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OS 3 Midterm > Compression Neuropathy Lab > Flashcards

Compression Neuropathy Lab Flashcards

1
Q

Bilateral UE weakness DDx

A
  1. Spinal cord
  2. Peripheral neuropathy
  3. Systemic (electrolyte abnormality)
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2
Q

Unilateral weakness in 1 limb DDx

A
  • Localized region of a limb
    • Mononeuropathy
    • Radiculopathy
    • Plexopathy
  • Entire limb
    • Plexopathy
    • Central lesion
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3
Q
  • Sx of radiculopathy
  • Objective
A
  • S:
    • Pain in the neck that radiates down the arm to a specific region in hand due to impingement of nerve at cervical spine (disc disease, herniation, degenerative arthritis)
  • O
    • numbness
    • weakness along distribution
    • decreased reflex (dep on what cervical level affected)
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4
Q

What is the first test we run if we suspect radiculopathy and why?

A

+ spurlings; CHEAPER than MRI and EMG

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5
Q

Diagnosing radiculopathy

A
  • Diagnose:
    • OA (for SB/translation)
      • ex OA F SrRl
    • AA (rotation only by FULLY flexing!)
      • AA Rr
    • C2-C7
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6
Q

Treatment for radiculopathy

A
  1. Cervical: contralateral traction (ST)
  2. Cervical subocciptal release (ST)
  3. Cervical: unilateral forearm fulcrum bending
  4. Cervical: bilateral forearm fulcrum bending
  5. OA MET
  6. AA MET
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7
Q

Symptoms of a plexopathy?

A
  • Intermittant numbness and tingling NOT consistent w 1 nerve root
  • Pain in neck/shoulder
  • Generalized, intermittant weakness of extremity
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8
Q

Speciality tests for plexopathy and what they indicate is causing the compression

A
  1. EAST
    1. general
  2. Adson
    1. Scalene muscles
    2. 1st rib
    3. Cervical rib
  3. Military brace
    1. Clavicle
  4. Wright
    1. Pec minor
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9
Q

Treat plexopathy (+ Adson test => 1st rib)

A
  1. Inhalation SD MET
  2. Exhalation SD MET
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10
Q

Treat plexopathy (+ Military brace => clavicle)

A
  1. Clavicle SC Elevated/adducted SD; MET
  2. Clavicle SC Horizontal extension SD; MET
  3. Clavicle AC IR SD; MET
    4.
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11
Q

Treat plexopathy (+ Wright test=> Pec minor)

A
  1. Pec minor counterstrain (f-F ADD)
    1. ​Pt lays on back; doc on opp or same side
    2. Contact pec minor TP:
      • ​inferomedial to coracoid process
    3. f-F ADD
      • Adduct patients arm across the chest , pulling shoulder anterior
    4. Hold for 90 seconds and return to neutral
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12
Q

Name 3 mononeuropathies

A
  1. Pronator teres (median n entrapment)

2. Carpal tunnel (median n entrapment)

3. Cubital tunnel (ulnar n entrapment)

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13
Q

Pronator teres syndrome

S:

O: (+ speciality test, sensation, reflexes)

A
  • S
    • Numbness/tingling of forearm => wrist => first 3 fingers of the hand
    • Weak grip
  • O
      • phalen/ OK test/ Tinels sign at wrist (all test median N)
    • Restisted pronation test
    • Decreased sensation
    • NL reflexes
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14
Q

What specialty tests test median N?

A
  1. Phalens
    1. ​put dorsal parts of hands together => wrist flexion for 60 sec
    2. +; paresthesia in distrib on median n => carpal tunnel
  2. Ok test (anterior intereouss branch => +; anterior interosseous nerve palsy)
    1. Make a ok sign with both hands
    2. +: one hand makes a pinched circle (DIP joint on index finger is extended, not flexed) => anterior interosseous palsy
  3. Tinels sign @ wrist
    1. ​Tap on transverse carpal L (between thenar/hypothenar em) while patients hand is extended
    2. + pain/numb/tingling to medial nerve distribution (thumb, index and 1/2 of 3rd finger) => carpal tunnel (median n. entrapment
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15
Q

OMT for pronator teres syndrome

A
  1. Pronator teres counterstrain (F PRO Add)
    1. Pt lays on back; doc on same side
    2. Find TP: near medial epicondyle
    3. F PRO Add
      1. Flex and pronate elbow (palms face floor); adduct
    4. Hold for 90seconds => neutral
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16
Q

Carpal tunnel syndrome

Subjective:

O: (speciality tests, sensation, reflexes)

