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UM - MSK > Peripheral Nerves > Flashcards

Peripheral Nerves Flashcards

1
Q

What are the 3 basic movements of nerves

A

Unfolding
Sliding
Elongation

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2
Q

What is unfolding

A

Straightening out of undulations

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3
Q

What is sliding

A

movement between the nerve and surrounding tissues at the mechanical interface

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4
Q

What is elongation

A

Tension is applied, movement occurs b/t neural elements and connective tissue layers

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5
Q

List the mechanisms of injury for peripheral nerve dysfunctions

A 
Compressions - most common
Ischemia
Crush Injury
Traction Injury/stinger
Severance
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6
Q

Seddon vs sunderland classification

A

seddon is 3 levels whereas sunderland takes the 3 levels and converts it into 5 based on histology

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7
Q

List the 3 grades of classification for seddon

A

Neuropraxia
Axonotmesis
Neurotmesis

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8
Q

What is neuropraxia

A

grade 1 of seddon: transient compression injury w/minimal structural changes

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9
Q

what is axonotmesis

A

grade 2 of seddon: axon damaged, but endoneurial tube is intact & prognosis depends on regeneration of axon

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10
Q

what is neurotmesis

A

grade 3 of seddon: entire nerve is injured

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11
Q

What is Grade 1 Sunderland

A

conduction block (like neuropraxia)

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12
Q

What is Grade 2 Sunderland

A

axonal injury (like axontomesis)

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13
Q

What is Grade 3 Sunderland

A

Axon and endoneurium injjury

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14
Q

What is Grade 4 Sunderland

A

axon, endoneurium and perineurium injury

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15
Q

What is Grade 5 Sunderland

A

complete disruption of all structures

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16
Q

What is wallerian degeneration

A

nerve fibers distal to the injury degenerate

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17
Q

What happens following peripheral nerve injury?

A

Wallerian Degeneration, myelin complex disrupted, schwann cells proliferate

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18
Q

What are filopodia

A

Fine growth cones that come appear in order to anchor to the basement membrane and enter the endoneurial tubes, growing 1-2mm/day

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19
Q

What is the pattern of recovery of a neuron

A

PROX TO DISTAL

  1. hypersensitivity
  2. perception for slow vibration
  3. perception of moving touch
  4. perception of constant touch
  5. perception of rapid vibration
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20
Q

What are the signs of a recovering nerve

A

voluntary mm contraction

hypersensitivity

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21
Q

What are potential complications to nerve healing

A
  • sprouts fail to make schwann cell contact
  • blocked by scar tissue
  • neuroma formation (cluster of nerve tissue from complications)
  • sprouts to wrong neural tube
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22
Q

How can PT help with nerve recovery

A

Patient education of how to protect it
Movements to protect adhesions and contractures
Protective devices

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23
Q

What is an entrapment

A

nerve doesn’t move by sliding due to adherence to other tissues and elongation causing symptoms of pain

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24
Q

What is thoracic outlet syndrome

A

Entrapment of the brachial plexus and vascular tissue (b/t anterior and middle scalenes, b/t 1st rib and clavicle, or b/t pectoralis minor and rib cage)

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25
Q

Suprascapular nerve entrapment

a) nerve roots
b) cutaneous distribution
c) injuries from

A

a) C5 & C6 (some C4)
b) proximal lateral 1/3 of arm
c) trauma (fxs, dislocations, penetrating) overuse, mass lesion, iatogenic cause

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26
Q

what is an iatrogenic cause

A

caused by a visit to a Dr

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27
Q

Where can the suprascapular nerve become entrapped

A

suprascapular notch
spinoglenoid notch
compression b/t spine of scap and infraspinatus and supraspinatus mms

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28
Q

what are the signs and symptoms for suprascapular nerve entrapment

A

Usually insidous onset
dull, aching pain in posterior shldr, increased w/OH activities
atrophy of infraspinatus and supraspinatus mm

