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Introduction to the Peripheral NS Flashcards

1
Q

Skin area supplied by a single spinal root.

A

Dermatome

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2
Q

Muscle group supplied by a single spinal root.

A

Myotome

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3
Q

Area of bone supplied by a single spinal root.

A

Sclerotome

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4
Q

What is a radiculopathy?

A

Nerve root dysfunction may be caused by structural (discs, osteophytes, tumors, etc) or non-structural (DM, infections, etc) conditions

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5
Q

What are the areas of the spine are most commonly affected by radiculopathy?

A
  1. Cervical (C5-C6 disc herniation = C6 nerve root compression​; C6-C7 = C7 nerve root compression)
  2. Lumbar (L4-5 disc hernation = L5 nerve root compression; L5-S1 = S1 nerve root compression)
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6
Q

Lumbosacral radiculopathy are due to what?

A

Paresthesias and weakness due to specific lumbosacral nerves: intervertebral discs (nucleus pulposus) herniates posterolaterally through the annulus fibrosus => central canal due to thin posterior longitudinal ligament and thicker anterior longitudinal ligament.

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7
Q

Lesion to L4 nerve root

  1. Disc affected
  2. Pain
  3. Sensory
  4. Weakness
  5. DTR loss
A
  1. L3-L4
  2. Pain = anterolateral thigh, knee, medial calf
  3. Sensory = Medial calf
  4. Weakness = hip flexion, knee extension
  5. Lose patella DTR
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8
Q

Lesion to L5 nerve root

  1. Disc affected
  2. Pain
  3. Sensory
  4. Weakness
  5. DTR loss
A
  1. L4-L5
  2. Pain: dorsal thigh, lateral calf
  3. Sensory loss: lateral calf, dorsum of foot
  4. Weakness: hamstrings, foot dorsiflexion, inversion/ eversion
  5. No DTR lost
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9
Q

Lesion to S1 nerve root

  1. Disc affected
  2. Pain
  3. Sensory
  4. Weakness
  5. DTR loss
A
  1. L5-S1
  2. Pain = Posterior thigh/ calf
  3. Sensory loss = posterolateral calf, lateral foot
  4. Weakness = hamstrings, foot plantarflexion
  5. Loss achilles DTR
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10
Q

Patient has hard time walking ON heels

What is the nerve root is has lumbosacral radiculopathy?

A

L5: hard time dorsiflexing

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11
Q

Patient has hard time walking on toes

What is the nerve root is has lumbosacral radiculopathy?

A

S1: hard time plantarflexing

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12
Q

Lesion to C5 nerve root

  1. Pain
  2. Sensory
  3. Weakness
  4. DTR loss
A
  1. Pain: scapula, shoulder
  2. Sensory loss: Lateral arm
  3. Weakness: shoulder abduction
  4. DTR lost: Biceps
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13
Q

Lesion to C6 nerve root

  1. Pain
  2. Sensory
  3. Weakness
  4. DTR loss
A
  1. Pain: scapula, shoulder, proximal arm
  2. Sensory loss: 1st and 2nd finger, lateral arm
  3. Weakness: shoulder abduction, elbow flexion
  4. DTR lost: Biceps +/-BR
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14
Q

Lesion to C7 nerve root

  1. Pain
  2. Sensory
  3. Weakness
  4. DTR loss
A
  1. Pain: scapula, shoulder/arm, elbow and forearm
  2. Sensory loss: 3rd finger
  3. Weakness: elbow/wrist/finger extension
  4. DTR lost: Triceps
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15
Q

Lesion to C8 nerve root

  1. Pain
  2. Sensory
  3. Weakness
  4. DTR loss
A
  1. Pain: scapula, shoulder/arm, medial forearm
  2. Sensory loss: 4th and 5th fingers
  3. Weakness: finger abduction and flexion
  4. DTR lost: finger flexors
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16
Q

Name the nerve root:

  1. Thumb and index finger
  2. Middle finger
  3. 4th and 5th finger
A
  1. C6
  2. C7
  3. C8
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17
Q

Name the nerve root:

  1. Medial forearm
  2. Nipple line
  3. Belly button
A
  1. T1
  2. T4
  3. T10
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18
Q

Name the nerve root

  1. Inguinal
  2. Medial calf
  3. Lateral calf
A
  1. L1
  2. L4
  3. L5
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19
Q

When diagnosing a brachial plexopathy which 2 muscle can help identify proximal lesions?

