final Flashcards
4 causes of peripheral nerve lesions
1: Compression
2. Trauma
3.systemic disorders
4. Systemic edematous conditions
First Degree classification
compression of a nerve causing local conduction block
Recovery to area occurs as damage is repaired
good progonosis
Neuropraxia
Second degree classification
Prolonged severe compression
degeneration of axon distal to injury
Regnereration can occur, good prognosis
* if lesion is too close to cell body = no regeneration
Aconotmesis
3rd degree classification
severing of the nerve trunk
surgery is type of repair
Neurotmesis
Regeneration of a nerve takes how long?
1-2mm a day
what direction does a nerve grow
Proximal to distal
Edema is present with complete lesion:
present initally, remain until fibers regenerate. the more fibres affected the worse the edema will be
Edema present with partial:
less the nwith complete, muscle function assists with lymphatic return
Altered tissue health with complete and Partial
complete: loss of autonomic function affects hair skin nails, tissue fragile, *loss of piloerection loss of swelling
Partial: increase piloerector over area of denervation
Motor function with complete and partial
Complete: Muscle flaccid
Partial: Muscle weakness, diminished deep tendon reflex
Holding pattern with complete and partial:
Complete: Sciatic nerve lesion = foot drop, drop wrist drop with radial nerve
Partial: finger drop rather than wrist
Contractures with complete and partial:
Complete: Contractures in atagonist mm
Partial: less severe then complete
Pain with Complete and Partial:
Complete: may not be interpreted as painful
Partial: an area of hyperesthesia (increased sensitivity) and dysesthesia ( abnormal sense of touch)
Permanent Lesion symptoms
Edema
holding pattern
scar tissue
Pain-more with partial permenant lesions
compensatory changes
several months before function returns if any
Compression syndromes eg: TOS, Carper tunnel, periformis syndrome
Neuropraxia
Causes of compression
External force ie: Crutches, backpack straps, splints
internal force: Hypertonic mm, trigger points, posture imbalances, saturday night palsy, pregnancy
Symptoms of compression
Pain tingling numbness weakness
the longer the disruption, the longer the recovery time*
Radial Nerve pathway
C5-T1
Radial nerve muscles innervated
Triceps
Aconeus
Brachioradialis
Extgensor carpi radialis longus and brevis
SUPINATOR
Extensor digitorum
Ex Carpi ulnaris
ex digiti minimi
Extenso Pollicis longus and brevis
extensor indicis
Ulnar nerve Pathway
C8-T1
under pec minor
Guyons canal is compression site for ulnar
M
Muscles innervated by ulnar nerve
Plexor carpi ulnaris
flexor digitorum profundus(medial half)
Adductor Pollicis *
Causes of ulnar lesions:
Fractures-Medial condyle
Dislocations
Post surgery complications
pathlogy -leprosy
prolonged compression
repetive action
direct trauma
Symptoms of ulnar nerve lesion
Claw hand
Fromonts sign positive
Median nerve Pathway
M c8-t1 L C5-c7
Between heads of pronator teres
Muscles innervated by median nerve
Pronator teres
Flex Carpi radialis
Thenar muscles - abductor pollicis brevis
palmaris longus
Flex digit profundus
1 and 1 lumbricles
Causes of median nerve lesion
Fracture at elbow
Dislocation - Lunate and scaphoid
duble crush compression
Symptoms of Median nerve lesion
Ape and oath hand
Sciatic Nerve pathway
L4-S1
Passes through greater sciatic foramen and UNDER periformis
Dorsal aspect of the foot
Muscles innervated by sciatic Nerve
Hamstrings & 1/2 adductor magnus-Sciatic
Tibial:
Gastroc Tib Post
Cmmon peroneal:
Tib ant
peroneals
Causes of Sciatic nerve lesion
Crossing your legs
Symptoms of Sciatic nerve lesion:
Foot drop
tibial nerve lesion may lead to claw toe-intrinisc foot mms
anesthesia experienced in dorsal of foot at webspace between toe 1&2
Facial- Bells palsy nerve pathway
CN Vii
Flaccid Paralysis of mm of facial expression
Pg 6 lp 17
