Midterm: PNI UE Flashcards
What are the 3 layers that encloses the peripheral nerves?
- Endoneurium
- Perineurium
- Epineurium
What is the cause of neuropraxia
Compression
What is the healing time of Neuropraxia?
1-2 months (3-5 weeks)
What are the feature or effect of Neuropraxia?
Minimal Weakness
Thick myelinated motor nerve
What are the structure(s) affected in Neuropraxia?
Conduction block
(-) Wallerian Degeneration
What is the cause of Axonotmesis ?
Severe compression + traction
What are the structures affected in Axonotmesis?
Axon ONLY
(+) Wallerian Degeneration
What type of Wallerian Degeneration is present in Axonotmesis?
Axonal Degeneration
What is the healing time of Axonotmesis?
1-2mm/day
Does Axonotmesis have a good prognosis?
It has a GOOD prognosis
What are the features of having Axonotmesis
Myelinated motor and sensory nerves
What is the cause of Neurotmesis ?
Trauma
What are the structures affected in Neurotmesis?
Complete severity of the neuron include surround structures
(+) Wallerian Degeneration
What is the treatment duration of a pt c Neurotmesis?
Surgery
What is the prognosis of patient with Neurotmesis?
Poor
What feature is present in Neurotmesis?
Any
Out of the 3 PNI Classifications, who does have a (+) Wallerian Degeneration?
Axonotmesis et Neurotmesis
What is the description of a First Degree PNI?
Focal conduction block without axonal damage
What Sunderland classification does Neurapraxia belong?
First degree
What degree is Axonotmesis based on Sunderland classification?
Second degree
What is the description of a second degree classification of PNI (Sunderland)?
Axon damage with wallerian degeneration, supporting structures intact
What degree is Neurotmesis based on Sunderland PNI Classification?
3rd, 4th, 5th
What is the description of a 3rd degree PNI?
Damage to axon and endoneurium
What is the description of a 4th degree PNI?
Damage to perineurium and endoneurium
What is the description of a 5th degree PNI?
Damage to axon and all supporting structures
What is a Sixth-degree Injury?
Mixed nerve injury that combines the other degrees of injury
Introduced by Mackinnon to describe a mixed nerve injury that combines the other degrees of injury
Sixth-degree Injury
Occurs when some fascicles of the nerve are working normally while other fascicles may be recovering, and other fascicles may require surgical intervention to permit axonal degeneration
Sixth-degree injury
(T/F) In 6th-degree injury, fascicles require surgical intervention to permit axonal degenetation
True
(T/F) some fascicles of the nerve are working normally while other fascicles may be recovering
True
Enumerate the sequelae of Peripheral Nerve Compression
- Paresthesia
- Motor Paresis
- Sensory Deficits
- Both Motor and Sensory Deficits
Which of the following is not part of the branches of brachial plexus?
A. Axillary nerve
B. Long thoracic nerve
C. Median nerve
D. Radial nerve
B. Long thoracic nerve
Which of the following has innervation from the medial cord of the brachial plexus?
A. Musculocutaneous Nerve
B. Axillary Nerve
C. Ulnar Nerve
D. Radial Nerve
C. Ulnar Nerve
Affectation of this cord in the brachial plexus will lead to limitation of Adduction, Internal Rotation and Extension
A. Lateral Cord
B. Posterior Cord
C. Medial Cord
B. Posterior Cord
What are the roots that belong to the brachial plexus?
C5, C6, C7, C8, T1
In the thoracic outlet syndrome, which of the following is/are subjected to compression?
A. Subscapular Nerve
B. subclavian Nerve
C. Jugular Nerve
D. Brachial Plexus
D. Brachial Plexus
Interval from the supraclavicular fossa to the axilla that passes between the clavicle and the 1st rib
Thoracic outlet
Where can you find the thoracic outlet?
From the supraclavicular fossa to the axilla that passes between the clavicle and the first rib
What are the 3 important structures that may be subjected to compression in thoracic outlet syndrome?
- Subclavian artery
- Subclavian vein
- Brachial Plexus
What are the muscles affected if you had flexion-hyperextension type of trauma in the neck
Scalene Muscles
What is the MOI of trauma to the neck?
Flexion-hyperextension type -> tearing of the scalene muscle bundles -> compression of the nerve roots and trunks
This is caused by undergoing chemo; breast cancer
Radiation fibrosis
What is the most common cancer that will cause radiation fibrosis?
