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Pathophys 2 > Peripheral nerve injuries > Flashcards

Peripheral nerve injuries Flashcards

1
Q

Epineurium

A

Surrounds spinal nerve

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2
Q

Perineurium

A

Surrounds fascicle

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3
Q

Endineurium

A

Surrounds myelinated neuron

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4
Q

General

A

Dendrites receive signal
CNS fibres do not regenerate- slow clean up, enviro not optimal
PNS fibres regenerate- fast clean up (macrophages), schwann cells assist
If cell body is damaged cell can’t regenerate
If axon is damaged reservation can occur, 1mm a day
Sensory- muscle to CNS
Motor- CNS to muscle

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5
Q

Transient iscaemia

A

Acute nerve compression
15 mins numbness + tingling
30 mins loss of P sensibility
45 muscle weakness
Relief of compression –> recovery + no nerve damage

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6
Q

Iscaemia aetiology

A

Brief blood clot in brain
Blockage of artery to heart

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7
Q

Iscaemia presentation

A

Weakness, numbness, paralysis in face, arm or leg- typically on one side of body
Slurred or garbled speech or difficulty understanding others
Blindness in one or both eyes or double vision
Vertigo, loss of balance/coordination

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8
Q

Neuropraxia

A

Reversible physiological nerve conduction block
Loss of some types of sensations + power
Spontaneous recovery after few weeks/days
May be due to mechanical compression which cause segmental demyelination
E.g. radial nerve compression (wrist drop)

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9
Q

Symptoms of neuropraxia

A

Weakness
P
Touch sensitivity
Loss of sensation
Tingling, numbness

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10
Q

Neuropraxia diagnosis

A

Difficult to diagnose
Commonly underreported
Nerve conduction tests to find out exact location of block along nerve

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11
Q

Neuropraxia management

A

Usually heals on its own
Brace, cast, splints can manage P

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12
Q

Axontemesis

A

More severe form of nerve injury seen in closed fractures, dislocations, obstetric palsies
Loss of conduction but nerve is in continuity + neural tube intact
Axon regeneration starts within hours of nerve damage
Schwaan cells
Demyelination + axon loss
Neuron can regrow

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13
Q

Axonotmesis diagnosis

A

Nerve conduction velocity test
Electromyography performed after 3-4 weeks shows signs of denervation and fibrillations

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14
Q

Neurotmesis

A

Originally meant severance of nerve
Now understood that severe injury may occur without nerve division
Wallarin degeneration and repair takes place but results are poor due to endometrial tube destruction, distal end not regenerated
Resultant scarring may occur
Demyelination + axon loss + damage to endineurium (can have fair growth), perineurium (poor growth), epineurium (no growth)

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15
Q

Wallarin degeneration

A

Results when nerve fibres is cut or crushed, in which part of axon separates from neuron cell body
Degenerates distal to injury
Occurs 7-21 days post injury

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16
Q

Double crush phenomenon

A

Upton + McComa (1973) proposed that idc near enough is impaired at one located it makes Px more susceptible to toner entrapments along side CNS

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17
Q

Damage to brachial plexus

A

Commonly injured by traction
Not commonly injured by clavicle fractures

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18
Q

Obstetric brachial plexus- Erbs Palsy

A

Difficult birth- baby position, paralysis can be partial or complete, most invalid root is C5
Nerves involved- supra scapular, musculocutaneous, axillary

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19
Q

Signs of Erbs palsy

A

Loss of sensations in arms, paralysis + atrophy of deltoid, biceps and brachialis
Stunted growth of affected arm
Impaired muscular, nervous and circulatory development

20
Q

Obstetric BPI- Klumpkes palsy

A

Difficult birth- neuropraxia or scarring
Lower plus lesion C8-T1
Frequently associated with pre-ganglion injury + Horner’s syndrome (constricted pupil)

