Compression Neuropathy Lecture Flashcards
C5 Nerve root
- Motor
- Sensation
- Reflex
- Motor: deltoid and biceps
- Sensation: lateral arm
- Reflex: biceps
C6 nerve root
- Motor
- Sensation
- Reflex
- Motor:
- Wrist extension
- Elbow flexion
- Sensation
- Radial forearm
- Thumb and index finger
- Reflex
- Bradioradialis
C7 nerve root
Motor
Sensation
Reflex
C7 nerve root
- Motor:
- Flex wrists
- Extend elbow
- Extend fingers
- Sensation:
- middle finger
- Reflex
- Triceps
C8 nerve root
Motor
Sensation
Reflex
-
Motor
- Flex fingers
-
Sensation
- Ulnar forearm
- Small finger & 1/2 of ring finger
- Reflex: N/A
Cervical nerve root compression is usually caused by…
Cervical disc disease
- bulging disc: compressed evenly w/o sig damage to cartilage rings
- herniation: some tearing of cartiage rings
What are the 2 types of herniated disk?
- Protrusion: no leakage of central material
- Extrusion: nucleus pulpsos flows out of disc spase
In cervical nerve root compression, how does the disc most commonly rupture?
Posterior-laterally, compression the nerve root as it leave intervertebral foramen
Cervical nerve root compression causes?
Radiculopathy: pain d/t compression of spinal N that radiates to dermatome
Test for cervical nerve root compression
and the diagnosis of a + test
-
Spurling
* +: cervical radiculopathy (herniated dic)
-
Spurling
-
2. Adson
- +: thoracic outlet syndrome
-
3. Hoffman
- +: cervical myelopathy (Cervical spinal tos
What is the test?
Extend and rotate head to the symptomatic side, looking for increase in pain
Spurling (+= cervical radiculopathy)
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
Adsons (thoracic outlet syndrome)
What is the test?
Firmly grasp middle finger => quickly snap or flip dorsal side => look for quick flexion of BOTH thumb and index finger
Hoffmans signs (+ cervical myelopathy)
Conservative treatments of compression neuropathy measures include:
- Modify activity, use of anti-inflammatories, splinting, and/or injections
- Multidisciplinary: PT, OMM, pain management
Pursue 3-6 months (except cubital tunnel syndrome)
Cubital tunnel syndrome tx
Operative decompression is probably justified in all XCPT mildest cases to prevent nerve damage
Radial N. (C5-8) function
Motor: Triceps brachii, anconeus, wrist extensors
Sensation: majority of the dorsum of the hand (via posterior interosseous n.)
Tx of radial n entrap High on the humerus
function usually returns in 4-5 months
- Compression of SRN
- Cheiralgia Paresthetica
- Waretenberg’s Syndrome
- Handcuff Neuropathy
Numbness, tingling, burning pain in SRN distriubtion
Caused by compression, edema, surgical injury
5- model treatment of cervical compression neuropathy
- rest
- avoidance of aggrevating behaviors
- stretch
- NSAIDS
- Counterstrain/ ME
4 sites of entrapment of median N
- Ligament of Struthers
- Pronator Syndrome
- Anterior Osseous Syndrome
- Carpal Tunnel Syndrome
Pronator syndrome occurs when
median n. passes between the superficial and deep heads of the pronator teres muscle
Pronator syndrome is seen in whom?
