Nerve pain and injuries Flashcards
peripheral nerve lesions have what mechanisms of injury
mechanical (compression)
crush and percussion (fx, compartment syndrome)
laceration
penetrating
stretch
high velocity trauma
cold
When treating someone with peripheral nerve damage, all areas of ….
face, trunk and extremities should be assessed.
allodynia
sensation of pain in response to stimulus that would not typically produce pain
analgesia
absence of pain while remaining conscious
anesthesia
absence of touch sensation
causalgia
constant, relentless, burning hyperesthesia and hyperalgesia that develops after a peripheral nerve injury
dyesthesia
distortion of any of the senses, especially touch
hyperesthesia
heightened sensation
hyperpathia
extreme exaggerated response to pain
hypesthesia
diminished sensation of touch
neuralgia
severe and multiple shock-like pain that radiate from a specific nerve distribution
pallanesthesia
loss of vibratin sensation
paresthesia
abnormal sensations such as tingling, pins and needles or burning sensations
double crush syndrome
two separate lesions along same nerve that create more severe symptoms than if only one lesion existed
mononeuropathy
an isolated nerve lesion; associated conditions include trauma and entrapment
neuroma
abnormal growth of nerve cells; associated conditions include vasculitis, AIDS, and amyloidosis
polyneuropathy
diffuse nerve dysfunction that is symmetrical and typically secondary to pathology and not trauma
examples Guillain-Barre syndrome, peripheral neuropathy, use of neurotoxic drugs and HIV
Wallerian degeneration
degeneration that occurs distally, specifically to myelin sheath and axon
Mildest form of nerve injury
neurapraxia
What is neurapraxia?
conduction block usually due to myelin dysfunction
In neurapraxia, is nerve conduction preserved?
yes, proximal and distal to the lesion
Are the nerve fibers damaged in neurapraxia? or degneration?
no no
Symptoms of neurapraxia?
pain, minimal muscle atrophy, numbness or greater loss of motor and sensory function, diminished proprioception
Recovery time period for neurapraxia?
4-6 weeks
What injuries are the most common with neurapraxia?
pressure injuries
If you fx the neck of the humerus, and/or have an anterior dislocation of the shoulder, what type of nerve injury do you most likely have?
axillary
If you fx the clavicle what type of nerve injury do you most likely have?
musculocutaneous
If you compress the nerve at the radial tunnel and/or fx the humerus what type of nerve injury do you most likely have?
radial
If you compress the nerve at the carpal tunnel and/or have pronator teres entrapment, what type of nerve injury do you most likely have?
median
If you compress the nerve in the cubital tunnel and/or have entrapment at Guyon’s canal then what type of nerve injury do you most likely have?
ulnar
In the LE, many nerve injuries for women are secondary to …
labor
delivery
or surgical procedures around the pelvis
If you have a THA, displace acetabular fx, anterior dislocation of the femur, hysterectomy, and/or appendectomy, what kind of nerve injury could you have?
femoral
If you have blunt force trauma to the butt, THA, and/or accidental injection to the nerve, which nerve could have the injury?
sciatic
If you have a fixation of the femur after fx or THA, which nerve is most likely injured?
obturator
If you have a femur, tibia or fibula fx and/or positioning during surgical procedures, which nerve is most likely injured?
fibular
If you have tarsal tunnel entrapment and/or popliteal fossa compression you most likely have what kind of nerve injury?
tibial
If you have a fx of the calcaneus or lateral malleolus what kind of nerve injury could you have?
sural
Who has better outcomes after peripheral nerve damage?
children
What also produces better outcomes for peripheral nerve damage?
earlier repair
more distal the lesion
What is the middle ground for nerve injuries?
axonotmesis
Is axonotmesis reversible?
yes since they maintain an anatomical relationship to each other
What can occur with axonotmesis?
wallerian degneration
How fast does the nerve regeneration in axonotmesis?
distally 1mm/day
Recovery is…. in axonotmesis?
spontaneous and varies from spotty to no recovery. Surgery may be required.
Most common type of axonotmesis?
traction
compression
crush
What is the most severe type of nerve injury?
neurotmesis
Is neurotmesis reversible?
no
What happens physically with neurotmesis injury?
flaccid paralysis and wasting of the muscle occurs and total loss of sensation by that nerve
all motor and sensory loss distal to the lesion becomes permanently impaired
How do you repair neurotmesis?
surgery and it could regenerate after that at about 1 mm/day with proximal recovery first and sensory recovery comes sooner than motor
What is the injury associated with neurotmesis?
complete transection of the nerve trunk
Peripheral nervous system pathology occurring in the anterior horn cell does what to:
sensory?
motor?
signs?
