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Musculoskeleton > Neural Entrapment > Flashcards

Neural Entrapment Flashcards

1
Q

Wallerian degeneration

A

Axons degenerate distal to the lesion to protect the nerve cell bodies.

Nerve cell bodies can regenerate axon but cannot regenerate the cell bodies

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2
Q

Layers of nerve damaged vs severity

A

Epinerum damage = high severity

Endoneruium = low severity

Perineruium = moderate severity

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3
Q

Reticolapathy

A

Damage to a nerve right when it comes out to form a root/ trunk.

Most severe damage

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4
Q

Plexus apathy

A

Damage to a nerve once it is in a plexus (i.e not a root/trunk)

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5
Q

Mononeruopathy vis polyneruopathy

A

Mono = one peripheral nerve is affected

Poly = multiple nerves are affected

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6
Q

Myotomes

A

C5: abduction of shoulder and elbow flexion

C6: flexion of elbow, wrist extension and abduction of shoulder

C7: elbow and fingers extension, wrist flexion, abduction of shoulder

C8: elbow extension and finger flexion

T1: finger abduction and abduction

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7
Q

Muscle strength testing scale

A

0: no contraction at all
1: weak contraction that is palpable
2: full ROM when gravity is eliminated
3: full ROM against gravity
4: full ROM against gravity and mild resistance
5: full ROM against gravity and maximal resistance

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8
Q

Dermatome

A

C5: lateral shoulder

C6: thenar eminence

C7: index finger (variable)

C8: hypothenar eminance

T1: medial forearm

T2: axilla

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9
Q

Cutaneous sensation of peripheral nerves

A

Axillary: Lateral deltoid/ shoulder

Musculocutaneous: Lateral forearm

Radial: dorsal webbing between thenar eminance and index finger

Ulnar: tip of hypothenar eminance

Median: tip of index finger

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10
Q

Reflex ratings

A

0: no response
1: slight by depressed response
2: normal response
3: very brisk response
4: clonus response (repeating)

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11
Q

Erb- duchenne palsy

A

Upper root nerve plexus damage (C5-C6)

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12
Q

Klumpke paralysis

A

Lower root brachial plexus injury ( C8-T1)

Also produces Horners syndrome (T1) in eyes
- contraction of pupil, drooping eyelid and sunken eyeball

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13
Q

Musculocutaneous nerve sensory branches

A

Lateral antebrachial cutaneous

  • Elbow sensation and forearm sensation only*
  • upper arm motor function only*
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14
Q

Common ways of damage to the axillary nerve

A

Anterior dislocation of GH joint

Crutch usage

Fracture of the surgical head of the humerus

Improper IM injections

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15
Q

Places of radial nerve damage

A

Axilla or proximal arm (Saturday nights palsy)

Radial groove fracture

Wrist fracture (posterior interosseous syndrome)

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16
Q

locations of median nerve damage

A

Elbow via supracondyler fracture or pronator hypertonicity

Forearm: anterior interosseous syndrome

Wrist: carpel tunnel MOST COMMON

17
Q

Pronator Syndrome (median nerve palsy)

A

Flexion of PIP in 1-3 digits affected

Flexion of MIP in 2-3 digits affected

Sign of benediction and simian hand

Abnormal pinch sign (cant make ok sign and cant hold paper)

Can’t pronate

18
Q

Locations of ulnar nerve damage

A

Elbow: posterior to medial epicondyle of humerus

Cubital tunnel (funny bone) MOST COMMON

Wrist (handlebar neuropathy)

Hand (hook of hamate fracture)

19
Q

Difference between guyons canal syndrome and elbow neuropathys of the ulnar nerve

A

Elbow location = lose of sensation of medial palm and 4th/5th digits

  • froments sign is key (cant use pads of fibers to grasp something, must use tips.)
  • cant flex 4th and 5th digits

Guyons canal = ulnar claw w/ no radial deviation and can still flex fingers.

