final exam peripheral neuropathies Flashcards
Characteristics of Peripheral Nerves:
can affect ________ or _______ nerves
can affect both ______ and ______
one or many
sensory and motor
Two types of peripheral neuropathies
mononeuropathies and polyneuropathies
What is the MOST common type of nerve injury affecting the general population?
mononeuropathies
________ have many types of etiologies and DM is the MOST common cause in the USA
polyneuropathies
________ is usually caused by some kind of nerve entrapment
mononeuropathies
What is the MOST common type of mononeuropathy?
Median nerve entrapment
Leprosy is the most common cause world-wide of which neuropathy _______________
polyneuropathies
neuronal degeneration:
degeneration of motor and sensory cell bodies and their subsequent axons
damage to the axon at a specific point below the cell body w/degeneration distal to injury
Wallerian degeneration:
diffuse axonal damage is known as _______________
axonal degeneration
injury to the myelin sheath without injury to the axon
segmental demyelination
What are the 4 ways a nerve is classified when damaged:
neuronal degeneration
Wallerian degeneration
axonal degeneration
segmental demyelination
mononeuropathies:
compressive injuries of the following nerves:
* median C5-T1
* ulnar C8- T1
* radial C5-T1
* femoral L2-L5
* sciatic L4-S3
* fibular L4-S2
* tibial L4-S3
mononeuropathies: common CNs injured -
trigeminal neuralgia (V), bells palsy (VII), ramsay hunt syndrome (VIII)
types of acquired polyneuropathies:
1) autoimmune
2) infectious
3) toxic and metabolic neuropathies
- GBS, CIDP, paraneoplastic neuropathy
- HIV-related polyneuropathies, lyme disease, leprosy
- alcoholic neuropathies, B12, B6 deficiency
types of acquired polyneuropathies associated w/ systematic disease:
diabetic neuropathy, hypothyroidism, RA, sarcoidosis, idiopathic polyneuropathy, critical illness polyneuropathy
heredity polyneuropathies:
Charcot Marie Tooth
__________ nerve implicated in carpal tunnel syndrome, however, can get impinged where along the path
-medical diagnostic test:
-medical management:
median
EMG
carpal tunnel release
PT exam/eval of Median Nerve Pathology:
—test along its entire path: (6)
myotomes
dermatomes
first rib elevated
scalenes compressing
carpal tunnel: phalen’s, tinnels signs
ULNT
PT Intervention: Median Nerve Pathology
–create _______,______,and _______
space, movement, and blood flow
PT Intervention: Median Nerve Pathology
–treat anything that is compressing it (rib, muscle) =
–nerve glides/flossing =
–cardio/aerobic training, bring nutrients to the injured area =
–once the nerve is ready you should strengthen and work on ________
space
movement
blood flow
functional tasks
Piriformis common trap area for which nerve?
sciatic nerve
Sciatic Nerve -medical diagnosis:
physical exam, EMG, MRI
Sciatic Nerve:
-nerve roots
-splits in two separate nerves:
L4-S3
tibial, common fibular
These test should be performed for diagnosis of sciatic nerve pathology:
palpation of piriformis
slump or SLR
PA’s
PT intervention of Sciatic Nerve Deficits
–create _______,______,and _______
space, movement and blood flow
PT intervention: Sciatic Nerve Deficits
–compression: (2)
–movement =
–blood flow =
–once the nerve is ready you should strengthen and work on ________
lumbar spine/piriformis
nerve glides/flossing
cardio/aerobic training
functional tasks
Bell’s palsy is _________ dysfunction
CN VII
Bells Palsy: can be preceded w/
exposure to cold
facial numbness and stiffness
jaw P!
decrease hearing and hyperacusis
Idiopathic acute unilateral facial paralysis is known as
bells palsy
Bell’s Palsy: medical management
________ for a week
_______ protection because _____ don’t work
can try to ____________ it but the data is mixed and there is a high risk of damaging hearing
corticosteroids
eye; eyelids
surgically decompress
Bell’s Palsy: Prognosis
____-_____% improve without treatment and 90% get better w/ __________
70-90%
corticosteroids
PT role in Bells Palsy:
retrain ______ muscles for function + dry needling
PT should maintain _____ of the eye
facial
protection
Most common cause of neuropathy in the United States:
diabetic neuropathy
1). Most common presentation of diabetic neuropathy is
2). Often one of the 1st signs of __________
distal symmetrical sensorimotor neuropathy
diabetes
Diabetic Neuropathy: _______ to ______ ascending numbness, paresthesias, and dysesthesias in feet. Can progress to hands. (glove hands, stockings feet)
distal to proximal
Diabetic Neuropathy: Usually lose ______ and _____ first followed by _______ then muscle weakness and atrophy
pain; temp; proprioception
What diagnostic tests are performed for diabetic neuropathy
glucose testing, EMG/nerve conduction testing, and stocking-glove presentation
Diabetic Neuropathy: medical management
optimize glucose control, diabetic foot care education, and medication can be used in the setting of p! (gabapentin)
PT exam for Diabetic Neuropathy:
-sensory screen (5)
-balance
-skin
-neuropathic p!
