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OS III Midterm > Compression Neuropathy > Flashcards

Compression Neuropathy Flashcards

1
Q

What are biomechanical causes of neuropathy?

A
  • -space-occupying lesions (cysts, herniated discs)
  • -degenerative changes (foraminal stenosis)
  • -post-trauma (compartment syndrome, fracture/cast)
  • -mechanical (muscle spasm, pinching d/t positioning)
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2
Q

What are systemic causes of neuropathy?

A
  • pregnancy
  • hypothyroidism
  • diabetes
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3
Q

What is the outer covering of a nerve?

A

-epineurium: contains the fascicles, blood vessels and connective tissue within

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4
Q

What is a fascicle?

A
  • covered by perineurium, contains groups of axons

- groups of fascicles together form a nerve, which is covered by epineurium

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5
Q

What layers cover an axon?

A
  • directly covered with myelin, which is then covered by the endoneurium
  • groups of axons together form a fascicle, which is covered by perineurium
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6
Q

What are the five degrees of nerve injury?

A

1st: neuropraxia (focal damage of myelin)
2nd: axonotmesis (some injury to axon itself)
3rd: neurotmesis (axon and endoneurium)
4th: neurotmesis (axon, endoneurium, and perineurium)
5th: neurotmesis (axon, endo-, peri-, and epineurium)

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7
Q

What motor, sensation, and reflex is associated with C5?

A

motor: deltoid and biceps
sensation: lateral arm
reflex: biceps

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8
Q

What motor, sensation, and reflex are associated with C6?

A

motor: wrist extension, elbow flexion
sensation: radial forearm, thumb and index finger
reflex: brachioradialis

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9
Q

What motor, sensation, and reflex are associated with C7?

A

motor: wrist flexion, elbow extension, finger extension
sensation: middle finger
reflex: triceps

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10
Q

What motor and sensation are associated with C8?

A

motor: finger flexion
sensation: ulnar forearm, little finger

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11
Q

What motor and sensation are associated with T1?

A

motor: finger abduction
sensation: medial arm

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12
Q

What is the usual cause of cervical nerve root compression?

A
  • cervical disc disease
  • -bulging disc (no significant damage to cartilage rings)
  • -herniation (some tearing of cartilage rings)
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13
Q

What is protrusion in regards to a disc herniation?

A
  • only a few cartilage rings are torn

- no leakage of central material

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14
Q

What is extrusion in regards to a disc herniation?

A
  • cartilage rings have been torn in a small area

- nucleus pulposus is able to flow out of the disc space

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15
Q

In what direction does the disc usually rupture?

A

posterolateral, because the longitudinal ligament is located centrally

(longitudinal ligament becomes the tectorial membrane)

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16
Q

What is radiculopathy?

A

-pain caused by compression of the spinal nerve that radiates in the distribution of the defined nerve root

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17
Q

List some tests for cervical nerve roots?

A

-Spurling, Adson, and Hoffman

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18
Q

What is a Spurling Test?

A

-extend and rotate neck toward symptomatic side
+ if radicular pain is exacerbated
= cervical radiculopathy (e.g. herniated disc)

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19
Q

What is the Adson Test?

A

-elevate chin and rotate head toward affected side while inhaling deeply

+ if radial pulse on affected side is obliterated
= thoracic outlet syndrome

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20
Q

What is the Hoffman Test?

A

-firmly grasp middle finger and quickly snap or flip the dorsal surface of distal phalanx ventrally

+ if thumb and index finger quickly flex
= cervical myelopathy (e.g. cervical spine stenosis)

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21
Q

How does the treatment of cubital tunnel syndrome differ from the general treatment of other cervical nerve root compression?

A

-cubital tunnel syndrome warrants operative decompression in most all cases (except super mild) in order to prevent nerve damage

–normally 3-6mos of PT, OMM, pain mgmt, splints, etc.

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22
Q

What motor function does the radial nerve supply?

