FINAL PERIPHERAL NERVE SENSORY DEFICITS Flashcards
Branchial plexus gives birth to what nerves?
RN, MN, UN, Axillary, and Musculocutaneous nerve
What is Endoneurium?
Electrically insulates individual nerve fibers.
What is Perineurium?
The sheath that serves as a diffusion barrier (allows blood flow, keeps toxin away from nerve fibers)
What is Epineurium?
Outer cover
What is Mesoneurium?
The slippery surface that limits friction
What prolonged stretch/compression on a nerve will lead to if circulation is restored?
Edema within CT covering. The swelling will lead to nerve pathology.
What are mechanisms of nerve injuries?
Compression or entrapment Traction Avulsion Laceration Burn Chemical Ischemic Radiation Injection Injuries
What are motor symptoms of nerve injury?
Weakness
Venous/lymphatic issues
Atrophy
Muscle/joint fibrosis
What are sensory symptoms of nerve injury?
Paresthesia Altered vibratiory perception Abnormal discrimination Decreased functional use Increased risk of burn.
What are autonomic symptoms of nerve injury?
Vasomotor - skin temperature, edema, color
Sudomotor - Sweat patterns
Pilomotor - Absence of goosebumps
Trophic - Nail and hair changes, slowed skin healing and slow bone growth in kids.
C5 motor screen wil perform what action?
Shoulder abd
C6 motor screen wil perform what action?
Elbow flexion and wrist extension
C7 motor screen wil perform what action?
Elbow extension, wrist flexion
C8 motor screen wil perform what action?
Digital flexion
T1 motor screen wil perform what action?
Digital abd/add.
C5 sensory screen wil result in feeling what part of the body?
Skin over deltoid
C6 sensory screen wil result in feeling what part of the body?
Tip of thumb, radial wrist
C7 sensory screen wil result in feeling what part of the body?
Tip of middle finger
C8 sensory screen wil result in feeling what part of the body?
Tip of SF, and ulnar wrist
T1 sensory screen wil result in feeling what part of the body?
Medial elbow
In complete nerve injury what are medical treatments
Surgery
Mononeuropathy is?
Damge to singe nerve
Miltiple monooneuropathy is?
multi-focal asymmetrical involvement of multiple nerves
Double crush syndrome?
One -nerve, multiple site of pathology
Polyneuropathy
B/L extremity damage to two or more PN due to metabolic changes
Peripheral polyneuropathy
often hands and feet, in smokers, alcoholism, autoimmune disease
What is neuropraxia?
Compression and loss of blood flow to a nerve = sensory and motor los.
Recovery weeks to months (Staruday night palsy, or sutternlands type 1)
Axonotmesis ?
Severe compression, axon distal to compression degenerate. Endoneurial tubes remain, good recovery (Sunderland type 2).
Sunderland Type 3 is?
destruction of endoneurial tubes
Sunderland type 4?
Destruction of perineurium
Singifican internal scarring impairing function
Nerve graft probably required
Sunderland type 5 and 6
Physiologic disruption of entire nerve or section of nerve
Requires surgery
With complete severed PN will see loss of sensation, motor control and reflexes.
Wallerian Degeneration ?
Breakdwon of the axon distal to site of injury.
Starts 48 -96 hrs after injury and concludes 3 wks after injury.
During this process there is deterioration of myelin and distal axons become disorganized.
When is primary nerve repain happen?
within first wk of injury
When does secondary nerve repain happen?
Wekks or more after injury
Nerve grafting is necessary when?
When primary repair on the cut ends can not occur due to tension on the nerve.
What is autograft?
Harvested from sensory nerves
What is allograft ?
Cadavers
What is conduits ?
Commercially available tubes to brige gap
Neurolysis ?
Free nerve from surrounding tissue
Nerve decompression
Remove nerve from impigement by moving nerve or cutting tissue
Tendon transfer
What is neuropraxia?
A conduction block, no anatomical disruption. All components attached
What is axonotmesis?
