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OS 3 Midterm > Compression Neuropathy Lecture > Flashcards

Compression Neuropathy Lecture Flashcards

1
Q

C5 Nerve root

  • Motor
  • Sensation
  • Reflex
A
  • Motor: deltoid and biceps
  • Sensation: lateral arm
  • Reflex: biceps
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2
Q

C6 nerve root

  • Motor
  • Sensation
  • Reflex
A
  • Motor:
    • Wrist extension
    • Elbow flexion
  • Sensation
    • Radial forearm
    • Thumb and index finger
  • Reflex
    • Bradioradialis
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3
Q

C7 nerve root

Motor

Sensation

Reflex

A

C7 nerve root

  • Motor:
    • Flex wrists
    • Extend elbow
    • Extend fingers
  • Sensation:
    • middle finger
  • Reflex
    • Triceps
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4
Q

C8 nerve root

Motor

Sensation

Reflex

A
  • Motor
    • Flex fingers
  • Sensation
    • Ulnar forearm
    • Small finger & 1/2 of ring finger
  • Reflex: N/A
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5
Q

Cervical nerve root compression is usually caused by…

A

Cervical disc disease

  1. bulging disc: compressed evenly w/o sig damage to cartilage rings
  2. herniation: some tearing of cartiage rings
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6
Q

What are the 2 types of herniated disk?

A
    1. Protrusion: no leakage of central material
    1. Extrusion: nucleus pulpsos flows out of disc spase
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7
Q

In cervical nerve root compression, how does the disc most commonly rupture?

A

Posterior-laterally, compression the nerve root as it leave intervertebral foramen

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8
Q

Cervical nerve root compression causes?

A

Radiculopathy: pain d/t compression of spinal N that radiates to dermatome

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9
Q

Test for cervical nerve root compression

and the diagnosis of a + test

A
    1. Spurling
      * +: cervical radiculopathy (herniated dic)
  • 2. Adson
    • +: thoracic outlet syndrome
  • 3. Hoffman
    • +: cervical myelopathy (Cervical spinal tos
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10
Q

What is the test?

Extend and rotate head to the symptomatic side, looking for increase in pain

A

Spurling (+= cervical radiculopathy)

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11
Q

What is the test?

Lift up chin, rotate head to the affected side while breathing in deeply, looking for missing radial pulse on affected side

A

Adsons (thoracic outlet syndrome)

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12
Q

What is the test?

Firmly grasp middle finger => quickly snap or flip dorsal side => look for quick flexion of BOTH thumb and index finger

A

Hoffmans signs (+ cervical myelopathy)

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13
Q

Conservative treatments of compression neuropathy measures include:

A
  1. Modify activity, use of anti-inflammatories, splinting, and/or injections
  2. Multidisciplinary: PT, OMM, pain management

Pursue 3-6 months (except cubital tunnel syndrome)

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14
Q

Cubital tunnel syndrome tx

A

Operative decompression is probably justified in all XCPT mildest cases to prevent nerve damage

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15
Q

Radial N. (C5-8) function

A

Motor: Triceps brachii, anconeus, wrist extensors

Sensation: majority of the dorsum of the hand (via posterior interosseous n.)

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16
Q

Tx of radial n entrap High on the humerus

A

function usually returns in 4-5 months

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17
Q
  • Compression of SRN
  • Cheiralgia Paresthetica
  • Waretenberg’s Syndrome
  • Handcuff Neuropathy
A

Numbness, tingling, burning pain in SRN distriubtion

Caused by compression, edema, surgical injury

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18
Q

5- model treatment of cervical compression neuropathy

A
  1. rest
  2. avoidance of aggrevating behaviors
  3. stretch
  4. NSAIDS
  5. Counterstrain/ ME
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19
Q

4 sites of entrapment of median N

A
  1. Ligament of Struthers
  2. Pronator Syndrome
  3. Anterior Osseous Syndrome
  4. Carpal Tunnel Syndrome
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20
Q

Pronator syndrome occurs when

A

median n. passes between the superficial and deep heads of the pronator teres muscle

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21
Q

Pronator syndrome is seen in whom?

A

Seen with repetitive pronating motions:

  • pianists
  • fiddlers
  • baseball players
  • dentists
  • weight trainers
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22
Q

Sx of pronator syndrome

A
  1. Achy pain in the mid/proximal forearm,
  2. Aggravated by repeated lifting
  3. May have sensory abnormality in the radial three & a half digits
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23
Q

Dx of pronator syndrome

A

pain with resisted forearm pronation

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24
Q

Anterior Interosseous n. is ______________ branch of _______ n. that innervates ____

A

deep motor branch

median n.

flexors

25
Q

Anterior Interosseous Syndrome

Etiology

A
  • Trauma, cast pressure
  • Bulky tendinous origin of ulnar head of pronator teres
26
Q

special test for carpal tunnel syndrome

A
  • Phalen’s–flex hands to 90°, reproduction of sxwithin 60 seconds is a positive sign
  • Tinel’s–tapping over the flexor retinaculum reproduces sx(esptingling) in the first 3.5 digits
  • Two point discrimination –unable to distinguish 2 points on a caliper if closer than 5mm
27
Q

