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PHTY3120 > L22: Upper limb entrapment neuropathies > Flashcards

L22: Upper limb entrapment neuropathies Flashcards

1
Q

What is peripheral neuropathic pain?

A

where n roots or peripheral trunks have been injured (mechanically or chemically) beyond capabilities of NS to adapt.

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2
Q

What are 8 causes of peripheral neuropathic pain?

A
  1. Metabolic
    • Diabetes
  2. Traumatic
    • Fractures
  3. Ischemic
    • Peripheral vascular disease
  4. Toxic
  5. Hereditory
  6. Infectious
  7. Compression
  8. Immune-related
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3
Q

What are 6 UL entrapment neuropathies?

A
  1. Suprascapular nerve entrapment
  2. Ulnar neuropathy- Cubital tunnel
  3. Pronator syndrome- Median nerve
  4. PIN entrapment- Nerve trapped in supinator
  5. Carpal tunnel syndrome
  6. Ulnar neuropathy (Guyon’s canal)- Between hook of hamate and pisiform
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4
Q

Peripheral neuropathic pain, it clinically present with either____ or _____ symptoms

A

positive; negative

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5
Q

What are the 2 negative symptoms of peripheral neuropathic pain? What does it cause?

A
  1. Sensory loss (anaesthesia)
  2. Motor weakness

Reduced impulse conduction, loss of axons or myelin

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6
Q

What are the 5 positive symptoms of peripheral neuropathic pain? What does it cause?

A
  1. Pain
  2. Paraesthesia (pins and needles)
  3. Hyperalgesia- Increase in painful response to something that is normally painful
  4. Allodynia- Increase in painful response to something that is NOT normally painful
  5. Spontaneous pain

Abnormal excitability of the nervous system

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7
Q

What is a clinical feature of musculoskeletal peripheral neuropathic pain?

A

Painful sensations

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8
Q

What are 2 painful sensations as a clinical feature of musculoskeletal peripheral neuropathic pain?

A
  1. Deep aching, cramping (i.e. nerve trunk pain)
    • Increase sensitivity of nociceptors in the surrounding tissues
  2. Superficial burning, stinging, paresthesia (i.e. dysesthetic pain)
    • Skin crawling sensation
    • Hyperexcitability of damaged tissue?
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9
Q

What are 5 clinical features of the physical examination of musculoskeletal peripheral neuropathic pain?

A
  1. Antalgic postures
  2. Active and passive movement impairments
  3. Pain with nerve compression / tensioning
  4. Signs of impulse conduction loss (depending on severity)
  5. Impairments in surrounding non-neural structures
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10
Q

What are 7 neurobiological mechanisms?

A
  1. Mechanical and chemical irritation –> Venous congestion
  2. Impaired intra-neural circulation, axoplasmic flow
  3. Inflammatory response of nerve trunk / root
    • Immune cell activation
    • Intra-neural oedema
    • Increased endoneural fluid pressure
  4. Sensitisation of nociceptors in neural connective tissue (nervi nervorum)
    • Increased mechanosensitivity, nerve trunk pain
  5. Progressive fibrosis
    • Reduced extensibility of neural connective tissue
  6. Progressive demyelination and formation of AIGS
    • Ectopic impulse generation
      • Mechanosensitivity, chemosensitivity, spontaneous firing, dysesthetic pain..
    • Neurogenic inflammation via antidromic discharge

(impulses towards periphery)

  1. Axonal degeneration
    • Negative symptoms..
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11
Q

Signs and symptoms of entrapment neuropathies often _____ (do/ do not) follow defined distributions for neurobiological mechanisms

A

do not

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12
Q

What are the 4 changes in the neurobiological mechanisms?

A
  1. Changes in peripheral structures
  2. Changes in dorsal root ganglia
  3. Changes in spinal cord
  4. Changes in cortical areas
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13
Q

What are 8 diagnostic tests for UL entrapment neuropathies?

A
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14
Q

What are the 2 types of UL entrapment neuropathies?

A
  1. Environmental
  2. Medical
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15
Q

What are 3 environmental risk factors for UL entrapment neuropathies?