Seen with repetitive pronating motions:
- pianists
- fiddlers
- baseball players
- dentists
- weight trainers
Sx of pronator syndrome
- Achy pain in the mid/proximal forearm,
- Aggravated by repeated lifting
- May have sensory abnormality in the radial three & a half digits
Dx of pronator syndrome
pain with resisted forearm pronation
Anterior Interosseous n. is ______________ branch of _______ n. that innervates ____
deep motor branch
median n.
flexors
Anterior Interosseous Syndrome
Etiology
- Trauma, cast pressure
- Bulky tendinous origin of ulnar head of pronator teres
special test for carpal tunnel syndrome
- 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
Carpal tunnel syndrome 5 factor model
meds
omt
testing
holistic
referral/other
- 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
Ulnar nerve sites of entrapment
- Cubital Tunnel
- Guyon’s Canal
ulnar n innervates what
- 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
Ulnar Nerve: Most common compression seen in the _____
elbow
Compression at the cubital tunnel formed by:
- Medial epicondyle
- Medial trochlea
- Olecranon
- Ulnar collateral ligament
Ulnar Nerve
Etiology
- Baseball pitchers
- Prolonged elbow flexion (during sleep)
- External compression against a hard surface
- Thickened cubital tunnel retinaculum
what do we do if we suspect thoracic outlet syndrome
cervical spine XR, chest XR
if cervical spine XR/CXR is (-) for thoracic outlet syndrome, what do we do
EMG/nerve conduction study to test for carpal tunnel
Common Fibular n. (Peroneal n.) nerve root
L4-S2
Deep fibular n. nerve root
L4-S2
Posterior tibial n. nerve root
L4-S2
Lateral Femoral Cutaneous n. nerve root
L2-3
L1,L2
- Motor
- Sensation
- Rrflex
- Motor: Hip flexion
- Sensation: Inguinal crease (L1), anterior thigh (L2)
L2-3
- Motor
- Sensation
- Rrflex
L2-3
-
Motor:
- Knee extension
-
Sensation:
- Anterior thigh (L2), anterior thigh just above knee (L3)
- Reflex:
L4
Motor
Sensation
Rrflex
L4
Motor:
- Dorsiflex ankle
Sensation
- Medial leg and foot
Rrflex
- Knee jerk (patella)
L5
Motor
Sensation
Rrflex
Motor: Extensor hallucislongus
Sensation: Lateral leg, dorsum of foot
Rrflex
S1
- Motor
- Sensation
- Rrflex
S1
Motor: plantarflex ankle
Sensation:
- lateral foot
- plantar foot
Rrflex
- Ankle jerk (achilles)
Treat common fibular N compression
- Posterior fibular head HVLA or ME
- ME on gastroc/soleus, biceps femoris
Treat Anterior tarsel tunnel sundrome
- Remove compressive forces
- Myofascial release of extensor retinaculum
- Traction tug of talonavicularjoint
- Hiss whip for navicular, cuneiforms, 1stand 2ndmetatarsal
3rd most common compression neuropathy
- Common Fibular Nerve Compression => Foot Drop
Median Nerve
- pronator syndrome (who)
- anterior interosseous syndrome (who)
- carpal tunnel syndrome (who)
- pronator syndrome (weight lifter)
- anterior interosseous syndrome (post-cast pressure)
- carpal tunnel syndrome (gymnasts)
*
- OK Sign: (+) test => ______
- Froment’s Sign: (+) test => ________
- Hoffman’s Sign: (+) test => _________
- Median nerve entrapment
- Ulnar N. entrapment
- CNS problem
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%
- Chronic back pain
- Muscle pain/spasms
- Stiffness; menaing ligament is lax and weak joint
What type of OMT would you perform in a pt with spinal disc disease?
BLT/Counterstrain,
Sxs in pts with weak back ligaments
Pain radiates down leg; predisposes to more injury; OA accelerates and + stress to other joints
- 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?
- Have pt point with 1 finger where pain is *points to right SI joint*
- 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
term used to describe pinching of the nerve roots as they exit the spinal cord or cross intervertebral disc
Radiculopathy
compression of the spinal cord itself
Myelopathy
result of damage to peripheral nerves, often causes weakness, numbness and pain, usually in hands and feet
Neuropathy
pain that starts in the lower back that is felt along the distribution of the sciatic nerve in the LE
Sciatica (a symptom)
Cause of sciatica
Sx?
- 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
-
Pain when getting up from sitting, esp if legs cross