Carpal tunnel syndrome 5 factor model

meds

omt

testing

holistic

referral/other

A
  • Medications: NSAIDs
  • OMT: MFR, ST, Lymphatics (if pregnant)
  • Testing: X-ray if concerned for fracture
    • MRI if concerned for soft tissue injury
  • Holistic: Rest from repetitive motions if possible & self-stretching
    • Wrist splinting with 30°of hand extension (usually at night)
  • Referral/Other: Steroids injections if failure of conservative measures
    • Surgical release if other treatments fail
28
Q

Ulnar nerve sites of entrapment

A
  1. Cubital Tunnel
  2. Guyon’s Canal
29
Q

ulnar n innervates what

A
  • Innervates skin & muscles of the ulnar side of the forearm and hand (flexors)
  • Deep branch in hand: motor innervation for interosseous muscles and adductor pollicis
  • Superficial branch in hand: sensory innervation to ring and pinky finger
30
Q

Ulnar Nerve: Most common compression seen in the _____

A

elbow

31
Q

Compression at the cubital tunnel formed by:

A
  1. Medial epicondyle
  2. Medial trochlea
  3. Olecranon
  4. Ulnar collateral ligament
32
Q

Ulnar Nerve

Etiology

A
  1. Baseball pitchers
  2. Prolonged elbow flexion (during sleep)
  3. External compression against a hard surface
  4. Thickened cubital tunnel retinaculum
33
Q

what do we do if we suspect thoracic outlet syndrome

A

cervical spine XR, chest XR

34
Q

if cervical spine XR/CXR is (-) for thoracic outlet syndrome, what do we do

A

EMG/nerve conduction study to test for carpal tunnel

35
Q

Common Fibular n. (Peroneal n.) nerve root

A

L4-S2

36
Q

Deep fibular n. nerve root

A

L4-S2

37
Q

Posterior tibial n. nerve root

A

L4-S2

38
Q

Lateral Femoral Cutaneous n. nerve root

A

L2-3

39
Q

L1,L2

  • Motor
  • Sensation
  • Rrflex
A
  • Motor: Hip flexion
  • Sensation: Inguinal crease (L1), anterior thigh (L2)
40
Q

L2-3

  • Motor
  • Sensation
  • Rrflex
A

L2-3

  • Motor:
    • ​Knee extension
  • Sensation:
    • Anterior thigh (L2), anterior thigh just above knee (L3)
  • Reflex:
41
Q

L4

Motor

Sensation

Rrflex

A

L4

Motor:

  • Dorsiflex ankle

Sensation

  • Medial leg and foot

Rrflex

  • Knee jerk (patella)
42
Q

L5

Motor

Sensation

Rrflex

A

Motor: Extensor hallucislongus

Sensation: Lateral leg, dorsum of foot

Rrflex

43
Q

S1

  • Motor
  • Sensation
  • Rrflex
A

S1

Motor: plantarflex ankle

Sensation:

  • lateral foot
  • plantar foot

Rrflex

  • Ankle jerk (achilles)
44
Q

Treat common fibular N compression

A
  1. Posterior fibular head HVLA or ME
  2. ME on gastroc/soleus, biceps femoris
45
Q

Treat Anterior tarsel tunnel sundrome

A
  1. Remove compressive forces
  2. Myofascial release of extensor retinaculum
  3. Traction tug of talonavicularjoint
  4. Hiss whip for navicular, cuneiforms, 1stand 2ndmetatarsal
46
Q

3rd most common compression neuropathy

A
  • Common Fibular Nerve Compression => Foot Drop
47
Q

Median Nerve

  • pronator syndrome (who)
  • anterior interosseous syndrome (who)
  • carpal tunnel syndrome (who)
A
  • pronator syndrome (weight lifter)
  • anterior interosseous syndrome (post-cast pressure)
  • carpal tunnel syndrome (gymnasts)
    *
48
Q
  1. OK Sign: (+) test => ______
  2. Froment’s Sign: (+) test => ________
  3. Hoffman’s Sign: (+) test => _________
A
  1. Median nerve entrapment
  2. Ulnar N. entrapment
  3. CNS problem
49
Q

In patients with spinal disc disease (herniation), 90% go back to NL in 1 month, even if not treated. What happens to the other 10%

A
  1. Chronic back pain
  2. Muscle pain/spasms
  3. Stiffness; menaing ligament is lax and weak joint
50
Q

What type of OMT would you perform in a pt with spinal disc disease?

A

BLT/Counterstrain,

51
Q

Sxs in pts with weak back ligaments

A

Pain radiates down leg; predisposes to more injury; OA accelerates and + stress to other joints

52
Q
  • Pt presents to FM clinic with 2 month hx of low back and right sharp, burning “Hip” pain that radiates down their leg.
  • What do you do first?
  • What is the diagnosis?
A
    1. Have pt point with 1 finger where pain is *points to right SI joint*
    1. Tell them to draw where pain starts and ends.*R SI joint => straight down back of leg to posterior knee*
  • Dx: low back pain with sciatica
53
Q

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

A

Radiculopathy

54
Q

compression of the spinal cord itself

A

Myelopathy

55
Q

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

A

Neuropathy

56
Q

pain that starts in the lower back that is felt along the distribution of the sciatic nerve in the LE

A

Sciatica (a symptom)

57
Q

Cause of sciatica

Sx?

A
  • Weak SI ligament
  • Sx
    • Pain when getting up from sitting, esp if legs cross
      • Need support (armrest/thight) to help up from seated postion
    • ​​Pain when walking; worsen with standing
58
Q
A

OS 3 Midterm (18 decks)

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