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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
Q

How do you DX pronator syndrome?

A

pain w/ resisted forearm pronation

may have sensory abnormality in radial three & 1/2 digits

26
Q

What is anterior interosseous syndrome?

A

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
Q

How do you DX ant interosseous syndrome?

A

no sensory sxs

DX w/ OK sign (pt is unable to hold & resist tip to tip of thumb to index piinch)

28
Q

What is carpal tunnel syndrome?

A

MOST COMMON COMPRESSION SYNDROME

compression of median N as passes w/ flexor tendons under flexor retinaculum

29
Q

How do you DX carpal tunnel syndrome?

A

night numbness of lateral 3 1/2 digits, tingling, wrist drop

common in repetitive motion jobs

DX w/ gold-standard EMG

30
Q

What special tests are done to assess for carpal tunnel syndrome?

A

Phalen’s sign (flex hands to 90) & Tinel’s sign (tap over flexor retinaculum)

31
Q

What nerve is affected in carpal tunnel syndrome?

A

Median Nerve

32
Q

What are the 2 sites of ulnar nerve entrapment?

A 
Cubital Tunnel (elbow)
Guyon's canal
33
Q

What does the ulnar nerve supply?

A

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
Q

What is cubital tunnel syndrome?

A

most common compression seen in elbow

common in baseball pitchers, prolonged elbow flexion, external compression against hard surface, thickened cubital tunnel retinaculum

35
Q

What are sx/dx of ulnar nerve entrapment?

A

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
Q

What is Froment’s sign and what is it used for?

A

pt must flex thumb in order to pinch paper btwn 1st & 2nd digits

dx of cubital tunnel syndrome

37
Q

What is thoracic outlet syndrome?

A

compression of brachial plexus or subclavian vessels

38
Q

What are the sites of compression for TOS?

A

scalene triangle
costoclavicular passage
@ pectoralis minor attachment @ coracoid process

39
Q

What are the sxs of TOS?

A

weakness, paresthesia of medial arm & forearm & arm which exacerbated by overhead activities

40
Q

What tests are used for dx of TOS?

A

EAST test/Roos test
Wrigth’s HyperABduction Test
Adson’s test
Military/Costoclavicular maneuver

41
Q

L1, L2 nerve root

A

motor for hip flexion

sensation to inguinal crease (L1) & ant thigh (L2)

42
Q

L2, L3 nerve root

A

motor for knee extension

sensation to ant thigh (L2), ant thigh above knee (L3)

43
Q

L4 nerve root

A

motor for ankle dorsiflexion
sensation to medial leg & foot
patellar reflex

44
Q

L5 nerve root

A

motor for extensor hallicus longus

sensation to lateral leg, dorsum of foot

45
Q

S1 nerve root

A

motor for ankle plantarflexion
sensation to lateral foot & plantar foot
Achilles reflex

46
Q

What is meralgia paresthetica?

A

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
Q

What test is + in meralgia paresthetica?

A

+ TInel’s sign 1cm medial & inferiot to ASIS

48
Q

What is common fibular nerve compression?

A

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
Q

What are sxs & tx of common fibular nerve compression?

A

FOOT drop w/ slapping gait, worsens w/ plantarflexion & inversion of foot

tx w/ posterior fibular head HVLA or MET

50
Q

What is anterior tarsal tunnel syndrome?

A

compression of deep fibular nerve @ inferior extensor retinaculum (thickened fascia affects dorsum of foot)

seen w/ prolonged plantar flexion & trauma (soccer player)

51
Q

What are sxs of anterior tarsal tunnel syndrome?

A

pain over dorsomedial aspect of foot, worse @ rest

weakness of extensor digitorum brevis

52
Q

What is tarsal tunnel syndrome?

A

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
Q

What are sxs of tarsal tunnel syndrome?

A

pain on plantar surface of foot, vague burning & tingling, does NOT usually affect gait

54
Q

What is spinal disc disease?

A

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
Q

What is the outcome of spinal disc dz?

A

weak back ligaments w/ radiating pain down legs

pt may change biomechanics & accelerate osteoarthritis & stress on other joints

56
Q

What is sciatica?

A

pain emerging from lower back felt along distribution of sciatic nerve in LE

a SYMPTOM (not a cause)

57
Q

What are the sxs/manifestations of sciatica?

A

pt may experience pain on walking but long periods of sitting also worsen pain

pain when get up from seated position

58
Q

What is an important complication or outcome of sciatica?

A

tight hamstrings leads to posterior pelvic tilt & flattening of lumbar curve

increased laxity of ACL & increased tension on PCL

59
Q

How do you tx pt w/ sciatica sxs?

A

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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