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pathologies Flashcards

1
Q

What is neurapraxia?

A

-first degree nerve injury
-mild focal compression (causing a conduction block)
>segmental demyelination
-reversible in hours to months
-no break in the fibers
-motor function loss

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2
Q

How fast do nerves repair?

A

1-2 mm /day

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3
Q

What is axonotmesis?

A
  • second degree nerve injury
  • prolonged, severe compression
  • Wallerian Degeneration
  • endoneurium still intact
  • prognosis >6months
  • sensory and autonomic loss
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4
Q

What is Wallerian Degeneration?

A
  • describes the path of destruction

- degeneration of an axon at a point of contact and distall

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5
Q

What is neurotmesis?

A
  • third degree nerve injury
  • -damaged endoneurium
  • Wallerian Degeneration
  • hard to regenerate
  • surgical intervention to suture
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6
Q

Causes of peripheral nerve lesions

A

compression, tight muscles, crutches, trauma, boney growth, tumors, systemic conditions with swelling

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7
Q

A neuropathy in which a single peripheral nerve is affected.

A

a mononeuropathy

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8
Q

A neuropathy in which several peripheral nerves are involved.

A

a polyneuropathy.

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9
Q

a neuropathy that involves the nerve root as it emerges from the spinal cord.

A

a radiculoneuropathy

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10
Q

a neuropathy that involves several nerve roots and occurs when infections create an inflammatory response.

A

polyradiculitis

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11
Q

What is Erb-Duchenne palsy?

A
  • injury to the superior roots of the brachial plexus.
  • traction injury
  • forceful pulling away of head from shoulder
  • no sensation over lateral arm (sensory loss C5 and C6 dermatomes)
  • waiter’s tip
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12
Q

What is the waiter’s tip position?

A
  • arm is adducted
  • medial rotation
  • elbow extended
  • forearm pronated
  • wrist & fingers flexed
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13
Q

What is Klumpke’s paralysis?

A
  • traction injury of lower brachial plexus
  • poor positioning at birth (breech), or pulled by forceps
  • falling from height and grabbing something to break fall
  • results in medial and ulnar lesions
  • whole hand claw hand - thumb on same plane as palm (wasting of thenar eminence)
  • sensory loss affecting C8-T1 dermatomes
  • can get Horner’s syndrome
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14
Q

What is Horner’s syndrome?

A
  • on affected side
  • miosis - constriction of pupil
  • ptosis - drooping eyelid
  • anhydrosis - loss of sweating to face and neck
  • enophthalmas - recession of eyeball into orbit
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15
Q

What is the path of the radial nerve?

A

-branches just before supinator
-posterior motor branch “posterior interosseous nerve”
>it enters supinator and travels down the lateral radius to the wrist
-superficial branch - travels down the posterior forearm to the hand

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16
Q

What causes a radial nerve lesion?

A
  • fractures - at the spiral/radial groove
  • dislocations - of head of radius, humeroradial or radioulnar joint
  • post-surgical complications
  • compression
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17
Q

What are the symptoms of a radial nerve lesion?

A
  • altered sensation at the posterior arm and hand (digits 1-3 and lateral 1/2 of 4)
  • wrist drop
  • if injury is proximal to elbow, both sensory and motor affected, if injury distal to elbow, only sensory or motor is affected
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18
Q

What is a radial nerve lesion at the axilla?

A

crutch palsy

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19
Q

What is a radial nerve lesion at the spiral groove of the humerus?

A

Saturday night palsy

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20
Q

What is posterior interosseous syndrome?

A
  • comes off in front of the lateral epicondyle of humerus
  • motor
  • get wrist drop
  • compression in the arcade/canal of Frohse
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21
Q

What is the arcade of Froshe?

A
  • fibrous arch in the supinator
  • between the 2 heads of supinator
  • occurs in 30% of people
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22
Q

What is a compression of the radial nerve as it passes under the tendon of brachioradialis?

A

cheiralgia paresthetica

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23
Q

Describe cheiralgia paresthetica

A
  • sensory
  • pain at dorsum of wrist, thumb, and subspace
  • cause: trauma, tight cast, swelling
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24
Q

What causes a median nerve lesion?

A
  • fractures at elbow, wrist, and carpals
  • dislocations at elbow, wrist, and carpals
  • compressions
  • trauma
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25
Q

What are the symptoms of median nerve lesions?

A
  • Ape hand and Oath hand
  • can’t grasp objects
  • can’t pronate forearm (can’t do air quotes)
  • weak wrist flexion, weak thumb movements
  • altered sensation of digit 1-3 and half of 4.
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26
Q

What is ape hand?

