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OS III Fall 2020 > DSA Compression Neuropathies > Flashcards

DSA Compression Neuropathies Flashcards

1
Q

What is neuropathy?

A

functional or pathological changes in peripheral nervous system

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2
Q

What is compression neuropathy?

A

process where a NERVE becomes entrapped as it passes thru a narrow tunnel or passage

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3
Q

Bio-mechanical causes of compression neuropathy

A

space occupying lesions
degenerative causes
post-trauma
mechanical (muscle spasm or pinching)

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4
Q

Systemic causes of compression neuropathy

A

pregnancy
hypothyroidism
diabetes

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5
Q

What pathological changes affect nerves?

A 
microvascular compression (ischemia)
thickened epineurium
myelin thinning distortion
microtubule closure
axonal degneration
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6
Q

What is the first degree category of nerve injuries?

A

Neuropraxia (focal damage of myelin fibers around axon w/ CT sheath intact)

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7
Q

What is second degree category of nerve injuries?

A

Axonotmesis (some disruption/injury to axon itself w/ myelin sheath intact)

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8
Q

What is the 3rd-5th degree category of nerve injuries?

A

Nerotmesis (requires surgical intervention to fix 5th degree disruption of axon thru epineurium)

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9
Q

C5 nerve root

A

motor to deltoid, biceps

sensation to lateral arm

biceps reflex

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10
Q

C6 nerve root

A

wrist extension, elbow flexion

sensation to radial forearm, thumb & index finger

brachioradialis reflex

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11
Q

C7 nerve root

A

wrist flexion, elbow extension, finger extension

sensation to middle finger

triceps reflex

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12
Q

C8 nerve root

A

finger flexion

sensation to ulnar forearm & small finger

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13
Q

T1 nerve root

A

finger abduction

sensation to medial arm

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14
Q

When does cervical nerve root compression occur?

A

usually caused secondary to cervical disc dz

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15
Q

How does cervical nerve root compression occur?

What does it cause?

A

disc ruptures posterior-laterally causing compression of nerve root as it exits the intervertebral foramen

causes radiculopathy (pain caused by compression of spinal nerve that radiates in distribution of defined nerve root)

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16
Q

What is the Spurling test?

A

+ is pain elicited by extending & rotating neck TOWARD symptomatic side

DX cervical radiculopathy (herniated disc)

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17
Q

What is the Adson test?

A

+ is obliteration of radial pulse on affected side when have pt elevate chin & rotate head toward affect side while inhale

DX thoracic outlet syndrome

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18
Q

What is the Hoffmann test?

A

+ is quick flexion of thumb & index finger when grabbing middle finger (dorsal side)

DX cervical myelopathy (cervical spinal stenosis)

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19
Q

What are the general tx options for cervical neuropathy?

A

conservative measures (change activity, use anti-inflammatory, splinting, PT & OMM for 3-6months)

surgical release if non-operative management fails

*will most likely need operative decompression for cubital tunnel syndrome

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20
Q

Radial nerve

A

motor to triceps brachii, anconeus & wrist extensors

sensation to majority of dorsum of hand (via posterior interosseous n)

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21
Q

What are the 3 sites for radial nerve entrapment?

A

high on humerus (secondary to fracture)
radial tunnel (repetitive rotatory movements)
@ the wrist (superficial branch w/ pronation)

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22
Q

What is cheiralgia paresthetica/handcuff neuropathy?

A

numbness, tingling, burning, or pain in SRN distribution

caused by compression, edema, surgical injury

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23
Q

What are the 4 sites for median nerve entrapment?

A

ligament of struthers
pronator syndrome
anterior osseous syndrome
carpal tunnel syndrome

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24
Q

What is pronator syndrome?

A

occurs as median nerve passes btwn superficial & deep heads of pronator teres muscle

usually w/ repetitive pronating motions, achy pain in mid & proximal forearm that worsens w/ repeated lifting

