peripheral neuropathy

Question 1

peripheral relay info to and from the

Answer 1

CNS

Question 2

peripheral nerves include

Answer 2

sensory and motor (ANS)

Question 3

symptoms of peripheral neuropathy

Answer 3

numbess/tingling/prickling (paresthesis)
pain (allodynia)
may affect internal organs (ANS)
may lead to paralysis, muscle wasting, organ failure

Question 4

mononeuroapthy

Answer 4

damage to one peripheral nerve (median in CTS)

Question 5

polyneuropathy

Answer 5

multiple peripheral nerves throughout body

Question 6

examples of polyneuropathy

Answer 6

guilian-barre syndrome, diabetes neuropathy, charcot-marie tooth disease

Question 7

what parts of nerve may be damaged

Answer 7

axonal or myelin sheeth damage

Question 8

what types of nerves may be damaged

Answer 8

motor
sensory
autonomic

Question 9

these neuropathies are caused by?

Answer 9

physical injury/trauma
(repetitive stress, cumulative damage from repetitive use/compression injury or entrapment)

disease or disorders
(metabolic/endocrine or autoimmune…..)

Question 10

ulnar nerve compression due to repetitive activity overuse is found in what canal

Answer 10

Guyon’s canal

Question 11

what medications cause peripheral neuropathy?

Answer 11

AIDS antiviral drug didanosine
antibiotics
gold compounds
chemotherapy drugs

Question 12

carpal tunnel syndrome due to

Answer 12

compression of median enrve cause of swelling in tissue in carpal tunnel

Question 13

sensations of median nerve compression/entrapment (which fingers)

Answer 13

tingling/numbness of thumb, index, and middle fingers

Question 14

median nerve is formed by what roots of BP

Answer 14

C5-C7 lateral cord of BP

C8-T1 median cord of BP

Question 15

median nerve innervation

Answer 15

2LOAF

1st and 2nd lumbrical
opponens pollicis
abductor pollicis BREVIS
flexor pollicis BREVIS

Question 16

conditions that may lead to carpal tunnel

Answer 16

obesity
pregnancy
diabetes
arthritis
hypothyrodism
trauma
repetitive work or task (cummulative trauma)

Question 17

transverse carpel ligament release is for

Answer 17

carpal tunnel (median nerve)

Question 18

CTS diagnosis

Answer 18

• examine neck, shoulder, elbow, pulses, and reflexes
• To exclude other conditions that can mimic carpal tunnel syndrome
• To identify compression

􏰀 Wrist physical exam
◦ For swelling, warmth, tenderness, deformity, and discoloration

􏰀 Phalen’s test & Tinel’s sign
􏰀 Nerve Conduction Velocity & Electromyography

Question 19

CTS symptoms

Answer 19

numbness “pins and needles in fingers”
pain that is worse at night (interupts sleep)
burning or tingling of thumb, index, and middle fingers or pain that moves up arm and elbow
hand weakness, difficulty gripping objects with hands, or dropping objects
difficulty manipualting small objects
swollen feeling in fingers

Question 20

cubital tunnel syndrome has what symptoms

Answer 20

numbness and tingling along ulnar nerve

Question 21

what is weak in cubital tunnel syndrome

Answer 21

weak grip

Question 22

most common site of ulnar nerve compression

Answer 22

elbow (cubital tunnel syndrome)

Question 23

ulnar innervation

Answer 23

forearm
flexor carpi ulnaris
flexor digi profundus (ulnar part)

thenar
adductor pollicis
flexor pollicis brevis (deep head)

fingers
palmar and dorsal interossei
3rd and 4th lumbricals

hypothenar muscles
abductor digi minimi
opponens digiti minimi
flexor digiti minimi