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29
Q

What are the 3 possible median nerve entrapments

A

Pronator syndrome
anterior interosseous syndrome
carpal tunnel syndrome

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30
Q

What are the signs and symptoms of Pronator syndrome

A

pain, tenderness, cramping of prox. anterior forearm mm, sensory changes
pain w/resisted pronation, tenderness to palpation, weakness of FPL, FDP and PQ, weak pinch

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31
Q

What is the pronator compression test

A

P applied for > 30 sec at edge of PT
Resisted finger flexion, prox. PIP of 3rd digit
Indicates compression at level of FDS

32
Q

Why does compression occur w/pronator syndrome

A

The fascial impingement of the lacertus fibrosis

33
Q

T or F: AIN Syndrome does not have sensory deficits

A

TRUE! It is a motor impairment only

34
Q

What is the primary site of compression for AIN syndrome

A

Point of division from median nerve and near the tendinous insertion of the PT mm

35
Q

What are the s/s for AIN

A

deep forearm pain that does not resolve w/rest
+ pinch test (3-jaw pinch)
Weakness of FPL and half FDP
+ EMG

36
Q

PTS vs AIN

a) sensory changes
b) pronator compression test

A

a) Positive sensory changes PTS not AIN

b) positive pronator compression test for PTS not AIN

37
Q

What are some causes of Carpal Tunnel Syndrome (CTS)

A

Anything that alters space of carpal tunnel

Fx, overuse, swelling, RA, pregnancy, etc

38
Q

S/S of CTS

A

Tingling and numbness in the thumb, index, and middle fingers
aching in thumb, writs, and digits of the hand
burning pain at night
dec. sensation to temp and touch
atrophy of thenar mm
+ Phalens test (compress CT)
+ Tinel’s test (tapping)

39
Q

Treatments for CTS

A
  • Conservative: splints w/wrist in 0-20 deg /
  • avoid contributing activities
  • NSAIDs
  • Steroid injections
  • promote tendon gliding
  • Sx
40
Q

What is open carpal tunnel surgery

A

Cut open the flexor retinaculum to open space for bone to relieve nerve tension

41
Q

What is endoscopic carpal tunnel surgery

A

shorter recovery time with less of an incision for healing

42
Q

What are the 4 locations for ulnar nerve entrapments

A

Cubital tunnel: around the tunel or posterior to medial epicondyle
Flexor carpi ulnaris mm belly
guyon’s canal

43
Q

What is the hx for cubital tunnel syndrome

A

prolonged flexion of the elbow, common in throwing athletes, manual laboreres, and musicians

44
Q

What are the s/s of cubital tunnel syndrome

A 
Pain in prox. ulnar aspect of forearm
Tingling in 5th and 4th digit
Clumsiness of hand
Hyperesthesia or numbness
dull ache after activity or at rest
radiation of pain
atrophy
dec. sensation
sudomotor changes
45
Q

What are the provocation tests for Cubital tunnel syndrome

A

+ tinels at elbow
+ fromnets sign (unable to do key grip and abduct thumb)
+ elbow flexion test
+ NCS, + EMG

46
Q

What is ulnar nerve transposition

A

Sx to move the nerve from the groove to the anterior aspect, under the flexor/pronator mm mass (submuscular) or inside the mm (intramuscular)

47
Q

What are the s/s of guyon’s canal syndrome

A

decreased palmar sensation

intrinsic mm weakness, + EMG

48
Q

What are the two spots for compression of the radial nerve

A

Radial tunnel

Posterior interosseous nerve (comp of PIN at arcade of froshe as it enters the prox border of the supinator mm)

49
Q

PIN S/S

A 
Aching pain along extensor surface of forearm and hand
pain at elbow
NO SENSORY PROB
Pain w/deep palpation distal to lat.
Weakness of finger extensors
50
Q

What is Wartenberg’s syndrome

A

Superficial radial nerve entrapment caused by direct trauma to forearm, blow to hand, tight cast, or tight watchband or bracelet

51
Q

S/S of superficial radial nerve entrapment

A

local tenderness at wrist
pain in forearm
numbness and paresthesia of dorsum of hand
sensory loss to rad distribution of hand