Disruption of axons and myelin sheaths, but endoneurial tubes are intact
What is Neurotmesis?
Complete severance or serious disorganization – No spontaneous recovery
Nerver regeneration is happening (scale)
1-4mm per day (after 3 weeks of Wallerian degeneration) (about 1 in per month).
What factors influence regeneration?
Age Amount of scare tissue How high the injury Delayed reconstruction Severity of injury Inaccurate alignment of fascicles during surgery Neuroma development.
What are nerve recovery function ?
Pain temperature Touch Propriception Motor
What are patterns of sensory recovery?
pain perception vibration of 30 cps moving touch constant touch vibration 256 cps
RN compression sites; High radial nerve injury
Crutch palsy - compression at axilla, motor and sensory involvement.
Saturday night palsy - compression of the RN at midhumerous, motor and sensory involvement (triceps OK).
Humeral shaft fx
What presentation will high radial nerve injury have?
Triceps works!
Weakness - wrist ext, supination, thumb ext, MP ext
Paresthesia - dorsum of the hand
Posterior Interosseous nerve palsy (PIN) Numerous compression areas will result in?
Primary motor involvement
Weakness - wrist ext, MP ext, thumb ext
Radial Tunnel will result in?
PIN compression
Pain 3-5 cm distal to LE
Deep burning, aching including at rest
No weakness or sensory involvement
Superficail radial sensory nerve (RSN) palsy will result in?
Wartensbergs Syndrome
Sensory involvement only
Wrist watch, handcuffs, splint or from with ECRL and branchioradialis
What are RN orthosis ?
TO stabilize wrist
MCP extension assist
Categories of Compression of the MN are?
Pronator syndrome
Anterior interousseous syndrome
Carpal tunnel syndrome
What is pronator syndrom?
Compression between the 2 heads of the pronator, at the ligament of struthers, lacertus fibrosis, hypertrophy of the pronator trees or at the arch of the FDS
Where would pain be with pronator syndrom?
Proximal volar forearm
Sensory involvement
Report of hand weakness
Anterior Interousses sundrom will present as?
Compression of deep motor branch at the pronator trees
Paralysis of FPL and FDP to index
No sensory symptoms, forearm pain present
What are compression sites of the UN?
Cubital tunnel
Guyon’s canal
Cubital tunnel what is it?
At the elbow cause by trauma sustain elbow flexion, cubitus valgus deformity, fx,
Sensory symptoms include pain, motor weakness
Test - Elbow flexion test
TX - Elbow pad, splint, injection, ulnar nerve transposition
Guyons Canal?
Pain , sensory symptoms and/or motor weakness
AKA - handle bar palsy
Test - compression to canal
Tx - padded glove, injection, surgery
Ulnar Nerve Orthosis?
Prevent RF/SF from clawing
Put MPs in flexion
What are therapeutic management of Nerve injuries ?
Orthosis - protect nerves PROM - prevent join contracrues Education - on injury, healing, ergonomics and protection of insensate areas Nerve gliding Pain management Desensitization Sensory re-education
Nerve Glides are?
gentel glides! that help limit adhesions after surgery, increase blood flow, help decrease neural symptoms and protective muscle guarding.
DUE not stretch or lengthen the nerve.
Should not produce nerve symptoms
Protective Reeducation is about ?
Educating pt on compensatory techniques for sensory protection
Education about injury and re-injury
Skin-checks
Avoidance of cold temps
Descriminative Sensory Reeducation
Sensory retruns from proximal to distal
Two phases;
Eraly phase - starts when protective sensation
Late phase - when moving/constant touch is 256 cps is perceived at fingertips with good localization
Desensitization benefits?
Systematic process used to reeducat the nervous system
Requires frequent sessions with various tactile stim throughout day
The mote frequently the pt participates the sooner they get better
Pain management is about?
Education Occupational based interventions Ultrasound TENS Iontophoresis Manual therapy NOT IF PT HAS SENSORY LOSS Superficial heat Fluidotherapy Paraffin Cold
