[CLMD] Peripheral Neuropathies [Sachen] *Eriks

Question 1

In addition to scapular pain in all of these levels, match the pain with the nerve root:

C5, C6, C7, C8

Medial forearm, Proximal arm, Shoulder, Elbow/forearm

Answer 1

C5 = Shoulder

C6 = Proximal arm

C7 = Elbow/forearm

C8 = Medial forearm

Question 2

Associate the pain pattern with the nerve root

L4, L5, S1

Latearl calf/Dorsal thigh

Medial calf/knee

Posterior thigh/posterior calf

Answer 2

L4 = Medial calf/knee

L5 = Lateral calf/dorsal thigh

S1 = Posterior thigh/posterior calf

Question 3

What DTR is lost with:

L4

L5

S1

Answer 3

L4 = Patella

L5 = None

S1 = Achilles

Question 4

How can radiation injury vs. neoplastic etiology be differentiated on the basis of involvement and pain in terms of brachial plexopathy?

Answer 4

• Radiation injury: upper trunk, lateral cord, painless
• Neoplastic: medial cord, painful (breast and lung)

Question 5

What are 6 motor signs/sx’s of peripheral nerve disease?

Answer 5

• Distal weakness
• Cramps
• Muscle fasciculations (twitching)
• Atrophy
• ↓ DTRs
• Reduced tone

Question 6

What are sx’s of a small unmyelinated fiber neuropathy?

Answer 6

• Pain
• “Burning” dysesthesias
• Paresthesias
• Temperature sensation abnormalities

Question 7

What will be seen on skin biopsy in a small (unmyelinated) fiber polyneuropathy?

Answer 7

↓ epidermal nerve fiber density

Question 8

Weakness in shoulder abduction with loss of sensation in the lateral arm is seen with lesion of what nerve root?

Answer 8

C5

Question 9

Weakness in shoulder abduction + elbow flexion with sensory loss in the 1st and 2nd digit is due to lesion of what nerve root?

Answer 9

C6

Question 10

Sensory loss in the medial calf + weakness in hip flexion and knee extension is due to lesion of which nerve root?

Answer 10

L4

Question 11

Sensory loss in the lateral calf/dorsum of foot + weakness in hamstrings + foot dorsiflexion, inversion, and eversion is due to lesion of what nerve root?

Answer 11

L5

Question 12

What is the dermatomal distribution for T1?

Answer 12

Medial forearm

Question 13

When diagnosing a plexopathy which 2 muscle can help identify proximal lesions?

Answer 13

• Rhomboids (Dorsal Scapular n. - C5)
• Serratus Anterior (Long thoracic n. - C5)

Question 14

What are the negative vs. positive sx’s associated with a large (myelinated) fiber peripheral neuropathy?

Answer 14

• Negative: ↓ vibration + ↓ joint position sense + arreflexia + ataxia + hypotonia
• Positive: tingling + pins and needles + numbness

Question 15

Which median mononeuropathy is associated with an insidious onset of diffuse/dull ache about th proximal forearm (rarely acute or sharp)?

Answer 15

Pronator Syndrome

Question 16

Pronator syndrome will have associated sensory loss where in the hand?

Answer 16

Diffuse numbness of hand, mostly 2nd-3rd fingers

Question 17

Which median nerve mononeuropathy is associated with an abnormal pinch sign w/ normal sensation?

Answer 17

Anterior Interosseous Syndrome

Question 18

What is a common site in the elbow and wrist contributing to ulnar mononeuropathy?

Answer 18

• Elbow: between medial epicondyle and olecranon
• Wrist: Guyon’s canal

Question 19

Which muscle and motion of the thumb will be impaired in ulnar mononeuropathy?

Answer 19

ADductor policis = weak thumb ADduction = Froment Sign

Question 20

What is the most common site for radial mononeuropathy to develop; presents with what deficit?

Answer 20

• Spiral groove of the humerus
• Presents with wrist drop due to paresis of extensor ms. of the wrist, finger, and thumb
• Elbow extension is SPARED!

Question 21

Key lab findings in guilian barre syndrome?

Answer 21

CSF: HIGH protein, normal cell count/normal glucose

NCVs : Slow conduction velocities