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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
Suprascapular nerve entrapment a) nerve roots b) cutaneous distribution c) injuries from
a) C5 & C6 (some C4) b) proximal lateral 1/3 of arm c) trauma (fxs, dislocations, penetrating) overuse, mass lesion, iatogenic cause
26
what is an iatrogenic cause
caused by a visit to a Dr
27
Where can the suprascapular nerve become entrapped
suprascapular notch spinoglenoid notch compression b/t spine of scap and infraspinatus and supraspinatus mms
28
what are the signs and symptoms for suprascapular nerve entrapment
Usually insidous onset dull, aching pain in posterior shldr, increased w/OH activities atrophy of infraspinatus and supraspinatus mm
29
What are the 3 possible median nerve entrapments
Pronator syndrome anterior interosseous syndrome carpal tunnel syndrome
30
What are the signs and symptoms of Pronator syndrome
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
31
What is the pronator compression test
P applied for > 30 sec at edge of PT Resisted finger flexion, prox. PIP of 3rd digit Indicates compression at level of FDS
32
Why does compression occur w/pronator syndrome
The fascial impingement of the lacertus fibrosis
33
T or F: AIN Syndrome does not have sensory deficits
TRUE! It is a motor impairment only
34
What is the primary site of compression for AIN syndrome
Point of division from median nerve and near the tendinous insertion of the PT mm
35
What are the s/s for AIN
deep forearm pain that does not resolve w/rest + pinch test (3-jaw pinch) Weakness of FPL and half FDP + EMG
36
PTS vs AIN a) sensory changes b) pronator compression test
a) Positive sensory changes PTS not AIN | b) positive pronator compression test for PTS not AIN
37
What are some causes of Carpal Tunnel Syndrome (CTS)
Anything that alters space of carpal tunnel | Fx, overuse, swelling, RA, pregnancy, etc
38
S/S of CTS
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
Treatments for CTS
- Conservative: splints w/wrist in 0-20 deg / - avoid contributing activities - NSAIDs - Steroid injections - promote tendon gliding - Sx
40
What is open carpal tunnel surgery
Cut open the flexor retinaculum to open space for bone to relieve nerve tension
41
What is endoscopic carpal tunnel surgery
shorter recovery time with less of an incision for healing
42
What are the 4 locations for ulnar nerve entrapments
Cubital tunnel: around the tunel or posterior to medial epicondyle Flexor carpi ulnaris mm belly guyon's canal
43
What is the hx for cubital tunnel syndrome
prolonged flexion of the elbow, common in throwing athletes, manual laboreres, and musicians
44
What are the s/s of cubital tunnel syndrome
``` 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
What are the provocation tests for Cubital tunnel syndrome
+ tinels at elbow + fromnets sign (unable to do key grip and abduct thumb) + elbow flexion test + NCS, + EMG
46
What is ulnar nerve transposition
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
What are the s/s of guyon's canal syndrome
decreased palmar sensation | intrinsic mm weakness, + EMG
48
What are the two spots for compression of the radial nerve
Radial tunnel | Posterior interosseous nerve (comp of PIN at arcade of froshe as it enters the prox border of the supinator mm)
49
PIN S/S
``` 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
What is Wartenberg's syndrome
Superficial radial nerve entrapment caused by direct trauma to forearm, blow to hand, tight cast, or tight watchband or bracelet
51
S/S of superficial radial nerve entrapment
local tenderness at wrist pain in forearm numbness and paresthesia of dorsum of hand sensory loss to rad distribution of hand
52
What is complex regional pain syndrome (CRPS)
Linked to fx or sprains of extremities w/pain and dysfunction out of proportion to injury
53
What is Type III CRPS
Combo of Type I and Type II w/both sensory and motor deficits
54
S/S Type I CRPS
Pain and swelling in extremity, stiffness and color changes Edema, functional deficits * Mostly sensory involvements
55
S/S Type II CRPS
More regionally confined Intermittent variable edema T changes * Motor dysfunction
56
What are the 3 stages in CRPS
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
What are the 4 diagnostic criteria for the international association for the study of pain for CRPS
- 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
What is allodynia
Increase in pain from a stimulus that normally does not cause pain
59
How many of the IASP criteria must you have to have CRPS
1 sign in >=2 categories and at least one symptom in 3 or 4 cat.
60
What are the behaviour symptoms of CRPS
emotions stress and anxiety Temperature
61
What are the sciatic nerve entrapments
``` Deep gluteal syndrome Piriformis syndrome (most common) ```
62
What 3 specific conditions contribute to piriformis syndrome
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
S/S of piriformis syndrome
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
What is meralgia paresthetica
Femoral nerve entrapment that is uncommon and pure sensory
65
S/S of meralgia paresthetica (femoral nerve entrapment)
``` 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
What is the most common nerve entrapment syndrom ein the LE
Tarsal Tunnel syndrome (TTS)
67
what is tarsal tunnel syndrome (TTS)
entrap of the posterior tibial nerve or one of its branches w/in the tarsal tunnel
68
S/S of TTS
Burning dysesthesia or anesthesias in plantar/medial aspect of foot WB increases symptoms Rearfoot pronation w/excessive eversion of the heel during stance
69
What is mortons neuroma S/S
``` 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
What is intercostal neuralgia
Shingles caused by infection from Herpes zoster -> nerve compression by disk protrusion
71
S/S of shingles
``` 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
What is morton's neuroma
Overgrowth of the nerve itself between the second and third toe on the foot
73
What is complex regional pain syndrome (CRPS)
Pain and dysfunction out of proportion to an injury, typically linked to fractures or sprains of the extremities with sympathetic NS involvement
74
What is CRPS Type I
Pain disproportionate to the initiating event with sensory involvement
75
What is Type II CRPS
More nerve involvement than CRPS Type I --> causalgia; Mostly motor involvement

UM - MSK (9 decks)

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