20
Q

Difference between simian hand and sign of benediction

A

Simian hand = passive sign of distal (usually wrist) Medial neuropathies

Sign of benediction = active sign of proximal medial neuropathies

21
Q

Myotome for L2-L4

A

Hip flexion and adduction

Knee extension

22
Q

Myotome for L4 and L5

A

Dorsiflexion of foot

hip abduction( has S1 also)

23
Q

Myotome for S1

A

Plantar flexion and hip abduction

Hip abduction also includes L4-5

24
Q

Myotome for L4-S2

A

Knee flexion

25
Q

Dermatome of lower leg

A

L2: upper lateral thigh

L3: Medial knee

L4: Medial malleolus

L5: medial foot

S1: heel of foot

S2: medial popliteal fossa

26
Q

Lower leg reflexes

A

Quads = L4

Achilles = S1

27
Q

Femoral neuropathy signs

A

Causes:

  • primarily by prolonged external rotation of hip and flexion of knee (like giving birth position)
  • also when using the saphenous vein for harvesting, femoral nerve may be knicked

Sings:

  • diminished quadriceps reflex
  • leg drags and buckling of the knee, instability of the knee as well.
  • loss of sensation of anterior medial thigh
28
Q

Lateral femoral neuropathy

A

Causes

  • obesity, diabetic, pregnant, tight clothes (especially in lateral thigh)
  • often trapped between ASIS and inguinal ligament if it is entrapped

Signs:

  • numbness on lateral thigh that gets worse at night and when hip is extended
  • use tinels test to determine
29
Q

Superior gluteal neuropathy

A

Causes:

  • injury, trauma, fracture/dislocation of greater trochanter
  • improper IM technique

Signs:

  • pelvic sag via (+) trendleberg
  • cant abduct or internally rotate hip well
30
Q

Sciatic neuropathy

A

Causes:

  • piriformis Syndrome (hypertrophy of overuse)
  • trauma
  • athletes that utilize gluteal muscles a lot
  • improper IM technique

Signs:

  • complete paralysis of all ankle movement and knee flexion
  • cant feel lower leg and foot
31
Q

Where on the butt and thigh should you inject into in order to avoid damage to the sciatic or gluteal nerves

A

Von hochstetter triangle

  • place palm on greater trochanter
  • place index finer on ASIS
  • place the middle finger on the iliac tubercle
  • between the fingers = OK
32
Q

Common fibular nerve neuropathy

A

MOST COMMON LOWER LEG NEUROPATHY

Causes:
- trauma (especially around fibular head) , overcrossed legs, bed ridden patients, rapid weight loss

Signs:

  • weak in dorsiflexion, ankle eversion and toe extension
  • often say “ feel like i am tripping over my toes”
  • loss of sensation in the anteriolateral leg and dorsiflexion of foot
33
Q

Superficial fibular neuropathy

A

Causes:
- compartment syndrome of lateral compartment and chronic ankle sprains

Signs:

  • atrophy of the lateral compartment leg muscles
  • loss of sensation in dorsum of foot (except for webbing between 1st and 2nd toes
  • weakness in ankle eversion
34
Q

How do you distinguish the the difference between superifical and deep neuropathies?

A

Sensory of webbing between the 1st and 2nd digits =deep

Entire rest of the dorsum of the foot = superficial

35
Q

Deep fibular neuropathy

A

Causes: tight shoe wear and braces of ankles
- “ski-boot” neuropathy can occur dismally and results similarly

Signs:

  • atrophy
  • loss of sensation of webbing between 1st and 2nd digits
36
Q

What kind of injection is corticosteroids?

A

IM but paraneural NOT intranerual

37
Q

Signs to consider aggressive/surgical treatment over conservative

A

Atrophy in affected area

Active damage on a EMG

Doesn’t respond at all to conservative treatments

38
Q

Most common nerve used for nerve grafting

A

Sural nerve

Musculoskeleton (36 decks)

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