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MI1 > Nerve Injuries > Flashcards

Nerve Injuries Flashcards

1
Q

What are the layers that divide nerve fascicles and trunks?

A
  • Perineurium
  • Endoneurium
  • Epineurium (trunk)
  • Mesoneurium
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2
Q

What is the function of the connective tissue and fluid in nerve trunks?

A

Provides a blood/nerve barrier that filters out substances that may interfere with neural conduction

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3
Q

What is axoplasm?

A
  • Fluid inside the cell body
  • Provides nutrition, lubrication & cushioning
  • Highly viscous
  • Thixotropic (must be moved, otherwise becomes very thick)
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4
Q

What are terminal boutons?

A

At the end of axons, can be receptors or motor end plates

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5
Q

What does antegrade and retrograde refer to?

A

Axoplasmic flow:
Antegrade: Axoplasm flows away from the centre to the periphery
Retrograde: Axoplasm flows from the periphery to the centre

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6
Q

What is axoplasmic flow powered by?

A

Mitochondria

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7
Q

What does axoplasmic flow allow?

A

Maintenance factors & chemical mediators to travel up & down the nerve keeping the nerve healthy

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8
Q

What are the disadvantages of axoplasmic flow?

A

When a nerve becomes sick/pinched & inflamed, chemical mediators can hang around for a long time

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9
Q

What are nerves supplied by?

A
  • Blood vessels

- Their own nerves (nervi nervorum)

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10
Q

What is the implication of nerves being supplied by nervi nervorum?

A

The nerve itself can become a source of pain, not just a conductor of pain

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11
Q

What are the 2 types of peripheral nerves?

A
  • Myelinated (A alpha, A beta, A delta)

- Unmyelinated (C fibres)

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12
Q

What are some of the causes of peripheral nerve injury & disease?

A
  • Trauma (direct pressure/blow or repetitive microtrauma)
  • Chronic entrapment (e.g. CTS)
  • Hereditary
  • Infection
  • Inflammation
  • Ischaemic
  • Toxic metabolic
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13
Q

What are the 3 types of traumatic peripheral nerve injuries?

A
  • Neuropraxia
  • Axonotmesis
  • Neurotmesis
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14
Q

What are the features of neuropraxia?

A
  • Focal damage of myelin fibres
  • Axon/connective tissue intact
  • Transient disruption of conduction
  • Recovery days-weeks
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15
Q

What are the features of axonotmesis?

A
  • Disruption of axon
  • Connective tissue in tact
  • Wallerian degeneration
  • Axonal regeneration over months-years
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16
Q

What are the features of neurotmesis?

A
  • Axon & connective tissue damaged
  • Neuroma formed at proximal stump
  • Requires grafting
  • Recovery years, often incomplete
17
Q

What are the differences between nociceptive, neurogenic and neuropathic pain?

A
  • Nociceptive: Pain messages carried by normal nerves about trauma
  • Neurogenic: Pain generated by a nerve, due to injured/diseased nerve or sensitisation of nervi nervorum
  • Neuropathic: Due to injured/diseased nerve/nerve root, prolonged CNS symptoms
18
Q

What are the techniques for differentiating nerve as a source of pain?

A
  • Tinel’s test (tap it)
  • Stretch it in a way that isolates it from muscle
  • Dermatomes (assess distribution)
  • Myotomes (assess weakness, reflex testing)
  • Test it (nerve conduction studies)
  • Nerve symptoms: May be unrelenting, not activity related
19
Q

What is the difference in clinical presentation of nerve root injury and peripheral nerve injury?

A
  • Nerve root: Line of pain that radiates

- Peripheral nerve: Patch of pain

20
Q

What are the precautions for neural tissue provocation tests?

A
  • High irritability
  • Acute disc symptoms
  • Neural/spinal surgery
  • Spondylolisthesis
  • Nerve root compromise
  • Spinal cord compromise
  • Bladder/bowel dysfunction
  • Rapid progression of neurological disease
21
Q

What is the role of physio in peripheral nerve injuries?

A
  • Splinting/taping/bracing: Offload, decompress, support
  • EPAs: decrease pain, stimulate muscle activity
  • Manual therapy & neural glides: decrease pain, compression, sensitivity (subacute phase only)
  • Exercises: maintain/increase range, strength, function
  • Education/advice
22
Q

What are some common upper limb peripheral nerve injuries?

A
  • Brachial plexus stinger
  • Thoracic outlet syndrome
  • Quadrilateral space syndrome
  • Radial tunnel syndrome
  • Carpal tunnel syndrome
  • Cubital tunnel syndrome
23
Q

What are some common lower limb peripheral nerve injuries?

A
  • Meralgia paraesthetica
  • Femoral nerve compression
  • Sciatic nerve compression
  • Common peroneal nerve injury
  • Tarsal tunnel syndrome
24
Q

What are the features of brachial plexus stinger?

A
  • C5-T1
  • Compressive force down into shoulder while neck is stretched away
  • Common in collision sports
25
Q

What are the features of thoracic outlet syndrome?

A
  • C6-T2
  • Compression of tissue between clavicle & first rib or between anterior & middle scalene or under pec minor
  • Diagnosed with Adsons’ & Wright’s tests
  • Caused by trauma, repetitive strain, anatomical defects
26
Q

What are the features of quadrilateral space syndrome?

A
  • Axillary nerve (C5-C6) injury
  • Quadrilateral space: Between humerus, teres major/minor & long head of triceps
  • Caused by improper crutch use, repetitive overhead activities, shoulder dislocation
27
Q

What are the features of radial tunnel syndrome?

A
  • Posterior interosseous nerve (C6-T1) injury
  • Radial tunnel: below triceps
  • Commonly occurs with supracondylar fracture of elbow
  • Caused by repeated pronation/supination
28
Q

What are the features of cubital tunnel syndrome?

A
  • Ulnar nerve (C8, T1) injury
  • Cubital tunnel: Behind medial epicondyle
  • Caused by repeated elbow flexion
29
Q

What are the features of carpal tunnel syndrome?

A
  • C5-T1
  • Median nerve injury
  • Caused by repeated wrist/finger flexion
30
Q

What are the features of meralgia paresthetica?

A
  • Lateral femoral cutaneous nerve injury (L2-L3)
  • Anterolateral thigh
  • Caused by compression of lateral femoral cutaneous nerve, e.g. tight belts/jeans
31
Q

What are the features of femoral nerve compression?

A
  • L2-L4

- Caused by direct trauma, compression, stretch injury

32
Q

What are the features of sciatic nerve compression?

A
  • L4-S3
  • Near piriformis/origin of hamstrings
  • Caused by muscle spasm/tightness with overuse/strain
33
Q

What are the features of common peroneal nerve compression?

A
  • L4-S2

- Most commonly caused by fractured head of fibula

34
Q

What are the features of tarsal tunnel syndrome?

A
  • Tibial nerve injury
  • L4-S3
  • Caused by eversion sprain or compression in tarsal tunnel

MI1 (18 decks)

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