Cervical Complaints & Peripheral Neuropathy (Exam 1)

Question 1

What are the cervical red flag complaints?

test q

Answer 1

-severe trauma/direct head trauma with loss of consciousness
-nuchal rigidity
-bladder dysfunction with onset of neck pain
-dysphagia
-cranial nerve or CNS symptoms

Question 2

What condition is this?
-soft tissue damage (stretch/rupture) to the ligaments and muscles surrounding the cervical spine
-hx of trauma like whiplash or sports injury, overuse or postural etiology, pain radiating into head, shoulders, and arms

Answer 2

cervical sprain/strain

Question 3

Which condition is this?
-hx of forward head with static loading of neck extension, pain radiating into neck, head, shoulder, and arms

Answer 3

postural strain

Question 4

What condition is this?
-hx of minor trauma like turning the head, or moderate trauma like an MVA, neck and arm pain
-if patient presents with neck and arm pain then they can pinpoint or “draw a line” of the pain, usually not dermatomal

Answer 4

cervical joint facet syndrome

Question 5

What condition is this?
-neck pain and stiffness (insidious/slow onset)
-decrease in ROM
-pain may refer to interscapular, shoulders, and occipital regions
-radiculopathy may be present with IVF encroachment

Answer 5

osteoarthritis/DJD/DDD

Question 6

What condition is this?
-presentation may differ with type/degree
-bilateral symptoms of clumsiness of hands, difficulty walking, possible urinary dysfunction, and possible shooting pains into arms

Answer 6

myelopathy (cord compression)

Question 7

What condition is this?
-neck pain
-neurological manifestation may be subtle (easily fatigued, difficulty walking with sensory loss)

Answer 7

rheumatoid arthritis

Question 8

What condition is this?
-pain in neck and shoulder radiating down the arm in the distribution of the involved nerve root
-paresthesia
-numbness
-sensory and reflex deficits

Answer 8

cervical disc herniation/cervical radiculopathy

Question 9

What is peripheral neuropathy?

Answer 9

-disorder/dysfunction of the nerves that lie outside the brain and spinal cord
-damage may be to a single nerve/nerve group (mononeuropathy), more than 2 discrete nerves in separate areas (multiple mononeuropathy) or multiple nerves simultaneously (polyneuropathy)
-nerves that can be affected include sensory, motor and autonomic nerves
-usually the nerve(s) have axonal damage or demyelination (rarely both)

Question 10

What are some symptoms of peripheral neuropathy?

Answer 10

-gradual onset of numbness and tingling in feet and hands, may spread upwards into legs and arms (paresthesia- spontaneous abnormal sensations, described by patients as “pins and needles” or tingling)
-burning pain or sharp, jabbing, or electric like pain
-extreme sensitivity to touch (dysesthesia- irritating sensations evoked by normally non-nociceptive stimuli)
-lack of coordination
-muscle weakness, atrophy, or paralysis
-diminished deep tendon reflexes
-bowel or bladder problems (autonomic nerves affected)

Question 11

What is the red flag of peripheral neuropathy?

Answer 11

bowel or bladder problems (autonomic nerves affected)

Question 12

What are some causes of peripheral neuropathy?

Answer 12

-alcoholism
-amyloidosis
-autoimmune diseases
-diabetes
-exposure to drugs, posions, toxins like heavy metals or chemo
-Guillain-Barre syndrome
-infections like lyme disease, shingles, hep C, HIV/AIDS, neurosyphilis
-inherited disorders like charcot marie tooth disease
-trauma
-tumors
-nutritional deficiencies
-kidney disease
-uremia
-liver disease
-hypothyroidism
-spinal conditions like disc lesions, stenosis, spondylolisthesis, facet syndrome, etc
-MS or other demyelinating conditions
-nerve compression or injuries like carpal tunnel syndrome
-syringomyelia
-vascular insufficiency (decrease oxygen supply to peripheral nerves can lead to nerve tissue damage)

Question 13

What autoimmune diseases can cause peripheral neuropathy?

Answer 13

lupus and RA

Question 14

What are the symptoms of diabetes that may indicate peripheral neuropathy?

Answer 14

-polyuria
-polydipsia
-fatigue
-blurry vision
-cuts and bruises, slow to heal
-tingling, pain, numbness in the hands and feet

Question 15

What is Guillain Barre syndrome?

Answer 15

-disorder that can appear after a respiratory or GI infection, recent surgery, or vaccine
-symptoms may include tingling, weakness starting in the lower extremities and spreading to upper body, unsteady gait, difficulty with eyes and facial movements, bowel/bladder difficulty

Question 16

What infections may cause peripheral neuropathy?

Answer 16

-lyme disease
-shingles
-hep C
-HIV/AIDS
-neurosyphilis

Question 17

Which vitamin deficiencies may indicate peripheral neuropathy?

Answer 17

B12, B1, and E (B12 is most common)

Question 18

Which mineral deficiency may indicate peripheral neuropathy?

Answer 18

copper

Question 19

What is syringomyelia?

Answer 19

fluid filled cyst near the spinal cord

Question 20

If numbness is discrete and follows a dermatome what is the ddx?

Answer 20

-IVD malformation
-stenosis of spine
-fracture
-tumor
-vascular malformation

Question 21

If numbness is discrete and is found for a specific peripheral nerve, what is the ddx?

Answer 21

-trauma
-overuse
-metabolic issue

Question 22

If numbness is is diffuse, what is the ddx?

Answer 22

metabolic disorder like diabetes or uremia