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OS3 EX1 > Compression Neuropathy > Flashcards

Compression Neuropathy Flashcards

1
Q

Definition of compression neuropathy?

A

process why a nerve becomes entrapped and it passes through a narrowing (tunnel, passage, etc). Can happen anywhere along length of a nerve

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2
Q

Biomechanical causes of CN

A

space occupying lesions, degenerative causes, post-trauma, mechanical/movement, spondylolisthesis

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3
Q

ex of space occupying lesions

A

herniated discs, cysts

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4
Q

ex of degenerative cause of CN

A

foraminal stenosis

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5
Q

ex of post-trauma cause of CN

A

fracture, hematoma, compression from equipment

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6
Q

ex of mechanical/movement cause of CN

A

muscle spasm, pinching from external or positional forces

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7
Q

Systemic causes of CN

A

pregnancy, hypothyroidism, diabetes

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8
Q

Anatomy of a nerve from inside out

A

axons covered by myelin sheath covered by endoneurium > grouped together in fascicles and covered by perineurium > groups of fascicles and the vessels and CT are surrounded by epineurium

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9
Q

microscopic pathological changes (of the nerve) that can be seen in CN

A

microvascular compressions (leading to ischemia), thickening of epineurium, thinning of myeline sheath, microtubular closure, axonal degeneration

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10
Q

What category of nerve injury is Neuropraxia? and what is it?

A

Neuropraxia = 1st degree injury.
involves focal damage of myelin fibers around the axon, but the CT sheath remains intact
Recovery: limited course from days to weeks (lease severe)

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11
Q

What category of nerve injury is axonotmesis and what is it?

A

Axonotmesis = 2nd degree injury.
There is some disruption/injury to the AXON itself, MYELIN SHEATH remains INTACT.
Recover: REGENERATION is possible, but PROLONGED (takes months) without a complete recovery

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12
Q

What category of nerve injury is neurotmesis?

A

Neurotmesis: can be a 3rd or 4th or 5th degree nerve injury

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13
Q

What would a 3rd degree nerve injury look like?

A

Neurotmesis
-disruption of the axon AND the endoneurium
Recovery: No axonal regeneration because there is INTRANEURAL FIBROSIS

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14
Q

What would a 4th degree nerve injury look like?

A

Neurotmesis
-disruption of the AXON and ENDONEURIUM and PERINERIUM (aka nerve fasciculi). There will be a large area of INTRANEURAL SCARRING at site of injury = prevents axon from advancing distal to the level of injury.
Recovery: if be NO IMPROVEMENT in function…need SURGERY to restore

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15
Q

What would a 5th degree nerve injury look like?

A

Neurotmesis
-disruption of the AXON and ENDONEURIUM and PERINEURIUM and EPINEURIUM. There will be substantial perineural HEMORRHAGE and SCARING.
Recovery: surgery is required

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16
Q

Name of the system that classifies nerve injury

A

Sunderland Classification (1st degree - 5th degree)

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17
Q

What can you use to identify where/what nerve is pinched?

A

used dermatomes/sensation, motor, and reflex nerve roots to narrow it down

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18
Q

If you impinge nerve root C5 where will you see changes (motor, sensation, reflex)?

A

Motor: deltoid, biceps
Sense: lateral arm
Reflex: biceps

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19
Q

If you impinge nerve root C6 where will you see changes (motor, sensation, reflex)?

A

M: wrist extension, elbow flex
S: radial forearm, thrum and index finger
R: brachioradialis

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20
Q

If you impinge nerve root C7 where will you see changes (motor, sensation, reflex)?

A

M: wrist flex, elbow extension, finger extension
S: middle finger
R: triceps

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21
Q

If you impinge nerve root C8 where will you see changes (motor, sensation)?

A

M: finger flexion
S: ulnar forearm, pinky finger

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22
Q

If you impinge nerve root T1 where will you see changes (motor, sensation)?

A

M: finger abduction
S: medial arm

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23
Q

Most common cause of cervical nerve root compression?