DTRs?
examples?
sensory intact
motor weakness and atrophy
fasciculations
decreased DTRs
ALS, polio
Peripheral nervous system pathology occurring in the muscle does what to:
sensory?
motor?
signs?
DTRs?
examples?
sensory intact
motor weakness
fasciculations are rare
normal or decreased DTRs
muscular dystrophy
Peripheral nervous system pathology occurring in the neuromuscular junction does what to:
sensory?
motor?
DTRs?
examples?
sensory intact
motor fatigue is greater than actual weakness
normal DTRs
myasthenia gravis
Peripheral nervous system pathology occurring in the peripheral nerve or mononeuropathy does what to:
sensory?
motor?
examples?
sensory loss along route of nerve
motor weakness and atrophy in peripheral distribution
may have fasciculations
trauma
Peripheral nervous system pathology occurring in multiple nerves or polyneuropathy does what to:
sensory?
motor?
DTRs?
examples?
impaired sensory in stocking glove distribution
motor weakness and atrophy; weaker distally than proximally; may have fasciculations
decreased DTRs
diabetic peripheral polyneuropathy
Peripheral nervous system pathology occurring in spinal roots and nerves does what to:
sensory?
motor?
signs?
DTRs?
examples?
corresponding dermatomal deficits
motor weakness in innervated pattern
may have fasciculations
decreased DTRs
herniated disc
UMN disease is
in descending motor tracts within cerebral motor cortex, internal capsule or brainstem or spinal cord.
UMN symptoms
weakness of muscles involved, hypertonicity, hyperreflexia, mild disuse atrophy, and abnormal reflexes
Damaged tracts of UMN disease are in the ….
lateral white column of the spinal cord
Examples of UMN lesions
cerebral palsy
hydrocephalus
ALS
CVA
birth injuries
MS
Huntington’s
TBI
pseudobulbar palsy
brain tumors
LMN diseases are
lesions in nerves or axons at or below level of brainstem usually within the final common pathway.
In LMN diseases, what part of the spinal cord is affected?
ventral gray
Symptoms of LMN disease?
flaccidity
weakness
decreased tone
fasciculations
muscle atrophy
decreased or absent reflexes
LMN examples
polio
ALS
guillain barre
tumors in spinal cord
trauma
progressive muscle atrophy
infection
bells palsy
carpal tunnel
muscular dystrophy
spinal muscular atrophy
UMN or LMN:
hyperactive reflexes
hypoactive reflexes
mild atrophy
fasciculations
atrophy
hypotonic to flaccid
hypertonic
UMN
LMN
UMN
LMN
LMN
LMN
UMN
hypokinesia disorders
apraxia
rigidity
bradykinesia
hyperkinesia disorders
ataxia
athetosis
chorea
tics
tremors
dysmetria
dystonia
Athetosis
slow, twisting, writhing movements that are large in amplitude.
Where are athetoid movements primarily seen?
face
tongue
trunk
extremities
When movements are brief in athetosis, they merge with what?
chorea
When movements are sustained in athetosis they merge with what?
dystonia and typically associated with spasticity
Athetosis is common in several forms of…
cerebral palsy secondary to basal ganglia pathology
Chorea is damage to
caudate nucleus
What is another form of chorea?
ballism
large amplitude
Ballism produces….
secondary to damage in….
flailing movements in limbs
subthalamic nucleus
Dystonia is…
sustained muscle contractions that cause twisting, abnormal postures and repetitive movements
In dystonia all…. are affected equally and involuntary movements are accentuated during ….
muscles
volitional movement and with progression can produce overflow
Diagnoses that include dystonia are…
parkinsons
cerebral palsy
encephalitis
Tics are …
sudden, coordinated movements at irregular intervals
What is an example of a pathology that presents with tics?
Tourettes
Resting tremors
at rest and may or may not disappear with movement. May increase with stress.
Example: pill rolling in Parkinsons
Postural tremors
voluntary contraction to maintain posture.
examples include rapid tremor associated with hyperthyroidism, fatigue or anxiety and benign essential tremor
Intention tremors
absent at rest, lesion of cerebellum or its efferent pathways and seen with MS.
