neuropathy

Question 1

Seddon’s Classification

Answer 1

Neurotmesis

Axonotmesis

Neuropraxia

Question 2

Sunderland’s classification

Answer 2

Class I: First degree

Class II: 2nd deg-4th deg

Class III: 5th degree

3 classes of injury: 5 degrees

Question 3

Neurotmesis

Answer 3

MOST devistating nerve injury
complete disruption of nerve along with its connective tissue (ie from laceration, fractures, gunshots)

-neurites cannot bridge and bud

Question 4

Neurotmesis tx

Answer 4

requires surgical intervention:

-resect necrotic tissue, realign fasculi

Question 5

Nerve fiber growth rate

Answer 5

regeneration ~1 mm/day

Question 6

Axonotmesis

Answer 6

axon disruption but supportive CT is maintained

new axons are able to regenerate and grow down corresponding endoneural tube

disruption to myelinated and unmyelinated axons

Question 7

Wallerian degernation

Answer 7

degeneration of the axons distally

Question 8

neuropraxia

Answer 8

transient block: disruption of myelin sheath

short lived paralysis may develop

repair can cause days to months

Question 9

Class I:

1st degree

Answer 9

1st: conduction deficit w/o axon interruption -equivalent to Neuropraxia

Question 10

Class II:
2nd degree

3rd

4th

Answer 10

2nd: axon severed w/o breaching the endoneurium
- breakdown of myelin and wallerian degneration
- regeneration follows pattern of axonal regrowth
- equivalent to seddons axonotmesis

3rd:
- nerve fiber disruption, lesion in endoneurum (epineurium and perineurieum intact), recovery is possible but may need surgery
- regeneration is often irregular and residual deficit

4th: only epineum remains in tact, requires surgical repair

Question 11

Class III: 5th degree

Answer 11

complete transection of nerve, requires surgical repair

Question 12

tinel vs villeix

Answer 12

tinel: tingling goes distally (TD–>touch down)

Villeix: tingling going proximally (VP)

Question 13

Common sites for peripheral nerve entrapment

Answer 13

adductor canal: saphenous nerve

fibular head/neck: common peronal nerve

Deep fascial proximal to ankle: superficial peroneal nerve

lateral malleolus: sural nerve

Question 14

borders of tarsal tunnel

Answer 14

Anterior: tibia:

lateral: posterior process talus and calcaneus
medial: flexor retinaculum

Question 15

what are some clinical signs of tarsal tunnel syndrome

Answer 15

pain aggravated by standing and relieved with rest–>
some may have worse at night and better throughout day with activity

may have raediating to prox calf

Question 16

Where does morton’s neuroma occur?

Answer 16

between 3rd and 4th met: 3rd innerspace

Question 17

what exams can you do to check mortons neuroma? what else would be present?

Answer 17

medial-lateral squeeze

focal tenderness
+Mulder’s click
Complaints of anesthesia to neighboring toes