A
  1. Prolonged postures in extremes of wrist flexion or extension
  2. Repetitive use of flexor muscles
  3. Exposure to vibration
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16
Q

What are 3 medical risk factors for UL entrapment neuropathies?

A
  1. Conditions that alter fluid balance in the body i.e. pregnancy, menopause, obesity..
  2. Post trauma i.e. fracture
  3. Neuropathic factors i.e. diabetes, alcoholism
17
Q

What are 8 standard symptoms of capal tunnel syndrome? What are symptoms mitigated by?

A
18
Q

What is the presenation of carpal tunnel syndrome?

A

Peaks in late 50s mainly in women (later on in 70s tends to be equal in male and females)

19
Q

What are the 4 features of stage 1 of CTS?

A
  1. Severe pain that may radiate from wrist to the shoulder
  2. Annoying tingling in hands and fingers
  3. Flick sign relieves symptoms
  4. Frequent awakenings during night with sensation of swollen, numb hand, sensation of hand stiffness during the morning
20
Q

What are the 2 features of stage 2 of CTS?

A
  1. Symptoms also present during the day, mainly with sustained postures and repeated movements
  2. Objects often falling from hand as unable to feel fingers
21
Q

What are the 3 features of stage 3 of CTS?

A
  1. Sensory symptoms may diminish
  2. Aching in thenar eminence
  3. Weakness and atrophy of thenar muscles
22
Q

What are the 4 issues of research into diagnostic criteria for CTS?

A
  1. no gold standard
  2. poor methodological quality
  3. patient selection bias (community v those attending a clinic)
  4. asymptomatic controls

Not one test will give you a Dx of CTS but a combination of signs and symptoms.

23
Q

What are 5 diagnostic tests for CTS?

A
  1. Phalen’s (wrist flexion)
    • EOR for 60sec –> reproduction of pain and PnN
  2. Reverse Phalen’s (extension)
  3. Tinel’s
    • Tapping over carpal tunnel to elicit symptoms
  4. Carpal compression (CC)
    • Sustained compression at carpal tunnel
  5. CC + wrist flexion
24
Q

What are 3 characteristics of nerve conduction tests (diagnostic tests) for CTS?

A
  1. Confirm focal damage to the median nerve inside the carpal tunnel
  2. Quantify neurophysiological severity by using a scale
  3. Define nerve pathophysiology: conduction block, demyelination or axonal degeneration
25
Q

What are 4 conservative treatments for CTS (management strategies)?

A
  1. Splinting **
  2. Activity modification
  3. Diuretics (if limb swelling)
  4. NSAIDS

** Treatment supported by high quality evidence

26
Q

What are 2 treatments if failed conservative treatment or progressive motor deficits for CTS (management strategies)?

A
  1. Steroid injection **
  2. Surgical decompression **

** Treatment supported by high quality evidence

27
Q

What are the most frequently employed modalities by hand therapists in the management of capal tunnel syndrome?

A
28
Q

What are 2 types of nerve gliding exercises?

A
  1. Tensioning: Elb Ext and Wrist Ext
  2. Sliding: Elb Ext and Wrist Flex
29
Q

What nerve gliding exercise technique is better for acute stage?

A

Sliders are better for acute stage

  • Demonstrate greater/lesser? longitudinal excursion and less strain on nerve
30
Q

What are 2 local and central effects of nerve gliding exercises?

A
  1. ↓ intraneural oedema, local inflammatory products, scar formation
  2. ↓ pain and sensitivity, unwanted fear of movement, attenuate ongoing peripheral input into CNS
31
Q

What are nerve gliding exercises?

A
32
Q

What are 2 types of end position for wrist finger sliding?

A
33
Q

There _____ (is/ is not) strong evidence supporting need for replacement of standard open carpal tunnel release by existing alternative surgical procedures

A

is no

34
Q

_____ treatment relieves symptoms significantly better than splinting, but unclear whether better than CSI

A

Surgical

35
Q

What is the treatment for mild/moderate and severe symptoms for CTS?

A
  • Mild to moderate symptoms –> conservative management
  • Severe symptoms –> nerve conductions tests done (depending on results = surgery might be beneficial from the start)
36
Q

_____ did better than those who were not managed.

A

Surgical treatment

PHTY3120 (29 decks)

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