52
Q

What is complex regional pain syndrome (CRPS)

A

Linked to fx or sprains of extremities w/pain and dysfunction out of proportion to injury

53
Q

What is Type III CRPS

A

Combo of Type I and Type II w/both sensory and motor deficits

54
Q

S/S Type I CRPS

A

Pain and swelling in extremity, stiffness and color changes
Edema, functional deficits
* Mostly sensory involvements

55
Q

S/S Type II CRPS

A

More regionally confined
Intermittent variable edema
T changes
* Motor dysfunction

56
Q

What are the 3 stages in CRPS

A

Warm (acute stage up to 6 mo w/increase in perfusion)
Cold (low skin temp w/low perfusion values)
Intermediate (high and low depending)

57
Q

What are the 4 diagnostic criteria for the international association for the study of pain for CRPS

A
  • sensory (hyperesthesia, hyperalgesia and allodynia)
  • vasomotor (T assym, skin color change/assym)
  • Sudomotor/edema (edema and or sweating changes/asymm)
  • Motor/trophic (motor dysfun/trophic changes)
58
Q

What is allodynia

A

Increase in pain from a stimulus that normally does not cause pain

59
Q

How many of the IASP criteria must you have to have CRPS

A

1 sign in >=2 categories and at least one symptom in 3 or 4 cat.

60
Q

What are the behaviour symptoms of CRPS

A

emotions
stress and anxiety
Temperature

61
Q

What are the sciatic nerve entrapments

A 
Deep gluteal syndrome
Piriformis syndrome (most common)
62
Q

What 3 specific conditions contribute to piriformis syndrome

A
  1. MF pain refered from trigger points in piriformis
  2. Nerve and vascular entrap by piriformis at greater sciatic foramen
  3. dysfunctions of the SI joint
63
Q

S/S of piriformis syndrome

A

Buttock pain radiating down post. aspect of thigh and calf
MF weakness on resisted abd
Paresthesias and dysthesia in nn distribution
Increase symptoms in FABER position
SI dysfuction
Loss of hip IR, stands in ER of legs

64
Q

What is meralgia paresthetica

A

Femoral nerve entrapment that is uncommon and pure sensory

65
Q

S/S of meralgia paresthetica (femoral nerve entrapment)

A 
Pain along course of nerve
Pain along anterolat. aspect of thigh
Hypersensitivity
Burning
tingling
relief w/rest
Inc. pain w/passive hip /, dec sensation, pain reproduced w/pressure on nerve
66
Q

What is the most common nerve entrapment syndrom ein the LE

A

Tarsal Tunnel syndrome (TTS)

67
Q

what is tarsal tunnel syndrome (TTS)

A

entrap of the posterior tibial nerve or one of its branches w/in the tarsal tunnel

68
Q

S/S of TTS

A

Burning dysesthesia or anesthesias in plantar/medial aspect of foot
WB increases symptoms
Rearfoot pronation w/excessive eversion of the heel during stance

69
Q

What is mortons neuroma S/S

A 
electrical shock or burning at ball of foot
Second toe and spreads out
Intermittent pain
increases w/WB and at night
Tender to palpate
Compress MT heads to reproduce symptoms
70
Q

What is intercostal neuralgia

A

Shingles caused by infection from Herpes zoster -> nerve compression by disk protrusion

71
Q

S/S of shingles

A 
headache, fever, malaise
burning pain following nerve path
unchanged by med or rest
numbness or itch at a particular place
rash or blisters following path of the nerve
72
Q

What is morton’s neuroma

A

Overgrowth of the nerve itself between the second and third toe on the foot

73
Q

What is complex regional pain syndrome (CRPS)

A

Pain and dysfunction out of proportion to an injury, typically linked to fractures or sprains of the extremities with sympathetic NS involvement

74
Q

What is CRPS Type I

A

Pain disproportionate to the initiating event with sensory involvement

75
Q

What is Type II CRPS

A

More nerve involvement than CRPS Type I –> causalgia; Mostly motor involvement

UM - MSK (9 decks)

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