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Physical Disabilities > FINAL PERIPHERAL NERVE SENSORY DEFICITS > Flashcards

FINAL PERIPHERAL NERVE SENSORY DEFICITS Flashcards

1
Q

Branchial plexus gives birth to what nerves?

A

RN, MN, UN, Axillary, and Musculocutaneous nerve

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2
Q

What is Endoneurium?

A

Electrically insulates individual nerve fibers.

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3
Q

What is Perineurium?

A

The sheath that serves as a diffusion barrier (allows blood flow, keeps toxin away from nerve fibers)

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4
Q

What is Epineurium?

A

Outer cover

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5
Q

What is Mesoneurium?

A

The slippery surface that limits friction

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6
Q

What prolonged stretch/compression on a nerve will lead to if circulation is restored?

A

Edema within CT covering. The swelling will lead to nerve pathology.

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7
Q

What are mechanisms of nerve injuries?

A 
Compression or entrapment 
Traction
Avulsion
Laceration
Burn
Chemical
Ischemic
Radiation
Injection Injuries
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8
Q

What are motor symptoms of nerve injury?

A

Weakness
Venous/lymphatic issues
Atrophy
Muscle/joint fibrosis

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9
Q

What are sensory symptoms of nerve injury?

A 
Paresthesia 
Altered vibratiory perception
Abnormal discrimination 
Decreased functional use 
Increased risk of burn.
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10
Q

What are autonomic symptoms of nerve injury?

A

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.

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11
Q

C5 motor screen wil perform what action?

A

Shoulder abd

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12
Q

C6 motor screen wil perform what action?

A

Elbow flexion and wrist extension

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13
Q

C7 motor screen wil perform what action?

A

Elbow extension, wrist flexion

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14
Q

C8 motor screen wil perform what action?

A

Digital flexion

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15
Q

T1 motor screen wil perform what action?

A

Digital abd/add.

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16
Q

C5 sensory screen wil result in feeling what part of the body?

A

Skin over deltoid

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17
Q

C6 sensory screen wil result in feeling what part of the body?

A

Tip of thumb, radial wrist

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18
Q

C7 sensory screen wil result in feeling what part of the body?

A

Tip of middle finger

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19
Q

C8 sensory screen wil result in feeling what part of the body?

A

Tip of SF, and ulnar wrist

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20
Q

T1 sensory screen wil result in feeling what part of the body?

A

Medial elbow

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21
Q

In complete nerve injury what are medical treatments

A

Surgery

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22
Q

Mononeuropathy is?

A

Damge to singe nerve

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23
Q

Miltiple monooneuropathy is?

A

multi-focal asymmetrical involvement of multiple nerves

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24
Q

Double crush syndrome?

A

One -nerve, multiple site of pathology

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25
Q

Polyneuropathy

A

B/L extremity damage to two or more PN due to metabolic changes

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26
Q

Peripheral polyneuropathy

A

often hands and feet, in smokers, alcoholism, autoimmune disease

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27
Q

What is neuropraxia?

A

Compression and loss of blood flow to a nerve = sensory and motor los.
Recovery weeks to months (Staruday night palsy, or sutternlands type 1)

28
Q

Axonotmesis ?

A

Severe compression, axon distal to compression degenerate. Endoneurial tubes remain, good recovery (Sunderland type 2).

29
Q

Sunderland Type 3 is?

A

destruction of endoneurial tubes

30
Q

Sunderland type 4?

A

Destruction of perineurium
Singifican internal scarring impairing function
Nerve graft probably required

31
Q

Sunderland type 5 and 6

A

Physiologic disruption of entire nerve or section of nerve
Requires surgery
With complete severed PN will see loss of sensation, motor control and reflexes.

32
Q

Wallerian Degeneration ?

A

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.

33
Q

When is primary nerve repain happen?

A

within first wk of injury

34
Q

When does secondary nerve repain happen?

A

Wekks or more after injury

35
Q

Nerve grafting is necessary when?