Breast CA
It is common to athletes that uses throwing / repetitive motions
Repetitive traction injury
What is the most common general manifestation of TOS?
UE paresthesia (98%)
What are the general manifestations of TOS?
- UE paresthesia
- Trapezis pain
- SH and/or arm pain
- Supraclavicular pain
- Chest Pain
- Occipital headache
- NA
- Paresthesias in the 4th and 5th fingers only
- Paresthesia in the 1st, 2nd, 3rd finger
What is the other name of Arterial Thoracic Outlet Syndrome?
Subclavian Artery Occlusion
(T/F) Dense fascial bands running forward and inferiorly from a cervical rib or elongated transverse process of C7 can cause Arterial TOS
True
(T/F) SUbclavian Artery Occlusion Sx may be positional and may interfere c occupations requiring overhead arm use
True
(T/F) there is absence of pulse with a completely abducted arm during overhead activity in TOS
True
What is Aneurysmal Disease caused by?
Embolization is caused by fragments of the clotted material within the aneurysm breaking loose and lodging in the distal vessels
What assessment is used to confirm presence of aneurysm?
Ultrasound study
What are the affected muscles in TOS?
Scalene, levator scapulae, pectoralis m, pectoralis M, anterior portion of the intercostals, suboccipital mm
Which of the following muscles help in Upward rotation of the scapula?
A. Rhomboids
B. Pectoralis Minor
C. Trapezius
D. Levator scapulae
C. Trapezius
In injury of the long thoracic nerve, entrapment of C5 and C6 as they pass through the _________
Scelaneus muscles
Where is the structure that compresses the nerve in UE traction that causes long thoracic nerve injury?
2nd rib
Compression and traction to the nerve by the _____ during general anestheis or with passive abduction of the arm will cause injury of the long thoracic nerve
Inferior angle of scapula
What is the result if you injured your long thoracic nerve?
Scapular winging
If the SA is weak where does the scapula goes or moves?
Upward
What muscle is affected in medial scapular winging?
Serratus anterior
What nerve is affected in medial scapular winging?
Long thoracic nerve
What nerve is affected in lateral scapular winging?
CN 11
What muscle sis affected in lateral scapular winging?
Trapezius
What nerve is affected in posterior scapular winging
DSN
What muscle is affected in posterior scapular winging?
Rhomboids and levator scapulae
Affected motion in Erb’s Palsy
- Elbow flexion
- FA supination
- Wrist extension
What is the MOI of Erb’s Palsy?
Shoulder depression and lateral flexion of the neck to the opposite side
What are the affected nerve root in Erb’s Palsy?
C5 et C6
Also known as the upper plexus injury
Erb’s palsy / Erb-Duchenne Palsy
Enumerate the Waiter’s Tip Deformity
- Sh- add IR
- Elbow extension
- FA pronation
- Wrist flexion
Which of the following sign and symptom is not related to HORNER’S SYNDROME?
A. Miosis
B. Anhidrosis
C. Ptosis
D. Exopthalmus
D. Exopthalmus
What deformity is cause by Kumpke Palsy?
(+) claw hand
(+) horner’s syndrome
If erb’s palsy is upper plexus injury, Klumpke Palsy is ______
Lower plexus injury
Nerve roots affected in Klumpke Palsy
C8, T1 roots, lower trunk, medial cord level
An upper limb neurodynamic tension test that assess the integrity of Radial nerve
A. ULNT 1
B. ULNT 2
C. ULNT 3
D. ULNT 4
C. ULNT 3
An upper limb neurodynamic tension test that assess the integrity of Axillary Nerve
A. ULNT 1
B. ULNT 2
C. ULNT 3
D. ULNT 4
B. ULNT 2
Most common entrapment nN. In shoulder 2* ______
Humeral neck Fx
Origin of the axillary nerve is from
Posterior cord (brachial plexus)
A specific space that if there is an injury in the axillary nerve it will cause entrapment
Quadrilateral space
Actions affected of deltoid paralysis
SH: flexion, abd, extension
Teres minor paralysis will affect what action?
External rotation
If there is injury of the axillary nerve, is there any sensation left?
Loss of sensation over deltoid prominence
MOI of Axillary Nerve Injury
- Anterior or inferior dislocation of humeral head
- Fracture of surgical neck of the humerus
- Forceful abd of humerus
- FOOSH