Extremity Compression Neuropathy Flashcards
This category of nerve injury is an injury to the axon itself. Regeneration is possible, but prolonged (months) without full recovery
Axonotmesis (second degree)
This category of nerve injury is a complete disruption of the axon with little likelihood of recovery
Neurotmesis
In cervical nerve root compression (usually caused secondary to cervical disruption (i.e., disc bulging or herniation), the disc most commonly ruptures in which direction?
Posterior-laterally causing compression of the nerve root as it exits the intervertebral foramen
This causes radiculopathy in the distribution of the nerve root
List motor and sensory for the following cervical nerve roots:
C5- C6- C7- C8- T1-
C5-Motor=deltoid, biceps; Sensory=Lateral arm
C6-Motor=wrist extension, elbow flexion; Sensory=radial forearm, thumb and index finger
C7-Motor=Wrist flexion, elbow extension, finger extension; Sensory=Middle finger
C8-Motor=Finger flexion; Sensory=Ulnar forearm, small finger
T1-Motor=Finger abduction; Sensory=Medial arm
What is the innervation pattern (motor and sensory) for the radial n.?
Motor to triceps brachii, anconeous, and wrist extensors
Sensory to majority of dorsum of hand (via posterior interosseous n.)
Describe what can cause a radial n. Entrapment High on the Humerus and the symptoms:
Usually secondary to a Humerus fracture or compression of nerve near spiral groove.
Symptoms: wrist drop, weakness of elbow flexion (Brachioradialis m.), possible tricep involvement, +/- triceps reflex diminished, pain/numbness
Describe causes and symptoms of radial tunnel syndrome d/t radial n entrapment:
Compression of posterior interosseous branch of radial n. as it passes under the supinator m. at the arcade of frohse (a purely motor branch); Can also have “Supinator syndrome” d/t repetitive rotatory movements such as rowing, discus, racquet sports and heavy manual labor
Symptoms: pain and tenderness 5 cm distal to lateral epicondyle. Wrist drop or pain with resisted supination
What are causes and symptoms associated with Pronator Syndrome d/t median nerve entrapment?
Occurs as median n. passes between superficial and deep heads of pronator teres m. Seen with repetitive pronating motion such as pianists, fiddlers, baseball players, dentists
Symptoms: achy pain in the mid/proximal forearm aggravated by repeated lifting. May have sensory abnormality in the radial 3 and a half digits
What are causes and symptoms of anterior interosseous syndrome d/t median n. entrapment?
Etiology is trauma, cast pressure; bulky tendinous origin of ulnar head of pronator teres; soft tissue masses; fibrous bands
No sensory symptoms
Have the pt do the “Ok” sign
What are etiologies and symtpoms of carpal tunnel syndrome d/t median n entrapment?
Common in repetitive motion jobs (wrist flexion) and in pregnancy
Symptoms: nighttime numbness of lateral 3 1/2 digits, tingling, wrist pain, dropping things, thenar atrophy
Do Phalens sign, Tinels sign, 2-pt discrimination
What are etiologies and symptoms of cubical tunnel syndrome d/t ulnar n entrapment?
Most common compression seen in elbow. Seen in baseball pitchers, prolonged elbow flexion (during sleep), external compression against a hard surface, thickened cubical tunnel retinaculum
Symptoms: parasthesia to 4th and 5th digits. Medial elbow pain radiating to the hand with decreased intrinsic muscle strength (can’t turn a key in a door)
Do Tinels sign at elbow, Froments sign
What are sites of compression and symptoms of thoracic outlet syndrome?
Scalene triangle, costoclavicular passage, at pec minor attachments at Coracoid process
Symptoms: weakness, paresthesia of medial arm, forearm and hand exacerbated by overhead activities
Do EAST test, wrights hyperabduction, military/costoclavicular test, Adsons
List the motor and sensory components of the following:
L1, L2-
L2, L3-
L4-
L5-
S1-
L1, L2-Motor=hip flexion; Sensory=Inguinal crease (L1), anterior thigh (L2)
L2, L3-Motor=Knee ext; Sensory=anterior thigh (L2), anterior thigh just above knee (L3)
L4-Motor=ankle dorsiflexion; Sensory=medial leg and foot
L5-Motor=Ext hallucis longus; Sensory=lateral leg, foot dorsum
S1-Motor=ankle plantarflexion; Sensory=Lateral foot, plantar foot
What are some etiologies and symptoms of Common fibular n. compression?
3rd most common compression neuropathy
Etiology-Leg hooked over a rail, i.e., bedridden, comatose, post-op; “Strawberry pickers palsy” time spent in squatting position; ankle sprains or trauma to fibular head; new meditators (d/t lotus position); lithotomy position during childbirth; idiopathic
Symptoms: pain along proximal 1/3 of lateral leg; Foot drop with slapping gait; Symptoms exacerbated during plantar flexion and inversion of the foot
Tx with posterior fibular head HVLA or ME; ME on gastroc/soleus, biceps femoris
Describe etiologies and symptoms of anterior tarsal tunnel syndrome d/t deep fibular n. compression
Deep fibular n compression at inferior extensor retinaculum
Etiology: trauma (recurrent ankle sprains, soccer players), Talonavicular dysfunction, prolonged plantar flexion, compression from shoes
Symptoms: pain over dorsomedial aspect of foot and worse at rest; weakness of ext digitorum brevis
Tx with MFR of ext retinaculum, traction tug of talonavicular joint, hiss whip
