Neuroanatomy/Sensory Reeducation

Question 1

Klumpke palsy refers to which brachial plexus level of injury?

Answer 1

(C7), C8, T1
isolated lower plexus lesions are uncommon and referred to as a klumpke palsy. Shoulder, elbow,and wrist extension are intact. Loss of finger flexion, extension, and intrinsic functino of the hand is observed.

Question 2

Erb’s/Erb-Duchenne palsy refers to which brachial plexus level of injury?

Answer 2

C5, C6
upper plexus lesions are most common.

Question 3

what is collateral sprouting

Answer 3

nerve growth factor is release from the distal portion of a resected nerve, stimulating neural regeneration into this region from uninjured adjacent nerves

Question 4

What are Merkel cells?

Answer 4

large, myelinated A-b slowly adaptive fibers that percieve constant touch pressure, such as when wearing gloves

Question 5

what are some common tx strategies for management of TOS?

Answer 5

stretching pec minor, upper trap, and scalene muscles and strengthening the middle and lower trapezius, serratus anterior, and levator scapulae

comprehensive mgmt should include pt education, core strengthening, postural exercises, strengthening exercises of shoulder girdle muscles, relaxation and stretching, especially of anterior chest wall

Question 6

what does the AIN innervate and how can you test for it?

Answer 6

FDP to IF and MF, FPL, and pronator quadratus and volar wrist capsule. When AIN dmange, patient cannot form O with thumb and IF

Question 7

what is the purpose of Berger’s test?

Answer 7

assess lumbrical involvement in CTS
patient holds a full fist position with the wrist in neutral for 30-40 seconds, which creates lumbrical invasion of the carpal canal. If test positive, pt will report pain and paresthesias within 30-40 seconds

Question 8

What is Horner’s syndrome?

Answer 8

occurs with the loss of sympathetic ganglionic function after avulsion of the T1 nerve root and is recognized by meiosis (papillary constriction), enophthalmos (inset orbit), ptosis (drooping eyelid), and anhydrous (dry eye)

Question 9

how long should a nerve repair be protected by immobilization?

Answer 9

7-10 days

Question 10

what motions/muscles increase compression in the cubital tunnel?

Answer 10

pressure within the cubital tunnel is increased with elbow flexion and is further increased with contraction of FCU

ulnar nerve enters the forearm through the 2 heads of FCU

Question 11

what is pronator syndrome?

Answer 11

describes a condition causing pain and paresthesias in the forearm, thumb, and IF

Question 12

what are Seddon’s 3 calssifications of peripheral nerve injury?

Answer 12

Neuropraxia
Axonotmesis
Neurotmesis

Question 13

what is neuropraxia, according to Seddon?

Answer 13

local conduction block
prognosis is excellent
axonal continuity and nerve conduction is preserved proximal and distal to injury

Question 14

what is axonotmesis according to Seddon?

Answer 14

leads to Wallerian degeneration of the distal axon

Question 15

how long does Wallerian degeneration take?

Answer 15

takes place over a period of 1-2 months for clinical signs, but within 48-160 hours post-injury one may notice failure of the neuromuscular condition.

Question 16

how long does reinnervation take?

Answer 16

Ideal reinnervation can be expected from 1-3 months of degeneration, functional rein nervation for up to 1 yr and no reinnervation could be expected after 3 years

Question 17

what is neurotmesis, according to Seddon?

Answer 17

involves complete transection of the entire nerve trunk
prognosis is poor unless surgical repair is performed

Question 18

what is Charcot elbow?

Answer 18

a type of neuropathic arthropathy whereby lack of protective sensation in the elbow can lead to progressive destructive changes in joint structure
often painless or presents with little pain

Question 19

what is the conservative tx for Charcot elbow?

Answer 19

AROM, PROM, strengthening, night orthosis with elbow in 20deg elbow flexion and daytime functional orthosis allowing full flexion and limiting extension to 0 degrees to control varus and valgus forces

Question 20

which mobilization techniques wouldbe helpful for improving shoulder external rotation?

Answer 20

tranditionally, anterior glides used to stretch anterior capsule; however, recent studies show improvement in external rotation after posterior glides, especially when ER limited in shoulder abduction. So anterior AND posterior glides are helpful