A
  • triceps brachii
  • anconeus
  • wrist extensors
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23
Q

What area of sensation does the radial nerve supply?

A

-majority of the dorsum of the hand (via posterior interosseous N.)

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24
Q

What are the three sites for radial nerve entrapment?

A
  • high on the humerus
  • radial tunnel
  • at the wrist
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25
Q

What are the characteristics of a radial nerve entrapment that happens high on the humerus?

A
  • usually secondary to a humerus fracture
  • Tx: fxn usually returns within 4-5mos

Symptoms: wrist drop, pain, numbness, weak elbow flexion (brachioradialis), triceps reflex diminished

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26
Q

What are the characteristics of a radial nerve entrapment at the radial tunnel?

A
  • due to repetitive rotatory mvmts (rowing, discus, racquet sports), or heavy manual labor
  • pain/tenderness 5cm distal to lateral epicondyle, wrist drop or pain w/ resisted supination
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27
Q

What are the characteristics of a radial nerve entrapment at the wrist (aka Cheiralgia Paresthetica, aka Wartenberg’s Syndrome, aka Handcuff Neuropathy)?

A
  • a superficial sensory branch is pinched b/w brachioradialis and extensor carpi radialis ligament during forearm pronation
  • sensation changes over the posterolateral hand
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28
Q

What three syndromes are caused my median nerve entrapment?

A
  • Pronator Syndrome
  • Anterior Osseous Syndrome
  • Carpal Tunnel Syndrome
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29
Q

What are the motor functions of the median nerve?

A
  • forearm flexion and pronation
  • wrist flexion and radial deviation
  • thumb abduction and opposition
  • index and middle finger abduction and flexion
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30
Q

What are the causes of pronator syndrome?

A
  • occurs as median n. passes b/w superficial and deep heads of the pronator teres m.
  • repetitive pronating motion: pianists, fiddlers, baseball players, dentists, weight trainers
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31
Q

What are the symptoms of pronator syndrome?

A
  • achy pain in the mid/proximal forearm, aggravated by repeated lifting
  • may have sensory abnormality in the radial three and a half digits
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32
Q

How is pronator syndrome diagnosed?

A

-pain w/ resisted forearm pronation

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33
Q

What is the cause of Anterior Interosseous Syndrome?

A
  • entrapment of the anterior interosseous n. (a deep motor branch of the median nerve) just distal to the pronator teres m.; it innervates flexors
  • trauma, casts, soft tissue masses, fibrous bands
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34
Q

Are there sensory symptoms associated with Anterior Interosseous Syndrome?

A

No

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35
Q

How do you test for Anterior Interosseous Syndrome?

A

-have pt. make the “ok” sign

+ if the pt. is unable to hold and resist pinching pressure of the tip of the thumb against the tip of the index finger, due to weak flexion ability

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36
Q

What is the treatment for Anterior Interosseous Syndrome?

A
  • elbow can be splinted in 90 degrees of flexion for up to 12 weeks
  • other general treatments
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37
Q

What is the most common compression syndrome?

A

carpal tunnel syndrome

-median nerve compression as it passes under the flexor retinaculum with other flexor tendons

38
Q

What are the symptoms of carpal tunnel syndrome?

A

-nighttime numbness of lateral three and a half digits, tingling, wrist pain, dropping things, thenar atrophy

39
Q

What can be causes of carpal tunnel syndrome?

A
  • common in repetitive motion jobs

- common in pregnancy

40
Q

How is carpal tunnel syndrome diagnosed?

A
  • the gold standard is an EMG

- other tests: Phalen’s and Tinel’s

41
Q

How is a two-point discrimination test used to diagnose carpal tunnel syndrome?

A

+ if the pt. is unable to distinguish between two points on a caliper if they’re closer than 5mm

42
Q

How do you treat carpal tunnel syndrome?

