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561 > Peripheral nerver injuries > Flashcards

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
Q

What are autonomic components that result from PNI

A

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

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26
Q

What are the 3 classes of nerve injuries

A

Class 1: neuropraxia
Class 2: axonotmesis
Class 3: neurotmesis

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27
Q

What are symptoms of neuropraxia

A

decreased strength
absence of deep tendon reflexes
hypo or hyperesthesia or sensation

28
Q

Characteristics of neuropraxia

A

Rapidly reversible

no anatomical changes to the nerve

29
Q

What is damaged in axonotmesis

A

nerve axon is damaged not myelin

30
Q

What is axonotmesis often a result of

A

crush injury (car accident, falls)

31
Q

What are symptoms of axonotmesis

A

motor or sensory loss

muscular atrophy, areflexia, possible trophic changes to skin and nails

32
Q

Where does wallerian degeneration occur in axonotmesis

A

distal to the lesion site (schwann cells remain intact so no problems w/ myelin)

33
Q

What is the rate of nerve regeneration

A

1mm/day

1in/mo

34
Q

What is neurotmesis

A

complete severance of nerve

35
Q

Where does wallerian degeneration occur in neurotmesis

A

distal to lesion and myelin affected

36
Q

What are symptoms of neurotmesis

A

complete motor and sensory loss

muscle atrophy, areflexia, possible trophic changes to skin and nails

37
Q

what is the cause of neurotmesis

A

severe trauma (farm injury, stab wounds)

38
Q

What is the prognosis for neurotmesis

A

regeneration may occur but prognosis for complete recovery is poor

39
Q

What is collateral sprouting

A

new axon terminals develop from the shaft of existing axons

40
Q

What is always required in neurotmesis

A

surgery

41
Q

what is a result from surgery in neurotmesis

A

neuromas from collateral sprouting

42
Q

When does nerve regeneration begin

A

2 weeks to 1 month after injury

43
Q

What is nerve regeneration dependent on

A

type of injury
age
single or multiple nerves

44
Q

What are signs of nerve regeneration

A 
sweating
temp discrimination
goosebumps
improved skin texture
nail growth
hyperasthesia
45
Q

What is a good predictor of nerve regeneration

A

wrinkle test

46
Q

What returns first in nerve regeneration

A

crude touch and pressure

47
Q

What can you use to determine nerve regrowth

A

monofilaments

48
Q

What does the peripheral nervous system include

A

structures lying outside of the brain and spinal cord

49
Q

What is the phalens test

A

fully flex wrist for 1 minute w/ dorsum of hands together.

test is positive if tingling in median nerve distribution in 1 min

50
Q

What is the reverse phalens

A

fully extend wrist for 1 min (prayer position)

positive if tingling in median nerve distribution w/in 1 min

51
Q

What is tinel’s

A

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
Q

What is the carpal compression test

A

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
Q

What is the elbow flexion test
When is it positive
what does it screen for

A

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
Q

How to test the ulnar nerve

A

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
Q

How to test the radial nerve

A

extend wrists and fingers

56
Q

how to test the median nerve

A

oppose thumb to fingers and flex the finger

57
Q

What would you see in a high level radial nerve injury

A

pronation of forearm, wrist flexion, an thumb in palmar abduction

58
Q

What would you see in a low level radial nerve injury

A

incomplete extension of the MP joints of fingers and thumb

59
Q

What would you see in a high level median nerve injury

A

ulnar deviation, pronation absent, loss of palmar abduction, opposition of thumb

60
Q

What would you see in a low level media nerve injury

A

loss of thumb flexion, palmar abduction, and opposition

61
Q

What would you see in sensory loss in both low and high level median nerve injuries

A

loss to volar aspects of thumb, index, middle finger, and radial side of ring finger

62
Q

What would you see in a high level ulnar nerve injury

A

hyperextension of MP joints of ring and little finger (claw hand)

63
Q

What would you see in low level ulnar nerve injury

A

trophy of 1st dorsal interossei

64
Q

What would OT do for treatment for PNI’s

A

ROM to prevent contracture
Splinting
Alternate ways of doing things

65
Q

What does OT for neuropathy emphasize

A

Protecting yourself while performing everyday tasks

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