LE Neuropathies- Shappy Flashcards
Parts of the PNS
Motor
Sensory
Autonomic
Neurapraxia
caused by mild ischemia
-segmental demylination blocking condition
Axonotmesis
Prolonged compression and necrosis
- axon damage connective tissue intact
Neurotmesis
Complete severance of axon and distruption of connective tissue
- gun shot, stab (can be surgical) or avulsion, amputations
- muscle fibers atrophy due to loss of trophic stubstances
Causes of PN injury
compression/ trauma, heredity, infections, toxins, metabolic, etc
Demylination
typically segmental
-damage to the mylin sheath around the nerve loosing the velocity of conduction
Degeneration (of PN)
typically more severe injury
- Anterograde or Wallerian degerneration (dead at the distal end)
- ex. foot dangling off the bed and having a nerve compression If the nerve is severed then Wallerian degeneration. If the axon stays intact, not Wallerian
Regeneration
Slow process, axonal sprouting
can get lost and not find correct endoneurial tube
if there is connective tissue, more likely of the target tissues have the connection to have the regrowth
Reinnervation
Can occur when adjacent neuron innervates muscle fibers of injured neuron, collateral sprouting
Mononeuropathy
single PN injured
Polyneuropathy
several PN injured
Radiculoneuropathy
(or Radiculopathy)
Nerve root injury
Polyradiculitis
infection creating inflammation of several nerve roots
Myopathy
Motor endplate injury
synpse issue
Signs and Symptoms of Peripheral Dysfunction
(Sensory)
tingling, numbness, burning, etc
- peripheral distribution
- nerve root (distal first, stocking glove distribution)
Signs and Symptoms of Peripheral Dysfunction
(Motor)
weakness, hypotonia, flaccid
- paresis or paralysis- peripheral distrubution
- weakness-myotome distributions of that spinal nerve
Signs and Symptoms of Peripheral Dysfunction
(automonic)
Vascular, sweating, hair, skin
Charcot-Marie-Tooth (CMT) Disease
Hereditary motor and sensory neuropathy or peroneal muscular atrophy; Charcot foot- the foot’s intrinsic muscles are wasting which creates a high arch and clawed toes
- distal limb muscle wasting and weakness
- skeletal deformities
- distal sensory loss
- DTR abnormalities
- balance issues which makes them walk farther appart have a large base of support
- looks like they are walking on glass
Charcot Foot
Chromosomal defect; high arch and toes curls
CMT Pathology
mutation in the proteins
-Schwaan cell demyelination along with hypertrophic onion bulb formation
onion bulb
(like seen in CMT)
palpable enlarged peripheral nerves due to Schwann cells and precesses attempting to remyelinate damaged nerves
Clinical Presentation of CMT
Pes Cavus and hammer toes
Weakness in DF and EVER, foot drop, and steppage gait
Wasting of intrinsic muscles (because the foot is holding in one position)
Loss of proprioception and cutaneous sensation (tingling and burning sensations present); having balance problems
CMT Diagnosis
EMG studies
- decresed NCV- both motor and sensory
- axonal degeneration or demyelination on nerve biopsy
CMT Treatment
Can not fix the cause, only treat the symptoms
- footdrop- bracing, remebering skin care due to the insensate feet
- gait training
- ROM exercises (can try, but this is something that the patient will need to learn to do everyday in order to get to neurtal)
- strengthening has questionable effects
- overall conditioning
- balance training- work on ways to compensate
Morton’s Neroma
Interdigital perineural fibroma
-usually between 3rd and 4th toes and is unilateral
found in runners, high heels, no cushion in your shoes, etc (squeezing the toes)
Morton’s Neuroma Pathology
thickenign of endoneurium and perineurium, demylinaiton, decreased blood supply
Causes of Morton’s Neuroma
Poor foot mechanics