A

usually a secondary manifestation of cervical disc disease (bulging disc or disc herniation)

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24
Q

What type of damage will you see in bulging disc

A

disc is compressed evenly without significant damage to the cartilage rings

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25
Q

What type of damage will you see in herniated disc

A

Protrusion: only a few cartilage rings are torn and there is no leakage of central material
Extrusion: cartilage rings have torn in a small area and the nucleus pulposus is able to flow out of the disc space

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26
Q

most common direction of disc rupture and complication

A

posterior-lateral –> compresses nerve root as it exists intervertebral foramen = radiculopathy

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27
Q

general treatment progression for CN:

A

first try conservative measures (splinting/NSAIDS/injections?OMM/PT for 3-6mon*)&raquo_space; if non-operative management fails consider surgical release
*exception is cubital tunnel syndrome

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28
Q

How does the treatment of cubital tunnel syndrome differ from the rest of the CN treatments?

A

surgical release is considered/justified in almost all cases (except the most mild) to prevent nerve damage

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29
Q

What nerves are at risk for UE CN?

A

radial N
median N
ulnar N
musculocutaneous and axillary Ns

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30
Q

What does the radial nerve do (motor, sensation)?

A

M: triceps, anconeus, wrist extensors
S: most of dorsum of the hand (via posterior interosseous N)

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31
Q

What are the 3 sites for radial nerve entrapment?

A

1) high on the humerus
2) Radial tunnel
3) at the wrist

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32
Q

High on the humerus radial n entrapment: cause/symptoms

A

cause: usually 2ndary to humerus fx or compression near spiral groove.
Pt will have WRIST DROP, WEAK ELBOW FLEX, +/- diminished tricep reflex, paresthesia.
Function should return in 4-5mon

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33
Q

Radial tunnel radial n entrapment: causes/symptoms

A

causes: repetitive rotatory movements (rowing, discus, tennis), heavy manual labor
Pt will have pain and tenderness 5cm distal to lateral epicondyle with wrist drop or pain + restricted to supination

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34
Q

radial nerve entrapment at the wrist: causes/symptoms

A

causes: the superficial/sensory branch is pinched during pronation
pt will have sensation changes over posterolateral hand (back of hand near thumb, digit 1 and digit 2)

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35
Q

What are the 3 other names for “handcuff neuropathy”? and what are the symptoms?

A

compression of superficial radial n
cheiralgia paresthetica
wartenberg’s syndrome

symptoms: numbness/tingling/burning/pain in SRN distribution (back of hand)

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36
Q

What are the 4 sites of median nerve entrapment?

A
  1. ligament of struthers (somewhere near the elbow)
  2. bw the superficial and deep heads of the pronator teres m = pronator syndrome
  3. distal to the pronator teres deep = AIS
  4. under the flexor retinaculum = carpal tunnel
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37
Q

What is the most common compression syndrome?

A

Carpal tunnel syndrome (median n entrap)

38
Q

What are the functions of the median N (motor).

A

forearm flex and pronation, wrist flex and radial deviation, thumb abduction and opposition, index/middle finger abduction and flexion

39
Q

What three syndromes did we discuss that are due to median N entrapment?

A

Pronator syndrome
Anterior Osseous Syndrome
Carpal Tunnel Syndrome

40
Q

Pronator syndrome: cause,S&S, dx tests

A

MEDIAN N
cause: repetitive pronating motions = piano, fiddlers, baseball, dentists, lifting weights
S&S: achy pain in mid/prox forearm that is worse with repeated lifting. +/- sensory changes in radial 3.5 fingers
Dx: pt will have pain with resisted forearm pronation

41
Q

Anterior Interosseous Syndrome (AIS): causes, S&S, dx tests, treatments

A

MEDIAN N
causes: trauma (cast pressure), bulky tendon of pronator teres m, soft tissue masses, fibrous bands
S&S: NO SENSORY SYMPTOMS (bc deep motor branch of median N) = flexor weakness
dx tests: “OK” sign can’t make round “O”, the fingers pinch flat
Tx: splint elbow in 90deg of flex for 12wks max

42
Q

Carpal Tunnel Syn: causes, S&S, dx test

A

MEDIAN N
causes: repetitive motion jobs with wrist flexion common, pregnancy
S&S: nighttime numbness of lateral 3.5fingers, tingling, wrist pain, you drop shit, thenar atrophy
Dx: EMG is gold-standard (but it hurts?). Phalen’s test. Tinel’s test. 2-pt discrimination (can’t tell if closer than 5mm).

43
Q

Treatment methods for Carpal Tunnel?

