Peripheral neuropathies and gait Flashcards
Mononeuropahty- pathophysiology
single nerve entrapment resulting in focal neurological deficits
can be caused by trauma ie humeral mid-shaft radial fracture damaging the radial nerve
Radiculopathy
lesion at level of the spinal cord- damages nerve root
causes- pain, weakness, paresthesias, and reduced reflexes
Carpal tunnel syndrome- causes
mostly uknown, generally an overuse and trauma injury to the median nerve travelling through the carpal tunnel deep to the flexor retinaculum
Carpal tunnel syndrome symptoms
Pain and parasthesis in areas innervated by the median nerve
What can be caused by advanced carpal tunnel syndrome
thenar eminence wasting
How is carpal tunnel diagnosed
history and physical
Other tunnel compression syndromes
Carpal tunnel syndrome
tarsal tunnel syndrome
cubtital tunnel syndrome
Polyneuropathy- pathophysiology and etiology
DIABETES, uremia, prophyria, hypothyroid> hyperthyroid, thiamine or B6 deficiency leads to –>
Intrinsic damage to nerves or their vascular supply
Involves multiple nerves of any type
Polyneuropathy- course
progressive
stepwise
relapsing/ remitting
Polyneuropathy- classic presentation
glove stocking pattern
Polyneuropathy- etiology
DIABETES IS THE MAJOR CAUSE
uremeia, porphyria
hypothyroid> hyperthyroid
thiamine or B6 deficiencies
polyneuropathy- Dx
stocking glove pattern is classic presentation
absent ankle reflexes (this is normal in the elderly)
Generally effects sensory more than motor fxn
Guillane Barre Syndrome- other name, preceeded by, progressin, tx, chronic
GBS is also called Acute inflammatory demylinating polyradiculoneuropathy (AIDP).
Follows a camplobacter or viral infxn
Starts in the LE and moves up to the diaphragm
Tx is IVIG and plasmophoresis
Chronic is Chronic Inflammatory demylinating polyradiculoneuropathy, can be AIDS associated
Nerve conduction studies, what are u looking at, how is it tested, what does inc time or dec amplitute tell u
Place electrodes on the muscle proximally and see if can stimulate muscle action
dec amplitude= axon loss, common in diabetes
inc latency= myelin loss, GBS
Electromyography- how is it done, what are you looking for
Needle is inserted into muscle and measure electrical patterns at rest and during movement.
At rest- abnormal movement- fasiculations, fibrillations
Movement- recruitment, first smaller motor units, then larger motor units- looking for amplitude changes.
Neuropathy: Parasthesis weakness dec reflexes pattern nerve conduction spontaneous waves
common sometimes usually distal small or slow rare
Myopathy: parasthesis weakness dec reflexes pattern nerve conduction spontaneous waves
rare always sometimes proximal small or normal frequent
H and P= parasthesis with dec reflexes = (neuropathy or myopathy)
neuropathy
H and P= weakness with no parasthesis=(neuropathy or myopathy)?
myopathy
Myopathy:
Nerve conduction study-
EMG
nerve conduction study- normal
EMG- spontaneous waves
Usual presentation of myopathy- what is effected, distal or proximal, bi/unilateral?
muscle weakness with no sensory involvement that preferrentially effects proximal muscles (hip and shoulders), symmetric
Specific myopathy diseases
Muscular dystrophies- duchene, becker
drugs- statins
inflammatory disorder- polymyositis
duchene vs becker- similarities and differences
Both are hereditary, symmetric, and involve lower extremities.
Duchene’s has much faster progression than Beckers
Polymyositis:
SSx
etiology
Dx
SSx: pain, weakness, loss of muscle mass in shoulders and thighs
etiology- unknown
Dx: high CK, abnormal EMG, anti Jo- Ab, anti- signal recognition particle Ab
Rating muscle strength:
0= no contraction 1= trace contraction 2= can move but not against gravity 3= can move against gravity 4= can move against gravity and resistance 5= normal
Hemi/monoplegia:
definition, due to
Tx
complete paralysis of affected limbs
caused by complete interruption of motor control
Tx: rehab that focuses on compensation, ROM to prevent contracture, electric stim to prevent atrophy
Hemi/monparesis:
definition, due to
tx
weakness of limbs
caused by partial loss of motor control
Tx: rehab focusing on strengthening affected muscles, avoiding maladaptive movements, and braces for function in weakness
Apraxia:
Definition, due to
tx
difficulty controlling movements due to problems in planning, normally associated with premotor cortex lesions.
tx: motor planning and repetitive movements
Ataxia:
Definition, due to
tx
gait instability, loss of balance, or impaired limb coordination
due to cerebellar or basal ganglia lesions
tx inhibiting tremors and spasticity, hydrotherapy
UMN lesions are assoc with
what can this cause
spasticity
can cause clonus, contracture, or pain
sensory deficits can cause:
can be caused by
can result in
propioceptive deficits
hemineglect
can be caused by right sided CVA
