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OS III Exam 1 and CPA 2 > Neuropathies > Flashcards

Neuropathies Flashcards

1
Q

What is a neuropathy?

A

Functional or pathological changes in the peripheral nervous system

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2
Q

What is compression neuropathy?

A

Process where a nerve becomes entrapped as it passes through a narrow tunnel or passage Can occur at any site along the nerve

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3
Q

Biomechanical causes

A

Space occupying lesion - Herniated disc or cyst

Degenerative causes - foraminal stenosis

Post-traumatic causes - Fracture and hematoma

Mechanical causes - Muscle spasm and pinching

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4
Q

Systemic causes

A
  • Pregnancy
  • Hypothyroidism
  • Diabetes
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5
Q

Structure of an Axon

A
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6
Q

Pathogenic Changes to Axon

A

Ischemia

Thickening of epineurium

Myelin thinning distortion

Microtubule Closure

Axonal degeneration

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7
Q

Nerve Damage: 1st Degree

A

Neuropraxia

Focal damage of myelin fibers arounf axons

Connective tissue sheath remains intact

Recovery: Days to weeks - less severe

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8
Q

Nerve Damage: 2nd Degree

A

Axonotmesis

Some disruption/injury to the axon itself

Myelin sheath remains intact

Recovery: Is possible but takes months

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9
Q

Nerve Damage: 3rd Degree

A

Neurotmesis

Disruption of axon and endoneurium

Recovery: Cannot occur as intraneural fibrosis occurs

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10
Q

Nerve Damage: 4th Degree

A

Neurotmesis

Disruption og axon, endoneurium, and perineurium (nerve fasciculi)

Large area of intraneural scarring at the injury site - Stops any nerve regeneration distal to the injury

Surgery required to restore neural continuity

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11
Q

Nerve Damage: 5th Degree

A

Neurotmesis

Whole nerve from the axon to the epineurium is damaged

Perineural hemorrhage and scarring occurs

Surgery required to restore neural continuity

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12
Q

Sites of Radial Nerve Entrapment

A

High on the humerus

Radial Tunnel

At the wrist

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13
Q

Radial Nerve Entrapment - High on the humerus

A

Usually secondary to a humerus fracture or compression of nerve near spiral groove

Symptoms: Wrist drop, weakness in elbow flexion (brachioradialis), +/- tricep involvement, pain/numbness

Treatment: Function usually returns in 4-5 months

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14
Q

Radial Nerve Entrapment - Radial Tunnel

A

Repetitive rotatory movement - rowing, discus, racquet sports

Heavy manual labor

Symptoms: Pain and tenderness 5 cm distal to lateral epicondyle, wrist drop or pain w/ resisted pronation

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15
Q

Radial Nerve Entrapment - At the wrist

A

Superficial branch (sensory) pinched between brachialialis and extensor carpi radialis longus during forearm pronation

Sensation change over posterolateral hand

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16
Q

Pronator Syndrome

A

Median nerve

Travels between the humeral (superficial) and ulnar (deep) head of the pronator teres

Worsens when pronating against force and flexing elbow against force

Positive Provocation maneuver

Pain over proximal middle forearm and numbness over palmar surface of thumb and thirst 3 digits

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17
Q

Provocation maneuvers

A

Tests for pronator syndrome and compression of median nerve by pronator teres

Flexion of middle finger against resistance

Causes compression by the flexor digitorum superficialis

18
Q

Anterior Interosseus Syndrome

A

Compression of median nerve

No sensory loss

Inability to make “OK” sign

Due to weak flexion ability of the index finger’s DIP and thumb’s IP

Treatment: General treatment and splinted elbow flexion at 90 for ~12 weeks

19
Q

Ulnar Nerve Entrapment/Cubital Tunnel Syndrome

A

Symptoms: Parasthesia to 4th and 5th digits, medial elbow pain that radiates down arm

Decreased intrinsic strength (can’t turn key)

Symptoms reproduced when elbow and wrist are flexed

Treatment: LImit elbow flexion and provide cushion

20
Q

Positive Tests for Ulnar Nerve Entrapment/Cubital Tunnel

A

+ Tinel Sign at Elbow

Froment sign - pinch paper between 1st and 2nd digit if thumb flexes (+)

