Compression Neuropathy Flashcards
involves focal damage of myelin fibers around axon
1st degree - neuropraxia
- some disruption/injury to the axon itself
- myelin sheath remains intact
2nd degree - axonotmesis
disruption of axon and:
- endoneurium
- endoneurium + perineurium
- endoneurium + perineurium + epineurium
3rd-5th degree - neurotmesis
what is the nerve root of deltoid and biceps muscles?
C5 - sensation to lateral arm
what is the nerve root of wrist extension and elbow flexion?
C6 - sensation to radial forearm, thumb and index finger
what is the nerve root of wrist flexion, elbow extension, and finger extension?
C7 - sensation to middle finger
what is the nerve root of finger flexion?
C8 - sensation to ulnar forearm and small finger
what is the nerve root of finger abduction?
T1 - sensation to medial arm
disk is compressed evenly without significant damage to cartilage rings
bulging disk
some tearing of the cartilage rings, with only a few cartilage rings torn
- NO leakage of central material
protrusion
some tearing of the cartilage rings, nucleus pulposus is able to flow out of the disc space
extrusion
what nerve root would be affected if C5 disk is herniated?
C6
what nerve root would be affected if T1 disk is herniated?
T1
- T1 and below, pedicle and nerve root numbers match
what nerve provides motor function to triceps brachii, aconeus, and the wrist extensors?
- sensation to majority of top (dorsum of the hand)
radial nerve
what are the three sites of radial nerve entrapment?
- high on the humerus
- radial tunnel
- at the wrist
wrist drop, weakness of elbow flexion (brachioradialis), possible tricep involvement, tricep reflex may be dinished, pain/numbness
high on the humerus (radial n)
- dx: function usually returns in 4-5 months
pain and tenderness 5 cm distal to lateral epicondyle
- wrist drop or pain with resisted supination
radial tunnel (radial n) - caused by repetitive rotatory movements
superficial branch (sensory) pinched between brachioradialis and ECRL during forearm pronation, sensation changes over posterolateral hand
at the wrist (radial n)
numbness, tingling, burning pain in superficial radial nerve distribution
- caused by compression, edema, surgical injury
cheiralgia paresthetica, aka “handcuff neuropathy”
achy pain in the mid/proximal forearm, aggravated by repeated lifting
- dx: pain with resisted forearm pronation
- occurs as the median nerve passes between the superficial and deep heads of pronator teres
- ex: weight lifter
PRONATOR SYNDROME
- median nerve
trauma, or cast pressure
- “OK” sign: pt unable to hold and resist tip to tip of thumb to index fingers
- no sensory sx
ANTERIOR INTEROSSEOUS SYNDROME
- median nerve
- tx: elbow splint to 90 degrees in flexion for up to 12 weeks
- ex: post-cast pressure
nighttime numbness of lateral 3.5 digits, tingling, wrist pain, dropping things, thenar atrophy
- common in repetitive motion jobs and pregnancy
- dx: gold standard is EMG
- ex: gymnast
CARPAL TUNNEL SYNDROME
- median nerve
- most common compression syndrome
- tx: Xray if fracture concern, MRI is soft tissue injury concern, wrist splinting with 30 degree hand extension (usually at night)
what special tests used for carpal tunnel?
phalen’s and tinel’s
flex hands to 90 degrees, reproduction of sx within 60 seconds is positive sign
phalen’s sign
tapping over flexor retinaculum reproduces sx (esp tingling) in first 3.5 digits
tinel’s sign
paresthesia to 4-5th digits, medial elbow pain radiating to the hand with decreased intrinsic muscle strength
- can’t turn a key in a door
- positive tinel’s sign at elbow
CUBITAL TUNNEL SYNDROME
- tx: padded elbow sleeve to limit terminal elbow flexion/prove cushion
pt has to flex thumb in order to pinch paper between 1st and 2nd digits (can’t straighten out thumb)
froment’s sign
pt seated, apply extension, external rotation, abduction at the affected shoulder joint
- if pain when rotating head toward affected side -> rib 1
- if pain when rotating head away from affected side -> scalenes
(+) test = reproduction of symptoms or diminished radial pulse
ADSON TEST
- ** indicates impingement at thoracic outlet**
monitor radial pulse. t affected shoulder, apply extension, abduction, have patient actively stand “at military attention”
(+) test = reproduction of symptoms or diminished radial pulse
MILITARY TEST
- ** indicates impingement at thoracic outlet**
instruct patient to actively abduct bilateral shoulders to 90 degrees, externally rotate the shoulders, flex elbows and open/close hands repeatedly
(+) test = reproduction of symptoms, weakness or discoloration of the hands
EAST TEST
- ** indicates impingement at thoracic outlet**
monitor radial pulse, abduct shoulder to 90, externally rotate to 90, flex the elbows to 90
- from ending position in step 1, hyperflex the affected shoulder while continuing to monitor the radial pulse
(+) test = reproduction of symptoms or diminished radial pulse
WRIGHT HYPERABDUCTION TEST
- ** indicates impingement at thoracic outlet d/t PECTORALIS MINOR**
what nerve roots allow hip flexion?
L1-2
what nerve roots allow knee flexion?
L2-3
what nerve root allows ankle dorsiflexion?
L4
what nerve root supplies extensor hallucis longus?
L5
what nerve root allows ankle plantarflexion?
S1
numbness or burning pain on anterolateral thigh
- hyperesthesia to the point of not putting anything in pockets
- trophic skin changes
(+) tinel’s sign 1cm medial and inferior to ASIS
MERALGIA PARESTHETICA
-** lateral femoral cutaneous nerve**
pain along proximal third of lateral leg
- foot drop with slapping gait
- sx exacerbated during plantarflexion & inversion of the foot
COMMON FIBULAR NERVE COMPRESSION (L4-S2)
- 3rd most common compression neuropathy
- tx: posterior fibular head HVLA or MET
- MET on gastroc/soleus, biceps femoris
pain over dorsomedial aspect of foot & worse at rest
- weakness of extensor digitorus brevis
- recurrent ankle sprains, soccer players
- prolonged plantar flexion, compression from shoes
ANTERIOR TARSAL TUNNEL SYNDROME (L4-S2)
- tx: remove compressive forces
- MFR to extensor retinaculum
- traction tug of talonavicular joint
- hiss whip for navicular, cuneiforms, 1-2 metatarsal
pain on plantar surface of foot (not very specific)
- vague burning/tingling/numbness
- gait seldom affected
TARSAL TUNNEL SYNDROME
- posterior fibular nerve
- tx: MFR or HVLA, NSAIDs, rest, US, PT
OK sign tests which nerve?
median
Froment’s sign tests which nerve?
ulnar
Hoffman’s sign tests what?
CNS
spinal disk disease:
- extremely painful acutely
- disk slowly shrivels away in a few days-weeks
- **most resolve without treatment within 2-6 weeks*
- 90% back to normal activity within 1 month regardless of tx
initial herniation
sharp, burning ‘hip” pain that radiates down their leg
- draws a line from right lower SI joint straight down back of leg to posterior knee
sciatica
- majority caused by sacroiliac ligament weakness
pinching of the nerve root as they exit the spinal cord/cross intervertebral disc
radiculopathy
compression of spinal cord itself
myelopathy
damage to peripheral nerves, often causes weakness, numbness and pain, usually in hands and feet
neuropathy
- posterior pelvic tilt, flattening of the lumbar curve
- posterior translation of the tibia, laxity of the ACL and increased tension on the PCL
tight hamstrings
why do the adductors need to be released before the hamstrings?
because a tight adductor magnus will cause limitation of full hamstring lengthening
