous branches. The introduction for
the fifth edition, published in 2010, was revised and new diagrams of the cutaneous
distribution of the trigeminal nerve added. New to this edition are a diagram of the spine
and spinal roots, a list of the common entrapment and compression palsies with arrows
to show these sites in the peripheral nerve diagrams, and new diagrams of the dermatome
and nerve distribution of the male inguinal region and the female perineum. The nerve
diagrams are not intended to illustrate anatomic detail but to show the usual order of
innervation so that the level of a lesion can be determined; the usual pattern is shown,
but there is considerable variation in the branching patterns of peripheral nerves
(Sunderland 1978). There have been a few minor changes to existing diagrams.
M.D. O’Brien
for The Guarantors of Brain
Sunderland S. Nerve and Nerve Injuries. 2nd ed. London: Churchill Livingstone; 1978.
See Compston A. From the archives. Brain 2010;133:2838–2844 for a detailed account of the history of this publication.
vi
MRC Nerve Injuries Committee, 1942–1943
Brigadier G. Riddoch, md, frcp (Chairman)
Brigadier W. Rowley Bristow, mb, frcs
G. L. Brown, msc, mb (1942)
Brigadier H. W. B. Cairns, dm, frcs
E. A. Carmichael, cbe, mb, frcp
Surgeon Captain M. Critchley, md, frcp, rnvr
J. G. Greenfield, md, frcp
Professor J. R. Learmonth, cbe, chm, frcse
Professor H. Platt, md, frcs
Professor H. J. Seddon, dm, frcs (1942)
Air Commodore C. P. Symonds, md, frcp
J. Z. Young, ma
F. J. C. Herrald, mb, mrcpe (Secretary)
MRC Revision Subcommittee, 1972–1975
Sir Herbert Seddon, cmg, dm, frcs (Chairman until October 1973)
Professor J. N. Walton, td, md, dsc, frcp (Chairman from October 1973)
Professor R. W. Gilliatt, dm, frcp
M. J. F. McArdle, mb, frcp
M. D. O’Brien, md, mrcp
Professor P. K. Thomas, dsc, md, frcp
R. G. Willison, dm, frcpe
Editorial Committee for the Guarantors of Brain, 1984–1986
Sir John Walton, td, md, dsc, frcp (Chairman)
Professor R. W. Gilliatt, dm, frcp
M. Hutchinson, mb, bds
M. J. F. McArdle, mb, frcp
M. D. O’Brien, md, frcp
Professor P. K. Thomas, dsc, md, frcp
R. G. Willison, dm, frcpe
Fourth edition prepared for the Guarantors of Brain, 1999–2000
Fifth edition prepared for the Guarantors of Brain, 2009–2010
Sixth edition prepared for the Guarantors of Brain, 2020–2022
M. D. O’Brien, md, frcp
ACKNOWLEDGEMENTS vii
The Guarantors of Brain are very grateful to:
Patricia Archer, phd for the drawings of the brachial plexus and lumbosacral plexus
Ralph Hutchings for the photography
Paul Richardson, Richard Tibbitts and Joanna Cameron for the artwork and
diagrams
Michael Hutchinson, mb, bds and Robert Whitaker, ma, md, mchir, frcs for advice
on the neuroanatomy
Sarah Keer-Keer, (Harcourt Publishers) for her help and encouragement.
viii CONTENTS
INTRODUCTION 1
COMMON COMPRESSION AND
ENTRAPMENT NEUROPATHIES 3
THE SPINE AND SPINAL ROOTS 4
SPINAL ACCESSORY NERVE 5
BRACHIAL PLEXUS 6
MUSCULOCUTANEOUS NERVE 14
AXILLARY NERVE 16
RADIAL NERVE 18
MEDIAN NERVE 26
ULNAR NERVE 32
LUMBOSACRAL PLEXUS 39
NERVES OF THE LOWER LIMB 40
DERMATOMES 58
NERVE AND MAIN ROOT SUPPLY OF MUSCLES 64
COMMONLY TESTED MOVEMENTS 66
INDEX 67