L11 UE Neuro Flashcards
Myelinated nerves are more sensitive to
stretch
compression
Patient History w/ neuropathic pain
burning, searing pain
hypo/hyperesthesia, allodynia
qualities are unique
symptoms make move
Peripheral Neuropathies can be caused by
Systemic Disease–> MS, Diabetes
Vitamin B and E deficiencies
Medications–> chemo, statins
alcohol
toxins
infection
congenital
trauma
entrapment
Peripheral neuropathy
damage or disease affecting nerves outside the CNS
Polyneuropathies
often bilateral, symmetrical
more likely to be systemic
Radiculopathies
one or two spinal nerve roots
usually unilateral
sensory, motor, and reflex changes
Mononeuropathies
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
Entrapment Neuropathies RF
ischemia
firbosis
demyelination
axon degeneration
neuroinflammation
altered axonal transport
CNS issues
NERVE ROOT vs Peripheral Nerve
Pain and/or sensory changes
often reflex changes
positive cervical clearning and scan provocation
Nerve Root vs PERIPHERAL NERVE
pain and or sensory cnages are often in smaller patches
no reflex changes (musculotaneous is the exception)
negative cervical clearing and scan exam
Double crush syndrome
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
Prevalence of Neuropathies
Carpal tunnel is most common in general pop and workforce
Most people experience cervical radiculopathy at C7
RF for Neuropathies
-physical factors; increased BMI
-systemic disease; DM, smoking
-occupational factors; vibration, manual labor
-psychosocial
-genetic predispositions
Cervical Radiculopathy
Nerve root comes out lateral, exits at one segment below
can be compression or inflammation of nerve or both that is causing S/S
Brachial plexopathy
multilevel
doesn’t match peripheral or spinal distribution
circumferential rather than dermatomal
Peripheral Mononeuropanty
matches a peripheral distribution, from level of entrapment distally
doesn’t match spinal distribution
What happens when nerve is injured?
changes to intracellular signaling transduction, molecular biologic mechanisms, neurotrophic factors and myelin sheath
microcirculation changes
inflammatory response
lymphatic system changes
scar tissue formation
Axillary Innervation
Muscles: deltoid, teres minor
Cutaneous: upper arm, deltoid
entrapment: quadrangular space
Spinal Accessory Innervation
Muscles: Traps, Levator scap, SCM, middle scalene
No cutaenous innervation
Suprascapular Innervation
Muscle: supraspinatus, infraspinatus
No cutaneous innervation
Long Thoracic Innervation
Muscle: serratus anterior
No cutaneous innervation
Entrapment: between clavicle and 1st rib, superifical along outer SA
Musculotaneous Innervation
Muscles: biceps and brachialis
Cutaneous: skin of lateral and post forearm
Entrapment: coracobrachialis, retractors
Axillary Injury
MOI: crutch use, throwers, shoulder dislocation
S/S: weakness, atrophy in deltoid/teres minor
Need to differentiate with c5 radiculopathy
Spinal Accessory Injury
MOI: direct trauma to traps, GH dislocation, cervical node biopsy
DDX: c4 radic