-foot and arch integrity (1)
pink prick 1st** –> P!, temp proprioception, light touch
pes planus
HIV-related polyneuropathies: there is an HIV-associated axonal sensory neuropathy (HIV-SN). Affects most patients with low _____ counts.
CD4 (HIV marker)
HIV-related polyneuropathies: MOST common neurologic complication for patients with _____ and/or _____
HIV;AIDS
HIV-related polyneuropathies causes _______ and _______ in extremities
P! and numbness
PT implication with HIV-SN;
desensitization techniques for P! control
exercise as tolerated
balance training: substitution w/visual + vestibular
Alcohol-related polyneuropathy:
gradual onset distal to proximal symmetric _______ loss. Looks similar to ________
_____ is a late complication
begins after _____ to ____ of alcohol abuse
DTRs are _____
sensory; CIDP
weakness
months to years
diminished
MOST common neurologic disease associated w/chronic alcoholism
Alcohol-related polyneuropathy:
alcohol-related polyneuropathy is due to alcohol toxicity and ensuing _______ and ______ deficiency
thiamine; B12
alcohol-related polyneuropathy: diagnosis
EMG/nerve conduction
exclusion
alcohol-related polyneuropathy: medical management
sobriety and vitamin supplementation
_______ is found in most animal products
B12
Low levels of B12 lead to
neuropathy, myelopathy (subacute and acute degeneration of corticospinal and dorsal column), dementia, and megaloblastic anemia
Low levels of B12 often causes
distal _____ and _____ instability and if not caught early result in distal ______ (late sign)
reduced ________ and ______ sense
numbness; gait
proprioception;vibration
B12 deficiency: diagnosis + medical management (1)
serum B12, nerve conduction test
B12 supplementation
PT implications for alcohol-related and B12-related neuropathies
MMTs
check sensation
observe/treat gait
support (give resources) rehab
strengthening
functional task
fall risk –> balance, compensation and remediation
bracing as needed (WC)
desensitization techniques
About 25% of patients have no other identified reason for their neuropathy therefore have ________ neuropathy
Usually occurs in the ______ decade
Has a _______ progression over the years
Distal ______ or _______ are most common
Degeneration of axons ________ an inflammatory process
No clear ______ treatments
idiopathic
6th (60s)
sensory or sensory-motor?
without
medical
PT implications: Idiopathic neuropathy
desensitization strategies for P! control
balance work
gaiit
skin checks
Occurs after week to months of having a critical illness_____________
These pts. are typically seen in _______ setting
High _____rate
critical illness polyneuropathy (CIP)
ICU
mortality
Patients who have been vented through several rounds of steroids, on potentially neurotoxic drugs and vasopressors while in ICU. This leads to a lack of
distal blood flow - nerves can’t get blood flow and lose finger + toes
Main Signs and Symptoms of CIP:
distal or generalized weakness, distal sensory loss, areflexia
myopathy -motor loss
CIP: medical management
nerve conduction test reveals _____
_________ control
treat underlying _____that got them into critical care
prevention and/or treatment of
improves over months if ________
50% _________ completely
axonal polyneuropathy
glucose
illness
secondary complications of being bedridden in the ICU for weeks to months
patient survives
recover
PT implications for CIP:
PTs will see and treat patients with CIP myopathy a lot in _______ setting
Diagnosis like these are why PTs are needed in the ICU to prevent ________complications
ICU
secondary
PT implications for CIP:
early mobility in ICU pts are less likely to lose ________ _______
overall strength
Charcot Marie Tooth:
progressive distal weakness, atrophy, and sensory loss over several years
___________ is MOST common feature
get ________toes and pes cavus deformity
type _______MOST common
foot drop
hammer
1A
CMT is a __________ syndrome similar to Huntington
Can progress into hands and forearms
hereditary
patients w/CMT often have a ______ managing and may need _____
podiatrist/sx
