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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
**_Anterior Interosseous Syndrome_** Etiology
* Trauma, **cast pressure** * Bulky tendinous origin of ulnar head of pronator teres
26
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
27
**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
28
**Ulnar nerve** sites of entrapment
1. **Cubital Tunnel** 2. **Guyon’s Canal**
29
**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
30
**Ulnar Nerve:** Most common compression seen in the \_\_\_\_\_
**elbow**
31
Compression at the **cubital tunnel** formed by:
1. Medial epicondyle 2. Medial trochlea 3. Olecranon 4. Ulnar collateral ligament
32
**Ulnar Nerve** Etiology
1. **Baseball pitchers** 2. Prolonged elbow flexion (during sleep) 3. External compression against a hard surface 4. Thickened cubital tunnel retinaculum
33
what do we do if we suspect **thoracic outlet syndrome**
cervical spine XR, chest XR
34
if **cervical spine XR/CXR** is (-) for **thoracic outlet syndrome,** what do we do
EMG/nerve conduction study to **test for carpal tunnel**
35
**Common Fibular n. (Peroneal n.)** nerve root
**L4-S2**
36
**Deep fibular n.** nerve root
**L4-S2**
37
Posterior tibial n. nerve root
**L4-S2**
38
**Lateral Femoral Cutaneous n.** nerve root
**L2-3**
39
**L1,L2** * Motor * Sensation * Rrflex
* **Motor:** Hip flexion * **Sensation**: Inguinal crease (L1), anterior thigh (L2)
40
**L2-3** * Motor * Sensation * Rrflex
**_L2-3_** * **Motor:** * **​**Knee extension * **Sensation**: * Anterior thigh (L2), anterior thigh just above knee (L3) * **Reflex**:
41
L4 ## Footnote Motor Sensation Rrflex
L4 Motor: * Dorsiflex ankle Sensation * Medial leg and foot Rrflex * Knee jerk (patella)
42
**_L5_** Motor Sensation Rrflex
**Motor**: Extensor hallucislongus **Sensation**: Lateral leg, dorsum of foot Rrflex
43
**S1** * Motor * Sensation * Rrflex
S1 Motor: plantarflex ankle Sensation: * lateral foot * plantar foot Rrflex * Ankle jerk (achilles)
44
Treat **common fibular N compression**
1. **Posterior fibular head** HVLA or ME 2. **ME** on gastroc/soleus, biceps femoris
45
Treat **Anterior tarsel tunnel sundrome**
1. Remove compressive forces 2. Myofascial release of extensor retinaculum 3. Traction tug of talonavicularjoint 4. Hiss whip for navicular, cuneiforms, 1stand 2ndmetatarsal
46
3rd most common compression neuropathy
* **Common Fibular Nerve Compression** =\> Foot Drop
47
**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**) *
48
1. OK Sign: (+) test =\> \_\_\_\_\_\_ 2. Froment’s Sign: (+) test =\> \_\_\_\_\_\_\_\_ 3. Hoffman’s Sign: (+) test =\> \_\_\_\_\_\_\_\_\_
1. Median nerve entrapment 2. Ulnar N. entrapment 3. CNS problem
49
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%**
1. Chronic back pain 2. Muscle pain/spasms 3. Stiffness; menaing ligament is lax and weak joint
50
What type of OMT would you perform in a pt with spinal disc disease?
BLT/Counterstrain,
51
Sxs in pts with weak back ligaments
Pain radiates down leg; predisposes to more injury; OA accelerates and + stress to other joints
52
* 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?
* 1. Have pt point with 1 finger where pain is \*points to right SI joint\* * 2. 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
term used to describe pinching of the nerve roots as they exit the spinal cord or cross intervertebral disc
Radiculopathy
54
compression of the spinal cord itself
**Myelopathy**
55
result of damage to peripheral nerves, often causes weakness, numbness and pain, usually in hands and feet
**Neuropathy**
56
pain that starts in the lower back that is felt along the distribution of the sciatic nerve in the LE
**Sciatica (a symptom)**
57
Cause of **sciatica** ## Footnote **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
58

OS 3 Midterm (18 decks)

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