final exam Flashcards
what are the 4 causes of peripheral nerve lesions?
- compression (internally ie: bony callus/HT muscles; externally ie: crutches)
- trauma (crushing or wound)
- systemic disorders (lepsory)
- systemic edematous conditions (pregnancy, hypothyroidism, kidney & heart failure)
at what rate does a nn regenerate per day?
1-2 mm per day
1/2 - 3/4 per week and 1 1/4 - 2 1/4 per month
what is the prognosis for the 3 clasifying nerve injuries (neuropraxia, aconotmesis & neuromesis)
neuropraxia: good
aconotmesis: good
neurotmesis: poor
first degree classification of nn injury
neuropraxia
second degree classification of nn injury
aconotmesis
third degree classification of nn injury
neurotmesis
what causes Neuropraxia injuries
compression of a nn causing local conduction block, no structural damage to the axon or the tissue distal to the lesion
what causes anconotmesis injuries
prolonged, severe compression of a nn that will cause a lesion at the site of compression, followed by degeneration of the axon distal to the injury; endoneurial tube remains in tact
what causes neurotmesis injuries
injury involves severing of the nn trunk; including the endoneurial tube. results in degeneration of the nn, regeneration may be difficult due to scar tissue build up on lesion site
how are Neurotmesis nn injuries repaired?
usually surgery
what is hyperesthesia?
abnormal increase to sensitivity
what is dysesthesia?
abnormal sense of touch
how will symptoms present with partial and complete nerve lesions when edema is present
complete: edema present initially, due to injury. damage to autonomic fibers so edema remains until regeneration & vasomotor function returns.
partial: edema present initially, due to injury. less edema than with complete. because there is some local mm function, assists with lympathic return
how will symptoms of altered tissue health present with partial and complete nerve lesions
complete: loss of autonomic function affects skin, hair, nails. fragile tissue, dystrophic & easily injuried. LOSS of piloerection. loss of sweating over area of denervation
partial: tissue changes, not as severe as complete. an INCREASE piloerection over area of denervation
how will symptoms of motor function present with partial and complete nerve lesions
complete: flaccidity; mm wasting within 3 wks. spontaneous contraction of mm fibers within few weeks (fibrillations). LACK or DIMINISHED reflex
partial: mm weakness, diminished tendon reflex
how will symptoms of holding patterns present with partial and complete nerve lesions
complete: drop foot with sciatic nn lesion, drop wrist with radial
partial: less apparent since some fibers are innervated. ex: partial radial nn lesion will have finger drop rather than full wrist drop
how will symptoms of contractures present with partial and complete nerve lesions
complete: affected mm unable to exert force on joint they cross. contractures will develop in antagonists as they draw into shorter portion
partial: same as complete. less severe than complete because there is some opposition to antagoinist
how will pain symptoms present with partial and complete nerve lesions
complete: pain variable. may be decreased or altered sensation
partial: likely area of hyperesthesia (abnormal increase to sensitivity) and dysesthesia (abnormal sense of touch)
how will scar tissue symptoms present with partial and complete nerve lesions
complete&partial: present at lesion site; could interfere with healing/regeneration process
Increased piloerector response is associated with which type of nerve lesion, complete or partial? and how is the other affected?
partial nn lesion.
complete is decreased response
What category of classification does Carpal Tunnel Syndrome fall under?
Neuropraxia: Compression Syndrome
- Compression of the Medial Nerve as it passes through the carpal tunnel at the wrist
What category of classification does Piriformis Syndrome fall under?
Neuropraxia: Compression Syndrome
- Piriformis syndrome is when the piriformis compresses the sciatic nerve.
What category of classification does Thoracic Outlet Syndrome fall under?
Neuropraxia: Compression Syndrome
- Compression of the Brachial Plexus and artery between:
- the middle and anterior scalenes (anterior scalene syndrome)
- the coracoid process and the pec minor muscle (pec minor syndrome)
- the clavicle and 1st rib (costoclavicular syndrome)
What are examples of external causes of compression in nerve lesions?
pressure from crutches, splints, backpack straps
What are examples of internal causes of compression in nerve lesions?