A

wasting of thenar eminence due to no opposition

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27
Q

What is oath hand?

A
  • only seen when asked to make a fist

- only digits 4 and 5 can be flexed

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28
Q

Where can a median nerve lesion occur?

A
  • ligament of struthers
  • carpal tunnel
  • pronator teres
  • anterior inerosseous
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29
Q

What is the ligament of struthers?

A
  • runs from an abnormal spur on the shaft of the humerus to the medial epicondyle
  • median nerve can be compressed above the elbow as it passes under
  • only in 1% of population
30
Q

What is pronator teres syndrome?

A
  • compression at proximal attachment of pronator teres of the median nerve
  • aching in anterior forearm
  • numbness in thumb and index finger
  • somes weakness in thenar muscles
31
Q

What is carpal tunnel syndrome?

A
  • compression through the carpal tunnel at the wrist

- most common entrapment condition in the arm

32
Q

What makes up the carpal tunnel?

A
  • carpal bones = floor
  • flexor retinaculum = roof
  • flexor retinaculum attaches to the scaphoid tubercle and the trapezium
33
Q

What travels through the carpal tunnel?

A
  • median nerve
  • flexor digitorum superficialis (4 tendons)
  • flexor digitorum profundus (4 tendons)
  • flexor pollicus longus (1 tendon)
34
Q

What are the symptoms of carpal tunnel syndrome?

A
  • numbness and tingling in digit 1-3 and 1/2 of 4
  • distinguishing feature = presence of nocturnal symptoms that wake person up
  • muscle weakness and clumsiness of thumb and fingers. ie. opening jars and doors
  • later get thenar wasting.
35
Q

What are the 2 ways to compress the median nerve in the carpal tunnel?

A
  • size of the tunnel decreases - bony callous, space occupying lesion, bony changes. ie. Rheumatoid arthritis
  • size of contents passing through increases:
    • repetitive actions. ie. edema then fibrosis & tendon thickening
    • retinaculum thickening from scar tissue (repeated trauma
    • systemic conditions that cause edema & fluid retention
36
Q

What is the path of the ulnar nerve?

A
  • travels over the flexor retinaculum between the pisiform and the hook of hamate (Guyon’s canal)
  • ulnar groove
37
Q

What are causes of an ulnar nerve lesion?

A
  • fractures at the medial epicondyle, mid forearm and wrist
  • dislocations of elbow
  • post-surgical complications (badly positioned arm while under anesthetic)
  • compression ie. resting elbow on hard surface; wearing tight wrist band; cycling
  • repetitive actions
  • direct trauma
38
Q

What are the symptoms of an ulnar nerve lesion?

A
  • ulnar claw hand
  • froment’s sign
  • tardy ulnar palsy
39
Q

What is ulnar claw hand?

A
  • baby finger hyperextended and abducted and MCP and flexed at IP
  • ring finger is hyperextended at MCP and flexed at IP (loss of lumbricals)
  • atrophy of inerosseous muscle
  • muscle wasting of hypothenar
  • altered sensation of little finger and medial 1/2 of ring finger (palmar and dorsal)
40
Q

What is froment’s sign?

A
  • hold paper between thumb and index finger
  • it can’t be done without adductor pollicis muscle
  • if positive the patient will flex thumb to use flexor pollicis longus
41
Q

What is tardy ulnar palsy?

A
  • common complication of elbow fractures
  • can occur years after a fracture
  • associated with callus formation of a valgus deformity of the elbow
  • these produce a gradual stretching of nerve in ulnar groove of medial epicondyle
42
Q

What is thoracic outlet syndrome?

A
  • compression of brachial plexus from structures in the thoracic outlet (from interscalene triangle to inferior border of axilla)
  • subclavian artery and vein may also be compressed
43
Q

What are causes of TOS?

A
  • whiplash
  • backpacks
  • apical breathing
44
Q

What are symptoms of TOS?

A
  • pain, numbness, weakness, tingling in the arm or across upper thoracic area or over scapula
  • trophic changes in the tissue with blood vessel compression
45
Q

Why would TOS happen?

A
  • presence of cervical rib at C7
  • anterior scalene syndrome - compression b/w anterior and mid scalene
  • costoclavicular syndrome - compression b/w the clavicle and rib 1
  • pectoralis minor syndrome - compression b/w coracoid process and pec minor
46
Q

What makes up the interscalene triangle?

A
  • anterior scalene
  • middle scalene
  • rib 1
  • brachial plexus and subclavian artery pass through.
47
Q

What is the name of the pathology for lateral femoral cutaneous nerve entrapment?

