Peripheral nerve injury Flashcards
What are the 3 types of nerve injuries?
- neuropraxia
- axonotmesis
- neurotmesis
______ = segmental demyelination, transient disruption, fast recovery with good prognosis
neuropraxia
______ = loss of axon continuity, prolonged disruption, longer recovery with fair prognosis
axonotmesis
______ = completely severed, recovery only possible with surgery with variable prognosis
neurotmesis
What are 4 ways to injure a nerve?
- compression
- traction
- avulsion
- laceration
What are 4 S & S of a peripheral nerve injury?
- altered/absent sensatin in nerve distribution
- decreased strength in muscles innervated by that nerve
- diminished reflex
- sympathetic changes
Scapular ______ in common in long thoracic n. injury
winging
Long thoracic nerve roots?
C5-7
Median nerve roots?
C5-T1
Where are common places for median n to get impinged?
- between pronator heads
2. carpal tunnel
S & S of median nerve palsy?
loss of dexterity in thumb and thenar wasting
Where are common sites for ulnar n to get impinged?
- cubital tunnel
- tunnel of guyon
- FCU
S & S of ulnar n palsy?
lose adduction strength in thumb; add and abd control of fingers; pt may complain of feeling clumsy
Radial n roots?
C5-T1
Axillary n roots?
C5-6
Where can radial n get impinged?
with crutches, radial head #, humeral head #, and beneath supinator
S & S of radial n palsy?
loss of use of triceps, wrist extensors and weaker supination
How can axillary n get injured?
humeral head #
Test for axillay n health?
test abduction, ER
Nerve roots of lateral cutaneous n ?
L2-3
Is lateral cutaneous n sensory, motor or both?
sensory
Sensory distribution of lateral cutaneous n ?
lateral thigh
What is impingement of the lateral cutaneous nerve called?
meralgia paresthetica
What are 3 causes of meralgia paresthetica?
- obesity
- pregnancy
- tight pants
Obturator n roots?
L2-4
Motor innervations of obturator n?
innervates medial compartment of thigh (obturator)
Sensory innervations of obturator n?
cutaneous branch innervates skin of the medial thigh
Femoral n roots?
L2-4
Motor innervations of femoral n?
anterior thigh muscles that flex hip joint (pectineus, iliac, sartorius) and extend knee (quads)
Sensory innervations of femoral n?
Supplies cutaneous branches to the anteromedial thigh (anterior cutaneous branches of the femoral n) and the medial side of the leg and foot (saphenous n)
Sciatic n roots?
L4-S3
Motor innervations of sciatic n ?
muscles of the post thigh and the hamstring portion of the adductor magnus. indirectly innervates the muscles of leg and foot
Sensory innervations of sciatic n?
no directly sensory functions, indirectly innervates (via terminal branches) the skin of lateral leg, heel, and both the dorsal and plantar surfaces of the foot
____ n = damaged in injuries to tarsal tunnel
tibial
Injury to nerve root = _______
radiculopathy
Injury to periperhal nerve = _______ _________
peripheral neuropathy
Damage to _____ ____ = fatiguable weakness
nerve root
Damage to _______ ____ = muscle will test weak from the beginning
peripheral nerve
Suprascapular n roots?
C5-6
What 3 management strategies must occur in the recovery phase of nerve injuries ?
- motor retraining
- desensitization
- discriminative sensory re-education
What two management strategies occur in the chronic phase of nerve injuries?
- compensatory function
2. preventive care
______ = group of disorders that involve compression of 1+ neuromuscular elements as they traverse the thoracic outlet
TOS
What are the 5 possible types of TOS?
- arterial
- venous
- traumatic neuromuscular
- true neurogenic
- symptomatic
What are 3 key impingement areas in TOS?
- scalene triangle
- costoclavicular space
- axillary interval
What are the 2 possible causes of TOS?
- congenital abnormalities
2. trauma
Arterial TOS is caused by compression of the ________ artery
subclavian
Most common cause of arterial TOS?
cervical rib
Pathology of venous TOS = venous thrombosis involving _____-______ veins
sub-axillary
_____ ______ TOS = lower plexus is stretched and angulated by presence of fibrous band from 1st rib to a cervical rib or a large transverse process on C7
true neurological
What nerve roots will be effected in true neurological TOS?
C8 & T1
______ ______ TOS = rare and usually following a clavicular #
traumatic neuromuscular
______ TOS = more common in females, frequently bilateral
symptomatic
Symptomatic TOS = likely compression or traction injury of _______ ______ within the thoracic outlet
brachial plexus
Injury to the brachial plexus, seen in symptomatic TOS, results in what 3 things?
- scalene muscle fibrosis
- scar tissue
- muscle imbalance
Lower plexus type symptomatic TOS clinical features?
pain in neck or supraclavicular region and radiates along medial arm, forearm and hand
Upper plexus type symptomatic TOS clinical features?
pain in shoulder region and radiates into ipsilateral head and neck, upper thorax and proximal arm
What are 6 special tests for TOS?
- allen’s
- adson’s
- ROOS test or elevated arm stress test
- hyperabduction test
- costoclaivculr maneuver
- supraclavicular pressure
Pulse alteration of paresthesias are ________ when interpreting TOS tests
unreliable
Low false-positive rates when a positive outcome is followed by _____ after the test
pain
How long does the ROOS test last for?
3 mins
When there is decreased strength in shoulder girdle muscles on symptomatic side, especially upper and middle traps, substitution or increased recruitment of ____, _____ _____ and ____ ______ also occurs; leading to what 3 positions of the scapula?
rhomboids, levator scap, pec minor; downward rotation; depression; anterior tilt
What are 6 steps in the conservative treatment of symptomatic TOS?
- decrease compression
- increase extensibility of tight tissue
- mobilize restricted joints
- strengthen weak muscles
- postural re-education
- re-educate breathing patterns
