Neuromuscular Disease Flashcards
Which lesions cause pain and which do not?
Nerve and plexus lesions are usually painful
Brain and cord lesions are not usually painful
What is the major difference between brain diseases and spine diseases?
Brain diseases have defects in cognition/cranial nerve function. If you see this-you are above the foramen magnum
Spine diseases have “Levels”or hemi levels, nerve root
What does the Babinski Sign show?
shows pyramidal tract (motor tract) dysfunction (up going toes with disease) Clonus and hyper-reflexia are along the same continuum
What are fasciculations?
involuntary twitching and contractions
Difference between nerve/ muscle disorders and spine/brain disorders?
Nerve and Muscle disorders have less reflex activity—Spine and Brain disorders have hyper-reflexes
Median Neuropathy
Tests? Treatment?
Tests-Phalan test>Tinel’s test bedside—Nerve conductions(ncs) for objective data
93 % success with surgery
Ulnar nerve treatment
Tx- avoid elbow flexion/pressure—brace (nite) avoid wrist pressure (Guyons canal)—surgery is not as successful here but remain an option if severe/refractory
Neurogenic type of Thoracic Outlet Syndrome
Neurogenic type- Pain from neck-Trap-medial scapula-axillae-inside biceps to ulnar forearm to hand (prob ulnar side)
Vascular Type of Thoracic Outlet Syndrome
Lost Arterial pulse-different positions– Ischemic symptoms (worse with exercise)-Most written about type and rare Tx- remove 1st rib
Treatment for Thoracic Outlet Syndrome?
Worse with abduction of shoulder-overhead reaching
Majority in thin people
Bruit in infra clavicluar space
Normal x ray/mri/emg and normal muscle bulk/dtr
Treatment: avoid provocative activity (Big trouble for a Hair dresser)
Surgery- very bad idea but readily avalilable –removal of 1st rib
Etiology of Radial Neuropathy?
most are Saturday Nite Palsy/Crutch Palsy—most recover –no treatment option
Phrenic nerve
Innervates the hemi diaphram
Painless
Found on cxr usually by accident
Phrenic Nerve treatment
No treatment option but it may be an issue in a severely pulmonary compromised person (copd/als/mid cervical quad/) in which case an electric diaphram pacer can be considered
Musculocutaneous Neuropathy
Innervation of Biceps alone sensory to dorsal forearm
Entrapment under coricoid process
Ortho may give an injection
Axillary Neuropathy
Sole innervation of Deltoid -Sensory over Deltoid- Painful !!! Weakness of Abduction
Injection in Posterior Deltoid/exercise induced/dislocated shoulder /direct trauma-football, rugby
