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NPTE Neuromuscular and Nervous System > Peripheral Nerve Lesions, Muscle Tone, UMN and LMN injuries > Flashcards

Peripheral Nerve Lesions, Muscle Tone, UMN and LMN injuries Flashcards

1
Q

What is double crush syndrome?

A

Existence of two separate lesions along the same nerve that create more severe symptoms than if only one existed

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2
Q

What is a mononeuropathy?

A

An isolated nerve lesion, often associated with trauma and entrapment

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3
Q

What is a neuroma?

A

Abnormal growth of nerve cells

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4
Q

What is a polyneuropathy? What conditions are associated with this dysfunction?

A

Diffuse nerve dysfunction that is symmetrical and typically secondary to pathology and not trauma

Associated conditions include GBS, peripheral neuropathy, use of neurotoxic drugs and HIV

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5
Q

What is Wallerian degeneration?

A

Degeneration that occurs distally, specifically to the myelin sheath and axon

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6
Q

List 3 classifications of acute nerve injuries in order of severity (least to most).

A

Neurapraxia
Axonotmesis
Neurotmesis

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7
Q

Describe neuropraxia. What is the most common example of neurapraxia?

A

Injury to nerve that causes a transient block of function (conduction block ischemia)

Never dysfunction may be rapidly reversed or persist a few weeks

Pressure injuries are the most common

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8
Q

Describe axonotmesis. What is the most common examples of axonotmesis?

A

Injury to nerve interrupting the axon and causing loss of function and Wallerian degeneration distal to the lesion

With no disruption to the endoneurium, regeneration is possible

Traction, compression and crush injuries are most common

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9
Q

Describe neurotmesis. What is the most common example of neurotmesis?

A

Cutting of the nerve with severance of all structures, complete loss of nerve function, and Wallerian degeneration

Surgical intervention needed for regeneration to occur

Complete transection of the nerve trunk leads to neurotmesis

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10
Q

What is an UMN disease?

A

Characterized by a lesion found in descending motor tracts within the cerebral motor cortex, internal capsule, brainstem or spinal cord

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11
Q

List 5 symptoms associated with UMN disease/injury.

A
  1. Weakness of involved muscles
  2. Hypertonicity
  3. Hyperreflexia
  4. Mild disuse atrophy
  5. Abnormal reflexes
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12
Q

List 6 examples of UMN lesions.

A 
Cerebral palsy 
Hydrocephalus
TBI
ALS
Huntington's chorea
Multiple sclerosis
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13
Q

What is a LMN disease?

A

Characterized by a lesion that affects nerves or their axons at or below the level of the brainstem

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14
Q

List 5 symptoms associated with LMN disease/injury.

A
  1. Flaccidity or weakness of involved muscles
  2. Decreased tone
  3. Fasciculations
  4. Muscle atrophy
  5. Decreased or absent reflexes
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15
Q

List 7 examples of LMN lesions.

A 
Poliomyelitis 
ALS
GBS
Muscular dystrophy 
Spinal muscular atrophy 
Bell's palsy
Carpal tunnel syndrome
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16
Q

What condition is considered to be an example of an UMN and LMN lesions?

A

ALS

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17
Q

Compare and contrast reflexes in UMN vs LMN lesions.

A 
UMN = hyperactive 
LMN = Diminished or absent
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18
Q

Compare and contrast atrophy in UMN vs LMN lesions.

A 
UMN = mild from disuse
LMN = present
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19
Q

Compare and contrast fasciculations in UMN vs LMN lesions.

A 
UMN = absent 
LMN= present
20
Q

Compare and contrast tone in UMN vs LMN lesions.

A 
UMN = hypertonic 
LMN= hypotonic to flaccid
21
Q

What is a clasp knife response?

A

Marked resistance to PROM suddenly gives way

22
Q

What is clonus?

A

Characteristic of an UMN lesion; involuntary alternating spasmodic contraction of a muscle precipitated by a quick stretch reflex

23
Q

What is spasticity?

A

Velocity dependent increased resistance to PROM

24
Q

What tool is used to determine the different grades of spasticity?

A

Modified Ashworth Scale

25
Q

Describe the different spasticity grades on the Modified Ashworth Scale.

A

0: No increase in muscle tone
1: Slight increase in muscle tone, minimal resistance at end of ROM
1+: Slight increase in muscle tone, minimal resistance through less than half of ROM
2: More marked increase in muscle tone, through most of ROM, affected part easily moved
3: Considerable increase in muscle tone, passive movement difficult
4: Affected part rigid into flexion or extension

26
Q

What is rigidity?

A

Increased resistance to PROM that is independent of the velocity of movement

27
Q

Describe the 2 different types of rigidity.

A

Lead pipe = rigidity that is uniform throughout the range (associated with basal ganglia lesions)

Cogwheel = rigidity that is interrupted by a series of jerks (associated with Parkinson’s disease)

28
Q

What is decerebrate rigidity?

A

A characteristic of a corticospinal lesion at the level of the brainstem that results in extension of the trunk and all extremities.

29
Q

What is decorticate rigidity?

A

A characteristic of a corticospinal lesion at the level of diencephalon where the trunk and LEs are positioned in extension and the UEs are positioned in flexion

30
Q

What is opisthotonos?

A

Prolonged, severe spasm of muscles, causing the head, back, an heels to arch backward; arms and hands are held rigidly flexed

31
Q

What 4 conditions is opisthotnos seen in?

A

Meningitis
Tetanus
Epilepsy
Strychnine poisoning

32
Q

What is athetosis?

A

Movement disorder that presents with slow, twisting and writhing movements that are large in amplitude.

Primarily seen in the face, tongue and extremities
Commonly seen in those with cerebral palsy

33
Q

What is Chorea?

A

A form of hyperkinesia that presents with brief, irregular, contractions that are rapid.

34
Q

Chorea occurs secondary to damage to the _____.

A

Caudate nucleus

35
Q

What is ballism?

A

A form of chorea that includes choreic jerks of large amplitude producing flailing movements of the limbs

36
Q

Ballism occurs secondary to damage to the _______.

A

Subthalamic nucleus

37
Q

What is dystonia?

A

A syndrome of sustained muscle twitching, abnormal postures and repetitive movements.

Often increased with volitional movement, and with progression, can produce overflow

38
Q

List 3 conditions associated with dystonia.

A

Parkinson’s disease
Cerebral palsy
Encephalitis

39
Q

What are tics?

A

Sudden, brief, repetitive, coordinated movements that will usually occur at irregular intervals.

40
Q

What are tremors? Describe 3 different types of tremors.

A

Involuntary, rhythmic, oscillatory movements that are classified into three groupings:

  1. Resting = tremors are observable at rest and may or may not disappear with movement; may increase with mental stress.
  2. Postural = tremors are observable during a voluntary contraction to maintain a posture
  3. Intention (kinetic) = tremors are absent at rest, but observable with activity and typically increase as the target approaches
41
Q

What is akinesia?

A

Inability to initiate movement

42
Q

What is asthenia?

A

Generalized weakness typically secondary to cerebellar pathology

43
Q

What is ataxia?

A

Inability to perform coordinated movements

44
Q

What is bradykinesia?

A

Movement that is very slow

45
Q

What is dysmetria?

A

Inability to control the range of a movement and force of muscular activity

NPTE Neuromuscular and Nervous System (26 decks)

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