A
  • Rhomboids (Dorsal Scapular n. - C5)
  • Serratus Anterior (Long thoracic n. - C5)
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20
Q

How can we differentiate radiation injury vs. neoplastic causes of brachial plexopathy?

A
  1. Radiation injury:
    1. ​Affects upper trunk, lateral cord
    2. Painless
  2. Neoplastic:
    1. Affects medial cord,
    2. Painful (breast and lung)
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21
Q

In what patients can ischemia cause brachial plexopathy and what part of the spine does it affect?

A

Diabetics

Lumbar

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22
Q

What is Parsonage-Turner Syndrome?

A

Inflammatory/idiopathic cause of brachial plexopathy (AI?) that causes

  1. Severe pain in shoulder area
  2. Followed by a few days of weakness
  3. ↓ in pain, as the muscles atrophy
  4. Within 6-18 months ==> spontaneous recovery, but steroids can help.
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23
Q

Classifications of peripheral neuropathy

A
  1. Mononeuropathy
  2. Polyneuropathy
  3. Mononeuropathy multiplex
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24
Q

What is the difference between a mononeuropathy and polyneuropathy?

A
  1. Mononeuropathy: 1 nerve is affected => specific pattern of sensory loss and weakness in a specific muscle
  2. Polyneuropathy: >1 nerve is affected => diffuse, symmetrical sensory/motor/both loss that begins distal => centrally
    1. Stocking/glove sensory loss
    2. hypo or arreflexia
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25
What is **Mononeuropathy Multiplex**
**Focal involvement** of 2 or more nerves that may occur in **some systemic disorders (DM, vasculitis)**
26
What are 6 **_motor_** signs/sx's of **peripheral nerve disease?**
1. **_Distal_** **weakness** 2. **Reduced tone** 3. **Cramps** 4. **Muscle fasciculations (twitching)** 5. **↓ DTRs** 6. **Atrophy**
27
**_Peripheral nerve disease_** **Positive** and **negative _sensory_ symptoms**
1. **Positive symptoms** 1. _Paresthesia_ "pins and needles" due to damage to large myelinated fibers 2. _Pain_ due to damage to small unmyelinated fibers 2. **Negative symptoms** 1. _Loss of sensation_
28
**_Large fiber peripheral neuropathy_** Positive and Negative Symptoms
* **Positive**: * tingling + * pins and needles + * numbness * **Negative**: * _↓ vibration & ↓ joint position sense +_ * arreflexia + * ataxia + * hypotonia
29
**_Small unmyelinated fiber peripheral neuropathy_** Postitive and negative symptoms
1. **Postitive** * Burning or jabbing 2. **Negative:** * ↓ pain, * ↓ temp
30
What are postitive and negative symptoms of a **motor fiber peripheral neuropathy?**
1. **Positive**: fasciculations, cramps, myokymia, restless legs, tightness 2. **Negative**: weakness, fatigue, areflexia, hypotonia, deformities
31
If patient has damage to **large myelinated sensory fibers**, they may have impairment of what signs?
1. Light-touch (cotton swab) 2. 2-point discrimination 3. Vibration (128 Hz tuning fork) 4. Joint position sense
32
**Small _unmyelinated_ sensory fibers peripheral neuropathy** Symptoms
* **Impariment** of * 1. **Temperature** perception * 2. **Pain** perception (pin prick)
33
If patient has damage to **small unmyelinated sensory fibers**, they may have impairment of what signs?
1. **Perception of temperature** 2. **Perception of pain (pin prick)**
34
