L11 UE Neuro

Question 1

Myelinated nerves are more sensitive to

Answer 1

stretch
compression

Question 2

Patient History w/ neuropathic pain

Answer 2

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

Question 3

Peripheral Neuropathies can be caused by

Answer 3

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

Question 4

Peripheral neuropathy

Answer 4

damage or disease affecting nerves outside the CNS

Question 5

Polyneuropathies

Answer 5

often bilateral, symmetrical
more likely to be systemic

Question 6

Radiculopathies

Answer 6

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

Question 7

Mononeuropathies

Answer 7

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

Question 8

Entrapment Neuropathies RF

Answer 8

ischemia
firbosis
demyelination
axon degeneration
neuroinflammation
altered axonal transport
CNS issues

Question 9

NERVE ROOT vs Peripheral Nerve

Answer 9

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

Question 10

Nerve Root vs PERIPHERAL NERVE

Answer 10

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

Question 11

Double crush syndrome

Answer 11

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

Question 12

Prevalence of Neuropathies

Answer 12

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

Question 13

RF for Neuropathies

Answer 13

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

Question 14

Cervical Radiculopathy

Answer 14

Nerve root comes out lateral, exits at one segment below

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

Question 15

Brachial plexopathy

Answer 15

multilevel
doesn’t match peripheral or spinal distribution

circumferential rather than dermatomal

Question 16

Peripheral Mononeuropanty

Answer 16

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

Question 17

What happens when nerve is injured?

Answer 17

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

microcirculation changes

inflammatory response

lymphatic system changes

scar tissue formation

Question 18

Axillary Innervation

Answer 18

Muscles: deltoid, teres minor

Cutaneous: upper arm, deltoid

entrapment: quadrangular space

Question 19

Spinal Accessory Innervation

Answer 19

Muscles: Traps, Levator scap, SCM, middle scalene

No cutaenous innervation

Question 20

Suprascapular Innervation

Answer 20

Muscle: supraspinatus, infraspinatus

No cutaneous innervation

Question 21

Long Thoracic Innervation

Answer 21

Muscle: serratus anterior

No cutaneous innervation

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

Question 22

Musculotaneous Innervation

Answer 22

Muscles: biceps and brachialis

Cutaneous: skin of lateral and post forearm

Entrapment: coracobrachialis, retractors

Question 23

Axillary Injury

Answer 23

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

Question 24

Spinal Accessory Injury

Answer 24

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

Question 25

Suprascapular Nerve Injury

Answer 25

DDX: RCT, C5 radiculopathy
MOI: direct trauma to spine of scap, repeptive overhead loading

Question 26

Long Thoracic Injury

Answer 26

MOI: improper crutch use, direct blow to side, inferior directed blow to shoulder, OH lifting
S/S: decreased abduction and elevation MMT, scapular winging

Question 27

Musculotaneous Injury

Answer 27

MOI: shoulder surgery, repetitive flexion and elbow flexion with pronation, rowers
S/S: biceps weakness, absent DTR, lateral forearm parethesia, typically non-painful

Question 28

Median Innervation

Answer 28

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

Question 29

Median Nerve: Lacertus Fibrosus/Ligament of Struthers

Answer 29

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

Question 30

Pronator Teres Syndrome

Answer 30

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

Question 31

Anterior Interosseous Syndrome

Answer 31

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

Question 32

Carpal Tunnel Syndrome

Answer 32

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

Question 33

Ulnar innervation

Answer 33

muscles: flexors, pinky, interossei, adductor
Cutaneous: ulnar hand, 5th ray, half of 4th finger

Question 34

Cubital Tunnel Syndrome

Answer 34

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

Question 35

Tunnel of Guyon Syndrome

Answer 35

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

Question 36

Radial innervation

Answer 36

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)

Question 37

Spiral Groove Compression

Answer 37

MOI: Ill fitting crutches, recent humeral fx, saturday night palsy, alcohol consumption

Clinical findings: weakness/pain in radial nerve distribution, wrist drop

Question 38

Posterior Interosseous syndrome

Answer 38

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

Question 39

Interventions

Answer 39

postural, ergonomic mods
tissue protection
patient ed
scar, soft tissue, jt mobs
strengthening
spinal traction
neural mobs
taping/splinting

Question 40

Refer patient back to MD

Answer 40

if there is brachial plxeopathy, peripheral polyneuropathies

Question 41

Red flags

Answer 41

B UE symptoms
distal to proximal progression
significant atrophy
constitiutional symptoms
exam doesn’t match history
no change with interventions