- HT mm. can be due to TP, postural imbalance, mm imbalance. if the nn penetrates the mm it is more susceptible. (ie: piriformis & sciatic nn)
- structural abnormalities (extra l cervical rib, callus at fracture site)
- trauma/overuse= edema & scar tissue
- poor positioning of limbs; while sleeping or during surgery (saturday night syndrome)
- systemic conditions; pregnancy, hypothyriodism, diabetes mellitus (systemic edema occurs)
What is Mononeuropathy? What are possible causes?
Mononeuropathy is damage that occurs to a single nerve.
- causes are the path the nerve travels, common points of compression, symptoms, muscles affected, causes and dysfunctions
what is the spinal innervation of the radial nerve?
C5-T1
what are the 2 branches of the radial nerve at the supinator?
posterior motor branch
superficial branch
what fracture causes a radial nerve injury
- primairly at the spiral groove of the humerus
- involved in approx 70% of humeral fractures. also involved in supracondylar & upper 1/3 radius fractures
what dislocation causes a radial nerve injury
head of the radius, humeroradal and radiaoulnar joint
what post-surgical complications causes a radial nerve injury
unrelieved pressure from poor positioning during surgery
what compression causes a radial nerve injury
- at axilla from crutches
- “saturday night palsy”
what is supinator syndrome? (radial nn injury)
- compression over the forearm
- fibrosis can occur on site where the nn penetrates supinator
- compression can lead to a first or second degree lesion
what nn is affected when someone has “wrist drop”
radial nerve
what causes wrist drop? what does it look like?
radial nn lesion.
wrist hands in flexion because the wrist flexors are unopposed due to flaccid extensors
where is the sensory dysfunction/altered sensation felt in a radial nn lesion
posterior arm, forearm and hand. the thumb, index, middle & half of the ring finger, finger tips;
- anesthesia is possible in the web of the thumb and 2nd finger
spinal innervation for the ulnar nerve
C8-T1`
what fractures cause the ulnar nerve to be affected?
medial condyle of the elbow, mid-forearm or wrist
what dislocation causes the ulnar nerve to be affected?
elbow
what are post-surgical complications involved with ulnar nerve
unrelieved pressure from arm hanging over the table or positioned improperly
what pathology affects the ulnar nerve
leprosy
what repetitive action affects the ulnar nerve
excessive stress with flexion/extension; compressions syndrome may develop due to fibrosis at the medial elbow or at guyons canal.
can result in first or second degree nn lesion
what direct trauma affects the ulnar nerve
contusion/laceration at wrist or hand; median nn can also be affected
what nerve lesion causes claw hand
ulnar
what is the presentation of claw hand
little finger hyperextended & abducted at MCP joint and the IP joint
ring finger is hyperextended at the MCP and a smaller amount of flexion at the IP joint
what special test is positive with ulnar nn lesion
forments sign
spinal innervation of the median nerve
medial cord (C8-T1)
lateral cord (C5-C7)
what fracture causes median nerve to be affected
at the elbow, wrist or carpals
what dislocation affects the median nn
elbow, wrist, carpals (specifically lunate & scaphoid)
what commpression affects the median nn
fibrosis & HT in overuse mm or entrapment of the nn at the carpal tunnel (pronator teres syndrome & carpal tunnel)
what trauma affects the median nn
traction injuries, contusions or lacerations (esp wrist/hand)
complete lesion of what nn causes ape hand
median
complete lesion of what nn causes oath hand
median
what is the presentation of ape hand
caused by median nn lesion.
thumb lies in the same place as the rest of the hand. loss of opposition
what is the presentation of oath hand
caused by median nn lesion.
occurs when person tries to make a fist; only the 3rd and 4th fingers can flex
what is compression of the median nn as it passes through the carpal tunnel?
carpal tunnel syndrome
what is the sensory area affected with carpal tunnel syndrome
numbness & tingling in the lateral 3 fingers and 1/2 of the fourth
what plexus does the sciatic nn originate
sacral
spinal innervation for sciatic nn
sacral plexus L4-S1
what two nerves do the sciatic nn branch into at the popliteal fossa?