A
  • NSAIDS, MFR, ST, lymphatics if pregnant
  • rest from repetitive motion, and self stretch
  • splint wrist with 30 degrees of hand extension
  • -usually at night
43
Q

If conservative treatment options fail in carpal tunnel syndrome, what are other treatments that can be used?

A
  • steroid injections

- surgical release

44
Q

What is a common site of ulnar nerve entrapment?

A

cubital tunnel

45
Q

What is the nerve function of the ulnar nerve?

A

-innervates skin and muscles of the ulnar side of the forearm and hand (flexors)

46
Q

What does the deep branch of the ulnar nerve in the hand do?

A

-motor innervation for interosseous muscles and adductor pollicis

47
Q

What does the superficial branch of the ulnar nerve in the hand do?

A

-sensory innervation to ring and pinky finger

48
Q

What is the most common nerve compression seen in the elbow?

A

Cubital Tunnel Syndrome

49
Q

What structures for the source of compression in the cubital tunnel?

A
  • medal epicondyle
  • medial trochlea
  • olecranon
  • ulnar collateral ligament
50
Q

What are common causes of cubital tunnel syndrome?

A
  • baseball pitchers
  • prolonged elbow flexion (eg. during sleep)
  • external compression against a hard surface
  • thickened cubital tunnel retinaculum
51
Q

What are the symptoms of cubital tunnel syndrome?

A
  • parasthesia to the 4th and 5th digits
  • medial elbow pain radiating to the hand
  • can’t turn a key in a door
52
Q

How do you test for cubital tunnel syndrome?

A

+ Tinel’s sign at elbow

-or if you get a reproduction of the symptoms with elbow flexion and wrist extension

53
Q

What is the treatment for cubital tunnel syndrome?

A
  • padded elbow sleeve to limit terminal elbow flexion and provide cushioning
  • other general treatments
54
Q

What is Froment’s Sign?

A
  • an indication of ulnar nerve entrapment in cubital tunnel syndrome
  • pt. has to flex the thumb in order to pinch paper b/w 1st and send digits d/t weak 1st dorsal interosseous m.
55
Q

What is thoracic outlet syndrome?

A

-compression of the brachial plexus and/or the subclavian vessels

56
Q

What are the sites of compression in thoracic outlet syndrome?

A
  • scalene triangle
  • costoclavicular passage

-at the pectoralis minor attachment at the coracoid process

57
Q

What are the symptoms of thoracic outlet syndrome?

A

-weakness, paresthesia of medial arm, forearm, and hand exacerbated by overhead activities

58
Q

What lower extremity nerves are at risk for compression?

A
  • common fibular n. (L4-S2)
  • deep fibular n. (L4-S2)
  • posterior tibial n. (L4-S2)
  • lateral femoral cutaneous n. (L2-L3)
59
Q

What is the motor function of nerve roots L1-L2?

A

-hip flexion

60
Q

What are the sensation functions of nerve roots L1-L2?

A
  • inguinal crease (L1)

- anterior thigh (L2)

61
Q

What are the motor functions of nerve roots L2-L3?

A

-knee extension

62
Q

What are the sensation functions of nerve roots L2-L3?

A
  • anterior thigh (L2)

- anterior thigh just above the knee (L3)

63
Q

What is the motor function of the nerve root L4?

A

-ankle dorsiflexion

64
Q

What is the sensory function of the nerve root L4?

A

-medial leg and foot

65
Q

What is the reflex associated with nerve root L4?

A

patellar reflex

extension reflex

66
Q

What is the motor function of the nerve root L5?

A

-extensor hallucis longus

67
Q

What is the sensory function of the nerve root L5?

A
  • lateral leg

- dorsum of foot

68
Q

What is the motor function of the nerve root S1?

A

-ankle plantarflexion

69
Q

What is the sensory function of the nerve root S1?

A
  • lateral foot

- plantar foot

70
Q

What reflex is associated with the nerve root S1?

A

-ankle jerk (achilles)

71
Q

What is Meralgia Paresthetica?

