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OS 3, Exam 2 > Extremity Compression Neuropathy Lecture/Lab/OSCE - Kelsey > Flashcards

Extremity Compression Neuropathy Lecture/Lab/OSCE - Kelsey Flashcards

1
Q

What is a compression neuropathy?

A

Nerve becomes entrapped as it passes through a narrow tunnel or passage.

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2
Q

Five pathological changes that occur with neuropathy.

A

1) Microvascular compression&raquo_space; ischemia
2) Thickened epineurium
3) Myelin thinning distortion
4) Microtubule closure
5) Axonal degeneration

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3
Q

Five etiologies of nerve entrapment.

A

1) Increased muscle mass by repetitive activity
2) Space occupying lesions (cysts/tumors)
3) Inflammation of surrounding tissues (=nerve anoxia)
4) Post traumatic conditions (hematoma, fx, compression)
5) Systemic - pregnancy, hypothyroid, diabetes

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4
Q

What are the three categories of nerve injury, least to most severe?

A

1) Neurapraxia
2) Axonotmesis
3) Neurotmesis

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5
Q

What is neurapraxia nerve injury?

A
  • Least severe
  • Focal damage to myelin fibers around axon, but CT sheath of axon remains intact
  • Limited course
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6
Q

What is axonotmesis nerve injury?

A
  • Injury to axon itself

- Regeneration possible, but months without full recovery

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7
Q

What is neurotmesis nerve injury?

A
  • Complete disruption of axon with little likelihood of recovery.
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8
Q

Tx options for compression neuropathy.

A

1) Conservative
- modification of activity, antiinflammatories, injections, splinting.
- Multidisciplinary - PT, OMM, pain mgmt
2) Surgery after 3-6 months if nonoperative mgmt fails

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9
Q

What is cervical nerve root compression caused by and what is it?

A

It is caused secondarily to cervical disc disease (disc bulging or HERNIATION).
When a disc ruptures posterior-laterally, it compresses the nerve root.

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10
Q

What is radiculopathy?

A

Compression of spinal nerve radiates in the distribution of the defined nerve root.

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11
Q

How do you test for cervical nerve root compression?

A

Spurlings

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12
Q

Central nerve root sensation, motor, and reflex dermatomes (C4-T1).

A

C4 - Superior shoulder
C5 - Lateral arm over deltoid. Motor: deltoid and biceps. Reflex: biceps
C6 - Radial forearm and thumb/index finger. Motor: wrist E and elbow F. Reflex: brachioradialis
C7 - middle finger. Motor: wrist F elbow E finger E. Reflex: triceps
C8 - Ulnar forearm and pinky finger. Motor: finger F
T1 - Medial arm. Motor: finger aBDuction

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13
Q

What are the three peripheral nerves at risk?

A

Radial nerve, median nerve, ulnar nerve

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14
Q

Two main sites of radial nerve entrapment.

A
  • High on the humerus

- Radial tunnel (at elbow level)

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15
Q

What is the normal radial nerve (C5-C8) function?

A
  • motor to WRIST EXTENSORS, triceps, and aconeus

- sensation to dorsum of hand

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16
Q

A person has a humerus fracture and consequential:
- wrist drop
- weakness of elbow F
- diminished triceps rflex
- pain/numbness
What nerve is entrapped? And how do you tx

A
  • Radial nerve entrapment high on humerus secondary to humerus fx or compression of nerve near spiral groove.
  • Tx - Function normally returns within 4-5 months
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17
Q

What is the main location of compression of radial nerve?

A

compression of posterior interosseus branch of the radial nerve as it passes UNDER THE SUPINATOR MUSCLE at the Arcade of Frohse.

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18
Q

Pain and tenderness 5cm distal to lateral epicondyle. This person does repetitive motions (rowing/discus/raquet sports/heavy labor).

  • What does this person have?
  • How do you dx this?
A
  • Supinator Syndrome, compression as it passes under the supinator muscle.
  • To dx, wrist drop or pain with resisted supination.
19
Q

What are the three sites (syndromes) of median nerve entrapment?

A

1) Pronator syndrome
2) Anterior interosseus syndrome
3) Carpal tunnel syndrome

20
Q

Normal functions of the median nerve.

A
  • Forearm flexion and pronation
  • Wrist flexion and radial deviation
  • Thumb abduction and opposition
  • Index and middle finger abduction and flexion
21
Q

Achy pain in the mid/proximal forearm, aggravated by repetitive lifting. Possible sensory abnormality in radial 3.5 digits. This person does repetitive motions - pianists, fiddlers, baseball players, dentists, weight trainers

  • What does this person have and what nerve is affected?
  • How do you dx this?
A
  • Pronator Syndrome, median nerve entrapment as it passes between superficial/deep heads of pronator teres muscle.
  • Dx by pain with resisted forearm pronation
22
Q

Which median nerve syndrome has no sensory symptoms?

A

Anterior Interosseus syndrome

23
Q

What is the etiology of the Anterior Interosseous Syndrome? How do you dx? What is the tx?