A

meralgia paresthetica

48
Q

What can cause meralgia paresthetica?

A
  • trauma (seat belt in MVA)
  • during delivery (feet in stirrups)
  • tight clothing
  • complication of surgery (hernia)
49
Q

Where does meralgia paresthica occur?

A

near the ASIS as the nerve passes under the inguinal ligament

50
Q

What will meralgia paresthica present with?

A

sensory alteration and/or burning pain on the lateral thigh

51
Q

What will injury to the femoral nerve present with?

A
  • can’t extend leg (@ knee), trouble flexing hip
  • wasting of quads
  • no sensation over anterior/medial thigh
52
Q

What is the path of the sciatic nerve?

A
  • lateral to ischial tuberosity
  • down posterior thigh
  • split at knee
53
Q

What causes a sciatic nerve lesion?

A
  • fractures (pelvis, femur, tibia, fibular head, ankle)
  • dislocation (hip, knee, ankle)
  • iatrogenic reasons (glute injury, hip surgery, meniscal repair, improper positioning during surgery)
  • compression from internal sources:
    • piriformis (piriformis syndrome)
    • ganglion
    • morton’s foot
    • flexor retinaculum (tarsal tunnel syndrome)
  • compression from external sources:
    • against fib. head (cast, splint)
    • crossing legs
    • trauma
54
Q

What are the symptoms of a sciatic nerve lesion?

A
  • pain at butt and down lateral leg and possibly to lateral foot
  • foot drop - paralysis of dorsiflexors and everters
    - leads to steppage gait
55
Q

What forms the tarsal tunnel?

A

the medial malleolus, calcaneous, talus, and the flexor retinaculum

56
Q

What is tarsal tunnel syndrome?

A

the tibial nerve being compressed at the ankle as it passes through the tarsal tunnel

57
Q

what can cause tarsal tunnel syndrome?

A

-swelling after trauma
-space occupying lesion (ie. ganglion)
-inflammation (ie. paratendonitis)
-valgus deformity
chronic inversion

58
Q

What are the symptoms of tarsal tunnel syndrome?

A
  • pain and paresthesia into sole of foot
  • symptoms often worse after long periods of standing or walking or at night
  • pain localized or radiates over medial ankle, distal to medial malleolus
59
Q

What is tarsal tunnel syndrome often misdiagnosed as?

A

plantar fascitis

60
Q

What is neuritis?

A
  • inflammation of the nerve

- mainly the sheath and CT are affected (usually the axon is not)

61
Q

What are the symptoms of neuritis?

A
  • constant dull pain

- can also get numbness and tingling

62
Q

What are causes of neuritis?

A
  • secondary to pathology (DM, leprosy, TB)
  • trauma to nerve
  • chronic exposure (to a toxin like lead, drugs, or alcohol)
63
Q

What is neuralgia?

A
  • nerve pain
  • recurrent attacks of sudden excruiating pain along distribution of the nerve
  • no associated pathology
  • has a trigger zone
64
Q

What is a trigger zone for neuralgia?

A
  • area that causes an attack when stimulated
  • usually it’s an area of skin supplied by the nerve
  • movement of the area increases pain
65
Q

What are commonly affected nerves of neuralgia?

A

trigeminal and intercostal nerves

66
Q

What is intercostal neuraliga?

A

-neuralgia that affects intercostal nerves that travel between the internal and innermost intercostal muscles

67
Q

What are causes of intercostal neuralgia?

A
  • diabetes

- post-herpes zoster

68
Q

What is the pathogenesis of Herpes Zoster?

A
  • starts with chicken pox
  • after recovered from chicken pox as a child the virus lays dormant in the sensory ganglia of the cranial or spinal nerves and becomes active later in life.
  • when reactivated, patient gets a generalized inflammatory response starting in the sensory ganglion and spreading along the nerves causing demyelination and degeneration
69
Q

What is Herpes Zoster commonly called?

A

Shingles

70
Q

How many nerves are usually affected with Herpes Zoster?

A

usually only one nerve affected.

-thoracic and trigeminal nerves are most common

71
Q

What are the symptoms of Herpes Zoster?

A
  • inflammation producing pain; tingling in the involved dermatome with a rash and the vesicles burst and encrust.
  • skin lesions can last up to a month and disappear as the effects of the virus resolve
  • intermittent attacks of deep, burning, sharp shooting pain along the affected nerve
  • trigger is often light touch and movement over affected area.

Neuro (13 decks)

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