NMS 3 Flashcards
shoulder depression
patient seated, doctor depressed patient’s shoulder while laterally flexing the cervical spine away from shoulder
repeat on other side
positive: pain
indicates: nerve root adhesions, dural sleeve adhesions
distraction test
with patient seated, doctor exerts upward pressure on patient’s head removing the weight of patient’s head from neck
positive: decreased pain or increased pain
indicates: (decreased)NR compression, (increased)sprain/strain
maximum cervical compression
patient seated and actively rotates, laterally flexes, hyperextends the neck to the right. if not pain the patient is asked to maximally laterally flex the neck. repeat on other side. no compression applied
positive: radicular pain/localized pain
indicates: NR compression/facet syndrome
jackson’s compression
patient is seated the doctor alterally flexes the patient’s head to the right and applies downward pressure. doctor the performs same on other side
positivie: radicular pain/localized pain
indicates: NR compression/facet syndrome
foraminal compression
seated patient actively rotates head from side to side. doctor exerts downard pressure from neutral postion. head is then rotated to each side with pressure
positive: radicularpain/localized pain
indicates: NR compression/facet
bakody’s AKA shoulder abuction
while seated, patient actively places affected arm’s palm on top of head. elbow should be at level of head
positive: relief of pain
indicates: IVD encroachment
propulsion/festinating/shuffling
parkinson’s, forward leaning posture with small, shuffling steps (acceleration, lack/arm mvmnt)
scissor
cerebral palsy
knees cross midline while walking
waddling
muscular dystrophy
steppage
anterior compartment syndrome, foot drop, L4 lesion/paralysis of tibialis anterior
trendelenburg
weak gluteus medius causing lurchingand drastic pelvic tilting on affected side
slappage/sensory ataxia
posterior column disease (difficulty walking in dark)
circumduction/hemiplegic
stroke; swinging, unilateral, spastic hemiplegia
spastic
UMNL
antalgic
gait is utilized to avoid provoking pain
drunken/motor acaxic
wide based pait (cerebellum)
acceleration of gait is through the action of?
iliopsoas and rectus femoris
deceleration is accomplshed by?
hamstrings
heel strike is accomlished by?
dorsiflexors
foot strike is accomplished by?
abductors
toe off is accomplished by?
quads
huntington’s chorea
MC age of onset is 35-44 neurodegenrative genetic disorder affects muscle coordination cognitive decline demintia
alzheimer’s
mental deterioration (cortical degenration) amnesia most definitive diagnosis: autopsy
charcot marie tooth
hereditary condition that affects both motor and sensory nerves
typical feature includes weakness of foot and lower leg muscles which may result in food drop and hgih stepped gait with frequent tripping or falls
lower leg atrophy (peroneal ms) will ocur after a period of time
muscular dystrophy
erb duchenne sex linked recessive disorder boys 3-7 proximal muscle weakness causing a waddling gait; toe walking, hyperlordosis (pot belly stance), pseudohypertrophy of calves, gower's sign large increased in CPK (CK-MM) decreased creatinine
tabes dorsalis
clinical condition of tertiary syphilis
wasting away of posteior columns
irregularities of pupil (argyll robertson)
slappage gait
guillian-barre syndrome
inflammatory polyneuropathy of PNS linked to recent immunizations or seen after recent flu infection
ascending paralysis(beginning at legs) and sensory symptoms
can become a medical emergency if it reaches the diaphragm
parkinson’s
chronic progressive condition associated with loss of dopamine in the substantia nigra causing basal ganglionic dysfunction
extrapyramidal tract involvement
gradual onset over 50
resting tremors, mask like face, festinating gait, cogwheel/lead pipe rigidity, forward stooped posture, bradykinesia
cerebral palsy
non-progessive motor disorder of the cerebral cortex due to anorexia to the brain prenatally or during birth trauma
scissor gait, spastic paralysis, athetoid (MC) and choreiform movements, normal intelligence
brown sequard
hemisection spinal cord usually caused by an injury
ipsilateral loss of motor function and dorsal columns with contra-lateral loss of pain and temperature
posterolateral sclerosis
gegeneration of the posterior columns and the corticospinal tracts as a result of a B12 deficiency
+schilling test
neurological symptoms are irreversible
glove and stocking paresthesia
ALS
lou gehrig’s
affects the corticospinal tract and anterior horn
usually begins in hands and feet and life expectancy is short
seen in males >40
fasciculations are present as well as spasticity and incrased DTR
LMNL in arms and UMNL in legs
myasthenia gravis
females 20-40
myoneural junction dysfunction
weakness in CN then proximal muscles affected
early signs: ptosis, diplopia, dysarthria, fatigue of muscles
diagnosed with tensilon test and terated with cholinesterase inhibiting drugs
MS
demyalination of CNS
motor and sensory tracts are affected
females 20-40 with periods of exacerbations and remissions, worse when moving from cold to warm climate
diploplia, scotomas, transient blindness, optic neuritis, pain, vertigo, UMNL in legs causing distal weakness
+lhermette’s
Charcot’s triad
diagnosis best with MRI
charcot’s triad
