Peripheral Nerve Injury Flashcards
What are the key examination procedures used to assess a patient with peripheral neuropathy?
Posture Edema ROM/Flexibility Muscle Performance Skin Pain Nerve integrity Provocative tests Reflexes Sensation
What are the positive prognostic indicators for peripheral nerve regeneration?
Survival of cell body
Absence of barriers that prevent axonal sprouting
Accurate growth toward appropriate end organs.
Accommodation of CNS to reorganize mixed afferent signals
What are the NEGATIVE prognostic indicators for peripheral nerve regeneration?
Advanced age
Poor cognition
Trauma
Transection
Describe rate of peripheral nerve regeneration based on lesion location.
Quicker regeneration proximal to distal.
What are the sensory disturbances associated with peripheral nerve pathology?
Hypoesthesia Hyperesthesia Paresthesia: Pins and needles Dysesthesia (unpleasant; burning) Causalgia: intense burning pain with skin changes
Which is more vulnerable to compression injuries, losses in vibration, and proprioception?
Large diameter Fibers or small diameter Fibers?
Large Diameter Fibers
What are non sensory impairments associated with peripheral nerve injury?
Flaccid paralysis Areflexia atrophy muscle fatigue/cramping Loss of synergistic action loss ROM Joint instability
What are the integumentary changes associated with peripheral nerve injury?
Smooth, glossy skin
Thinned or absent nails and hair
What are the autonomic dysfunctions associated with peripheral nerve injury?
Loss of vasomotor tone
Alteration of sweating
What are issues surrounding strengthening of denervated muscle?
If nerve block brain can’t communicate to muscle
Wont speed regeneration
Start as soon as mm can be activated
Prevent atrophy/de conditioning in related yet innervated muscle groups
What are the indications for use of e-stim for someone with peripheral neuropathy?
Denervated muscle- direct current- prevent atrophy and promote growth
Stimulate re-innervatred muscle
Pain control
Inflammation control
What are the indications for use of modalities, (heat, cold, pulsed ultrasound, contrast baths)?
Heat- promote effective stretching in chronic phase of recovery
Cold- Control inflammation, may potentially slow nerve re growth
Pulsed ultrasound- Control pain
Contrast baths- Control edema
What are the indications for sensory re-education?
Expose to and ID of area with reduced sensation Progressively complex tactile inputs With and without vision Spatial and temporal variation Promote increase intrinsic feedback Reward correct performance
What are the patient education topics for peripheral nerve injury?
Skin protection Joint protection Exercise Manage inflammation Manage edema
What are the joint protection principals?
RESPECT pain
Avoid improper postures or positions
Avoid staying in 1 position for long
Use strongest and largest muscles and joints
Avoid sustained joint activities
Maintain muscle strength, joint ROM, and conditioning
Use assistive devices and or splints
