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OPP 2.1 > neurovascular entrapment > Flashcards

neurovascular entrapment Flashcards

1
Q

brachial plexus nerve roots

A

C5-T1

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2
Q

plexux roots location

A

b/w anterior and middle scalene

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3
Q

primary trunks location

A

lateral to scalenes and superior to clavicle

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4
Q

anterior and posterior divisions location

A

posterior to clavicle

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5
Q

cords location

A

in axilla, posterior to pectoralis minor

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6
Q

radial nerve spinal nerves?

A

C5-T1

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7
Q

radial nerves innervate

A
  1. triceps brachii
  2. brachioradialis
  3. supinator
  4. wrist extensors
  5. hand extensors
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8
Q

median nerve spinal nerves?

A

C6-T1

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9
Q

median nerve innervates

A
  1. pronator teres
  2. wrist flexors
  3. flexor pollicis longus
  4. opponen pollicis
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10
Q

ulnar nerve spinal nerves?

A

C8-T1

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11
Q

ulnar nerve innervates

A
  1. hand flexors

2. intrinsic hand mm

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12
Q

autonomics to the UE: sympathetic

A

inferior cervical (stellate) ganglion: T2-T6

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13
Q

where is inferior cervical ganglion located?

A

adjacent to C7 and 1st rib

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14
Q

mononeuropathy

A

pathology affecting a single periphernal nerve –> sensory symptoms in peripheral cutaneous distribution (ex: carpal tunnel syndrome)

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15
Q

radiculopathy

A

pathology affecting nerve root –> sensory symptoms in corresponding dermatome (ex: herniated disc)

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16
Q

UE reflexes

A

biceps - C5
brachioradialis - C6
triceps - C7

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17
Q

tests the examine UE

A
  1. mm strength
  2. sensation (light and sharp)
  3. DTR
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18
Q

cervical spondylosis

A

degenerative changes (ex: osteophyte formation) of spine that often causes foraminal narrowing and cervical canal stenosis, which comopresses the nerve root

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19
Q

disc herniation

A

nucleus pulposus prolapses through the annulus of an intervertebral disc and compress the nerve root

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20
Q

cervical radiculopathy

A
  1. cervical spondylosis
  2. disc herniation
  3. infection (ex: herpes zoster, lyme)
  4. infiltration by tumor (ex: lymphoma)
21
Q

patient presentation with cervical radiculopathy

A
  • pain in neck, shoulder, upper thoracic, UE
  • paresthesia or numbness in upper limb
  • weakness in upper limb
  • may have precipitating event due to physical exertion or trauma (ex: whiplash)
22
Q

C5 cervical radiculopathy affects?

A
  • deltoid and biceps mm strength

- biceps reflex

23
Q

C6 radiculopathy affects?

A
  • biceps and wrist extensors mm strength

- brachioradialis reflex

24
Q

C7 radiculopathy affects?

A
  • finger extensors mm strength

- triceps reflex

25
Q

which cervical radiculopathy commonly occurs?

A

C7 radiculopathy commonly affected

26
Q

C8 radiculopathy affects?

A
  • finger flexors mm strength
27
Q

T1 radiculopathy affects?

A
  • interossei mm strength
28
Q

UMN vs LMN is use to?

A

differentiate b/w CNS and PNS lesions

29
Q

UMN (CNS) lesion

A
  • spastic
  • increased tone
  • hyperreflexia
30
Q

LMN (PNS) lesion

A
  • flaccid
  • decreased tone
  • hyporeflexia
  • fasiculation
  • atrophy
31
Q

special tests for cervical radiculopathy

A
  1. compression test/Spurling Maneuver

2. Distraction test

32
Q

thoracic outlet syndrome

A

signs and symptoms that arise from the compression of neurovascular bundle

33
Q

common causes of thoracic outlet syndrome

A
  1. cervical rib
  2. scalene syndrome
  3. costoclavicular syndrome
  4. hyperabduction syndrome (compression by pec minor and coracoid process when arm raised above head)
34
Q

thoracic outlet syndrome - patient presentation

A
  1. neurogenic - will mimic cervical radiculopathy

2. vascular

35
Q

special tests for thoracic outlet syndrome

A
  1. Spurling Maneuver/Compression test
  2. hyperabduction test
  3. adson’s/costoclavicular test
  4. Roo’s test
  5. eval scalenes and pec minor for hypertonicity
  6. eval for cervical rib, upper rib, and clavicular SD
36
Q

ulnar nerve entrapment at elbow

A
  • tardy ulnar palsy

- cubital tunnel syndrome

37
Q

tardy ulnar palsy

A

entrapment of ulnar nerve (C8-T1) in epicondylar groove

38
Q

cubital tunnel syndrome

A

compression of ulnar nerve (C8-T1) b/w the 2 heads of the flexor carpi ulnaris

39
Q

common causes of ulnar nerve entrapment at elbow

A
  • repeated flexion at elbow
  • trauma or chronic inflamm
  • arthritis
  • osteophytes
40
Q

ulnar nerve entrapment at wrist

A

guyon’s canal neuropathy - entrapment of ulnar nerve in Guyon’s Canal with palmar carpal ligament ant, flexor retinaculum post, b/w hamate and pisiform

41
Q

common causes of ulnar nerve entrapment at wrist

A
  • repeated trauma (common in cyclists)

- fracture of hook of hamate

42
Q

symptoms of ulnar nerve entrapment

A
  • medial elbow pain that may radiate distally
  • numbness/paresthesia in 4th and 5th digits
  • motor symptoms - claw hand, weakness of intrinsic hand mm, loss of dexterity
  • symptoms may increase with flexion of the elbow
43
Q

special tests for ulnar nerve entrapment

A
  1. Tinel’s test - tap as nerve passes through both epicondylar groove and Guyon’s canal
  2. elbow flexion test
  3. pressure test
44
Q

carpal tunnel syndrome

A
  • compression of media nerve (C6-T1) as it travels under flexor retinaculum
45
Q

common causes of carpal tunnel syndrome

A
  1. reptitive motions
  2. trauma
  3. obesity
  4. pregnancy
  5. diabetes
  6. rheumatoid arthritis
  7. hypothyroidism
  8. CT diseases
46
Q

carpal tunnel syndrome - patient presentation

A
  • pain in the wrist and hand, can radiate proximally
  • numbness/paresthesia in 1st - 1/2 of 4th digits
  • motor symptoms - weakness in abduction and opposition of thumb, decreased grip strength, atrophy of thenar eminence, loss of dexterity
  • symptoms worst at night
  • provoked by flexion and extension of wrist
47
Q

special tests for ulnar nerve entrapment

A
  1. tinel’s test
  2. phalen’s test
  3. prayer sign
48
Q

what do you use to confirm nerve entrapment dx?

A
  1. nerve conduction studies

2. electromyography (EMG)

49
Q

double crush syndrome

A
  • if nerve is compressed at 2 separate locations along the course of a nerve, even though the degree of indiv compression is insuff to cause symptoms, the cumulative effect is suff enough to cause symptoms
  • initial injury reduces axoplasmic flow and the 2nd injury further reduces signaling potential below threshold –> symptoms
  • check the entire length of the nerve and nerve roots when eval for a nerve entrapment syndrome

OPP 2.1 (6 decks)

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