Due to weak 1st dorsal interosseus and ADP muscle

21
Q

Median Nerve Entrapment/Carpel Tunnel Syndrome

A

Most common compression syndrome

Compression as passes under flexor retinaculum

Symptoms: Nighttime numbness of lateral 3.5 digits, tingling, wrist pain, grip weakness, thenar atrophy

Caused by repetitive wrist flexion and pregnancy

Treatment: Gold Standard EMG

22
Q

Thoracic Outlet Syndrome and Symptoms

A

Compresion of the brachial plexus and/or subclavian vessels

Symptoms: Weakness, paresthesia of medial arm, forearm, and hand exacerbation by overhead activities

23
Q

Testing for Thoracic Outlet Syndrome

A
24
Q

Points of Compression that cause Thoracic Outlet Syndrome

A

Sclene Triangle

Costclavicular passage

Attachment of the pectoralis minor attachment at the coracoid process

25
Q

Mergalgia Paresthetica and Causes

A

Compression of the lateral femoral cutaneous nerve under the inguinal ligament as it travels through the inguinal canal

Causes: very intense athletics, obseity, tight belts/gun holsters, seat belt misplaced or post-MVA

26
Q

Symptoms f Meralgia Paresthetica

A

Numbness or buring pain on anterolateral thigh

Hyperesthesia over anterolateral leg (can’t put items in pockets)

Trophic skin changes (later)

+ Tinnel’s sign 1 cm medial and inferior to ASIS

27
Q

Common Fibular Nerve Compression

A

3rd most common compression neuropathy

Common peroneal nerve is compressed as it wraps around the fibular neck and enters the fibular tunnel

Common peroneal nerve = L4-S2

28
Q

Causes of Common Fibular Nerve Compression

A

Leg hooked over a rail (bedridden, post-op)

“Strawberry Pickers Palsy” - spends a long time squatting

Ankle sprain (commonly posterior fibular head SD)

New meditators (sitting criss cross)

Lithotomy position during childbirth

Idiopathic

29
Q

Symptoms of Common Fibular Nerve Compression

A

Decreased sensation, numbness, tingling on outer part of lower leg and foot

Foot drop

Slapping gait (where foot is slapping with each step)

30
Q

Tarsal Tunnel Syndrome

A

Compression of posterior tibial nerve in the tarsal tunnel behind the medial malleolus w/ the overlying flexor retinaculum

31
Q

Causes of Tarsal Tunnel Syndrome

A

Idiopathic 50% of the time

Space-occupying lesion

Trauma to medial malleolus, distal tibia, or calcaneus

Autoimmune (RA, ankylosing spondylitis)

Diabetes

Lifestyle (standing for long periods)

32
Q

Symptoms of Tarsal Tunnel Syndrome

A

Pain on plantar surface of foot

Nonspecific burning, tingling, or numbness over plantar part of foot

Gait is usually not effected

33
Q

Treatments of Tarsal Tunnel Syndrome

A

Rest

NSAIDS

Ultrasound

PT and Acupunture

OM - Myofascial release and HVLA

34
Q

Anterior Tarsal Tunnel Syndrome

A

Compression of deep fibular nerve at the inferior extensor retinaculum

Deep fibular nerve = L4-S2

35
Q

Symptoms of Anterior Tarsal Tunnel Syndrome

A

Pain over dorsomedial aspect of foot that worsen at rest

Weakness of extensor digitorum brevis = flexing the proximal and medial phalanges of the 2nd-5th toes

36
Q

Causes of Anterior Tarsal Tunnel Syndrome

A

Trauma (recurrent ankle sprain, soccer players)

Talonavicular dysfunction

Prolonged plantar flexion (high heels)

Compression from shoes

37
Q

Froment’s Sign

A

Tests for Ulnar Nerve Palsy or Compression

Tests strength of adductor pollicus of the thumb

Compressing paper between thumb and hand with thumb straight - Paper shouldn’t slip

Abnormal - Patient flexes thumb to prevent paper from slipping

38
Q

Radiculopathy

A

Presents in neck andradiateds down a specific pattern on arm

Numbness, weakness, decreased reflexes related to cervical levels

Positive Spurling’s test

39
Q

Causes of Radiculopathy

A

Impingement of nerve at the level of the cervical spine due to a disc disease, disc herniation, degenerative arthritis

40
Q

Radiculopathy testing

A

Spurling’s Test

MRI of Cervical Spine and maybe upper extremity

EMG (cheaper than MRI)

41
Q
A

OS III Exam 1 and CPA 2 (2 decks)

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