Peripheral Nerve Problems

Question 1

Seddon’s Classification - PN (3)

Answer 1

1. neuropraxia
2. axonotmesis
3. neurotmesis

Question 2

Neuropraxia

Answer 2

injury - mild recovery

Question 3

Axonotmesis

Answer 3

injury - severe regeneration

1mm/day recovery

Question 4

Neurotmesis

Answer 4

injury degeneration

neuroma formation

Question 5

Sunderland’s Classification PN - Degree 1

Answer 5

structures remain intact local conduction block and dymyelination

Question 6

Sunderland’s Classification PN - Degree 2

Answer 6

axonal disruption with distal (Wallerian) degeneration

Question 7

Sunderland’s Classification PN - Degree 3

Answer 7

disruption of axons and endoneurial tubes fascicles remain intact

Question 8

Sunderland’s Classification PN - Degree 4

Answer 8

disruption of axons, endoneurial tubes only epineurium intact loss of fascicular integrity

Question 9

Sunderland’s Classification PN - Degree 5

Answer 9

complete nerve transection

Question 10

Radial Nerve Palsy

Answer 10

most commonly injured peripheral nerve fx of humerus

(1:10 have radial nerve complications)

elbow dislocation Monteggia fx-dislocation

Question 11

High Radial Nerve (4)

Answer 11

1. triceps
2. anconeus
3. brachioradialis
4. ECRL

Question 12

Low Radial Nerve (9)

Answer 12

1. ECRB
2. supinator
3. EDC
4. EDM
5. ECU
6. APL
7. EPL
8. EPB
9. EIP

Question 13

High Median Nerve (7)

Answer 13

1. PT
2. FCR
3. PL
4. FDS
5. FDP (index and long)
6. FPL
7. PQ

Question 14

Low Median Nerve (4)

Answer 14

1. OP
2. FPB (superficial head)
3. APB
4. Lumbricals (index and long)

Question 15

High Ulnar Nerve (2)

Answer 15

1. FCU
2. FDP (ring and small)

Question 16

Low Ulnar Nerve (8)

Answer 16

1. ADM
2. ODM
3. FDM
4. Lumbricals (4 and 3)
5. 3 palmar interossei
6. 4 dorsal interossei
7. FPB (deep head)
8. Add Pol

Question 17

ape hand deformity

Answer 17

median nerve injury

Question 18

claw hand deformity

Answer 18

ulnar nerve injury

Question 19

wrist drop deformity

Answer 19

radial nerve injury

Question 20

anterior interosseous syndrome

Answer 20

entrapment of motor branch of median nerve unable to make “ok” sign

Question 21

Froment’s sign

Answer 21

flexion of the IP with lateral pinch FPL attempts to compensate for paralyzed or weak adductor pollicis and FPB ulnar nerve

Question 22

Wartenberg’s sign

Answer 22

unable to adduct the 5th finger due to weak interosseous muscle ulnar nerve

Question 23

elbow flexion test

Answer 23

provocative test for ulnar nerve compression elbow flexed and wrist in neutral for up to 5 minutes

Question 24

Wallerian degeneration

Answer 24

breakdown of the axon distal to the site of injury occurs 48-96 hours after injury

Question 25

atrophy due to PN injury

Answer 25

30% weight loss of tissue in first month 50-60% by two months 60-80% by four months

Question 26

primary nerve repair

Answer 26

occurs within the first week of injury

Question 27

delayed or secondary nerve repair

Answer 27

performed a week or more after injury

Question 28

nerve graft

Answer 28

down when repair cannot be done with undue tension of the nerve's cut ends

Question 29

neurolysis

Answer 29

surgical dissection and exploration of a damaged nerve to release from restrictions or adhesions

Question 30

nerve decompression

Answer 30

involves cutting tissue that constrict the nerve or physically moving the nerve

Question 31

orthoses: high radial nerve injuries

Answer 31

wrist immobilizations low profile mobilization tenodesis mobilization

Question 32

low radial nerve injury (PIN)

Answer 32

nerve divides in forearm into a superficial sensory branch and a motor branch (PIN) \*paralysis or paresis of ulnar wrist extension, digit extension, thumb extension, and radial ABduction \*may have dorsal wrist pain

Question 33

low radial nerve injury (radial tunnel syndrome)

Answer 33

compression in proximal forearm \*dull aching and burning in lateral forearm \* - EMG result \*orthosis: long arm, elbow flexion, wrist extension, forearm supination

Question 34

low radial nerve injury (superficial sensory branch)

Answer 34

compressions can occur with pronation from the BR and ECRL and at the distal forearm due to lack of excursion of the nerve during repetitive wrist flexion and ulnar deviation \*spontaneous recovery common

Question 35

postop management: radial nerve laceration repair (above elbow/below axilla)

Answer 35

static orthosis elbow 90 deg flexion forearm neutral wrist extension MP 10-20 deg flexion \*4 weeks: elbow to 60 deg \*5 weeks: elbow to 30 deg \*6 weeks: discontinue

Question 36

postop management: radial nerve decompression

Answer 36

dynamic wrist and MP extension orthosis for function

Question 37

high median nerve palsy (pronator syndrome)

Answer 37

compression of the nerve between the 2 heads of pronator teres muscle or under the proximal edge of the FDS arch

Question 38

provocative tests for pronator syndrome

Answer 38

resistive elbow flexion or isolated resistive to the long finger FDS

Question 39

orthoses: anterior interosseous syndrome

Answer 39

figure 8 splints

Question 40

low median nerve palsy (carpal tunnel syndrome)

Answer 40

most common nerve entrapment in the UE \*paresthesia in the thumb, index, middle, and radial half of ring finger \*pregnancy induced CTS \*orthoses: wrist neutral

Question 41

postop management: high median nerve injuries

Answer 41

orthosis blocking with the wrist in 30 deg flexion for 4-6 weeks \*4 weeks: wrist to 20 deg \*5 weeks: wrist to 0-10 deg \*6 weeks: discontinue

Question 42

postop management: median nerve laceration at wrist

Answer 42

usually tendon involvement at well so patient education is important

Question 43

postop management: decompression of high median nerve injuries

Answer 43

rarely done try conservative measures first

Question 44

postop management: decompression of low median nerve injuries (CTR)

Answer 44

carpal tunnel release transection of the transverse carpal ligament many don't need postop therapy may do wrist orthosis for positioning

Question 45

high ulnar nerve compression (cubital tunnel syndrome)

Answer 45

night orthosis elbow 30-70 deg forearm and wrist neutral digits free \*may need anti-clawing orthosis

Question 46

low ulnar nerve injuries

Answer 46

compression at guyon's canal due to tumor, lipoma, or ganglion fracture of the hook of the hamate anti-claw orthosis

Question 47

postop management: ulnar nerve laceration repair (elbow to wrist level)

Answer 47

dorsal blocking orthosis wrist 20-30 deg flexion MP 45 deg extension \*increase wrist extension at 3 and 5 weeks \*6 weeks: discontinue

Question 48

postop management: high ulnar nerve decompression

Answer 48

cubital tunnel release transposition: subQ or submuscular long arm orthosis

Question 49

postop management: low ulnar nerve decompression

Answer 49

recommend due to high incident of space occupying lesions bulky dressings used full ROM usually allowed