Exam 4 Flashcards
What is paresthesia?
The sensation of numbness, prickling, or tinglng experienced in central and peripheral nerve lesions
What are the potential causes of paresthesias?
anatomical or mechanical peripheral nerve injuries; more common to occur at sites that undergo increased pressure or mechanical forces (wrist)
What is the difference between paresthesia and paresis?
Paresthesia- change in sensation
Paresis- change in movement
Where is the associated location of paresthesia for a patient with cervical injury?
arms and hands
Where is the associated location of paresthesia for a patient with a lumbar injury?
buttocks, legs, and feet
Spurling’s sign
radicular pain reproduced when the examiner exerts downward pressure on the vertex while tilting the head toward the symptomatic side
Differentiate between acute and chronic back pain- how will presentations differ?
Acute- presents with localized discomfort that occurs after mechanical stress; may have trouble standing erect; pain may radiate to buttox and thigh
Chronic- hallmark symptom is radiation to one or both buttocks, pain aggravated by activity
What is the straight leg test?
With the patient supine and relaxed, elevate the leg until it begins to bend or the patient reports severe pain in buttock or back; considered positive when the pain is elicited below the level of the knee when the leg is raised less than 60 degrees; would be positive if herniated disc
S&S of epicondylitis
S: stiffness at the elbow, especially at night; difficulty extending the arm in the morning; pain that is worse with gripping or shaking hands
O: inability to fully extend arm at elbow
Describe the Phalen’s test
Test for carpal tunnel: Patient engages in full flexion of wrists by placing back of hands touching in front of them; positive if tingling sensation of the median nerve
Describe Tinel’s sign
Test for carpal tunnel: Examiner taps anterior wrist briskly; positive if this illicits pins and needles sensation of the median nerve over the hand
Describe Finkelstein’s test
Test for De Quervain’s tenosynovitis: patient should flex thumb toward the palm and make a fist (holding thumb under fingers) and deviate wrist towards the ulna; positive if pain on the wrist on the thumb side
Describe McMurray’s test
Test for medial meniscus injury: positive if there is a click sound upon manipulation of the knee
What is the standard diagnostic test for osteoporosis?
Dual energy x-ray absorptiometry (DXA)
Treatment/Management for osteoporosis
Non-pharm: gait training, activity, eliminate hazards in home, prevent fractures
Pharm: Calcium & Vitamin D, estrogen, biphosphonates, testosterone supplements, fluoride
Hormone replacement with estrogen for osteoporosis causes increased risk for what?
breast CA, CAD, stroke, DVT
What is the most common entrapment neuropathy?
carpal tunnel syndrome
What is the clinical presentation for carpal tunnel syndrome?
S: aching sensation that radiates to thenar area; pain at night and in the morning with numbness/paresthesia at thumb & 4th metatarsal, frequently drops objects and can’t open jars
O: Possible swelling, redness, nodules, deformity, muscle atrophy; tests are Allen’s sign, PHalen’s maneuver, Tinel’s sign
Management for carpal tunnel syndrome
Non-Pharm: prevent flection/extension by using a splint
Pharm: NSAIDs, corticosteroid injections, Vitamin B6
What are the red flags when assessing a patient with low back pain?
Hx of trauma, fever, incontinence, unexplained weight loss, a cancer history, long term steroids, parenteral drug use, intense localized pain and an inability to get into a comfortable position
What are the special tests for assessing lower back pain?
-Straight-leg raise: places the L5 & S1 nerve roots and the sciatic nerve under tension
-Reverse straight-leg raise: Places the L1-L4 nerve roots under tension
-Prone rectus femoris test: places the L1-L4 nerve roots under tension
Treatment for low back pain (non-radiating)
Non-pharm: exercise, CBT, electromyography, Tai chi/yoga, relaxation, heat, massage, acupuncture, spinal manipulations
Pharm: NSAIDs, tylenol, muscle relaxers
Clinical presentation of Cauda Equina Syndrome
S: acute or insidious onset, pain in both legs that may be more severe in one, numbness in lower extremities, difficulty voiding, loss of bowel/bladder control
O: Stumbling gait, quadricep or hip extensor weakness, difficulty rising from chair, unable to walk on heels or toes, bilateral footdrop
Why is it so important to recognize cauda Equina?
Because it is a medical emergency and the patient would need an immediate surgical nerve decompression to prevent further injury