21
Q

Klumpkes palsy physical exam

A

Deficit of small muscles of hand- claw hand

22
Q

Management goals of Klumpkes palsy

A

Paralysis may recover completely , improve or remain unaltered

23
Q

Long thoracic nerve

A

Branch from brachial plexus (C5, 6 + 7)
In pectoral region on surface of serrates anterior just behind mid axillary line

24
Q

Clinical features of long thoracic damage

A

Aching or weakness with arm movements, winging of scapula

25
Q

Accessory nerve

A

Superficial- easily injured by trauma/surgery (e.g. whiplash)
Asymmetry of shoulders + weakness of abduction

26
Q

Suprascapular nerve

A

Injured in clavicle or scapular fractures
Shoulder weakness (abd, ext rot)
May present as orator cuff disease or cervical spondylosis

27
Q

Axillary nerve

A

Shoulder weakness
Deltoid wasting
Abduction still maintained by supraspinatous

28
Q

Radial nerve

A

Commonly injured at elbow, upper arm or axilla

29
Q

Radial nerve lower lesion

A

Possibly due to dislocations at elbow or to local wound
Iatrogenic lesion of post interosseous nerve- occasionally seen post surgery to proximal radius
Result is weakness of metacarpopharyngeal –> hand clumsiness

30
Q

Radial nerve high lesion

A

Occur with fractures of humerus
Obvious wrist drop
Sensory loss limited to superior radial nerve distribution

31
Q

Radial nerve very high lesion

A

Shoulder surgery
Saturday night palsy (occurs from prolonged direct pressure to radial nerve- e.g. resting on chair)
Triceps paralysed/reflex absent
Treatment depends upon open or closed injuries

32
Q

Ulnar nerve

A

Common via elbow/wrist
Open wounds may damage at any level
Guyon’s canal syndrome
Entrapment of ulnar nerve in cubital tunnel

33
Q

Ulnar nerve high lesion

A

Elbow damage
Ulnar neuritis cubital tunnel syndrome (compression of ulnar nerve at level of elbow)

34
Q

Ulnar nerve low lesions

A

Claw hand deformity
Unexplained lesions

35
Q

Treatment of ulnar nerve damage

A

Suture (of open wounds), passive/active exercises
IF unsuccessful, hand function compromised severely

36
Q

Median nerve

A

Most injured ear wrist or high forearm

37
Q

Median nerve low lesion

A

Carpal dislocation
Loss of abd of thumb, sensory loss over radial three and a half digits

38
Q

Median nerve high lesions

A

Forearm fracture/elbow dislocation- clinically the same but long flexors of the thumb, index and middle fingers paralysed/radial wrist flexor + forearm promotors lost
‘Pointing sign’ due to damage of index + middle finger

39
Q

Treatment of median nerve damage

A

Suture, nerve grafting/wrist splinted in flexion to avoid tension
Severe disability follows non-recovery

40
Q

Femoral nerve

A

Usually injured via traction or pressure preoperatively (around surgery)
Loss of quad action, deep tendon reflexes and numbness of ant thigh and medial leg

41
Q

Sciatic nerve

A

Complete division rare except gun shot wound
Traction lesion
Post total hip replacement

42
Q

Clinical features of sciatic damage

A

Complete lesion- hamstring and all below knee paralysed, drop foot, sensory loss below knee
Sometimes only deep part affected ]Complications- tropic ulcers/foot drop

43
Q

Treatment of sciatic damage

A

Suture, traction
Generally poor prognosis
Amputation

44
Q

Clinical features of ulnar nerve damage

A

Numbness + tingling in ulnar half of ring/pinky finger
May be related to specific postures
Initial stages may be difficult to see

45
Q

Management of ulnar nerve damage

A

Conservative measures
Night slinging
Surgical release in advancing cases with intrinsic wasting

46
Q

Guyon’s canal compression

A

Symptoms may be motor, sensory or both
Ganglion from triquetrohamate Jt
Ulnar artery aneurysm
Fractured hook of hamate

47
Q

Iscaemia findings

A

Physical exam and test vision
Eye movements, speech, language

Pathophys 2 (5 decks)

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