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PTRS 745 Exam 2 > Peripheral Nerve Injury > Flashcards

Peripheral Nerve Injury Flashcards

1
Q

Content: Neural Structures in the PNS (4)

A
  1. Muscle spindle receptors
  2. GTO
  3. Motor Endings
  4. Axons
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2
Q

Q: What do the rami communicantes connect with?

A

Sympathetic Ganglia

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3
Q

Diagram: Axon Characteristics Table

A
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4
Q

Content: Mechanisms of Nerve Injury (5)

A
  1. Compression or crush
  2. Laceration
  3. Stretch
  4. Radiation
  5. Electricity
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5
Q

Content: Sedden’s Classification of Nerve Injury (3)

A
  1. Neurpraxia
  2. Axonotmesis
  3. Neurotmesis
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6
Q

Content: Neurapraxia (3)

A
  1. Low severity injury
  2. Nerve remains intact but electrical conduction is interrupted by ischemia/compression
  3. Secondary injuries can be caused by vascular damage leading to intrafascicular edema
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7
Q

Content: Axonotmesis (3)

A
  1. Axon is disrupted by myelin sheath is intact
  2. Typically due to a crush injury
  3. If neuronal tubules are maintained, regeneration/restoration of sensory/motor may return
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8
Q

Content: Neurotmesis (3)

A
  1. Loss of nerve conduction and damage to surrounding nerve trunk CT
  2. In extreme cases complete nerve transection occurs
  3. Commonly a neuroma forms over the proximal stump preventing normal regeneration
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9
Q

Diagram: Seddon’s Classification of Nerve Injury

A
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10
Q

Diagram: Summary of Seddon’s Classification

A
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11
Q

Content: Any Peripheral Nerve Injury in Extremity Trauma by %

  1. After LE Fx
  2. After UE wound
  3. After Crush Injury
A
  1. 1.77
  2. 1.85
  3. 1.91
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12
Q

Q: What are the most common peripheral nerve injuries following extremity trauma?

A

Radial/Ulnar after Humerus Fx (1.03%) and Sciatic/lumbosacral plexus/femoral after Pelvis Fx (1.76%)

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13
Q

Diagram: Signs and Symptoms of Mixed Peripheral Nerve Lesions (Axonotmesis or Neurotmesis)

A
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14
Q

Q: What conditions can cause peripheral nerve injury due to compression of the nerve roots? (4)

A
  1. Degenerative disc/joint disease
  2. Spondylolisthesis
  3. Spine deviations
  4. Narrowing of the intervertebral foramen
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15
Q

Q: Compression of the following nerves caues what UE syndrome?

  1. Brachial Plexus
  2. Ulnar n.
  3. Radial n.
  4. Medial n.
A
  1. Thoracic outlet syndrome
  2. cubital tunnel syndrome or compression on tunnel of Guyon
  3. Radial n. compression
  4. Carpal Tunnel Syndrome
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16
Q

Q: Compression of the following nerves caues what LE syndrome?

  1. Sciatic n.
  2. Peroneal n.
  3. Tibial n.
A
  1. Piriformis syndrome
  2. Peroneal n. compression
  3. Tarsal tunnel syndrome
17
Q

Content: Upper Plexus Injury (C5-6) (4)

A
  1. Shld depression and lateral felxion of neck
  2. Loss of shld ABD, ER
  3. Weakness of arm flexion and forearm supination
  4. Waiter’s tip position
18
Q

Content: Lower Plexus Injury (C8-T1) (2)

A
  1. Compression of the cervical rib or stretching the arm overhead
  2. Paralysis of the intrinsic muscles of the hand
19
Q

Content: Thoracic Outlet Syndrome (TOS) (3)

A
  1. Brachial plexus pain
  2. Paresthesia, numbness, weakness
  3. Nerve tension when the plexus is stretched
20
Q

Content: Axillary Nerve Injury

  1. Nerve Root
  2. Cause
  3. Weakness
  4. Sensroy
A
  1. C5-6
  2. Acute dislocation or Humeral Neck Fx
  3. Squared shld from deltoid atrophy, Shld ABD/ER weakness,
  4. Sensory loss on lateral deltoid
21
Q

Content: Musculocutaneous Nerve Injury

  1. Nerve Root
  2. Cause
  3. Weakness
  4. Sensory
A
  1. C5-7
  2. Projectile wounds
  3. Atrophy along flexor surface of upper arm, elbow flexion/supination weakness
  4. Sensory loss on radial side of forearm
22
Q

Content: Median Nerve Injury

  1. Nerve Root
  2. Cause
  3. Clinical Presentation
  4. Weakness
  5. Sensory
  6. Palsy
A
  1. C6-8, T1
  2. Impingement in hypertrophied pronator teres or carpal tunnel syndrome
  3. Burning/tingling/itching/numbness in palm of hand/fingers/thumb/index/middle finger
  4. No arm pronation/thumb ABD, weak grip
  5. Sensory loss in the thenar region
  6. Ape hand with thenar eminence atrophy
23
Q

Content: Ulnar Nerve Injury

  1. Nerve Root
  2. Cause
  3. Clinical Presentation
  4. Weakness
  5. Sensory
  6. Palsy
A
  1. C8-T1
  2. Cubital tunnel syndrome or compression of Guyon’s canal
  3. Pain/numbness/tingling in ring and little fingers
  4. Loss of 4th/5th digit spherical and cylindrical power grip, thumb ADD, finger ADD/ABD
  5. Sensory loss in hypothenar region
  6. Partial claw with atriphy b/t MT and hypothenar region
24
Q