A
  • S
    • Wake up at night with wrist pain and numb/ting in first 3.5 fingers
    • Day: pain is intermittant and dull/achy
  • O
      • Phalen/ prayer/ OK/ Tinnel test
    • Decreased sensation
    • NL reflexes
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17
Q

+ special tests for carpal tunnel

A
  1. Phalens
  2. Tinels
  3. OK
  4. Prayer
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18
Q

OMT for carpal tunnel

A
  1. Wrist extension carpal SD; HVLA
  2. Wrist flexion carpal SD; HVLA
  3. Wrist: isotonic MET
  4. Wrist: flexor retinaculum MFR
  5. Wrist: figure 8; ART
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19
Q

Name SD if this is hard

A

Wrist flexion SD (likes to flex, cant extend)

20
Q

Name SD if this is hard

A

Wrist extension SD (like to extend, cant flex)

Pic if flexing wrist

21
Q

Name SD if this is hard

22
Q

Name SD if this is hard

23
Q

Cubital tunnel syndrome

Subjective

Objective (sp tests, sensation, reflexes)

A
  • S
    • Numbness and pain from medial forearm => 4th/5th fingers
  • O
      • Tinnel posterior/superior to elbow/ + Froments
    • Decreased sensation
    • NL reflexes
24
Q

Speciality tests for ulner nerve palsy

A
  1. Froments sign
    1. Tell pt to pinch piece of paper with [thumb and index finger] while doc pulls on paper.
      • test: IP joint of thumb flexes => ulnar nerve palsy/weak ADDUCTOR POLLICIS
  2. Tinels test at elbow
25
SD for cubital tunnel syndrome (not on CPA)
1. Elbow extension/flexion SD 2. Elbow adbuction/adduction SD
26
S: His new job is warehouse stocking for a local distribution company that involves lifting and moving heavy boxes. Numbness is limited to the right gluteal region, but he has paresthesia and dysesthesia that travels from the right buttock to the right foot on the posterolateral aspect of the leg. What is this? Keys?
S: His new job is **warehouse stocking** for a local distribution company that involves lifting and moving heavy boxes. Numbness is limited to the **right gluteal region**, but he has paresthesia and dysesthesia that travels from the **right buttock to the right foot** on the **posterolateral** aspect of the **leg**. * **Herniated disc (lumbosacral radiculopathy; L5-S1)**
27
* In l**umbosacral radiculopathy**, ____ is the most common affected segment, most commonly due to \_\_\_\_\_\_\_\_\_. * Symptoms?
* L5-S1; herniated disc * Pain from **butt** =\> radiates =\> **posterolateral ankle or foot**
28
Red flag symptoms of **lumbosacral radiculopthy**
1. WL 2. Fever 3. Chills 4. Loss of bowel or bladder control
29
Posterior pelvic, lumbar and sacrum **TP**
1. **UP L5** 1. ​superomedial surface of PSIS 2. **LP L5** 1. ​Inferior to PSIS, pressing superior 3. **PL3 gluteus** 1. ​2/3 lateral from PSIS to tensor fascia lata 4. **PL4 gluteus** 1. ​Posterior part of TFL
30
**Lumbar: Upper Pole L5 (UPL5), Counterstrain**
* Doc on same or opp side * **TP:** superomedial border of PSIS * **E Adduct IR/ER**
31
**Lumbar, Lower Pole L5 (LPL5), Counterstrain**
* Doc sitting on same side of TP * Pt: on stomach of thigh hanging off * TP: Inferior border of PSIS * **F IR Adduct** * ​flex hip to 90 * adduct knee and IR
32
**High Ilium Sacroiliac (HISI), Counterstrain**
* Stand on same side as TP * Pt on stomach * **TP:** 2-3cm lateral from TP * **e-E Abduct ER**
33
**Lumbar:** Type 1 (Neutral) SD, Long Lever Lateral Recumbent, MET
* Doc: face pt; monitor with cephalad hand * Pt: LR; PTP up * NUDR * **N**eutral * PTP **UP** * pt force **D**OWN * **R**ecumbant * Tech * Flex hips and knees until motion is felt uner hand * Lift patients ankles (SB spine into barrier) * Pt pushes ankles down against docs counterforce for 3-5 seconds * Pt relaxes =\> bring to next barrier * Repeat 3-5x until no restriction
34
**Lumbar:** Type 2 *_(Extended) SD,_* Long Lever Lateral Recumbent, MET
Doc: face pt; monitor with cephalad hand Pt: Modified SIM- chest to bed; PTP up **_SUUE_** * Sims * PTP UP * pt force UP * Extension Tech 1. Flex hips and knees until motion is felt under hand 2. Drop pts legs off table 3. Pt raises ankles up to ceiling against docs counterforce for 3-5 seconds 4. Pt relaxes =\> bring to next barrier 5. Repeat 3-5x until no restriction
35
