Comp. Nero Flashcards
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What is neuropathy?
functional or pathological change in the peripheral NS
4 Biomechanical Causes of Neuropathy
- Space Ocupying lesions (cust/herniated disc)
- Degenerative (stenosing age)
- Post Traumatic (Fracture/hematoma/equipment compression)
- Mechanical (muscle spams/external force)
3 systemic causes of Neuropathy
- Diabetes
- Pregnancy
- Hypothyroidism
5 pathological changes in Neuropathy
-Microvascular compression ->ischemia • Thickened epineurium • Myelin thinning distortion • Microtubule closure • Axonal degeneration
Where are 3 places for radial N. entrapment?
High on Humorerus
Radial tunnel
at the wrist
Associted symptoms of Radial N entrapment
Wrist drop
Pain on L. epicondyle
pain with resisted supination
weakness of elbow flexion
Associated symptoms of Medial N. entrapment
achy pain mid/proximal forearm
pain with resisted pronation
cramping in finger
Anterior Interosseous syn.
What test with?
Trt?
Median N. entrapment
Ok Sign
Splint the elbow
Club cast and dull pain associated with
Weakness of the long flexor muscle of the thumb
Symptoms of Ulnar N. entrapment
- Paraesthesia 4/5th digits
- Medial elbow pain radiated to hand, dec strength
- Tinneal sign at elbow
- symptoms reproduced with elbow extension flexion and wrist extension
What is cubital tunnel syn.?
Ulnar N entrapment at the elbow
Medial N. Entrapment Sym.
Note: MOST COMMONLY COMPRESSED Nerve!
Nighttime numbness of lateral 3 ½ digits, tingling, wrist pain, dropping things, thenar atrophy
How do you test for MEdian N entrapment?
gold-standard EMG
Sympt. of Thoracic Outlet Syn.
Weakness, paresthesia of medial arm, forearm, and
hand exacerbated by overhead activities
What are the four tests to determine Thoracic Outlet Syn?
- Military/Costoclavicular maneuver
- Wright’s HyperABduction Test
- EAST Test/Roos Test
- Adson Test
Sympt. OF Maralgia Paresthetica
- Numbness or burning pain on anterolateral thigh
- Hyperesthesia to the point of not putting anything in pockets
- Trophic skin changes later on
- (+) Tinnel’s sign 1cm medial and inferior to the ASIS
Innervation of Common Fibular N. and motion
L4-S2
plantar flexion and inversion of the foot.
How can you cause Common fibular N. entrapment?
- Leg gets hooked over a rail
- Spend a prolonged time squating
- Ankle Sprains or Trauma to Fibular Head
What is Tarsal Tunnel Syn?
Compression of posterior tibial nerve in the tarsal tunnel behind the medial malleolus with the overlying flexor
retinaculum
What does P. Tibial N. innervate?
motor to the plantar muscles of the foot and sensation to plantar aspect of the foot and toes
Sym. of P. Tibial N Entrapment
-Pain on plantar surface of foot • Not very specific, on plantar aspect of the foot • Vague burning • Tingling • Numbness • Gait seldom affected
OMM trt for Tarsal N entrapment?
Myofascial release
• HVLA
ANTERIOR TARSAL TUNNEL SYNDROME is due to compression of what N.?
Deep fibular nerve (L4-S2) compressed at the inferior extensor retinaculum
What are symptoms of Anterior Tarsal Tunnel Syn.?
-Pain over dorsomedial aspect of foot and worse at rest
• Weakness of extensor digitorum brevis
Three types of injury of Nerves
Neuropraxia (1st degree )
Axometesis (2nd Degree)
Neuromesis (3rd to 5th)
With Neuroesis (3 to 5th degree) What occurs
Axon Damage plus CT coverings begin to damaged in successive order around the Nerve
-Cannot fully recover b/c loss to the CT
Axometesis what occurs
Disruption to Axon itself (in the name), can have full recovery
Neuropraxia
- Damaged the Myelin sheath surrounding the Axon
- fully reversible
- shortest duration of days to weeks
C5 associated with what reflex, Motor, Sensation
Reflex: Biceps
Motor: Deltoid and Biceps
Sensation: Lateral Arm
C6 associated with what reflex, Motor, Sensation
Reflex: Brachioradialis
Motor: Wrist extension and Elbow flexion
Sensation: Radial forearm Thumb and index finger
C7 associated with what reflex, Motor, Sensation
Reflex: Triceps
Motor: Wrist flexion, Elbow extension Finger extension
Sensation: Middle Finger
C8 associated with what Motor and Sensation
Motor: Finger flexion
Sensation: Ulnar forearm, Small finger
T1 associated with what Motor and Sensation
Motor: Finger ABDuction
Sensation: Medial Arm
What is Handcuff Neuropathy?
Superficial Radial N entrapment aka Chairalgia prostetia aka Wartenburg’s Syndrome
What is the sensory distribution for the Superficial Radial N.?
The Dorsum of hand, First through middle fingers
What is the Gold standard for diagnosing Carpal Tunnel Syndrome?
EMG
L1/L2 Motor and Sensation
Motor: Hip Flexion
Sensation: Inguinal crease (L1),anterior thigh (L2)
L2, L3 Motor and Sensation
Motor: Knee Extension
Sensation: anterior thigh just above knee (L3); Antrio thigh (L2)
L4 Reflex, Motor, Sensation
Reflex: Patellar
Motor: Ankle dorsiflexion
Sensation: Medial leg and foot
L5 , Motor, Sensation
Motor: Extensor hallucis longus m.
Sensation: Lateral leg, foot dorsum
S1 Reflex, Motor, Sensation
Reflex: Achilles
Motor: Ankle Plantar Flexion
SensationL: Lateral foot, plantar foot
Symptoms of Common Fibular N. Entrapment
- Pain along proximal third of lateral leg
- Foot drop with a slapping gait
- Sx exacerbated during plantarflexion & inversion of the foot
Sciatica is ____ NOT a _____ …
Most often caused by?
A symptom NOT a cause
Most often caused by WEAKNESS of the Sacroiliac ligament