25
How do you DX pronator syndrome?
pain w/ resisted forearm pronation may have sensory abnormality in radial three & 1/2 digits
26
What is anterior interosseous syndrome?
deep motor branch of median N distal to pronator teres due to trauma & cast pressure, bulky tendinous origin of ulnar head of pronator teres, soft tissue masses, fibrous bands
27
How do you DX ant interosseous syndrome?
no sensory sxs DX w/ OK sign (pt is unable to hold & resist tip to tip of thumb to index piinch)
28
What is carpal tunnel syndrome?
MOST COMMON COMPRESSION SYNDROME compression of median N as passes w/ flexor tendons under flexor retinaculum
29
How do you DX carpal tunnel syndrome?
night numbness of lateral 3 1/2 digits, tingling, wrist drop common in repetitive motion jobs DX w/ gold-standard EMG
30
What special tests are done to assess for carpal tunnel syndrome?
Phalen's sign (flex hands to 90) & Tinel's sign (tap over flexor retinaculum)
31
What nerve is affected in carpal tunnel syndrome?
Median Nerve
32
What are the 2 sites of ulnar nerve entrapment?
``` Cubital Tunnel (elbow) Guyon's canal ```
33
What does the ulnar nerve supply?
motor to skin & muscles of ulnar side of forearm & hand flexors deep branch (to interosseous muscles & adductor pollicis) superficial branch (sensory innervation to ring & pinky finger)
34
What is cubital tunnel syndrome?
most common compression seen in elbow common in baseball pitchers, prolonged elbow flexion, external compression against hard surface, thickened cubital tunnel retinaculum
35
What are sx/dx of ulnar nerve entrapment?
sxs of paresthesia to 4th & 5th digits, medial elbow pain radiating to hand w/ decreased intrinsic muscle strength (can't turn key in door) + Tinel's sign at elbow sxs reproduced w/ elbow flexion & wrist extension
36
What is Froment's sign and what is it used for?
pt must flex thumb in order to pinch paper btwn 1st & 2nd digits dx of cubital tunnel syndrome
37
What is thoracic outlet syndrome?
compression of brachial plexus or subclavian vessels
38
What are the sites of compression for TOS?
scalene triangle costoclavicular passage @ pectoralis minor attachment @ coracoid process
39
What are the sxs of TOS?
weakness, paresthesia of medial arm & forearm & arm which exacerbated by overhead activities
40
What tests are used for dx of TOS?
EAST test/Roos test Wrigth's HyperABduction Test Adson's test Military/Costoclavicular maneuver
41
L1, L2 nerve root
motor for hip flexion | sensation to inguinal crease (L1) & ant thigh (L2)
42
L2, L3 nerve root
motor for knee extension | sensation to ant thigh (L2), ant thigh above knee (L3)
43
L4 nerve root
motor for ankle dorsiflexion sensation to medial leg & foot patellar reflex
44
L5 nerve root
motor for extensor hallicus longus | sensation to lateral leg, dorsum of foot
45
S1 nerve root
motor for ankle plantarflexion sensation to lateral foot & plantar foot Achilles reflex
46
What is meralgia paresthetica?
compression of lateral femoral cutaneous nerve (L2, L3) under inguinal ligament @ inguinal canal due to obesity, tight clothing, intense athletics sxs include numbness or pain on anterolateral thigh, hyperesthesia (don't put things in pockets)
47
What test is + in meralgia paresthetica?
+ TInel's sign 1cm medial & inferiot to ASIS
48
What is common fibular nerve compression?
compression as nerve winds around fibular neck & enters fibular tunnel that affects L4-S2 dermatomes occurs if leg hooked over rail, squatting, ankle sprain or trauma to fibular head
49
What are sxs & tx of common fibular nerve compression?
FOOT drop w/ slapping gait, worsens w/ plantarflexion & inversion of foot tx w/ posterior fibular head HVLA or MET
50
What is anterior tarsal tunnel syndrome?
compression of deep fibular nerve @ inferior extensor retinaculum (thickened fascia affects dorsum of foot) seen w/ prolonged plantar flexion & trauma (soccer player)
51
What are sxs of anterior tarsal tunnel syndrome?
pain over dorsomedial aspect of foot, worse @ rest weakness of extensor digitorum brevis
52
What is tarsal tunnel syndrome?
compression of posterior tibial nerve in tarsal tunnel behind medial malleolus w/ overlying flexor retinaculum often idiopathic, seen w/ space occupying lesion, trauma, autoimmune or lifestyle
53
What are sxs of tarsal tunnel syndrome?
pain on plantar surface of foot, vague burning & tingling, does NOT usually affect gait
54
What is spinal disc disease?
initial herniation that is extremely painful acutely disc slowly shrivels away so resolves in 2-6 weeks usually affects middle aged to elderly pts
55
What is the outcome of spinal disc dz?
weak back ligaments w/ radiating pain down legs pt may change biomechanics & accelerate osteoarthritis & stress on other joints
56
What is sciatica?
pain emerging from lower back felt along distribution of sciatic nerve in LE a SYMPTOM (not a cause)
57
What are the sxs/manifestations of sciatica?
pt may experience pain on walking but long periods of sitting also worsen pain pain when get up from seated position
58
What is an important complication or outcome of sciatica?
tight hamstrings leads to posterior pelvic tilt & flattening of lumbar curve increased laxity of ACL & increased tension on PCL
59
How do you tx pt w/ sciatica sxs?
must release adductors first (b/c tight adductor magnus will cause limitation of full hamstring lengthening) must treat hamstring trigger points tx posterior pelvic tilt

OS III Fall 2020 (7 decks)

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