09 04 TBL lecture

Question 1

Neuropathy

Answer 1

general term for nerve disorder

• axon/myelin
• large/small diameter
• affect both sensory and motor fibers in nerve
• damage can be permanent or reversible.

Question 2

Radiculopathy

Answer 2

neuropathy affecting the spinal nerve roots

Question 3

Symptoms of diabetic neuropathy?

Answer 3

compromise of microvascular blood supply of peripheral nerves.

• Distal symmetrical polyneuropathy
  
  • glove and stocking pattern of sensory loss

Onset is sudden and sensorimotor deficits in the nerve distribution may be accompanied by painful paresthesia

Question 4

Complex regional pain syndrome

Answer 4

Type 1.
Reflex sympathetic dystrophy
-follows an injury w/o specific nerve damage

Type 2.
Causalgia
-Follows damage to a specific nerve.

Intense local burning pain accompanied by edema, sweating, and changes in skin blood supply.

Question 5

Treatment for neuropathy

Answer 5

• anticonvulsants
• serotonin-norepinephrine re-uptake inhibitors
• tricyclic anti-depressants

Question 6

Guillain- Barre

1. what it is?
2. Onset?
3. Diagnosis?
4. Treatment?

Answer 6

Acute inflammatory demyelinating polyneuropathy

Onset: 1-2 weeks after viral infection
-progressive weakness (areflexia), tingling paresthesias of hand and feet, motor invovlemtn typically much more severe than sensory involvement.

Diagnosis:

• CSF with high protein concentration w/o elevated white blood count
• EMG/nerve conduction = demyelination

Treatment:

• supportive care and immune therapy
  
  • plasmapheresis or intravenous immunoglobulin therapy

Question 7

symptoms of radiculopathy?

Answer 7

burning, tingling pain that radiates/shoots down a limb in the dermatome of the affected root.

-may be loss of reflexes and motor strength

Question 8

straight-leg rouse test

Answer 8

mechanical nerve root compression in the lumbar-scaral region

• traction on nerve root
• test is + if it reproduces the patient’s typical radicular pain and paresthesias

If a response occurs in less than a 10 degree angle or more than a 60 degree angle, pain is probably not caused by root compression

Question 9

crossed straight-leg rousing test

Answer 9

elevate asymptomatic leg
- causes typical symptoms in symptomatic leg.

Specificity = 90% – little false positives.

Question 10

Cervical disc herniations usually move to what position?

Answer 10

herniation occurs laterally

Question 11

Lumbar disc herniations usually happen where? And which nerve do they affect

Answer 11

posteriolateral disc herniations
- affect lower spinal root

Lateral disc herniation
- affect higher spinal root

Central disc herniations (usually occurs at lower levels of caudal equina)–> impinge on nerve roots lower that level of herniation OR compress the spinal cord if it occurs above L1.

Question 12

What muscles are you testing when looking at :

C5

C6

C7

Answer 12

deltoid, infraspinatus, biceps

wrist extensors, biceps

triceps

Question 13

What muscles are you testing when looking at :

L4

L5

S1

Answer 13

Iliopsoas, quadricpes

Foot dorsiflexion, big toe extension, foot eversion, inversion

foot plantar flexion ( Achilles tendon)

Question 14

How can spinal stenosis occur?

Answer 14

inflammation of ligamentum flavum

-affect below level of lesion