Peripheral Nerve Injuries

Question 1

Effects of skeletal movement on nerve health

Answer 1

• Improves blood flow
• Facilitates gliding of fascicles & nerves
• Facilitates axoplasmic transport
• Prevents “wrinkling” of axons within endoneurium

Question 2

Sensory signs of peripheral nerve dysfunction

Answer 2

• Decreased sensation
• Absent sensation
• Abnormal sensation (e.g. allodynia, ectopic foci)

Question 3

Autonomic signs of peripheral nerve dysfunction

Answer 3

• Loss of or increase in sweating
• Loss of “shunting” from superficial capillaries
• Other

Question 4

Motor signs of peripheral nerve dysfunction

Answer 4

• Paresis
• Paralysis
• If denervation, atrophy of denervation or fibrillations

Question 5

Classification of neuropathies: how many nerves are affected?

Answer 5

• Mononeuropathy (i.e. carpal tunnel)
• Multiple mononeuropathy/double crush (i.e. CTs & cubital or bilateral CT)
• Polyneuropathy (i.e. diabetic neuropathy)

Question 6

Classification of neuropathies: how severe is the damage?

Answer 6

• Traumatic myelinopathy/neurapraxia (i.e. “foot is asleep”)
• Traumatic axonopathy/axonotmesis (interruption of axons & myelin sheath, Wallerian degeneration)
• Severance/neurotmesis (spontaneous recovery impossible, medical intervention required)

Question 7

Locations of ulnar nerve entrapment

Answer 7

Cubital tunnel or Guyon canal

Question 8

Guyon’s canal syndrome

Answer 8

Compression of ulnar nerve between hook of hamate and volar carpal ligament

Question 9

Ulnar nerve palsy/ulnar nerve lesion

Answer 9

• Claw hand deformity of ring & small fingers
• Nerve has been completely cut
• Deformity occurs because extensors are unopposed by intrinsics

Question 10

Types of median nerve entrapment

Answer 10

• Carpal tunnel syndrome
• Pronator syndrome
• Anterior interosseous syndrome
• Low median nerve palsy
• High median nerve palsy

Question 11

Pronator syndrome

Answer 11

• Compression of median nerve between two heads of pronator teres
• Pain/weakness in resisted pronation at medial proximal forearm

Question 12

Anterior interosseous syndrome

Answer 12

• Compression of the anterior interosseous nerve (motor branch of median nerve) as it penetrates the FDP in the forearm
• Inability to make “OK” sign

Question 13

Low median nerve palsy

Answer 13

• Laceration of nerve at wrist level
• Ape hand deformity
• Client’s ability to oppose is weak

Question 14

High median nerve palsy

Answer 14

• Proximal injury

- Loss of pronation of forearm, wrist flexors, index and long finger flexion, FPL, and distal losses in hand

Question 15

Types of radial nerve injuries

Answer 15

• Injury from midshaft humeral fracture
• Saturday night palsy
• Radial tunnel
• Wartensburg syndrome

Question 16

Radial tunnel

Answer 16

Compression of the posterior interosseous nerve (branch of deep radial nerve) as it divides and pierces the Arcade of Frohse and causes compression between the supinator and radial head

Question 17

Wartenberg’s syndrome

Answer 17

Superficial radial cutaneous nerve irritation due to tight cast or watch band, direct trauma, surgical injury, etc.