Peripheral neuropathies and gait

Question 1

Mononeuropahty- pathophysiology

Answer 1

single nerve entrapment resulting in focal neurological deficits
can be caused by trauma ie humeral mid-shaft radial fracture damaging the radial nerve

Question 2

Radiculopathy

Answer 2

lesion at level of the spinal cord- damages nerve root

causes- pain, weakness, paresthesias, and reduced reflexes

Question 3

Carpal tunnel syndrome- causes

Answer 3

mostly uknown, generally an overuse and trauma injury to the median nerve travelling through the carpal tunnel deep to the flexor retinaculum

Question 4

Carpal tunnel syndrome symptoms

Answer 4

Pain and parasthesis in areas innervated by the median nerve

Question 5

What can be caused by advanced carpal tunnel syndrome

Answer 5

thenar eminence wasting

Question 6

How is carpal tunnel diagnosed

Answer 6

history and physical

Question 7

Other tunnel compression syndromes

Answer 7

Carpal tunnel syndrome
tarsal tunnel syndrome
cubtital tunnel syndrome

Question 8

Polyneuropathy- pathophysiology and etiology

Answer 8

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

Question 9

Polyneuropathy- course

Answer 9

progressive
stepwise
relapsing/ remitting

Question 10

Polyneuropathy- classic presentation

Answer 10

glove stocking pattern

Question 11

Polyneuropathy- etiology

Answer 11

DIABETES IS THE MAJOR CAUSE
uremeia, porphyria
hypothyroid> hyperthyroid
thiamine or B6 deficiencies

Question 12

polyneuropathy- Dx

Answer 12

stocking glove pattern is classic presentation
absent ankle reflexes (this is normal in the elderly)
Generally effects sensory more than motor fxn

Question 13

Guillane Barre Syndrome- other name, preceeded by, progressin, tx, chronic

Answer 13

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

Question 14

Nerve conduction studies, what are u looking at, how is it tested, what does inc time or dec amplitute tell u

Answer 14

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

Question 15

Electromyography- how is it done, what are you looking for

Answer 15

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.

Question 16

Neuropathy:
Parasthesis
weakness
dec reflexes
pattern
nerve conduction
spontaneous waves

Answer 16

common
sometimes
usually
distal
small or slow
rare

Question 17

Myopathy:
parasthesis
weakness
dec reflexes
pattern
nerve conduction
spontaneous waves

Answer 17

rare
always
sometimes
proximal
small or normal
frequent

Question 18

H and P= parasthesis with dec reflexes = (neuropathy or myopathy)

Answer 18

neuropathy

Question 19

H and P= weakness with no parasthesis=(neuropathy or myopathy)?

Answer 19

myopathy

Question 20

Myopathy:
Nerve conduction study-
EMG

Answer 20

nerve conduction study- normal

EMG- spontaneous waves

Question 21

Usual presentation of myopathy- what is effected, distal or proximal, bi/unilateral?

Answer 21

muscle weakness with no sensory involvement that preferrentially effects proximal muscles (hip and shoulders), symmetric

Question 22

Specific myopathy diseases

Answer 22

Muscular dystrophies- duchene, becker
drugs- statins
inflammatory disorder- polymyositis

Question 23

duchene vs becker- similarities and differences

Answer 23

Both are hereditary, symmetric, and involve lower extremities.
Duchene’s has much faster progression than Beckers

Question 24

Polymyositis:
SSx
etiology
Dx

Answer 24

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

Question 25

Rating muscle strength:

Answer 25

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

Question 26

Hemi/monoplegia:
definition, due to
Tx

Answer 26

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

Question 27

Hemi/monparesis:
definition, due to
tx

Answer 27

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

Question 28

Apraxia:
Definition, due to
tx

Answer 28

difficulty controlling movements due to problems in planning, normally associated with premotor cortex lesions.
tx: motor planning and repetitive movements

Question 29

Ataxia:
Definition, due to
tx

Answer 29

gait instability, loss of balance, or impaired limb coordination
due to cerebellar or basal ganglia lesions
tx inhibiting tremors and spasticity, hydrotherapy

Question 30

UMN lesions are assoc with

what can this cause

Answer 30

spasticity

can cause clonus, contracture, or pain

Question 31

sensory deficits can cause:
can be caused by
can result in

Answer 31

propioceptive deficits
hemineglect
can be caused by right sided CVA