final exam peripheral neuropathies Flashcards by Demond Fleming

Characteristics of Peripheral Nerves:
can affect ________ or _______ nerves
can affect both ______ and ______

one or many
sensory and motor

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Two types of peripheral neuropathies

mononeuropathies and polyneuropathies

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What is the MOST common type of nerve injury affecting the general population?

mononeuropathies

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________ have many types of etiologies and DM is the MOST common cause in the USA

polyneuropathies

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________ is usually caused by some kind of nerve entrapment

mononeuropathies

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What is the MOST common type of mononeuropathy?

Median nerve entrapment

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Leprosy is the most common cause world-wide of which neuropathy _______________

polyneuropathies

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neuronal degeneration:

degeneration of motor and sensory cell bodies and their subsequent axons

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damage to the axon at a specific point below the cell body w/degeneration distal to injury

Wallerian degeneration:

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diffuse axonal damage is known as _______________

axonal degeneration

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injury to the myelin sheath without injury to the axon

segmental demyelination

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What are the 4 ways a nerve is classified when damaged:

neuronal degeneration
Wallerian degeneration
axonal degeneration
segmental demyelination

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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

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mononeuropathies: common CNs injured -

trigeminal neuralgia (V), bells palsy (VII), ramsay hunt syndrome (VIII)

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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

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types of acquired polyneuropathies associated w/ systematic disease:

diabetic neuropathy, hypothyroidism, RA, sarcoidosis, idiopathic polyneuropathy, critical illness polyneuropathy

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heredity polyneuropathies:

Charcot Marie Tooth

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__________ nerve implicated in carpal tunnel syndrome, however, can get impinged where along the path
-medical diagnostic test:
-medical management:

median
EMG
carpal tunnel release

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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

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PT Intervention: Median Nerve Pathology
–create _______,______,and _______

space, movement, and blood flow

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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

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Piriformis common trap area for which nerve?

sciatic nerve

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Sciatic Nerve -medical diagnosis:

physical exam, EMG, MRI

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Sciatic Nerve:
-nerve roots
-splits in two separate nerves:

L4-S3
tibial, common fibular

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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