- Excessive pronation
- Poor intermetatarsal mobility
Extrinsic factors
- High heel shoes
- Narrow toe box
- Thin sole shoes
- Jogging and shear forces
Morton’s Neuroma Clinical Presentation
burning, tingling, sharp pain, numbness
-radiating into toes or foot
Morton’s Neuroma Diagnosis
MRI
Provocation Test
- palpation of the involved area (bone versus between the bones)
- matarsal sqeeze test (won’t tell you if its the bone or the neuroma)
Morton’s Neuroma Treatment
Surgical (cut the ligament to open up the space
Non-surgical
-injections, shoe modification, orthotics, activity modification, NSAIDS, moving the metatarsals to open up the space
Nerve Entrapments
Iliacus Syndrome
Saphenous Neuropathy
Obturator Neuropathy
Proximal Tbial Neuropathy
Common Peroneal Neuropathy
Superficial Peroneal Neuropathy
Deep Peroneal Neuropathy
Posterior Tibial Nerve Compression (Tarsal Tunnel Syndrome)
Metabolic Neuropathies
Alcoholic Neuropathy
Chonic Renal Failure
Anemia
Infections/Inflammations
Iliacus Syndrome
Femoral Nerve (L2,3,4) entrapment between inguinal ligament and iliopsoas
- muscle weakness
- sensation- dermatomal to anterior thight, lower leg and foot
Saphenous Neuropathy
Saphenous nerve is a branch of femoral and only sensory loss
just distal to the ingunal ligament
Obturator Neuropathy
medial thigh muscle weakness
fascial tighness, groin injury with inflammation, tumor, etc (space occupying lesion)
Proximal Tibial Neuropathy
L4,5,S1,2; off of sciatic nerve
Posterior lower leg muscle weakness and sensory loss (heel)
Popliteal fossa hematoma, baker’s cyst
Common Peroneal Neuropathy
(L4,5,S1)
lateral anterior compartment innervation of lower leg
trauma-contusion, cast, etc
-pain, foot drop, sensation
(everion, DF)
icing the knee too close to the fibular head- nerve runs close to the surface near here
Superficial Peroneal Neuropathy
Lateral compartment motor and sensation dorsolateral foot and ankle
Deep Peroneal Neuropathy
anterior tarsal tunnel impingement (extensor retinaculum)
toe extensors and sensation dorsomedial
Posterior Tibial Nerve Compression
Tarsal Tunnel Syndrome
- space occupying lesions, foot mechanics, trauma, etc
- burning, tingling, numbness, tap test or Tinel’s sign
- Plantar muscle weakness distal to impingement
posterior/ inferior to the medial mallelous
-TOM, DICK, and HARRY
Tendons: posterior tibialis, flexor digitorum longus, flexor hallus longus
posterior tibial nerve (medial and lateral plantar nerve- toe flexion)
Metabolic Neopathies
Diabetic Polyneuropathy or Mononeuopathy
Alcoholic Neuopathy
Chronic Neuropathy
Anemia
Diabetic Polyneuopathy or Mononeuropathy
nerve and schwann cell damage: sodium-potassium and ATP deficiencies, microcirculation issues (thickening) and ischemia
loss of nerve axons both myelinated and unmyelinated
Alcoholic Neuropathy
direct toxic effect of alcohol or deficiencies in thiamine and other B vitamins for malnutrion
Chronic Renal Failure
Uremic toxins- demyelination of PNS
Anemia
B12 deficiency with Pernicious anemia
Infections/ Inflammtions causing Neuropathies
Guilain-Barre Syndrome
Post-Polio Syndrome
Herpes Zoster- Shingles
Guillain-Barre Syndrome
immune-mediated-bacteria and viral infection
Post-Polio Syndrome
Neuromusclar atrophy over decades
Herpes Zoster-Shingles
Dormant chickenpox virus
How to treat Phantom Limb
Mirrors, Tens at most distal end (using electricity), using heat/cold, taping, massage
Treating the nerve
Which is more likely to have regeneration: axonotmesis or neurotmesis?
axonotmesis
Baker’s Cyst
back in the popital fossa
fairly mobile, not always painful
can test to see if it’s infected
friction causes fluid build up near the gastro and hamstrings in the posterior aspect of the knee; taking the fluid out will not cure; need to fix the problem (stretching)
