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NMSK Exam 3 > Introduction to the Peripheral NS > Flashcards

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
Q

What is Mononeuropathy Multiplex

A

Focal involvement of 2 or more nerves that may occur in some systemic disorders (DM, vasculitis)

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26
Q

What are 6 motor signs/sx’s of peripheral nerve disease?

A
  1. Distal weakness
  2. Reduced tone
  3. Cramps
  4. Muscle fasciculations (twitching)
  5. ↓ DTRs
  6. Atrophy
27
Q

Peripheral nerve disease

Positive and negative sensory symptoms

A
  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
Q

Large fiber peripheral neuropathy

Positive and Negative Symptoms

A
  • Positive:
    • tingling +
    • pins and needles +
    • numbness
  • Negative:
    • ↓ vibration & ↓ joint position sense +
    • arreflexia +
    • ataxia +
    • hypotonia
29
Q

Small unmyelinated fiber peripheral neuropathy

Postitive and negative symptoms

A
  1. Postitive
    • Burning or jabbing
  2. Negative:
    • ↓ pain,
    • ↓ temp
30
Q

What are postitive and negative symptoms of a motor fiber peripheral neuropathy?

A
  1. Positive: fasciculations, cramps, myokymia, restless legs, tightness
  2. Negative: weakness, fatigue, areflexia, hypotonia, deformities
31
Q

If patient has damage to large myelinated sensory fibers, they may have impairment of what signs?

A
  1. Light-touch (cotton swab)
  2. 2-point discrimination
  3. Vibration (128 Hz tuning fork)
  4. Joint position sense
32
Q

Small unmyelinated sensory fibers peripheral neuropathy

Symptoms

A
  • Impariment of
      1. Temperature perception
      1. Pain perception (pin prick)
33
Q

If patient has damage to small unmyelinated sensory fibers, they may have impairment of what signs?

A
  1. Perception of temperature
  2. Perception of pain (pin prick)
34
Q

If patient has damage to peripheral motor fibers, they may show what signs?

A
  1. Atrophy (wasting of muscle mass)
  2. Muscular weakness
  3. Depressed or absent DTR (muscle stretch)
  4. Fasciculations
  5. Cramps
35
Q

3 median N mononeuropathies

Sensory distrubution

A
  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
Q

Sx of pronator syndrome

A
  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
Q

Which median nerve mononeuropathy is associated with an abnormal pinch sign w/ normal sensation?

A

Anterior Interosseous Syndrome

38
Q

What is Anterior Interosseous Syndrome?

what will you see in nerve conduction studies and needle EMG?

A

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. <strong>Nerve conduction studies:</strong> median and ulnar N are NL
  2. <strong>Needle EMG</strong>
    1. ABNL FPL, FDP, PQ
    2. NL median, medial cord, C8 muscle
39
Q

Symptoms of Carpal Tunnel Syndrome

A
  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
Q

Common sites for ulnar nerve entrapment

A
    • Elbow: between medial epicondyle and olecranon
    • Wrist: Guyon’s canal
41
Q

Ulnar mononeuropathy at the elbow will show what abnormalities on EMG?

A
  1. 1st dorsal interosseous
  2. Abductor digiti minimi
  3. Adductor policis
  4. Flexor carpi ulnaris
  5. Flexor digitorum profundus
42
Q

Speciality tests for ulner neuropathy

A

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
Q

4 places radial nerve can get entrapped => radial mononeuropathy?

Which is the most common?

A
  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
Q

Radial mononeuropathy due to compression as it winds around the humerus in the spiral groove causes what?

A

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
Q

What do you usually see on EDX in Radial mononeuropthy due to Saturday night palsy?

A
  1. EMG findings in extensors of wrist and digits and perhaps brachioradialis
  2. Radial motor and sensory studies = NL
46
Q

What autonomic findings and can you see in a peripheral neuropathy (aka polyneuropathy)?

A
  1. Problems with
    1. pupils
    2. sweating
    3. impotence
    4. hypoTN/HTN
47
Q

Drug-induced peripheral neuropathy can be due to what drug?

A

Cis-platinum

48
Q

. 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?

A

Tumor recurrence that is compressing the medial cord.

49
Q
  1. 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?
A

Radiation therapy that damages the upper trunk of the lateral cord.

50
Q

Vit B12 deficiency (aka ______) mimics what disorder?

A

Subacute combined degeneration

ALS = UMN and LMN dysfunction; mimics a peripheral neuropathy

51
Q

Pt has :

  1. Numbness and tingling and feet/ lower legs
  2. DEC DTR,
  3. BUT you also see UMN signs.

What should you suspect?

A

Vit B12 deficiency (subacute combined degeneration) or ALS

52
Q

Peroneal neuropathy of fibular head causes what?

A
  1. Weakness of foot dorsiflexion and eversion
  2. Weakness of toe extension
  3. Sensory loss dorsum of foot; +/- lateral calf
53
Q

LMN deficits:

A
  1. Atrophy of muscles
  2. Diminished/no reflexes (hypo/areflexia)
  3. Fasciculations
  4. Weakness
54
Q

UMN deficits

A
  1. Babinski sign (extensor plantar response)
  2. Hoffman’s signs (babinski 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
Q

Pyramidal cells + corticospinal and corticobulbar tract ultimately join together to produce what?

A

UMN and LMN dysfunction => ALS (Lou Gehrigs disease)

56
Q

Miller Fisher Syndome is what?

A

type of GBS =>

  1. opthalmoplegia,
  2. ataxia
  3. areflexia
57
Q

Nerve root/radiculopathies present with WHAT?

A

present with PAIN = paresthesias = pins and needles

58
Q

Peripheral neuropathy present with what symptoms

A
  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
Q

Small unmyelinated Fiber Polyneuropathy

A
  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
Q
  • DB Melitis:
A

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
Q

Findings with DM

A
  1. Segmental demyelination: thinly myelinated fibers
  2. DEC in small MYE/UNMYE
  3. Endoneurorial arterioles = thick, hylanized, PAS +
62
Q

if you see neuropathy under 30, with marked slowing of nerve conduction velocities = think of what

A

CMT = hereditary demyelination of MOTOR AND sensory nerves

63
Q

Sx of GB

A
  1. Ascending motor paralysis
  2. No DTR
  3. No sensory problems
  4. Stops after 4-6 weesk
64
Q

Multifocal Motor Neuropathy sx

A
  • Slowly progressive distal weakness of hands>feet

NMSK Exam 3 (17 decks)

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