A

When primary repair on the cut ends can not occur due to tension on the nerve.

36
Q

What is autograft?

A

Harvested from sensory nerves

37
Q

What is allograft ?

A

Cadavers

38
Q

What is conduits ?

A

Commercially available tubes to brige gap

39
Q

Neurolysis ?

A

Free nerve from surrounding tissue

40
Q

Nerve decompression

A

Remove nerve from impigement by moving nerve or cutting tissue
Tendon transfer

41
Q

What is neuropraxia?

A

A conduction block, no anatomical disruption. All components attached

42
Q

What is axonotmesis?

A

Disruption of axons and myelin sheaths, but endoneurial tubes are intact

43
Q

What is Neurotmesis?

A

Complete severance or serious disorganization – No spontaneous recovery

44
Q

Nerver regeneration is happening (scale)

A

1-4mm per day (after 3 weeks of Wallerian degeneration) (about 1 in per month).

45
Q

What factors influence regeneration?

A 
Age 
Amount of scare tissue
How high the injury 
Delayed reconstruction 
Severity of injury 
Inaccurate alignment of fascicles during surgery 
Neuroma development.
46
Q

What are nerve recovery function ?

A 
Pain
temperature
Touch 
Propriception 
Motor
47
Q

What are patterns of sensory recovery?

A 
pain perception 
vibration of 30 cps
moving touch 
constant touch 
vibration 256 cps
48
Q

RN compression sites; High radial nerve injury

A

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

49
Q

What presentation will high radial nerve injury have?

A

Triceps works!
Weakness - wrist ext, supination, thumb ext, MP ext
Paresthesia - dorsum of the hand

50
Q

Posterior Interosseous nerve palsy (PIN) Numerous compression areas will result in?

A

Primary motor involvement

Weakness - wrist ext, MP ext, thumb ext

51
Q

Radial Tunnel will result in?

A

PIN compression
Pain 3-5 cm distal to LE
Deep burning, aching including at rest
No weakness or sensory involvement

52
Q

Superficail radial sensory nerve (RSN) palsy will result in?

A

Wartensbergs Syndrome
Sensory involvement only
Wrist watch, handcuffs, splint or from with ECRL and branchioradialis

53
Q

What are RN orthosis ?

A

TO stabilize wrist

MCP extension assist

54
Q

Categories of Compression of the MN are?

A

Pronator syndrome
Anterior interousseous syndrome
Carpal tunnel syndrome

55
Q

What is pronator syndrom?

A

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

56
Q

Where would pain be with pronator syndrom?

A

Proximal volar forearm
Sensory involvement
Report of hand weakness

57
Q

Anterior Interousses sundrom will present as?

A

Compression of deep motor branch at the pronator trees
Paralysis of FPL and FDP to index
No sensory symptoms, forearm pain present

58
Q

What are compression sites of the UN?

A

Cubital tunnel

Guyon’s canal

59
Q

Cubital tunnel what is it?

A

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

60
Q

Guyons Canal?

A

Pain , sensory symptoms and/or motor weakness
AKA - handle bar palsy
Test - compression to canal
Tx - padded glove, injection, surgery

61
Q

Ulnar Nerve Orthosis?

A

Prevent RF/SF from clawing

Put MPs in flexion

62
Q

What are therapeutic management of Nerve injuries ?

A 
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
63
Q

Nerve Glides are?

A

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

64
Q

Protective Reeducation is about ?

A

Educating pt on compensatory techniques for sensory protection
Education about injury and re-injury
Skin-checks
Avoidance of cold temps

65
Q

Descriminative Sensory Reeducation

A

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

66
Q

Desensitization benefits?

A

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

67
Q

Pain management is about?

A 
Education 
Occupational based interventions 
Ultrasound
TENS
Iontophoresis 
Manual therapy
NOT IF PT HAS SENSORY LOSS
Superficial heat 
Fluidotherapy
Paraffin
Cold

Physical Disabilities (12 decks)

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