**Lumbar:** Type 2 (**Flexed) SD**, Long Lever Lateral Recumbent, MET
Doc: face pt; monitor with cephalad hand Pt: LR; PTP down **FDDR** * **F**lexed * PTP **d**own * pt force **d**own * **R**ecumbant Tech 1. Lean back back 2. Straighten bottom leg; flex top hip and lift ankle 3. Pt pushes down to floor against docs counterforce for 3-5 seconds 4. Pt relaxes =\> bring to next barrier 5. Repeat 3-5x until no restriction
36
S: His new job is a long haul trucker. His pain is located in his right gluteal region, but has dysesthesia that travels down the back of his thigh to his right knee. You notice that he has a worn square imprint of his wallet in the right back pocket of his jeans. What is this?
S: His new job is a l**ong haul trucker.** His pain is located in his **r**i**ght gluteal region,** but has dysesthesia that **travels down the back of his thigh to his right knee**. You notice that he has a worn square imprint of his wallet in the right back pocket of his jeans. ## Footnote **Piriformis syndrome:**
37
Important to rule out **true sciatica** due to _________ (need imaging studies)
**lumbar disc herniation**
38
Sx of **piriformis**
1. Pain sitting, standing or lying longer than 15-20 min 2. Pain/paresthesia from [sacrum =\> gluteal area =\> posterior thigh =\> stops above knee] 3. **CONTRALATERAL SI pain** 4. Weak IPSILATERAL LE 5. Diff walking (foot drop)
39
**OMT** for piriformis syndrome
1. **Piriformis counterstrain (F abd ER)** 2. **Supine self-stretch** 3. **Piriformis MET**
40
History reveals that he has paresthesiasand numbness over the anterolateral aspect of his left thigh with no other radiation. His new job as a security officer makes him wear a utility belt to work and he’s very stationary inside a booth which has caused him to gain a lot of weight. This is evidenced by extra abdominal adipose tissue that lays down over the top of his pants. What is this?
History reveals that he has **paresthesias and numbness over the anterolateral aspect** of his left thigh with **no other radiation**. His new job as a security officer makes him wear a **utility belt** to work and he’s **very stationary i**nside a booth which has caused him to **gain** a lot of **weight**. This is evidenced by extra abdominal adipose tissue that lays down over the top of his pants. * **Meralgia PAresthetica (lateral femoral cutaneous N entrapment)**
41
**Speciality test** for meralgia paresthetica
**+ tinels** sign 1cm inferior and medial to ASIS
42
Meralgia Paresthetica Treatment * Behavioral model * Biomechanical
* Behavioral model * wear looser clothes * lose weight * Reassurance its not serious * Biomechanical 1. Treat SD of psoas, sacrum, innominate, anterior thigh muscles 2. Local MFR to abdoment 3. L2-L3
43
S: The pain is actually numbness and paresthesia that occurs over the lateral aspect of his lower leg and the dorsum of his left foot. He was recently hired as a meditation coach and now spends hours each day with his legs crossed
S: The pain is actually numbness and paresthesia that occurs over the **lateral aspect of his lower leg =\> dorsum of his left foot**. He was recently hired as a **meditation coach** and now spends hours each day with his **legs crossed** ## Footnote **Common fibular nerve neuropathy**
44
Sx common fibular N neuropathy
* **Numbess/paresthsia [lateral aspect of lower leg =\> dorsum of L foot]** * Pain is due to etiology; traumatic compression is painful, not crossing legs * **Legs crosses** * not painful * **Foot drop** * weak dorsiflexors
45
S: He has recently began working as a hospital chaplain and is continually walking around the hospital. The pain is limited to the plantar aspect of his right foot. He has flat feet with almost no longitudinal arch.
* Tarsal tunnel syndrome: compression of posterior tibial nerve behind medial mallelous and flexor retinaculum =\> non-specific **pain on plantar surface of foot.** * **gait** is **not** usually **affected**
46
OMT for **Tarsal Tunnel Syndrome**
1. Calcaneus HVLA: inversion/eversion SD 2. Talus Tug HVLA: plantarflexed/dorsiflexed SD 3. Gastrocnemius Counterstain (plantarflexion) 1. TP: proximal gastroc muscle belly 2. Position: F Abduct ER 4. Ankle Figure 8, ART
47

OS 3 Midterm (18 decks)

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