A

NSAIDS… steroid injections/surgery if everything else doesn’t work
OMT: MFR, ST, lymphatics (if preggers)
xray (if think fx), MRI (if soft tissue injury)
stop repetitive motions, splint wrist at 30deg extension @night

44
Q

Two locations for ulnar nerve entrapment?

A
  1. cubital tunnel = cubital tunnel syndrome

2. guyon’s canal

45
Q

Ulnar nerve: motor, sensory

A

motor: muscles of ulnar side of forearm and hand (flexors). deep branch in hand = interosseous and adductor pollicis
sense: ring finger? and pinky

46
Q

What is the name of the syndrome we talked about in class that deals with ulnar n entrapment?

A

Cubital Tunnel Syndrome = most common compression in the elbow

47
Q

What structures form the cubital tunnel (and are therefore the cause of the compression)

A

medial epicondyle, medial trochlea, olecranon, ulnar collateral L

48
Q

What activities can cause Cubital Tunnel syndrome?

A

baseball pitchers, prolonged elbow flexion during sleep, external compression against something hard, thickened cubital tunnel retinaculum.

49
Q

Cubital Tunnel syndrome: S&S, dx tests, tx?

A

S&S: paresthesia to 4th and 5th digits, medial elbow pain that radiates to the hand with decreased intrinsic muscle strength = can’t turn key in a door
dx tests: (+) Tinel’s test at elbow, Froment’s sign (pinch paper)
symptom reproduction with elbow flex and wrist ext
tx: general and padded elbow sleeve to limit terminal elbow flexion + cushions

50
Q

What things are compressed in thoracic outlet syndrome?

A

brachial plexus and/or subclavian vessels

51
Q

What are the 3 sites of compression in thoracic outlet syn (TOS)?

A
  1. scalene triangle (bw the anterior and middle scalenes)
  2. costoclavicular passage (under the clavicle)
  3. pec minor attachment at coracoid process
52
Q

What are the symptoms of TOS?

A

weakness, paresthesia of medial arm, forearm, and hand that is made worse with overhead activities

53
Q

If you suspect TOS take these steps for diagnosis…

A
  1. c-spine xray if yes = cool. if unclear/negative > EMG if diagnosis = cool if inconclusive > arteriography or venography
54
Q

What are the special tests and results that would indicate TOS?

A
  1. Military/costoclavicular maneuver = hold pt arms in extension and abduction, they retract scapula/ext spine. (+) with symptom reproduction/dec pulse
  2. East/Roos test = open close hands above head. (+) with symptom reproduction
  3. Wright’s hyperabduction test =
    Adson’s test = monitor radial pulses as they look away. (+) decrease in pulse on side contralat to the direction they’re looking
55
Q

A (+) Wright’s hyperabduction test indicates what?

A

thoracic outlet syndrome due to Pectoralis Minor m

56
Q

What LE nerves are at risk of compression and what are their nerve roots?

A

Common Fibular N (peroneal n) = L4-S2
Deep fibular n = L4-S2
posterior Tibial N = L4-S2
lateral fermoral cutaneous n = L2, L3

57
Q

L1 and L2: motor, sense?

A

motor: hip flex
sense: inguinal crease (L1) and anterior thigh (L2)

58
Q

L2 and L3: motor, sense?

A

motor: knee extension
sense: anterior thigh (L2) and ant thigh just above knee (L3)

59
Q

L4: motor, sense, reflex?

A

motor: ankle dorsiflexion
sense: knee, medial leg and foot
reflex: patellar

60
Q

L5: motor, sense?

A

motor: extensor hallucis longus
sense: lateral leg, dorsum of the foot

61
Q

L6: motor, sense, reflex?

A

motor: ankle plantarflexion
sense: lateral foot and plantar aspect of foot
reflex: achilles

62
Q

What nerve is compressed in meralgia paresthetica?

A

Lateral femoral cutaneous N

63
Q

What causes meralgia paresthetica?

A

lat fem cut n compression in inguinal canal

from… v hard sports, fat, tight belt, seatbelt, anatomic abnormality = runs through sratorius m

64
Q

What are the symptoms of meralgia paresthetic?

A

numbness/burning on skin of ANTEROLATERAL THIGH, eventually trophic skin changes, (+) tinne’s sign 1cm inferomedially to ASIS

65
Q

What do the branches of the common fibular N innervate?