A

-compression of the lateral femoral cutaneous n. underneath the inguinal ligament at the inguinal canal

72
Q

What are possible etiologies of meralgia paresthetica?

A
  • -very intense athletics
  • -obesity
  • -tight girdle or belt, or tight clothing
  • -seat belt misplacement or post-accident
  • -anatomic anomaly (eg. runs through sartorius)
73
Q

What are the symptoms of meralgia paresthetica?

A

-numbness or burning pain on anterolateral thigh
-hyperesthesia to the point of not using pockets
-trophic skin changes (later on)
+ Tinel’s Sign 1cm medial and inferior to ASIS

74
Q

What does the common fibular nerve divide into?

A
  • deep branch that innervates the anterior compartment (tibialis anterior, extensor digitorum longus and brevis)
  • superficial branch that innervates the lateral compartment (fibularis longus and brevis)
75
Q

Where does the compression of the common fibular nerve happen?

A

-as the nerve winds around the fibular neck and enters the fibular tunnel

76
Q

What are possible etiologies of common fibular nerve compression?

A
  • leg hooked over a rail (bedridden, comatose)
  • time spent in a squatting position
  • ankle sprains or trauma to fibular head
  • lithotomy position during childbirth
  • idiopathic
77
Q

What are the symptoms of common fibular nerve compression?

A
  • pain along proximal third of lateral leg
  • FOOT DROP w/ a slapping gait

-exacerbation of symptoms during plantarflexion and inversion of foot

78
Q

What is the treatment for compression of the common fibular nerve?

A
  • posterior fibular head HVLA or muscle energy

- muscle energy on gastroc/soleus or biceps femoris

79
Q

What is Anterior Tarsal Tunnel Syndrome?

A
  • compression of the deep fibular nerve (L4-S2)

- -at the inferior extensor retinaculum

80
Q

What are the symptoms of Anterior Tarsal Tunnel Syndrome?

A
  • pain over dorsomedial aspect of foot
  • pain worse at rest
  • weakness of extensor digitorum brevis
81
Q

What are common causes of Anterior Tarsal Tunnel Syndrome?

A
  • trauma (recurrent ankle sprains, i.e. soccer players)
  • talonavicular dysfunction
  • prolonged plantarflexion
  • compression from shoes
82
Q

What is the treatment for Anterior Tarsal Tunnel Syndrome?

A
  • remove compressive forces
  • myofascial release of extensor retinaculum
  • traction tug of talonavicular joint
  • hiss whip for navicular, cuneiforms, 1st-2nd metatarsal
83
Q

What is Tarsal Tunnel Syndrome?

A

-compression of the posterior tibial n. in the tarsal tunnel behind the medial malleolus w/ the overlying flexor retinaculum

84
Q

What is the function of the posterior tibial nerve?

A
  • motor to plantar muscles of the foot

- sensation to plantar aspect of the foot and toes

85
Q

What is the etiology of Tarsal Tunnel Syndrome?

A
  • idiopathic in 50% of cases
  • cysts, lipomas, tenosynovitis
  • trauma to medial malleolus, distal tibia, or calcaneus
  • congenital
  • autoimmune, diabetes
86
Q

What are the symptoms of Tarsal Tunnel Syndrome?

A
  • pain on plantar surface of the foot
  • -vague burning, tingling, numbness
  • gait is seldom affected
87
Q

What are treatments for Tarsal Tunnel Syndrome?

A
  • MFR, HVLA
  • Physical therapy
  • Rest and NSAIDS
  • acupuncture
88
Q

What does the “ok sign” test for?

A

medial nerve entrapment

89
Q

What does the Froment’s Sign test for?

A

ulnar nerve entrapment

90
Q

What does Hoffman’s Sign test for?

A

CNS problems

91
Q

What causes the majority of Sciatica?

A

-weak SI ligaments

OS III Midterm (13 decks)

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