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Peripheral nerver injuries Flashcards

1
Q

What is neuropathy

A

Damage to a peripheral nerve

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2
Q

What is the pattern of damage in peripheral nerve injury

A

follows pattern of nerve distribution

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3
Q

what is the pattern of damage in the central nervous system

A

produces loss in dermatomes and myotomes

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4
Q

What are dermatomes

A

area of skin nerve innervates

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5
Q

what are myotomes

A

area of muscle innervated by nerves

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6
Q

What are the 4 categories of PNI’s

A

Polyneuropathy
Mononeuropathy
Multiple mononeuropathy
Radiculopathy

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7
Q

what is polyneuropathy

A

Bilateral symmetrical damage to peripheral nerves

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8
Q

What areas are affected 1st in polyneuopathy

A

distal segments then proximal segment (stocking and glove)

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9
Q

What is more involved in polyneuropathy

A

lower extremities

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10
Q

What is the most common form of polyneuropathy

A

Diabetes mellitus

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11
Q

What is mononeuropathy

A

damage to a single nerve

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12
Q

what is a common cause of mononeuropathy

A

trauma

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13
Q

What is an example of mononeuropathy

A

radial nerve injury that results in wrist drop

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14
Q

what is multiple mononeuropathy

A

damage of multiple single peripheral nerves

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15
Q

what is the pattern of multiple Mononeuropathy

A

asymmetrical

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16
Q

what is an example of multiple mononeuropathy

A

diabetes mellitus

polyarteritis

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17
Q

What kind of issue do you see in those with neuropathy

A

blood supply issues

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18
Q

What is radiculopathy

A

spinal nerve root damage to dorsal or ventral roots

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19
Q

What causes radiculopathy

A

compressed nerves in the spine cause pain, numbness, tingling, or weakness

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20
Q

What is an example of Radiculopathy

A

herniated disc

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21
Q

What are consequences of a PNI

A

Motor paresis or paralysis
muscle atrophy
abnormal sensation
autonomic components

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22
Q

What is hyperalgesia

A

increased sensitivity to pain

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23
Q

what is dysesthesia

A

light touch is perceived as painful or unpleasant

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24
Q

what is paresthesia

A

sensation of numbness or tingling of the skin

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25
What are autonomic components that result from PNI
Alterations in sweating finger changes-clubbed fingers vascular control diminished- changes in BP or HR skin changes- smooth, shiny Nail changes- brittle bowel/bladder dysfunction hair over denervated skin will thin/fall out
26
What are the 3 classes of nerve injuries
Class 1: neuropraxia Class 2: axonotmesis Class 3: neurotmesis
27
What are symptoms of neuropraxia
decreased strength absence of deep tendon reflexes hypo or hyperesthesia or sensation
28
Characteristics of neuropraxia
Rapidly reversible | no anatomical changes to the nerve
29
What is damaged in axonotmesis
nerve axon is damaged not myelin
30
What is axonotmesis often a result of
crush injury (car accident, falls)
31
What are symptoms of axonotmesis
motor or sensory loss | muscular atrophy, areflexia, possible trophic changes to skin and nails
32
Where does wallerian degeneration occur in axonotmesis
distal to the lesion site (schwann cells remain intact so no problems w/ myelin)
33
What is the rate of nerve regeneration
1mm/day | 1in/mo
34
What is neurotmesis
complete severance of nerve
35
Where does wallerian degeneration occur in neurotmesis
distal to lesion and myelin affected
36
What are symptoms of neurotmesis
complete motor and sensory loss | muscle atrophy, areflexia, possible trophic changes to skin and nails
37
what is the cause of neurotmesis
severe trauma (farm injury, stab wounds)
38
What is the prognosis for neurotmesis
regeneration may occur but prognosis for complete recovery is poor
39
What is collateral sprouting
new axon terminals develop from the shaft of existing axons
40
What is always required in neurotmesis
surgery
41
what is a result from surgery in neurotmesis
neuromas from collateral sprouting
42
When does nerve regeneration begin
2 weeks to 1 month after injury
43
What is nerve regeneration dependent on
type of injury age single or multiple nerves
44
What are signs of nerve regeneration
``` sweating temp discrimination goosebumps improved skin texture nail growth hyperasthesia ```
45
What is a good predictor of nerve regeneration
wrinkle test
46
What returns first in nerve regeneration
crude touch and pressure
47
What can you use to determine nerve regrowth
monofilaments
48
What does the peripheral nervous system include
structures lying outside of the brain and spinal cord
49
What is the phalens test
fully flex wrist for 1 minute w/ dorsum of hands together. | test is positive if tingling in median nerve distribution in 1 min
50
What is the reverse phalens
fully extend wrist for 1 min (prayer position) | positive if tingling in median nerve distribution w/in 1 min
51
What is tinel's
percussion over the median nerve at the wrist from distal to proximal. point at which tingling starts indicated approximate location of nerve compression (also used for regeneration)
52
What is the carpal compression test
pressure over the medan nerve for 30 sec positive if tingling occurs in the median nerve distribution (when used with phalans, is a good indicator of nerve damage)
53
What is the elbow flexion test When is it positive what does it screen for
client full flexes elbows w/ the wrists fully extended for 3-5 min test is positive if tingling occurs in the ulnar nerve distribution of forearm screens for cubital tunnel syndrom
54
How to test the ulnar nerve
have client pinch w/ the thumb and index finger while palpating 1st dorsal interossei hold piece of paper between thumb and index finger-when pulled away, tip of thumb flexes= positive froments sign
55
How to test the radial nerve
extend wrists and fingers
56
how to test the median nerve
oppose thumb to fingers and flex the finger
57
What would you see in a high level radial nerve injury
pronation of forearm, wrist flexion, an thumb in palmar abduction
58
What would you see in a low level radial nerve injury
incomplete extension of the MP joints of fingers and thumb
59
What would you see in a high level median nerve injury
ulnar deviation, pronation absent, loss of palmar abduction, opposition of thumb
60
What would you see in a low level media nerve injury
loss of thumb flexion, palmar abduction, and opposition
61
What would you see in sensory loss in both low and high level median nerve injuries
loss to volar aspects of thumb, index, middle finger, and radial side of ring finger
62
What would you see in a high level ulnar nerve injury
hyperextension of MP joints of ring and little finger (claw hand)
63
What would you see in low level ulnar nerve injury
trophy of 1st dorsal interossei
64
What would OT do for treatment for PNI's
ROM to prevent contracture Splinting Alternate ways of doing things
65
What does OT for neuropathy emphasize
Protecting yourself while performing everyday tasks

561 (11 decks)

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