A condition that involves the compression of the brachial plexus and artery between:
The middle and anterior scalenes,
coracoid precess and pec minor,
Clavicle and 1st rib :
TOS
Two types of mood disorders:
1.Depression- Major and Dysthymia
2. Bipolar Disorder
Symptoms of depression
depressed mood
Anhedonia (decreased pleasure)
weight loss or gain
insomnia or hypersominia
agitation or slowing down
fatigue
feelins of worthlessness
lack of concentration
thoughts of suicide over 2 weeks
5 or more of these
The earlier amd more frequent of the onset of these symptoms the more likely it is that the person will require medication
True
Major Depressive Disorder symptoms
presistant unpleasant mood
depressed mood, anhedoinia, feelings of worthlessness, guilt, decreased concentration
psychomotor agitation,
insomnia ,
decreased libido
changes in weight
thoughts of death/suicide
Dysthemia Symptoms
Chromic mild depressive disorder
same as above but milider form
Low self esteem*
Classes of depression symptoms
Melancholic- depression worse in morning
Atypical- opposite of melancholic
Psychotic- delusions and hallucinations
Catatonic- excessive mobility, negativism,
repetative speech
Chronic- depression for 2+ years
Postpartum- within 6 weeks of birth
bipolar disease is also called
Manic depression
Clinical manifestations of Bipolar/ manic episodes
decreased need for sleep and food, labile mood, irritability, racing thoughts, highly distracted, inflated self esteem, escessive involvement in pleasurable experiences
how fast does mania develop
within hours or days, or over a few weeks
mania without depression is called
Unipolar and is rare
Anxiety disorders affect what precentage of people and more men or women
28.8%
women more then men
5 categories of anxity disorders
Panic disorder-intense fear, cardiac, respiratory
PTSD-Tramautic event
Generalized anxiety disorder-excessive worry
Soicial phobia-social interaction
OCD-repeat thoughts and actions
is Panic disorder more common in men or women
Women- peak mid adolesence and again in mid 30s
symptoms of a Panic disorder
headaches, dizzy, fainting
cardiac symptoms, chest pain
respiratory symptoms
sweating
nausea or abdominal distension
psycholigical symptoms- fear of dying
does OCD affect men or women more
Both equally
can occur in children
usual 20 years
Social Phobia is also known as
social anxiety disorder
how long must the fear from social phobia be present
6 months
5 types of Dementia
Alzhimers
Vascular dementia
Creutzfeltdt- jakob disease
Wernicke- korsakoff syndrome
Huntingron Chorea
most common type of dementia
Alzhimers 60-80%
Is there a cure for alhzimers?
No
Main clinical feature of Vascular dementia
Slowness in psychomotor function
what type is most common due to alcoholism
Wenmicke- Korsakoff
Is there a cure for huntingtons Disease
No, drugs to help
The consequece of pain Eg: stubbing toe
Nociceptive Pain
Arises from direct injury or dysfunction of the sensory axons of peripheral or central nerves
eg: nerve pain due to MS or phantom limb
No outside stimulus
Neuropathic Pain
Regards pain as Seperate sensory modality evoked by the activity of specific receptors that transmit information to pain centers or regions in the forbrain where pain is experienced
Specificity theory
A modification of specificity theory
eg: repeated sweeping of a soft bristled brush on the skin, over or near a painful area may result in pain reduction for several minutes to several hours
Gate control theory
These neurons and their receptive endings detect stimuli that threaten the integrity of innervated tissues
First order Neurons
these neurons are located in the spinal cord and process nociceptive information
Second order neurons
These neurons project pain information to the brain. The thalamus and somatosensory cortex integrate and modulate pain as well as the persons subjective reaction to the pain experience.