tibial and fibular/peroneal division
what fractures affect the sciatic nn
pelvis, femur, tibia, fibula, ankle (usually inversion)
what dislocations affect the sciatic nn
hip, knee (usually peroneal), ankle
what adverse reactions affect the sciatic nn
injections into the glutes
hip surgery
meniscal repair
improper positioning during surgery or traction post-surgery
what compressions from internal sources affect the sciatic nn
- piriformis syndrome
- tarsal tunnel syndrome
- mortons foot
what compression from external source affects the sciatic nn
compression against the fibular head (cast, splint, crossing legs)
prolonged squatting
what type of trauma affects the sciatic nn
such as a contusion to the glutes
what nn is affected with foot drop
sciatic
what nn lesion can cause claw toe
sciatic tibial branch
what nn is affected with bells palsy
CN VII (7)
what are the 4 causes of bells palsy
compression from edema
conditions affecting the parotid gland
compression from inflammation (trauma)
exposure to a chill/draft
What is the diagnostic criteria for major depressive episode?
- persistent unpleasent mood
- depressed mood, anhedonia (inability to experience pleasure), feeling of worthlessness, excessive guilt, decreased concentration, psychomotor agitation or retardation (restlessness), insomnia or hypersomnia, decreased libido, changes in weight/appetite, thoughts of death/suicide
(five or more of these symptoms)
what are the two categories of depressive disorders?
major depressive disorder
dysthymia
what is characterized by chronic mild depression
dysthymia
what are the symptoms of dysthymia?
-mild depressive symptoms
- same as major depressive disorder but milder
- low self-esteem, sleep, energy & appetite distubances
- can lead to major depressive state if ignored or undiagnosed
What are the six various subclasses of depression symptoms?
- melancholic
- atypical
- phychotic
- catatonic
- chronic
- postpartum
______ features are when depression is worse in the morning, insomnia with early morning waking up, anorexia with weight loss, psychomotor agitation/retardation, excessive guilt, loss of interest in activities, inability to respond to pleasurable stimuli, loss of joy
melancholic features
_____ depression sx opposite of melancholic. depression tends to get worse as the day progresses. overeating & hypersomnia are a symtoms
atypical depression
______ feature symptoms involve delusions and hallucinations that may or may not be mood related
psychotic feature
______ depression symptoms involve excessive mobility or motoric immobility, extreme negativism, repetitive speech & peculiar voluntary movements
catatonic depression
_____ is used when referring to depression that has been present for 2+ years
chronic
______ refers to depression that occurs within 6 weeks of giving birth. hormones and stress play a role
postpartum
What is the role of hormones in postpartum depression?
they both play a part in postpartum depression.
what is an alternative name for bipolar disease
manic depression
what are the clinical manifestations for bipolar disease?
- decreased need for sleep & food
- labile mood
- irritability
- racing thoughts
- highly distracted
- rapid and pressured speech
- inflated self-esteem
- excessive involvement in pleasurable experiences
mania without depression is called ______
unipolar
Describe what is meant by mania. How quickly does this symptom manifest?
Mania is classified as episodes of elation and irritability, with or without periods of depression.
- Mania can begin abruptly within hours or days or develop over a few weeks. If left untreated it can get worse over time.
What is hypersomnia?
Hypersomnia is characterized by recurrent episodes of excessive daytime sleepiness or prolonged nighttime sleep.
_______ is characterized by intense fearfulness that occurs without a precipitating potentially dangerous event, accompanied by subjective as well as objective manifestation
anxiety disorders
what are the subjective manifestations of anxiety disorders?
heightened awareness to deep fear of impending disaster or death
what are the objective manifestations of anxiety disorders?
restlessness
sweating
palpitations
increase HR & BP
dry mouth
desire to run & escape
What percentage of people are affected by anxiety disorders? Who is statistically more at risk for experiencing anxiety disorders?
Anxiety disorders affect approximately 28.8% of all people, women more often than men
What are the five subdivided categories of Anxiety Disorders?
panic disorder
PTSD
GAD
social phobia
OCD
characterized by an experience of intense fear with neurologic, cardiac, respiratory & psychological symptoms
panic disorder
a stress response as a result of experiencing a traumatic event
PTSD
characterized by excessive, uncontrollable worry
GAD
characterized by an intense fear reaction to social interaction
social phobia
characterized by repetitive thoughts and actions
OCD
at what age do panic disorder typically develop?
The disease can peak at mid-adolescence and again in the
mid thirties
at what age do social phobia typically develop?
between ages 11-19
at what age do OCD typically develop?
20 years of age