1. Nerves and the arms and legs 4 patients with symptoms

2. Patient 1 Mrs Smith is 50 She complains if waking up in the morning with pins and needles in her hands She also develops this when she is driving She has noticed some weakness of her hands She has recently felt tired and gained weight

3. What is causing the symptoms in her hands? Why is she worse at night and when she drives? What might be the underlying cause for her symptoms? How can we test for this ?

4. Patient 2 Mrs Brown is 48 Last year she was involved in a road accident and developed neck pain She works as a secretary and has a new computer at work She has developed pain in her neck at work and at night Last week after decorating she has severe pain from her shoulder to her hand and some tingling in all of the fingers

5. What might be causing the pain in her arm What might be going on after her accident? What might have contributed to her symptoms? Think about how you will explain this to her What might we offer her?

6. Patient 3 Mr Green He develops increasing problems with weakness in his hands both sides but worse on the right When he is examined he is noted to have wasting of the muscles in his hands and arms He has fasiculation of the muscles He has increasing problems swallowing

7. What are the possible causes of muscle weakness Why have some of the muscles wasted? What does the fasiculation suggest? Where in the nervous system might the damage to the nerves be? Will he have sensory symptoms?

8. Case 4 Mrs Blue is 62 He has Type 2 Diabetes He has been on treatment for 5 years He has recently noticed numbness in his feet He attends the clinic and is noted to have an ulcer on his heal, he had not noticed it His foot looks swollen

9. What might be the cause of the numbness in his feet? Why are people with Diabetes prone to skin and nerve damage? Why has he developed an ulcer on his foot? Why is the foot deformed?