Module 0 Flashcards
During the history what symptoms would indicate radiculopathy? Select all that apply.
A. Muscle weakness in a peripheral nerve pattern
B. Parenthesis in a cutaneous pattern
C. Pain that is unrelieved by rest
D. Parenthesis in a dermatomal pattern
C and D
What is the significance of the endoceurium in the context of positive atonal repair>? Endometrium acts:
A. As a guide conduit for the sprouting axons
B. As a source of nerve growth factors
C. In creation of scar tissue
A
Define Wallerian Degeneration. Choose all that apply
A. A process at the distal stump of a damaged axon, preparing the way for axonal sprouting
B. A process organized by Schwann cells following a lesion of an axon
C. A process only occurring in CNS axonal damage
D. A process involving the breakdown of the proximal stump of a damaged axon
A, B
Define transneuronal degeneration
When one neuron is lost, the neuron ahead or behind in the synaptic chain may also be lost
Define axonotmesis
Axonal disruption of some of the axons in a nerve, without displacement of the endoneurium
The axon reaction refers to:
A. The process of degeneration occurring at the distal stump of the disrupted axon
B. The reaction of the axon to the loss of connection with its cell body
C. The total effect on the cell body due to the loss of its axon
D. Depersal of the nucleolus, only
C
Describe the process of chromatolysis. Choose TWO.
A. Displacement of the nucleus
B. Dispersal of the Nissl Substance
C. Dispersal of the rER
D. Dispersal of the nucleolus
B, C
Axonal sprouting of PNS axons occurs due to growth factors released from:
A. Oligodendrocytes
B. Mast cells
C. Schwann cells
D. Endothelial cells
C
What is a neuroma? Choose all that apply.
A. Enlarged knot of axonal sprouts and scar tissue
B. Malignant tumor of neurons
C. Tissues created in a nerve affected by neurotmesis
D. Incomplete sprouting of axons unable to enter the endoneurial tube
A, C, D
Describe the process of recovery following axonal damage in the CNS. Choose the best single answer.
A. Wallerian regeneration
B. Neuronal mitosis
C. Axonal sprouting
D. Neuroplasticity
D
Which one of these describes the Dermatome affected most by an L5-S1 disc herniation
A. L4
B. S1
C. L5
B
The Achilles reflex would be lost in an __ nerve root lesion.
A. S1
B. L4
C. L5
A
Desires entrapment at the intervertebral disc by disc herniation, what other structure may be responsible for the pain syndrome called sciatica?
A. Entrapment by the gastrocnemius muscle
B. Entrapment by the piriformis muscle
C. Entrapment by the gluteus Maximus muscle
B
There is an orthopedic test that is well-known to be specific to diagnosis of spinal root involvement and disc herniation. What is it:
A. Provacative test called Babinski’s test
B. Stretch test called Gaenslen’s Test
C. Tension test called the Straight Leg Raise (SLR)
C
T or F
Disc herniation always require surgery to reduce them
F
What are the four cardinal sings of inflammation ?
Pain, heat, swelling, redness
What helps to differentiate involvement of MSK damage versus NM system damage?
Pain progression
Pattern of pain
Does lumbar sprain strain while causing soft tissue damage typically affect spinal nerves?
No
What is a common cause of Spinal nerve injury?
Intervertebral disk injury
Symptoms of spinal nerve entrapment:
Pain not affected by rest
Pain progression
Pain pattern includes areas not directly impacted by mechanism of injury
Signs of spinal nerve entrapment:
Antalgic posture
Weakness
Reflex changes
Sensory changes
Positive orthopaedic testing
What is shooting pain called?
Radicular pain
What is radiculopathy?
Injury or irritation of a nerve with pain that radiates from the injured area in a recongnizable pattern
What was the type of onset for Mrs. Cornwell?
Acute, stopped her from finishing her job
What are some sprain/strain findings?
Pain on movement, rest relieves pain
Pain only in area of injury
No radiating pain
Improves with time
Is pain subjective or objective?
Subjective
What contributes to and complicates both the presentation and the healing of physical trauma?
Emotional trauma and stress
What makes up the CNS?
What makes up the PNS?
Brain and spinal cord
Cranial and spinal nerves
How many spinal nerves are there and where do they originate?
31, spinal cord, part of PNS
Composition of peripheral nerves
Sensory, motor, autonomic fibers
Radic/o, radicul/o, rhiz/o
Nerve root
Path/o
Disease
Myel/o
Spinal cord
Encephal/o
Brain
Praxi/o
Action or movement
Cept/o
To receive or detect
Noci-
To harm or injure
-tmesis
To cut
-paresis
Weakness
What is the first thing to relieve a stimulus?
Primary Afferent axon’s receptor
What are some of the least specific receptive end organs?
Receptors for tissue damage typically affect
What type of receptor receives all types of damaging stimuli?
Polymodal C-fiber free nerve ending
What does the receptor on the primary afferent axon receive?
Stimulus
Where does perception occur?
Cortex of cerebrum
Define receptive fields
Area innervated by C-fiber axon further refined at level of cord and cortex
What are bundles of axons in the periphery?
Nerves
What are bundles in the CNS?
Tracts
Axons of C-fibers are myelinated or unmyelinated?
Unmyelinated
The areas that have smaller receptive fields do what?
Project more strongly to the cerebral cortex
T or F
Pain localization is more accurate in the face than low back
T
Does nervous tissue itself exhibit receptive field patterns?
No
Spinal nerve irritation results in what type of pain pattern?
Dermatomal
Peripheral nerve irritation results in what type of pain pattern?