A
  • Trauma, bulky TENDINOUS origin of ulnar head or pronator teres.
  • Dx is the “ok” sign (weak index’s DIP and thumb’s IP)
  • Tx is to splint elbow in 90degrees of flexion for up to 12 weeks.
24
Q

***What is the most common compression syndrome?

A

Carpal Tunnel Syndrome

- Compression of nerve as it passes under flexor retinaculus.

25
Q

Nighttime numbness of lateral 3.5 digits, tingling, wrist pain, dropping things, thenar atrophy. Repetitive motions (wrist flexion) and pregnancy.
What is this and how do you dx?

A

CARPAL TUNNEL SYNDROME

Diagnose with EMG (gold standard), phalen’s, tinel’s, 2-pt discrimination.

26
Q

Tx of carpal tunnel syndrome

A
  • Rest
  • Wrist splint 30 degrees on hand extension
  • NSAIDs
  • Steroid injections
  • Surgical release
27
Q

Main site of ulnar nerve entrapment.

A

Cubital tunnel (syndrome)

28
Q

Fx of ulnar nerve.

A
  • Innervation of skin and muscles of ulnar side of forearm and hand flexors.
  • Deep branch in hand and superficial branch.
29
Q

What forms the compression at the cubital tunnel?

Etiology

A

Medial epicondyle, medial trochlea, olecranon, ulnar collateral ligament.
- Baseball pitchers, prologned elbow flexion (sleep), external compression against hard surface, thickened cubital tunnel retinaculum.

30
Q

Can’t turn a key in the door - what is this?
Parasthesis to 4th/5th digits, medial elbow pain radiating to hand with decreased intrinsic muscle strength.
Tx for this.

A

Cubital tunnel syndrome

31
Q

Test and tx for cubital tunnel syndrome.

A

Dx by Froment’s sign (pinch paper - FPL and ADP muscles).

Tx padded elbow sleeve to limit terminal elbow flexion

32
Q

What is thoracic outlet syndrome. What are the 3 possible zones?

A

Compression of brachial plexus and or subclavian vessels.

@ 1) scalene triangle, 2) costoclavicular passage, 3) pectoralis minor attachment at the coracoid process.

33
Q

S/s of thoracic outlet syndrome.

Dx

A
  • Hurts to do anything over their head.
  • Weakness, paresthesia of medial arm, forearm, and hand exacerbated by overhead activities.
    Dx: EAST (Roos), Adson’s, Wright’s hyperabduction test, Military/costoclavicular maneuver.
    • EMG, arterography or venography
34
Q

LE nerve roots - motor and sensation and reflex

A

L1, L2 - Motor: hip F. Sensation: inguinal crease (L1) and anterior thigh (L2)
L2, L3 - Motor: knee E. Sensation: anterior thigh (L2) and anterior thigh just above the knee (L3)
L4 - Motor: ankle dorsiflexion. Sensation: medial leg and foot sensation. Reflex: patellar
L5 - Motor: extensor hallucis longus. SensationL lateral leg and dorsum of foot.
S1 - Motor: ankle plantar flexion. Sensation: lateral foot and plantar of foot. Reflex: achilles.

35
Q

What are the LE nerves at risk?

A
  • Common fibular nerve (L4-S2)
  • Deep fibular nerve (L4-S2)
  • Posterior tibial nerve (L4-S2)
  • Lateral femoral cutaneous nerve (L2, L3)
36
Q

What is this:
Seen in people who are bedridded, comatose, post op, or time spend in squatting position. (3rd most common compression neuropathy)

A

Common fibular nerve compression - compression as nerve winds around fibular neck and enters fibular tunnel

37
Q

Pain along proximal third of lateral leg, FOOT DROP with slapping gait, exacerbated during plantarflexion/inversion of foot.
Dx and Tx

A

Dx is Common fibular nerve compression

Tx is posterior fibular head HVLA or ME, ME of gastroc/soleus, biceps femoris

38
Q

Compression from shoes (heels) or stomach sleeper, think what…
s/s - pain over dorsomedial aspect of foot and worse at rest, weakness of extensor digitorum brevis (toe extension).

A
  • Anterior tarsal tunnel syndrome - deep fibular nerve compression at the inferior extensor retinaculum.
39
Q

Tx of - Anterior tarsal tunnel syndrome

A

remove compressive forces, MFR of extensor retinaculum, traciton tug of talonavicular joint, hiss whip

40
Q

***What is tarsal tunnel syndrome?

A

Compression of POSTERIOR TIBIAL NERVE in tarsal tunnel behind medial malleolus with OVERLYING FLEXOR RETINACULUM.

41
Q

Pain on plantar surface of foot, vague burning/tingling/numbness.
Dx and tx

A

Dx - tarsal tunnel syndrome

Tx- MFR and HVLA

42
Q

Meralgia paresthetica (only sensory of anterolateral thigh down to knee), think what?

A

Lateral femoral cutaneous nerve.

43
Q

Name the 4 central compression neuropathy special tests.

A

1) Spurlings
2) Compression
3) Distraction
4) Valsalva

44
Q

***What does Fromnet’s sign tests for?

A

Strength of adductor pollicis, which is weak with ulnar nerve palsy

OS 3, Exam 2 (10 decks)

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