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Nerves > Peripheral Nerve Problems > Flashcards

Peripheral Nerve Problems Flashcards

1
Q

Seddon’s Classification - PN (3)

A
  1. neuropraxia
  2. axonotmesis
  3. neurotmesis
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2
Q

Neuropraxia

A

injury - mild recovery

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3
Q

Axonotmesis

A

injury - severe regeneration

1mm/day recovery

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4
Q

Neurotmesis

A

injury degeneration

neuroma formation

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5
Q

Sunderland’s Classification PN - Degree 1

A

structures remain intact local conduction block and dymyelination

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6
Q

Sunderland’s Classification PN - Degree 2

A

axonal disruption with distal (Wallerian) degeneration

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7
Q

Sunderland’s Classification PN - Degree 3

A

disruption of axons and endoneurial tubes fascicles remain intact

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8
Q

Sunderland’s Classification PN - Degree 4

A

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

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9
Q

Sunderland’s Classification PN - Degree 5

A

complete nerve transection

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10
Q

Radial Nerve Palsy

A

most commonly injured peripheral nerve fx of humerus

(1:10 have radial nerve complications)

elbow dislocation Monteggia fx-dislocation

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11
Q

High Radial Nerve (4)

A
  1. triceps
  2. anconeus
  3. brachioradialis
  4. ECRL
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12
Q

Low Radial Nerve (9)

A
  1. ECRB
  2. supinator
  3. EDC
  4. EDM
  5. ECU
  6. APL
  7. EPL
  8. EPB
  9. EIP
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13
Q

High Median Nerve (7)

A
  1. PT
  2. FCR
  3. PL
  4. FDS
  5. FDP (index and long)
  6. FPL
  7. PQ
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14
Q

Low Median Nerve (4)

A
  1. OP
  2. FPB (superficial head)
  3. APB
  4. Lumbricals (index and long)
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15
Q

High Ulnar Nerve (2)

A
  1. FCU
  2. FDP (ring and small)
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16
Q

Low Ulnar Nerve (8)

A
  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
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17
Q

ape hand deformity

A

median nerve injury

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18
Q

claw hand deformity

A

ulnar nerve injury

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19
Q

wrist drop deformity

A

radial nerve injury

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20
Q

anterior interosseous syndrome

A

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

21
Q

Froment’s sign

A

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

22
Q

Wartenberg’s sign

A

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

23
Q

elbow flexion test

A

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

24
Q

Wallerian degeneration

A

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

25
Q

atrophy due to PN injury

A

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

26
Q

primary nerve repair

A

occurs within the first week of injury

27
Q

delayed or secondary nerve repair

A

performed a week or more after injury

28
Q

nerve graft

A

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

29
Q

neurolysis

A

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

30
Q

nerve decompression

A

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

31
Q

orthoses: high radial nerve injuries

A

wrist immobilizations low profile mobilization tenodesis mobilization

32
Q

low radial nerve injury (PIN)

A

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

33
Q

low radial nerve injury (radial tunnel syndrome)

A

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

34
Q

low radial nerve injury (superficial sensory branch)

A

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

35
Q

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

A

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

36
Q

postop management: radial nerve decompression

A

dynamic wrist and MP extension orthosis for function

37
Q

high median nerve palsy (pronator syndrome)

A

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

38
Q

provocative tests for pronator syndrome

A

resistive elbow flexion or isolated resistive to the long finger FDS

39
Q

orthoses: anterior interosseous syndrome

A

figure 8 splints

40
Q

low median nerve palsy (carpal tunnel syndrome)

A

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

41
Q

postop management: high median nerve injuries

A

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

42
Q

postop management: median nerve laceration at wrist

A

usually tendon involvement at well so patient education is important

43
Q

postop management: decompression of high median nerve injuries

A

rarely done try conservative measures first

44
Q

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

A

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

45
Q

high ulnar nerve compression (cubital tunnel syndrome)

A

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

46
Q

low ulnar nerve injuries

A

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

47
Q

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

A

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

48
Q

postop management: high ulnar nerve decompression

A

cubital tunnel release transposition: subQ or submuscular long arm orthosis

49
Q

postop management: low ulnar nerve decompression

A

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

Nerves (17 decks)

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