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PHTH 7212 Pathophysiology > LE Neuropathies- Shappy > Flashcards

LE Neuropathies- Shappy Flashcards

1
Q

Parts of the PNS

A

Motor

Sensory

Autonomic

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2
Q

Neurapraxia

A

caused by mild ischemia

-segmental demylination blocking condition

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3
Q

Axonotmesis

A

Prolonged compression and necrosis

  • axon damage connective tissue intact
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4
Q

Neurotmesis

A

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
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5
Q

Causes of PN injury

A

compression/ trauma, heredity, infections, toxins, metabolic, etc

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6
Q

Demylination

A

typically segmental

-damage to the mylin sheath around the nerve loosing the velocity of conduction

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7
Q

Degeneration (of PN)

A

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
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8
Q

Regeneration

A

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

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9
Q

Reinnervation

A

Can occur when adjacent neuron innervates muscle fibers of injured neuron, collateral sprouting

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10
Q

Mononeuropathy

A

single PN injured

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11
Q

Polyneuropathy

A

several PN injured

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12
Q

Radiculoneuropathy

(or Radiculopathy)

A

Nerve root injury

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13
Q

Polyradiculitis

A

infection creating inflammation of several nerve roots

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14
Q

Myopathy

A

Motor endplate injury

synpse issue

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15
Q

Signs and Symptoms of Peripheral Dysfunction

(Sensory)

A

tingling, numbness, burning, etc

  • peripheral distribution
  • nerve root (distal first, stocking glove distribution)
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16
Q

Signs and Symptoms of Peripheral Dysfunction

(Motor)

A

weakness, hypotonia, flaccid

  • paresis or paralysis- peripheral distrubution
  • weakness-myotome distributions of that spinal nerve
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17
Q

Signs and Symptoms of Peripheral Dysfunction

(automonic)

A

Vascular, sweating, hair, skin

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18
Q

Charcot-Marie-Tooth (CMT) Disease

A

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
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19
Q

Charcot Foot

A

Chromosomal defect; high arch and toes curls

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20
Q

CMT Pathology

A

mutation in the proteins

-Schwaan cell demyelination along with hypertrophic onion bulb formation

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21
Q

onion bulb

(like seen in CMT)

A

palpable enlarged peripheral nerves due to Schwann cells and precesses attempting to remyelinate damaged nerves

22
Q

Clinical Presentation of CMT

A

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

23
Q

CMT Diagnosis

A

EMG studies

  • decresed NCV- both motor and sensory
  • axonal degeneration or demyelination on nerve biopsy
24
Q

CMT Treatment

A

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
25
Q

Morton’s Neroma

A

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)

26
Q

Morton’s Neuroma Pathology

A

thickenign of endoneurium and perineurium, demylinaiton, decreased blood supply

27
Q

Causes of Morton’s Neuroma

A

Poor foot mechanics

  • Excessive pronation
  • Poor intermetatarsal mobility

Extrinsic factors

  • High heel shoes
  • Narrow toe box
  • Thin sole shoes
  • Jogging and shear forces
28
Q

Morton’s Neuroma Clinical Presentation

A

burning, tingling, sharp pain, numbness

-radiating into toes or foot

29
Q

Morton’s Neuroma Diagnosis

A

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)
30
Q

Morton’s Neuroma Treatment

A

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

31
Q

Nerve Entrapments

A

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

32
Q

Iliacus Syndrome

A

Femoral Nerve (L2,3,4) entrapment between inguinal ligament and iliopsoas

  • muscle weakness
  • sensation- dermatomal to anterior thight, lower leg and foot
33
Q

Saphenous Neuropathy

A

Saphenous nerve is a branch of femoral and only sensory loss

just distal to the ingunal ligament

34
Q

Obturator Neuropathy

A

medial thigh muscle weakness

fascial tighness, groin injury with inflammation, tumor, etc (space occupying lesion)

35
Q

Proximal Tibial Neuropathy

A

L4,5,S1,2; off of sciatic nerve

Posterior lower leg muscle weakness and sensory loss (heel)

Popliteal fossa hematoma, baker’s cyst

36
Q

Common Peroneal Neuropathy

A

(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

37
Q

Superficial Peroneal Neuropathy

A

Lateral compartment motor and sensation dorsolateral foot and ankle

38
Q

Deep Peroneal Neuropathy

A

anterior tarsal tunnel impingement (extensor retinaculum)

toe extensors and sensation dorsomedial

39
Q

Posterior Tibial Nerve Compression

A

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)

40
Q

Metabolic Neopathies

A

Diabetic Polyneuropathy or Mononeuopathy

Alcoholic Neuopathy

Chronic Neuropathy

Anemia

41
Q

Diabetic Polyneuopathy or Mononeuropathy

A

nerve and schwann cell damage: sodium-potassium and ATP deficiencies, microcirculation issues (thickening) and ischemia

loss of nerve axons both myelinated and unmyelinated

42
Q

Alcoholic Neuropathy

A

direct toxic effect of alcohol or deficiencies in thiamine and other B vitamins for malnutrion

43
Q

Chronic Renal Failure

A

Uremic toxins- demyelination of PNS

44
Q

Anemia

A

B12 deficiency with Pernicious anemia

45
Q

Infections/ Inflammtions causing Neuropathies

A

Guilain-Barre Syndrome

Post-Polio Syndrome

Herpes Zoster- Shingles

46
Q

Guillain-Barre Syndrome

A

immune-mediated-bacteria and viral infection

47
Q

Post-Polio Syndrome

A

Neuromusclar atrophy over decades

48
Q

Herpes Zoster-Shingles

A

Dormant chickenpox virus

49
Q

How to treat Phantom Limb

A

Mirrors, Tens at most distal end (using electricity), using heat/cold, taping, massage

Treating the nerve

50
Q

Which is more likely to have regeneration: axonotmesis or neurotmesis?

A

axonotmesis

51
Q

Baker’s Cyst

A

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)

PHTH 7212 Pathophysiology (12 decks)

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