If patient has damage to **peripheral _motor_ fibers, t**hey may show what signs?
1. **Atrophy (wasting of muscle mass)** 2. **Muscular weakness** 3. **Depressed or absent DTR (muscle stretch)** 4. **Fasciculations** 5. **Cramps**
35
3 **median N** **mononeuropathies** Sensory distrubution
1. **Pronator Syndrome** 2. **Anterior Osseous Syndrome** 3. **Carpal Tunnel Syndrome** **Sensory distrubution:** first 3.5 fingers of hand on palmar side, and tips of fingers on dorsum of hand.
36
Sx of **pronator syndrome**
1. **_Insidious**_ onset of _**diffuse/dull achy pain_** in the _proximal forearm_ (rarely acute & sharp 1. Worse with repeated forearm pronation (screwdriver) 2. Forearm muscles are easily fatigured 3. **_Diffuse numbness**_ of hand: mainly in _**2nd/3rd fingers_** 4. **_No_** nocturnal awakening
37
Which **median nerve mononeuropathy** is associated with an abnormal pinch sign w/ normal sensation?
**Anterior Interosseous Syndrome**
38
What is **Anterior Interosseous Syndrome?** what will you see in **nerve conduction studies** and **needle EMG?**
**No pain/weakness**, but **cannot do okay sign;** they make a teardrop bc anterior interroseous nerve is responsible for long flexors of thumb and index finger. 1. Nerve conduction studies: median and ulnar N are NL 2. Needle EMG 1. ABNL FPL, FDP, PQ 2. NL median, medial cord, C8 muscle
39
**Symptoms of Carpal Tunnel Syndrome**
1. Wake up at night with wrist pain and numb/ting in first 3.5 fingers 1. Loss of sensation over the thenar eminence 2. Day: pain is intermittant and dull/achy
40
Common sites for **ulnar nerve entrapment**
1. - **Elbow**: between medial epicondyle and olecranon 2. - **Wrist**: Guyon's canal
41
**Ulnar mononeuropath**y at the **elbow** will show what _abnormalities_ on **EMG**?
1. 1st dorsal interosseous 2. Abductor digiti minimi 3. Adductor policis 4. Flexor carpi ulnaris 5. Flexor digitorum profundus
42
Speciality tests for **ulner neuropathy**
**Froments sign** * Tell pt to pinch piece of paper with [thumb and index finger] while doc pulls on paper. * **+ test:** flexion of IP joint of thumb =\> ulnar neuropathy =\> weak ADDUCTOR POLLICIS
43
4 places **radial nerve** can get entrapped =\> **radial mononeuropathy**? Which is the _most common?_
1. **Axilla**: Crutch palsy (axilla compressed by crutches) 2. **Humerus/spiral groove**: Saturday night palsy\*\*\* (MC) 3. **Supinator** (posterior interrouseous branch) 4. **Wrist** (superficial radial sensory branch)
44
**Radial mononeuropathy** due to compression as it winds around the **humerus in the spiral groove** causes what?
**Saturday night palsy** 1. **Wrist drop**: loss of _wrist_, _finger_ and _thumb_ extension 2. **Can _STILL_ extend elbow bc triceps are spared.** 3. **Brachioradialis +/- spared** 4. +/-sensory loss dorsal thumb web
45
What do you usually see on EDX in **Radial mononeuropthy** due to **Saturday night palsy?**
1. EMG findings in **extensors of wrist** and **digits** and perhaps **brachioradialis** 2. **Radial motor** and **sensory** studies = NL
46
What autonomic findings and can you see in a **peripheral neuropathy (aka polyneuropathy)?**
1. Problems with 1. **pupils** 2. **sweating** 3. **impotence** 4. **hypoTN/HTN**
47
Drug-induced peripheral neuropathy can be due to what drug?
**Cis-platinum**
48
. W who had breast cancer had a L mastectomy and local radiation. 2 years later, in L arm, patient gets pain in the upper chest, numbness in the 4th and 5th digits of the L hand, and a problem with dexterity due to weakness. MC due to what?
