1- Lower extremity Entrapment Neuropathies (and brachial plexus injuries) - YQ Flashcards
What is the physical compression or irritation of peripheral nerves called (Ex. ulnar nerve) ?
entrapment
Does entrapment only effect sensation of one dermatome?
No; it is not only ONE dermatome since a peripheral nerve often has multiple spinal root sources (ex. ulnar nerve = c7,c8, t1)
What are areas of anatomical vulnerability?
Ulnar nerve (funny bone)
Head of fibula
What are the three classification of nerve injuries? Where does entrapment fall under?
Neuropraxia (entrapment)
Axontemesis (entrapment)
Neurotemesis (NOT entrapment) only one that is NOT a true entrapment)
What is a reversible compression of a nerve called?
Neuropraxia
ex. lunate bone moving and causing carpal tunnel in the wrist
A nerve injury with the preservation of the nerve sheath with afferent fiber degeneration distally causing complete denervation is called what?
axonotemesis
What is a nerve injury called when the nerve is completely severed?
Neurotemesis
Between neuropraxia, axotemesis, and neurotemesis, which is not a true entrapment?
neurotemesis
How do you diagnose an entrapment neuropathy and distinguish it from systemic disease?
MRI (first)
EMG/Nerve conduction studies
When determining a treatment, what do you aim to do?
correct the underlying pathology when possible
A 35 yo runner comes in complaining of sensation changes/paraesthesia in peripheral nerve distribution, pain when he walks, and occasional lower motor neuron signs and symptoms secondary to peripheral nerve compression, what do you suspect he has?
a nerve entrapment.
What is the most common site of compression/entrapment for brachial plexus entrapment?
thoracic outlet
What is the #1 cause of Erb’s palsy? what about in adults?
Difficult childbirth = #1 reason
Gunshot wounds = #1 in adults
A 30 yo male patient walks in holding their arm in internal rotation, with their forearm extended and pronated. They complain t hat they cannot lift their arm above their head. What condition do you think they could have? What root levels does it effect?
Erb’s Palsy; C5/C6
A 42 yo f patient visits your clinic. They complain of weakness of the wrists and finger flexors. Their forearm is supinated with their wrists and fingers hyperextended. When you see their hand, it looks like it is in a claw shape. What condition do you think they have? What root levels does it affect?
Klumpke’s Palsy; C8/T1
Klumpke’s Palsy affects primarily what nerve?
Ulnar nerve.
What are the three most common causes of Thoracic outlet syndrome, from most to least?
- Brachial plexus compression (most)
- subclavian vein compression
- subclavian artery compression (least)
What are the causes of thoracic outlet syndrome?
Hypertonic scaleneus anterior **` hypertonic pectoralis minor somatic dysfunction of 1st rib cervical rib decreased costoclavicular space
A 14 yo f patient comes in complaining of tingling numbness (paresthesia) in the C8 and T1 dermatomes, what could be the cause?
Thoracic outlet syndrome (via compression of the brachial plexus/ulnar n)
A 25 yo m patient comes into your clinic complaining of tingling in entire wrist/hand region, what could be wrong?
Thoracic outlet syndrome via subclavaian artery compression
If a patient experiences only generalized unilateral UE edema and coolness of the extremity, with pain and darkness of the extremity, what could they have?
Thoracic outlet syndrome via subclavian vein compression
Match the thoracic outlet special test with their area.
a) Roo’s
b) Adson’s test
c) Reverse Adson’s test
1) tight scalenes on ipsilateral rotation
2) generalized
3) Cx rib/1st rib dysfunction (contralateral rotation)
a - 2
b- 1
c - 3
Which of the following is a thoracic out let special test of a hypertonic pec minor?
a) Roo’s
b) Costoclavicular space
c) Adson’s
d) reverse Adson’s
e) hyperabduction test
e) hyperabduction test
Is piriformis syndrome an entrapment neuropathy of the lower extremity?
YES! Don’t forget this!!