Third Order Neurons
Pain conducted by mylenated A fibers is typically
Fast and sharp
Pain conducted by Unmyelinated C fibers is typically
Slow, dull continously conducted pain
In the spinal cord, the transmission of impulses between the nociceptive neurons and the dorsal horn neurons is mediated by what
Chemical neurotransmitters carry the impulse
Fast conducting fibers travel to the
Thalamus
Conrtalateral
bright sharp or stabbing
Slow conducting fibers
difuse, dull, aching, unpleasant.
chronic and visceral pain
a neuroanatomic pathway that begins in the midbrain is called
PAG region
periaquedductal gray region
The PAG area is often reffered to as
Endogenous analgesia center
Three families of endogenous opiod peptides are?
Enkephalins
endorphins
Dynorphins
The point at which a stimulas is preceived as painful
Pain threshold
Total pain experience
the pain scale
Pain tolerance
is pain tolerance variable?
yes
is threshold pain variable?
no. uniform from one person to another
6 types of pain
-Cutaneous pain- sharp burning on skin and tissues
-Deep somatic pain- more diffuse and throbbing, muscles bones, tendons
-Visceral Pain: diffuse - organs
-Acute Pain: less than 6 months
-Chronic Pain- More than 6 months
-Referred Pain- orginates at visceral, radiates elsewhere
a form of self distraction or cognitive control in which individuals focus their attention on the positive aspects of the experience and away from their pain
Cognitive Reappraisal
___ and ____ are physical agents that provide pain relief
Heat and Cold
when excessive heat is used, the heat itself becomes ___
a noxious stimulus
how does Cold effect pain
Cold may reduce afferant activity reaching the posterior horn of the spinal cord by modulating sensory input.
15-20 minutes at a time
caution to anyone whose circulation is compromised
Aspirin, NSAIDS or acetaminophen
Non-narcotic analgesics
Narcotics, Morphine, codeine etc
Opioid analgesics
tricyclic anti depressants, anti-seizure, corticosteriods
Adjuvant analgesics
Reduced tactile sensation
Hypoesthesia
Lost Tactile sensation
Anesthesia
unpleasant sensation
Paresthesia
Absence of pain
Analgesia
Increased pain
Hyperalgesia
Reduced Pain
Hypoalgesia
Reduced temperature sensation
Hypothermia
Lost temperature Sensation
Athermia
The puzzling phenomenon of pain that follows a non-noxious stimulus to apparently normal skin.
wind touching sheets ect.
Allodynia
Pain that results from pathology of the nervous system ( internal source)
Neuropathic pain
Severe, brief, often repetitive attacks of lightning like or throbbing pain
Neuralgia
one of the most common and severe neuralgias, manifested by facial tics or spasms
trigeminal neuralgia
Herpes Zoster is also called
Shingles, same virus that causes chickenpox
abnormally exaggerated response to pain
Hyperpathia
A rare disorder of the extremeties characterized by autonomic and vasomotor instability
Complex regional pain syndrome ( CRPS)
formally known as Reflex sympathetic dystrophy (RSD)
Two forms of CRPS
CRPS i - RSD
CRPS ii- Causalgia
CRPS ii is diagnosed as
The presence of continuing pain
CRPS i is diagnosed as
The presence of an initiating traumatic event
what age do you number or word graphic pain scale for children
8 and older
a tumor comprised of nerve scales
Neuroma
what is the treatment for someone with a painful neuroma
relaxation to decrease SNS firing, Local massage is Ci’d if painful. AF and AA ROM proximal and distal
4 types of primary headaches
- Migraine
- Tension
- Cluster
- Chronic Daily
Headaches associated with a condition of illness
Secondary
Red flags of secondary headaches
pregression of headache, new headache under 5 or over 50, pregnant, immunosuppressants, cancer
Two types of migranes
Without Aura- %85
With Aura- %15
symptoms of a migrane without aura
lasts 1-2 days
Visual disturbances, stars, sparks, flashes of lights
Symptoms of migraine with Aura
Similar as without but reversible visual symptoms
lasts 5 min to an hour
Preheadache symptoms such as fatigue and irritability that happen hours or days before the attack
Prodrome is also called
Pre headache
