L11 UE Neuro Flashcards

1
Q

Myelinated nerves are more sensitive to

A

stretch
compression

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2
Q

Patient History w/ neuropathic pain

A

burning, searing pain
hypo/hyperesthesia, allodynia
qualities are unique
symptoms make move

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3
Q

Peripheral Neuropathies can be caused by

A

Systemic Disease–> MS, Diabetes
Vitamin B and E deficiencies
Medications–> chemo, statins
alcohol
toxins
infection
congenital
trauma
entrapment

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4
Q

Peripheral neuropathy

A

damage or disease affecting nerves outside the CNS

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5
Q

Polyneuropathies

A

often bilateral, symmetrical
more likely to be systemic

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6
Q

Radiculopathies

A

one or two spinal nerve roots
usually unilateral
sensory, motor, and reflex changes

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7
Q

Mononeuropathies

A

one single peripheral nerve gets trapped somewhere along its course

site of S/S depends on the nerve

source of S/S is entrapment

Onset is often slow, mild and chronic S/S

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8
Q

Entrapment Neuropathies RF

A

ischemia
firbosis
demyelination
axon degeneration
neuroinflammation
altered axonal transport
CNS issues

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9
Q

NERVE ROOT vs Peripheral Nerve

A

Pain and/or sensory changes
often reflex changes
positive cervical clearning and scan provocation

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10
Q

Nerve Root vs PERIPHERAL NERVE

A

pain and or sensory cnages are often in smaller patches
no reflex changes (musculotaneous is the exception)
negative cervical clearing and scan exam

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11
Q

Double crush syndrome

A

compression at one site makes it more sensitive to compression at another due to impaired axoplasmic flow

usually caused by failed surgeries, peripheral and central nerve root issue

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12
Q

Prevalence of Neuropathies

A

Carpal tunnel is most common in general pop and workforce
Most people experience cervical radiculopathy at C7

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13
Q

RF for Neuropathies

A

-physical factors; increased BMI
-systemic disease; DM, smoking
-occupational factors; vibration, manual labor
-psychosocial
-genetic predispositions

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14
Q

Cervical Radiculopathy

A

Nerve root comes out lateral, exits at one segment below

can be compression or inflammation of nerve or both that is causing S/S

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15
Q

Brachial plexopathy

A

multilevel
doesn’t match peripheral or spinal distribution

circumferential rather than dermatomal

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16
Q

Peripheral Mononeuropanty

A

matches a peripheral distribution, from level of entrapment distally
doesn’t match spinal distribution

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17
Q

What happens when nerve is injured?

A

changes to intracellular signaling transduction, molecular biologic mechanisms, neurotrophic factors and myelin sheath

microcirculation changes

inflammatory response

lymphatic system changes

scar tissue formation

18
Q

Axillary Innervation

A

Muscles: deltoid, teres minor

Cutaneous: upper arm, deltoid

entrapment: quadrangular space

19
Q

Spinal Accessory Innervation

A

Muscles: Traps, Levator scap, SCM, middle scalene

No cutaenous innervation

20
Q

Suprascapular Innervation

A

Muscle: supraspinatus, infraspinatus

No cutaneous innervation

21
Q

Long Thoracic Innervation

A

Muscle: serratus anterior

No cutaneous innervation

Entrapment: between clavicle and 1st rib, superifical along outer SA

22
Q

Musculotaneous Innervation

A

Muscles: biceps and brachialis

Cutaneous: skin of lateral and post forearm

Entrapment: coracobrachialis, retractors

23
Q

Axillary Injury

A

MOI: crutch use, throwers, shoulder dislocation
S/S: weakness, atrophy in deltoid/teres minor
Need to differentiate with c5 radiculopathy

24
Q

Spinal Accessory Injury

A

MOI: direct trauma to traps, GH dislocation, cervical node biopsy
DDX: c4 radic

25
Suprascapular Nerve Injury
DDX: RCT, C5 radiculopathy MOI: direct trauma to spine of scap, repeptive overhead loading
26
Long Thoracic Injury
MOI: improper crutch use, direct blow to side, inferior directed blow to shoulder, OH lifting S/S: decreased abduction and elevation MMT, scapular winging
27
Musculotaneous Injury
MOI: shoulder surgery, repetitive flexion and elbow flexion with pronation, rowers S/S: biceps weakness, absent DTR, lateral forearm parethesia, typically non-painful
28
Median Innervation
Muscles: pronators, flexors of wrist and fingers, thumbs Cutaneous: palm of hand 1-3 fingers, dorsum, tops of fingers 2-3 Entrapment: ligament of struthers, bicipital aponeourosis, pronator teres, FDS, carpal tunnel
29
Median Nerve: Lacertus Fibrosus/Ligament of Struthers
S/S: pain and paresthesias in median, deep pain at ligament, pain increases at night Exam findings: weakness in all median muscles, decreased thumb opp, benedictions hand, positive distal tinel's, elbow flexion and supination cause S/S
30
Pronator Teres Syndrome
MOI: repetitve pronation activity S/S: pain/paresthesias in hand/fingers Clinical findings: weakness in all median muscles except pronator teres and ECRB. Positive proximal tinels, sensory loss in median n, resisted pronation w/elbow extended causes S/S
31
Anterior Interosseous Syndrome
S/S: difficulty writing or making a fist. dull pain in proximal 1/3 of forearm Clinical findings: weakness in FDP, FPL, pronator quad. + OK sign, no sensory loss, direct pressure at FDS arch causes pain
32
Carpal Tunnel Syndrome
S/S: pain or paresthesias in fingers, not palm, pain/cramp worse at night, difficulty with grasp/pinch Clinical findings: + flicks, + tinels, + phalen's, sensation at thumb is intact but atrophy of muscles
33
Ulnar innervation
muscles: flexors, pinky, interossei, adductor Cutaneous: ulnar hand, 5th ray, half of 4th finger
34
Cubital Tunnel Syndrome
MOI: rests elbows on desk or prolonged elbow flexion, baseball/javelin/boxing S/S: pain in forarm and tingling in medial fingers Clinical findings: atrophy of hand intrinsics, + compression, + froment, + claw entrapment of ulnar nerve at elbow
35
Tunnel of Guyon Syndrome
MOI: drills, jackhammers, cycling S/S: worse at night, pain in palmar lateral hand, worse at night, wrist extension aggravates Clinical findings: + tinel's at hamate, +phalens, -palmar creases with resisted 5th finger abd, abd/add of pinky are normal entrapment of ulnar nerve at wrist
36
Radial innervation
muscles: triceps, anconeus, ECRL, supinator, extensors of forearm and fingers Cutaneous: post lateral upper arm and elbow, post forearm, radial side of hand, dorsum of hand (not DIPS)
37
Spiral Groove Compression
MOI: Ill fitting crutches, recent humeral fx, saturday night palsy, alcohol consumption Clinical findings: weakness/pain in radial nerve distribution, wrist drop
38
Posterior Interosseous syndrome
MOI: repetitive pronation, forearm extension, and wrist flexion S/S: deep pain in post forearm, difficulty making fist Clinical findings: pain on compression distal to lateral humeral epicondyle, weakness of finger and wrist extensors (except ECRL), + wrist drop, no sensory deficits DDX: lateral epicondylitis
39
Interventions
postural, ergonomic mods tissue protection patient ed scar, soft tissue, jt mobs strengthening spinal traction neural mobs taping/splinting
40
Refer patient back to MD
if there is brachial plxeopathy, peripheral polyneuropathies
41
Red flags
B UE symptoms distal to proximal progression significant atrophy constitiutional symptoms exam doesn't match history no change with interventions