scanning speech, intention tremors, nystagmus
syringomyelia
pathological longitudinal cyst of central canal of spinal cord
fluid filling cavities expand in adult years
los of sens of pain and temperature over shoulders and back in a cape like distribution
cerebrum
sensory and motor interpretation
language
stroke, cerebral palsy, alcholism, alzheimer’s tumor
cerebellum
balance, coordination, dysmetria, dyssynergia, diadochokinesia, tandem gais,
MS, alcoholism, and a form of cerebral palsy
posterior column
2 point discrimination, vibration, and joint position sense
MS, tabes dorsalis, leprosy
corticospinal
voluntary motor, flexors of the hands and feet
UMNL
lateral spinothalamic
pain and temperature
syringomyelia
anterior spinothalamic
crude light touch
vestibulospinal
balances reflexes and postural muscles
benign positional vertigo and labyrinthitis
rubrospinal
muscle tone and synergy to proximal flexors of the extremities
reticulospinal
muscle tone and synergy to the voluntary extensor muscle
lateral corticospinal
corsses at medullary pyramids and travels to the flexors of the extremities
ventral corticospinal
crosses at the segmental level and then to the flexors of the trunk
UMNL
de quervain’s tenosynovitis
inflammation of extensor pollicis brevis and abductor pollicis longus tendons on the side of the wrist at the base of the thumb
can be brought on by simple strain injury
treated by braching the htumb and wrist
+finkelstien’s
trigger finger
finger becomes locked in a flexed position
finger locks when one of the tensond that flex the finger becomes inflamed and swollen
to straighten the finger, a person must force the swollen area into the sheath produca popping or snapping
dupuytren’s contracutre
an abnormal thickening underneath the skin of the aplm and fingers
caused the last tow fingers to curl into the palm
lateral on the middle finger may be involved
boutonniere deformity
hyper-extension of the DIP and hyperflexion fo PIP
seen with RA
swan neck deformity
hyperflexion of the DIP and hyper extension of PIP
seen with RA
mallet finger
a deformity in which the finger tip is curled in and cannot straighten itself
this deformity usually results from injury, which either damages the tendon or tears the tendone from the bone
deep peroneal nerve
anterior compartment syndoome
canc affect any and all 4 muscles of that compartment: tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius
s/s similar to charcot marie tooth
repetitive loading and microtrauma, tibial fracture
common peroneal
fibular head
presents with pain in tehlateral aspect of the leg, weak peroneal muscle or foot drop
caused by trauma
morton’s neuroma
between the 3rd and 4th metatarsals
caused by repetitive microtrauma, narrow toed shoes, RA, foot deformities
presents with apin in the toes and dorsum of the foot
surgery may be necessary
tibial nerve
tarsal tunnel syndrome
presents with buringin paresthesia and decreased sensation on soles of feet and weak muscles of the fot, aggravated by walking or standing
treaetment: adjust, orthoic support to keep foot in slight inversion
sciatic
pelvis, hip, pipliteal fossa
caused by trauma, traction, wallet pressure, piriformis, muscle spasm
presents with sensory pain in posterior butt, thigh, leg down to floor
weak nee flexion and decreased achilles relfex
lateral femoral cutaneous nerve
meralgia paresthetica
over the pelvic brim unde the inguinal ligament
L2,3 nerve roots
caused by extenal pressure, obesity, tight jeans
presents with buringin dysesthesia on anteriolateral thigh
treatment: advise with weight loss and loose clothing
dorsal scapular nerve
lfaring of the scapula
nerve injury and paralysis of the rhomoid msucles
flaring/winging is more obvious with arm abduction
long thoracic nerve
scapular winging
result of numerous case, indluding taumatic, iatrogenic and idiopathic processes that most often result in enrve injury and paralysis of the serratus anteiror
radial nerve
wrist drop, erb’s palsy, saturday night palsy, crutch palsy
site: spral groove
caused by trauma, lead poisoning, pressure from crutches
presents with los of triceps relfex
decreased sensationoto posteiror arm, forearm and psterolateral 3.5 fingers
klumpke paralysis
palsy of lower brachial plexus from childbirth
creastes a claw hand deformity with flexion of the wrist
if it affects T1, it can cause Horner’s syndrome
ulnar nerve
site: tunnel of guyon, cubital tunnel
caused by direct trauam or repetitive microtrauma
presents with pain, tingling, numbness in the last 2 digits and weakness of adductor pollicis and hypothenar atrophy
cubital tunnel entrapement will present with weak wrist flfexion on the ulnar side
pronator teres syndrome
between heads of pronator teres at elbow
atnerior interosseous nerve
presents witih pain and paresthesia on the volar aspect of forearm, lateral palm and lateral digits
caused y hypertonicity of muscle by things such as occupation
pain with pornation, wrist felxion, thenar atrophy
pinch grip test
trigger point therapy, stray and stretch
carpal tunnel syndrome
site: under the flexor retinaculum
caused by trauma, obesity, fluid retension (pregnancy), hypothyroidism, RA
presents with numbness and tingling in the first 3 digits
thenar atrophy, nocturnal pain, weak opponens pollicis (ape hand appearnce)
tests: tinel’s, phalen’s, grip strength with dynamometer