Content: Radial Nerve Injury

  1. Nerve Root
  2. Cause
  3. Clinical Presentation
  4. Weakness
  5. Sensory
  6. Palsy
A
  1. C5-8, T1
  2. Compression of radial sulculs, radial head, ECRB and supinator
  3. Pain and tenderness in the proximal forearm, lack of numbness
  4. Weakness: finger extension, supination; Unable to: push (triceps), make fist/grip, stab wrist in extension
  5. Sensory loss on posterior arm, forearm, and radial side of hand
  6. Wrist drop
25
Q

Content: Sciatic Nerve Injury

  1. Nerve Root
  2. Cause
  3. Clinical Presentation
  4. Weakness
  5. Sensory
A
  1. L4-5, S1-3
  2. Compression from tight piriformis, hip dislocation, femur fx.
  3. Sciatica pain
  4. Posterior thigh, leg/calf, foot atrophy, weak knee flexion, loss of ankle control
  5. Sensory loss in lateral/posterior (lower)leg and plantar foot
26
Q

Content: Common Peroneal Nerve Injury

  1. Nerve Root
  2. Cause
  3. Clinical Presentation
  4. Weakness
  5. Sensory
A
  1. L4-S2
  2. Compression from crossing leg, head/neck of fibula fx
  3. Gait impairment during LR with foot slap and excessive hip flexion to clear toes
  4. Deep = foot drop, Superficial = eversion weakness
  5. Sensory loss anterior/lateral leg and dorsal foot
27
Q

Content: Tibial Nerve Injury

  1. Nerve Root
  2. Cause
  3. Clinical Presentation
  4. Weakness
  5. Gait
A
  1. L4-S3
  2. Tarsal Tunnel Syndrome
  3. Tingling/burning/electrical shock/numbness/(shooting) pain on medial ankel and plantar foot
  4. Inability to flex ankle or toes
  5. Gait impairment during terminal stance
28
Q

Content: Nerve Injury Management - Acute Phase

  1. Description
  2. Immobilization
  3. Movement
  4. Splinting/bracing
  5. Pt. Education
A
  1. Immediately after sx/injury
  2. Time dictated by surgeon
  3. Amount and intensity dictated by type of injury/sx repair
  4. To prevent deformities or tension on the injuried site
  5. Protection of the injury site
29
Q

Content: Nerve Injury Management - SubAcute Phase

  1. Description
  2. Motor retraining
  3. Desensitization
  4. Discrimative sensory reeducation
A
  1. Signal of reinnervation (muscle contraction and increased sensitivity)
  2. Hold in shortened position, electrical stimulaiton
  3. Multiple texture for sensory stimulation and vibration
  4. Identification of objects with/without visual cues
30
Q

Content: Nerve Injury Management - Chronic Phase

  1. Description
  2. Compensatory Function
  3. Preventive Care
A
  1. Reinnervation potential peaked with minimal or no signs of neurological recovery
  2. Compensatory function is minimized during the recovery BUT is emphasized when full neurological recovery does not occur
  3. Emphasis on lifelong care to involved region
31
Q

Content: Neural Mobilization for compression and neural tension (3)

A
  1. Release tension, compression, or entrapment due to inflammatory conditions in the surrounding CT or nerves
  2. Release adhesive scar tissue
  3. Free up the nerve to slide in its sheath
32
Q

Content: Neural Testing and Mobilization for the Median n, (tx of TOS and CTS) (7)

A
  1. Shoulder depression
  2. Shoulder abduction (slightly)
  3. Extend elbow
  4. Shoulder ER
  5. Supinated the forearm
  6. Wrist and fingers extension
  7. Contralateral cervical bending
33
Q

Content: Neural Testing and Mobilization for the Radial n. (tx of PINS, Tennis elbow, DeQuervain’s) (7)

A
  1. Shoulder depression
  2. Shoulder abduction (slightly)
  3. Extend elbow
  4. Shoulder INTERNAL rotation
  5. pronate the forearm
  6. Wrist and fingers flexion
  7. Contralateral cervical bending
34
Q

Content: Neural Testing and Mobilization for the Ulnar n. (tx of C8-T1, Lower BP) (7)

A
  1. Wrist and fingers extension
  2. Forearm supination
  3. Elbow flexion
  4. Shoulder depression
  5. Shoulder external rotation
  6. Shoulder abduction
  7. Contralateral cervical bending
35
Q

Content: Neural Testing and Mobilization for the Sciatic n. (tx sciatic, tibial, sural, peroneal n. entrapment/compression) (6)

A
  1. Straight-leg raise (SLR)
  2. Ankle dorsiflexion

Modifications:

  1. Ankle plantar flexion/eversion: Tibial nerve
  2. Ankle dorsiflexion/inversion: Sural nerve
  3. Ankle plantar flexion/inversion: C. Peronealnerve
  4. Adduction and IR increase tension
36
Q

Content: Principles of Treatment (5)

A
  1. Greater irritability > gentle the technique
  2. Stretch force is applied to the tissue resistance slower
  3. Neurological symptoms should not last when the stretch is released
  4. Positioning the patient at the point of tension, passively move one joint at the time to further stretch the tissue.
  5. Move the joint where the nerve is trapped at the end and carefully, respecting the symptoms

PTRS 745 Exam 2 (12 decks)

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