Neuropathy Basics Flashcards
What is a neuropathy?
Functional or pathological changes in the peripheral nervous system
What is compression neuropathy?
Process where a nerve becomes entrapped as it passes through a narrow tunnel or passage Can occur at any site along the nerve
Biomechanical causes of compression neuropathy
Space occupying lesion - Herniated disc or cyst
Degenerative causes - foraminal stenosis
Post-traumatic causes - Fracture and hematoma
Mechanical causes - Muscle spasm and pinching
Systemic causes of compression neuropathy
- Pregnancy
- Hypothyroidism
- Diabetes
Structure of an Axon
Pathogenic Changes to Axon
Ischemia
Thickening of epineurium
Myelin thinning distortion
Microtubule Closure
Axonal degeneration
Nerve Damage: 1st Degree
Neuropraxia
Focal damage of myelin fibers arounf axons
Connective tissue sheath remains intact
Recovery: Days to weeks - less severe
Nerve Damage: 2nd Degree
Axonotmesis
Some disruption/injury to the axon itself
Myelin sheath remains intact
Recovery: Is possible but takes months
Nerve Damage: 3rd Degree
Neurotmesis
Disruption of axon and endoneurium
Recovery: Cannot occur as intraneural fibrosis occurs
Nerve Damage: 4th Degree
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
Nerve Damage: 5th Degree
Neurotmesis
Whole nerve from the axon to the epineurium is damaged
Perineural hemorrhage and scarring occurs
Surgery required to restore neural continuity
Radiculopathy
Presents in neck andradiateds down a specific pattern on arm
Numbness, weakness, decreased reflexes related to cervical levels
Positive Spurling’s test
Causes of Radiculopathy
Impingement of nerve at the level of the cervical spine due to a disc disease, disc herniation, degenerative arthritis
Radiculopathy testing
Spurling’s Test
MRI of Cervical Spine and maybe upper extremity
EMG (cheaper than MRI)
Radiculopathy - C Spine: Contralaterial Traction, Supine
Plexopathy
Disorder effecting a network of nerves, blood or lympatic vessels
Think thoracic outlet syndrome
Lumbosacral Radiculopathy Patterns for L3-S1
Plexopathy Patient Presentation
Patient complains of intermittent numbness and tingling, not consistent with one nerve root
Complains of pain in shoulder or neck region
Generalized intermittent weakness in extremities
Tenderpoints associated with Lumbosacral Radiculopathy
Lumbosacral Radiculopathy
L5-S1 most common segment affected
Commonly due to herniated disc
Leads to pain down one leg
Red Flag Symptoms for Lumbosacral Radiculopathy
Weight loss
Fever
Chills
Loss of bowel or bladder control
Definition of Bulging Disc
Compressed evenly without signifcant damage to the cartilage rings
Usually caused secondary to cervical disc disease
Protrusion Heriated Disc
Some tearing of the cartilage ring
Only a few cartilage rings are torn in the anulus fibrosis
No leakage of central material (nucleus pulposus)
Extrusion Herniated disc
Cartilage rings have torn in a small area
Nucleus pulposus is able to flow out of the disc space
Direction of disc rupture
Most commonly ruptures posterior-laterally which compresses the nerve root as it exits the intervertebral foramen which commonly causes a radiculopathy
Herniated discs and compression of nerve roots through the C/T/L spine
C-Spine - compresses nerve root below
eg. Disc between C4-C5 compresses nerve root of C5
T&L-Spine - compresses nerve root above
eg. Disc between L3-L4 compresses nerve root L3
General Treatment for radiculopathy caused by herniated discs
Modify activity, use NSAIDS, splinting &/or injections
OMT, PT, pain management
Should be pursued if persists 3-6 months (except for cubital tunnel syndrome
Surgical release is considered when non-operative management fails
Cubital tunnel syndrome - operative decompression is considered in call cases tor prevent nerve damage
Cheiralgia Paresthetica/Wartenberg’s syndrome/Handcuff neuropathy
Compression of the superficial radial nerve
Numbness, tingling, burning in SRN (superficial branch of radial N) distruction
Caused by compression, edmea, surgical injury
