Peripheral Nerve Injuries Of UE (2) Flashcards
What is mononeuropathy?
Damage to selected peripheral nerves like the median nerve (traumatic or non traumatic)
What is polyneuropathy?
Metabolic (diabetes or alcoholic)
What is Grade 1 neuropraxia?
Focal segmental demyelination (full recovery)
What is grade 2 axonotmesis?
Axon damaged with intact Endoneurium (full recovery)
What is grade 3 axonotmesis?
Axon and Endoneurium damaged with intact Perineurium (partial recovery)
What is grade 4 axonotmesis?
Axon, Endoneurium, and Perineurium damaged with intact Epineurium (no recovery, requires surgery)
What is grade 5 neurotmesis?
Complete nerve transection (no recovery, requires surgery)
What is a grade 6 injury?
Mixed nerve injury
How can PNI be diagnosed?
Using electromyography combined with nerve conduction study
What are some involuntary activation that occurs with PNIs?
Fibrillation potential and fasciculations
What pain occurs with PNIs?
Burning
Primarily distal
Projected or referred
Where can the median nerve be damaged?
Carpal tunnel (most common)
Pronator teres
Anterior interosseus
What are the motor loss involved with pronator teres syndrome?
Flexor pollicis longus
Flexor digitorum profundus (1 and 2)
Pronator quadratus
Opponens pollicis
Flexor pollicis brevis
What is the sensory loss involved in the pronator teres syndrome?
Thenar eminence and digits 1-3 (possibly 4 too)
What are the special tests of pronator teres syndrome?
+ pronator teres syndrome test
+ tinels in forearm
- phalens
What is the sensory loss in anterior interosseus syndrome?
No sensory loss but have aching
What is the motor loss in anterior interosseus syndrome?
Flexor pollicis longus
Flexor digitorum profundus (1 and 2)
Pronator quadratus
What are the sensory loss of carpal tunnel syndrome?
Median nerve distribution except for the thenar eminence
What is the motor loss of carpal tunnel syndrome?
Atrophy of thenar muscles
When do patients with carpal tunnel syndrome complain of paresthesia?
At night or with increased use of
What are the special tests for carpal tunnel syndrome?
Pain radiating distal to proximal
Report dropping objects
+ tinels at wrist
+ phalens and reverse phalens
What are the provocative tests of carpal tunnel syndrome?
Phalens
Tinels
CCT
What is the clinical prediction rule of carpal tunnel syndrome?
Hand shaking improves symptoms
Wrist-ratio index > .67
Symptom severity score > 1.9
Diminished sensation in median sensory field 1
Age > 45
Where can the ulnar nerve be damaged?
Cubital tunnel (elbow)
Guyons canal (wrist)
What is the second most common peripheral nerve injury?
Cubital tunnel syndrome
What are the sensory losses of cubital tunnel syndrome?
Sensory deficits at the 5th digit and ulnar 1/2 of 4th digit
What are the motor losses of cubital tunnel syndrome?
Atrophy of ulnar intrinsics
What are special tests for cubital tunnel syndrome?
+ elbow flexion test
+ tinels at cubital tunnel
What are sensory losses of Guyans canal syndrome?
Limited to palm
If there is Guyons canal at zone 1 what do you lose?
Motor and sensory
If there is Guyons canal at zone 2 what do you lose?
Motor only
If there is Guyons canal at zone 3 what do you lose?
Sensory only
What are special tests for Guyons canal syndrome?
+ phalens and reverse phalens
+ tinels at Guyons canal
+ froments sign
+ wartenbergs sign
Where are the locations where the radial nerve is damaged?
Upper arm lesion
Posterior interosseus
Radial tunnel
Wartenbergs syndrome
What is an upper arm lesion caused by?
Fractures or prolonged compression (crutch or Saturday night palsy)
Where is sensory loss in an upper arm lesion if the lesion is at the spiral groove?
Dorsum of hand and 1st two digits (most common)
Where is motor loss in an upper arm lesion if the lesion is at the spiral groove?
Weakness distal to tricep (wrist drop)
Where is sensory loss in an upper arm lesion if the lesion is proximal to the spiral groove?
Posterior arm, posterior 1/3 forearm, Dorsum of hand, and web space
Where is motor loss in an upper arm lesion if the lesion is proximal to the spiral groove?
Triceps
What causes posterior interosseus syndrome?
Fracture or RA
Where does posterior interosseus syndrome occur?
Arcade of froshe
What are the sensory losses in posterior interosseus syndrome?
None
What are the motor losses in posterior interosseus syndrome?
Supinator
Wrist extensors
How does the wrist present in posterior interosseus syndrome?
Radial deviation with wrist extension
What is present in radial tunnel syndrome?
Lateral elbow pain below epicondyle (no sensory or motor losses)
Where does wartenbergs syndrome most commonly occur?
Where the nerve exits the Musculotendinous junction of the brachioradialis and ECR
What is the sensory loss of wartenbergs syndrome?
Dorsal radial wrist and hand (worse with pronation, wrist/finger flexion, and ulnar deviation)
What is motor loss to wartenbergs syndrome?
None
What nerve is damaged if there is an ape hand presentation?
Median
What nerve is damaged if there is a bishops (Benedict) hand?
Ulnar
What nerve is damaged if there is a claw or intrinsic minus hand?
Combined median and ulnar
What nerve is damaged if there is a wrist drop?
Radial
Where does thoracic outlet syndrome occur?
Between scalenes (no venous)
1st rib and clavicle
Pec minor
What is interventions for thoracic outlet syndrome?
Posture education
Stretching/strengthening to improve posture
How does an axillary nerve injury occur?
Dislocation
What are the sensory losses to axillary nerve injury?
Lateral deltoid (axillary patch)
What are the motor losses to axillary nerve injury?
Teres minor and deltoid
What causes a suprascapular nerve injury?
Direct blow or cyst
What is a suprascapular nerve injury often mistaken for?
RC tear
What are the sensory losses of a suprascapular nerve injury?
None
What are the motor losses of a suprascapular nerve injury?
RC weakness (atrophy of Supra and Infraspinatus)
What is a sign that someone has a suprascapular nerve injury?
Deep burning worse with horizontal adduction
How can you get a long thoracic nerve injury?
Idiopathic or fall on your side
What is presentation of someone with a long thoracic nerve injury?
Winging and aching
What are the nerve injuries that are considered birth injuries?
Brachial plexus birth palsy
Klumpke
What is affected in brachial plexus birth palsy?
C5-C6 roots
What is affected in a kempke?
C7, C8, and T1
What is the shoulder presentation in erbs palsy (C5-6)?
Extended, IR, and slightly abducted
What may denervated muscles require?
Support like splinting or AAROM
What has been shown to not be beneficial in nerve injury rehab?
Electrical stimulation
What should be controlled early in nerve injuries?
Inflammation
What should be prevented in nerve injuries?
Overstretching denervated muscles or injured nerve
Prevent joint contractures
What type of strengthening exercises should be used for nerve injuries?
Low load (avoid muscle fatigue or failure)