**Tumor recurrence** that is compressing the **medial cord.**
49
2. W who had breast cancer had a L mastectomy and local radiation. Patient begins to experience numbness in the thumb, index finger AND weakness of elbow flexion, but NO pain. MC due to what?
**Radiation therapy** that damages the **upper trunk of the lateral cord.**
50
**Vit B12 deficiency** (aka \_\_\_\_\_\_) mimics what disorder?
**Subacute combined degeneration** **ALS** = _UMN_ and _LMN_ dysfunction; mimics a peripheral neuropathy
51
Pt has : 1. Numbness and tingling and feet/ lower legs 2. DEC DTR, 3. BUT **_you also see UMN signs._** **What should you suspect?**
**Vit B12 deficiency** (subacute combined degeneration) or ALS
52
**Peroneal neuropathy of fibular head** causes what?
1. Weakness of **foot dorsiflexion** and **eversion** 2. Weakness of **toe extension** 3. **Sensory loss dorsum** of **foot**; +/- **lateral calf**
53
LMN deficits:
1. **Atrophy** of **muscles** 2. **Diminished/no reflexes** (hypo/areflexia) 3. **Fasciculations** 4. **Weakness**
54
**UMN deficits**
1. **Babinski sign** (extensor plantar response) 2. **Hoffman’s signs (b**abinski sign of UE) = hold ring finger = ask pt to relax hand =\> flick ring finger =\> looking for contraction of hand, specifically thumb and index finger 3. **INC reflexes or tone (**hyperreflexia) 4. **Spasticity** 5. **Crossed adductor response** = have pt sitting or laying, tap on adductor muscle on thight =\> + sign if you get a response from both legs
55
**Pyramidal cells** + **corticospinal** and **corticobulbar tract** ultimately join together to produce what?
**UMN** and **LMN** **dysfunction** =\> ALS (Lou Gehrigs disease)
56
**Miller Fisher Syndome i**s what?
type of GBS =\> 1. **opthalmoplegia,** 2. **ataxia** 3. **areflexia**
57
**Nerve root/radiculopathies** present with WHAT?
present with **PAIN** = **paresthesias** = **pins and needles**
58
**Peripheral neuropathy** present with what symptoms
1. pain, 2. weakness, 3. sensory loss, 4. impaired reflexes due diffuse lesions of peripheral nerves 5. Symmetrical and most severe in distal portion of limbs * Legs are usually affected first and more severe than arms =\> stocking glove appearance
59
**Small unmyelinated Fiber Polyneuropathy**
1. **Pain** 2. **Buring dysthesias** 3. **Parathesias** 4. **Temperature sensation ABNL** 5. Signs 1. DEC pinprick/temp sensation 2. Dysthesias to light tough 3. NL strenghth, reflexes, propioception, vibratory sensation
60
* DB Melitis:
distal symmetric **sensorimotor** polyneuropathy of **LMN** * Numbess * Loss of pain * Paresthesias * Balance issues * ANS problems: postural hypoTN, Incomplete bladder emptying =\> INC infections Starts in toes/forefoot =\>Stocking glove distribution
61
Findings with **DM**
1. **Segmental demyelination:** thinly myelinated fibers 2. DEC in small MYE/UNMYE 3. Endoneurorial arterioles = thick, hylanized, PAS +
62
if you see neuropathy under 30, with marked slowing of nerve conduction velocities = think of what
**CMT** = hereditary demyelination of **MOTOR** AND **sensory** nerves
63
Sx of GB
1. Ascending motor paralysis 2. No DTR 2. No sensory problems 4. Stops after 4-6 weesk
64
Multifocal Motor Neuropathy sx
- Slowly progressive distal weakness of **hands**\>feet

NMSK Exam 3 (17 decks)

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