Cutaneous
Does irritation of the CNS result in conscious awareness? Why?
No, there are no sensory receptors on the brain
What are the receptive fields of the spinal nerve afferent axons?
Dermatomes
In what dermatome was Mrs. Cornwell having pain?
S1
What direction to lumbar discs typically herniate?
Dorsolaterally
What disc was affected with Mrs, Cornwell?
L5-S1
S1 NR affected
Where did Mrs. Cornwell describe her pain to be?
Shooting down her leg pain in lateral calf, lateral foot, little toe
How is the integrity of the spinal nerves evaluated?
MSRs
L4 muscle indicator
Tibialis anterior
L4 reflex indicator
Patellar
Medial leg, foot, great toe, anterior knee
L4 dermatome pattern
L5 muscle indicator
Extensor hallicus longus
L5 reflex indicator
Medial hamstring
L5 Dermatome pattern
Dorsum of the foot, heel
S1 muscle indicator
Fibularis longus/brevis
S1 reflex indicator
Achilles
S1 dermatome pattern
Lateral leg, foot, little toe
What nerve root is affected if the patient cannot extend their big toe?
L5
What nerve root is affected if the patient cannot do eversion?
S1
Surrounds all the fascicles of the nerve
Epineurium
Surrounds each nerve fasicle
Perineurium
Surrounds individual axons
Endoneurium
What is the majority of endoneurium made of?
Non-living product of fibroblasts (matrix)
What type of connective tissue is endoneurium?
Loose connective tissue
What type of connective tissue is Epineurium and Perineurium?
Dense irregular
What is the part of the axon that always degenerates if a nerve is severely damaged?
Part distal to the injury
Process of nerve repair.
Proximal stump sprouts into the uninterrupted endoneurial tube
PNS or CNS
Always has connective tissue investments
What are connective tissue investments important?
PNS
Provides nutrients blood supply, waste transport ion to axon protects axon.
How can lesions occur?
As compressions or entrapments
If the axon is disrupted in the PNS…
The distal stump degenerates
If there is damage to the axon in the CNS….
The neuron will likely die
Explain retrograde transeuronal degeneration
Neuron before the lesion might undergo degeneration
Explain orthography transneuronal degeneration
Neuron after the lesion might also undergo degeneration
What is neuronal irritation or damage from compression, mild injury, resulting in a non-severed axon?
Neuropraxia
What is said about recovery for neuropraxia?
Full recovery can be achieved
What is moderate to severe compression, where the distal stump begins to undergo Wallarian degeneration but the endoneurium is not displaced?
Axonotmesis
What is said about recovery for Axonotmesis?
Regeneration of proximal stump can occur 1-2 mm per day
What is transection of an axon where the whole nerve is severed and the 2 ends of the endoneurium are displaced so the axon sprouts cannot find their way back?
Neurotmesis
What is said about the recovery for neurotemesis?
Surgery might be required, won’t heal on its own
What can cause a neuroma?
Neurotemesis
What is the axon reaction?
Reaction of the cell body to the loss of its axon
What is a complex ball of axon sprouts a scar tissue on a damage nerve axon?
Neuroma
What nerve is irritated in Morton’s neuroma?
Where is the nerve irritated?
Medial plantar nerve
Between 3rd and 4th toes
Important features of the axon reaction
Chromatolysis
Neuronal cell body swelling
displacement of nucleus
Dispersal of nucleolus
What is the first thing that happens after an axon is damaged?
Swelling of the proximal and distal stumps
What is the axon reaction also called?
Retrograde reaction
T or F
Neurons recover in the PNS
T
T or F
Neurons will die in the CNS
T
Likely die
What causes swelling of the cell body?
Dispersal of ribonucleic acid acid attracts water into cell body swelling displacement
What directs the recovery of axonal sprouts?
Endoneurial tube
Define hypoxia
Deficiency of oxygen in the tissues
Damage to axons in the CNS can occur by
Hypoxia from stroke or TBI
What do fMRIs show?
Level of brain engagement or activity
During history, what symptoms would indicate radiculopathy?
Pain unrelieved by rest parenthesis in dermatomal pattern
What organizes wallerian degeneration?
Schwann cells
Define transneuronal degeneration
When one neuron is lost, the neuron ahead or behind in the synaptic chain may also be lost
What is axonal disruption of some of the axons in a nerve without displacement of the endoneurium?
Axonotmesis
Describe the process of chromatolysis
Dispersal of the Nissl substance dispersal of the rER
What type of nerve entrapment involves cutaneous patterns of sensory loss?
Peripheral
What type of nerve entrapment involves more muscles being affected?
Peripheral
What type of nerve entrapment involves motor loss linked to nerve and muscles innervated by nerve?
Peripheral
What segments are more vulnerable to spinal nerve entrapments?
After L2 when the spinal cord ends
Where is the nucleus found during swelling in the cell body of the axon reaction ?
Periphery
Why is there dispersal of the nucleolus of the cell during the axon reaction?
Ribosomal RNA is made by the nucleolus and it is no longer needed
How is learning and memory constantly happening in the brain?
Neuronal plasticity
Ways to make sure that nerve recovery is effective?
Brain getting all nutrients
Describe the process of recovery following axonal damage in the CNS
Neuroplasticity
Neuroapraxia
(Irritation) = peripheral nerve gets “dinged”
Axonotmesis
(moderate to severe compression) = gets interruption, can recover by 2mm a day, endoneural tube is fine
Neurotemsis
(Transection) = real problem - (can only be reconnected though possible surgery) injury/degeneration/neuroma formation (Endoneuronal tubes do not line up anymore - neuroma forms)