symptoms of a prodrome
Food craving
contipation/Diarrhea
mood changes
mm stiffness, in the neck
fatigue
increased urination
Symptoms of an Aura
Visual
olfactory hallucinations
tingling numbness on side where headache is
difficult speaking
confussion
vertigo
partial paralysis
hearing things
decreased hearing
decreased sensation
increased sensation
Aura without a migraine
silent migraine
before puberty, migraines are equally distributed between the sexes
True
Diagnosis of 3 symptoms for migraines in children
abdominal pain, nausea vomitting, throbing headache, unilateral location, aura, relief during sleep, positive family history
A common feature of migraine in children is
intense nausea and vomiting
may be confused with appendicitis
what age do many children undergo spontaneous prolonged remission with migraines
after their 10th birthday
A type of primary neurovascular headache that includes severe unrelenting, unilateral pain in the orbital, retro-orbital, temporal, supraorbital and infraorbital region
Cluster Headaches
Pain behind the eye radiated to the
ipsilateral trigeminal nerve (temple cheek and gum)
Symptoms of Cluster headaches
restlessness
lacrimation
nasal congestion
rhinorrhea
forehead sweating
miosis
ptosis
eyelid edema
what is the most common type of headache
Tension
what can cause a tension headache
overuse of analgesics or caffeine
what type of headache occurs 15 days or more a month
Chronic Daily headaches
trigger points in what muscles can result in dizziness when a person rotates their head quickly while driving
SCM
know phases of MVA injury and symptoms of whiplash LP 9 pg 6
abnormal positioning of the head and neck relative to the body
Torticollis
Affected muscles of torticollis
IPSILATERAL SCM
upper trap
levator scap
scalenes
contralateral splenius capitis
multifidi & Rotators
suboccipitals
Acute acquired torticollis may result from
Activated trigger pioints by holding phone to one ear, sleeping funny, prolonged exposure to cold
Torticollis present from infancy
Congenital torticollis
not usually painful
Symptom picture of spasmatic torticollis
Adult onset
typical position
affected muscles twitch and shoulder shrugs
laying down with arms raised sleeping improves
what is a common cause of head pain
TMJ
how does the pain present with TMJ
almost always referred as fascial muscle pain, headache , neckache, earache
can cause chronic pain problems in adults and children
degeneration of the annular fibres of the intervertebral disc
Degenerative disc disease
which discs are mostly affected wit DDD
C/S and L/S
What age is common for traumatic rupture in lumbar spine
30-45
less likely after 50 as disc fibrosed
annual fibres are intact
Protrusion (posteriolateral)
Outermost annular fibres are intact
Prolapse
rupture of entire annulus fibrosus no fragmentation of disc
Extrusion
Disc fragments in epidural space
Sequestration
with disc prolapse is pain worse in the morning or night
worse in the morning when the person is inactive
central herniation in the C/S can lead to
UMN lesion
herniation in the lumbar spine can lead to
Cauda equina syndrome
caused by sensitized helpter T cells and an antibody directed attack on the achetocoline receptor in the neuromuscular junction
Myasthenia gravis
generalized infection of the Parenchyma, caused by a virus, also by bacteria, fungi, or other organisms
Encephalitis
Reduced or interrupted blood flow
Ischemia
an interrpution of blood flow in the cerebral vessel due to thrombi or emboli OR bleeding into the brain tissue
Stroke
deprivation of oxygen with maintained blood flow
Hypoxia
progressive deterioation of skeletal muscles because of mixed muscle hypertrophy, atrophy, and necrosis
Muscular Dystrophy
damage to the immature brain
Hypoxia and ischemia in utero, post partum
Trauma or rupture of the cerebral blood vessels, toxicity and ifection can all cause
Cerebral Palsy
Cleft spine
neural tube defects
Spina Bifida
inflammation and selective destruction of the CNS myelin
Multiple Sclerosis
result of vascular injury and bleeding
Hematoma
uncontrolled cell growth in brain
Brain tumor
