Class 3 - Nerve Compression/Entrapment & Compartment Syndrome

Question 1

Compression or entrapment nerve injuries are known as _____ which see segmental demyelination with rapid and complete recovery of function!

Answer 1

neuropraxia

Question 2

With neuropraxia there is no structural damage to the axon or to the tissue ____ to the lesion.

Answer 2

distal

Question 3

What can cause neuropraxia?

Answer 3

external forces (pressure)
internal forces (structural abnormalities)
overuse
systemic conditions: pregnancy, D.M., R.A., neuromuscular disorders

Question 4

What nerve roots contribute to the median nerve?

Answer 4

C5-T1

Question 5

What is the hallmark symptom of CTS?

Answer 5

nocturnal wrist pain - painful numbness

Question 6

With CTS, ___ symptoms precede ____ symptoms

Answer 6

sensory precede motor

Question 7

CTS pain is BL in __% of cases!

Answer 7

50%

Question 8

Thenar weakness (advanced cases), loss of grip strength, inability to pinch + sensory loss leading to clumsiness in the hands are all symptoms of…

Answer 8

CTS

Question 9

What are the 2 special tests used by neurologists to tests for CTS?

Answer 9

Phalen’s test (wrist is flexed to 90* for 1 minute)

Tinel’s sign (percussion or compression over the flexor retinaculum)

Question 10

When is surgery indicated for CTS?

Answer 10

if conservative tx fails after 2-3 months OR untreated symptoms for longer than 1 year

Question 11

What is conservative tx for CTS?

Answer 11

ergonomic measures
wrist splints
steroid injections (50% experience relief for at least 1 year)

Question 12

TOS compression usually occurs where?

Answer 12

between the interscalene triangle and inferior border of the axilla

Question 13

Vascular TOS involves compression of the…

Answer 13

subclavian artery and/or vein

Question 14

Disputed or non-specific TOS is differentiated by:

Answer 14

chronic pain with symptoms of brachial plexus entrapment without any specific evidence of such!

Question 15

Chronic compression on nerve roots leads to edema and ischemia in the nerves, which leads to what type of nerve injury?

Answer 15

neuropraxia

Question 16

If compression on nerves is not relieved, neuropraxia will progress to…

Answer 16

axonotmesis

Question 17

Provocative tests to elicit symptoms for TOS have a high rate of _____

Answer 17

false positives

Question 18

TOS must be ddx’d from:

Answer 18

cervical radiculopathy
cervical spondylosis
reflex sympathetic dystrophy
Raynaud’s disease

Question 19

What is morton’s neuroma?

Answer 19

a benign growth of nerve tissue that develops in the foot, usually the common digital nerve

NOT a true tumor, it’s a PERINEURAL FIBROMA –> fibrous tissue formation around a nerve

Question 20

Chronic (exertional) compartment syndrome is most often caused by…

Answer 20

athletic exertion

Question 21

Interdigital perineural fibroma is also called..

Answer 21

Morton’s neuroma

Question 22

MORTON’S NEUROMA:
Women are affected __ than men
Average age is __ to __ years

Answer 22

more

45-60

Question 23

What is “hyalization”?

Answer 23

the process whereby tissue degenerates into a translucent glass-like substance, or the state of being hyaline

Question 24

With morton’s neuroma, pain is most commonly felt where?

Answer 24

between the 3rd & 4th toes

Question 25

Conservative tx for Morton’s neuroma includes…

Answer 25

orthotics or pads to relieve pressure on the area, shoes with a wider toe box and lower heel

massage
local anesthesia or corticosteroids

Question 26

What is Horner’s syndrome?

Answer 26

relatively rare disorder characterized by four classic signs, all related to the sympathetic nerve supply to the eye

Question 27

What are the 4 classic signs of Horner’s syndrome?

Answer 27

miosis (constricted pupil)
ptosis (drooping eyelid)
anhidrosis (absence of facial sweating)
enopthalmos (sinking in of the eyeball)

Question 28

Oculosympathetic palsy is also called…

Answer 28

Horner’s syndrome

Question 29

What is a pancoast tumor?

Answer 29

Rare form of cancer at the top/apex of the lung

Question 30

Horner’s syndrome may be inherited as a autosomal/sex, recessive/dominant genetic trait
and is usually __lateral

Answer 30

autosomal dominant

UNILATERAL

Question 31

If the onset of Horner syndrome is before two years of age, then the iris will be…

Answer 31

hypopigmented/lacking colour

Question 32

What is the cause of Horner syndrome?

Answer 32

due to an interruption of the sympathetic nerve supply to the eye d/t either lesion or growth - could be a neuroblastoma, lesion in brain stem, upper spinal cord, neck, or eye orbit… etc

idiopathic

genetically inherited