A

the deep branch of CFN: anterior compartment of leg (tibialis anterior, extensor digitorum longus and brevis, extensor hallicus longus).
the superficial branch of CFN: lateral compartment (fibularis longus and brevis)

66
Q

What are the nerve roots associated with the common fibular N?

A

L4-S2

67
Q

what are some causes of Common fibular nerve compression?

A

compression as nerve enters fibular tunnel (lat side of knee)

  • leg hooked over a rail (bedridden, coma, post-op)
  • lots of squatting (picking stawberries)/or lotus position
  • ankle sprain/trauma to fibular head
  • lithotomy position during childbirth
  • idiopathic
68
Q

Common fibular n compression: S&S, tx?

A

s&s: pain along proximal 1/3 of lateral leg, FOOT DROP = SLAPS THE FLOOR, symps worse during plantarflex & inversion
Tx: post fibular head HVLA or ME on gastroc/soleus, biceps femoris

69
Q

What are the reason for anterior tarsal tunnel syndrome?

A

DEEP FIBULAR N compression in the tarsal tunnel at the inferior extensor retinaculum

  • trauma to distal tibia/calcaneus (ankle sprains, soccer)
  • talonavicular dysfunction
  • prolonger planter flexion
  • compression from shoes too tight
70
Q

How do you treat anterior tarsal tunnel syndrome?

A

remove compression forces, MFR of extensor retinaculum, traction tug of talonavicular joint, hiss whip navicular, cuneiforms, 1/s metatarsal

71
Q

what are symptoms of Anterior tarsal tunnel syndrome?

A

pain over dorsomedial foot that is worse at rest.

extensor digitorum brevis weakness

72
Q

Tarsal Tunnel Syndrome is caused by

A

compression of POSTERIOR TIBIAL N in the tarsal tunnel behind the medial malleolus with the overlying flexor retinaculum

73
Q

what does the posterior tibial nerve innervate: motor, sense?

A

motor to the planter muscles of the foot

sense: to plantar aspect of foot and toes

74
Q

What can cause tarsal tunnel syndrome?

A 
idiopathic (50%)
space-occupying lesions
trauma to medial malleolus, distal tibia, calcaneus
ankylosing spondylitis
long time standing
75
Q

Tarsal tunnel syndrome: S&S, Tx?

A

POSTERIOR TIBIAL N
s&s: pain on planter surface of foot (vague burning/tingling/numbness), rarely effects gait
Tx: NSAIDs, US, PT, acupuncture, rest
OMM tx: MFR, HVLA

76
Q

(+) OK Sign

A

median nerve entrapment

77
Q

(+) froment’s sign

A

ulnar n entrapment

78
Q

(+) hoffman’s sign

A

CNS problem

79
Q

Stereotypical cause of median nerve entrapment syndromes:

A

pronator syndrome - weight lifter
anterior interosseous syn - post case pressure
carpal tunnel syn - gymnasts

80
Q

1 most common compression neuropathy

A

median nerve compression = carpal tunnel syndrome

81
Q

3 most common compression neuropathy

A

common fibular n compression = foot drop

82
Q

What is the path of internal herniation?

A

acute = extreme pain and then the disc slowly shrivels away in days to weeks and most resolve tx in 2-6wks. 90% back to normal activity within 1 mon

83
Q

Spinal disc disease that doesn’t resolve will have what s&s?

A

weak back ligaments that cause pain to radiate down their legs, and can accelerate osteoarthritis

84
Q

definition of radiculopathy

A

term used to describe pinching of the nerve roots as they exit the spinal cord or cross intervertebral disc

85
Q

definition of myelopathy

A

compression of the spinal cord itself

86
Q

definition of neuropathy

A

result of damage to peripheral nerves, often causes weakness, numbness and pain, usually in hands and feet

87
Q

What is sciatica?

A

A SYMPTOM. pain that comes from lower back felt along the back of the leg (not in the dermatomal pattern, but along nerve distribution).

88
Q

What is the major cause of sciatica?

A

sacroiliac ligament weakness

89
Q

What are the symptoms of sciatica?

A

pain with walking or long periods of sitting, pain when getting up from sitting. hamstrings and quadratus femoris are both tight.

90
Q

OMM Treatments of sciatica?

A

treat BOTH the hamstrings and the quadratus femoris ms so you don’t creat unbalanced tension between flexors and extensors that may make the problem worse. Release adductor magnus FIRST.

OS3 EX1 (11 decks)

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