Question 24

most common compressive neuropathy

Answer 24

carpal tunnel syndrome

Question 25

2nd most common compressive neuropathy

Answer 25

cubitial tunnel syndrome

Question 26

cubital tunnel syndrome affects what gender more

Answer 26

men

Question 27

cubital tunnel may causes what deformity

Answer 27

ulnar claw hand deformity

Question 28

cubital tunnel syndrome may be casued by

Answer 28

``` - constricting fascial bands ◦ subluxation of the ulnar nerve over the medial epicondyle ◦ cubitus valgus ◦ hypertrophied synovium ◦ tumors, ganglia ◦ direct compression ◦ repeated resting elbow on hard surface ```

Question 29

Work may aggravate cubital tunnel syndrome secondary

Answer 29

to repetitive elbow flexion and extension

Question 30

occupational implications for neuropathies

Answer 30

upper/lower extremity + hands

Question 31

peripheral nerve injuries result in loss to what part of peripheral nerve

Answer 31

sensory, motor, or both

Question 32

peripheral nerve injuries occur from

Answer 32

trauma (blunt or wound) or acute compression

Question 33

peripheral nerve injuries may result

Answer 33

demyelination or axonal degeneration

Question 34

neuropraxia is what level of severity?

Answer 34

lease severe nerve injury

Question 35

neuropraxia what is blocked? no what? most common finding?

Answer 35

◦ block of nerve conduction (temp), but axon and myeline sheet are intact ◦ demyelination of injured nerve ◦ no nerve denervation muscle changes ◦ no Tinel sign (test to detect/confirm injured or irritated nerve) ◦ recovery may be spontaneous or could take up to 12 weeks, recovery is usually complete loss of motor function most common finding

Question 36

axonotmesis

Answer 36

◦ common causes: traction (stretch injury causes BP injury) or crash injury ◦ anatomic disruption of axon with little disruption of connective tissue (n. sheath) ◦ requires regrowth of the axon to the target muscle ◦ prolonged recovery - axons grow in adults at about 1” per month (1mm per day) ◦ dennervated muscle will lose its nerve receptors within 12 to 18 months

Question 37

neurotmesis

Answer 37

``` - anatomic disruption of both axon and connective tissue (sheath) – most severe type of nerve injury – less likely to recover by axonal regeneration – no chance of spontaneous recovery – early surgical treatment necessary ```

Question 38

regeneration has to do with

Answer 38

peripheral nerve axons

Question 39

reinnervation occurs only if

Answer 39

◦ sensory fibers reach their sensory end organs | ◦ motor fibers reach their muscle targets

Question 40

examples of reinnervation problems

Answer 40

Mismatched sensory fibers may reinnervate a different sensory area within the nerve's sensory distribution Motor fibers may regenerate but the muscle may not be completely reinnervated due to the long period of denervation

Question 41

when do you indicate surgery for closed injuries

Answer 41

Surgery indicated if no evidence of recovery at 3 months following injury

Question 42

majority of brachial plexus injuries caused by

Answer 42

trauma

Question 43

brachial plexus injuries caused by

Answer 43

``` - motorcycle accidents ◦ Blunt trauma ◦ Stab or gunshot wounds ◦ Inflammatory (brachial plexitis) ◦ Compression (tumor) ◦ Neuropathies ◦ Obstetric brachial plexus palsy ```

Question 44

BP avulsion injury

Answer 44

nerve has been pulled out from the spinal cord and has no chance to recover

Question 45

BP rupture injury

Answer 45

nerve has been stretched and some torn, but not at the spinal cord

Question 46

BP neurapraxia injury

Answer 46

nerve has been stretched or compressed but is still attached (not torn) and has excellent prognosis for rapid recovery (transient)

Question 47

axonotmesis

Answer 47

axons have been severed; prognosis moderate

Question 48

neurotmesis

Answer 48

entire nerve has been divided; prognosis very poor

Question 49

crash injury (BP) surgery indications

Answer 49

◦ Surgical exploration of the nerve may be delayed for as long as several weeks ◦ after 3 months with no evidence of reinnervation (electrodiagnostically or clinically), surgical repair or nerve graft indicated

Question 50

how is BP nerve repaired?

Answer 50

􏰀 Direct repair of nerve continuity 􏰀 Performed when the 2 ends of the nerve are directly coapted 􏰀 Without tension

Question 51

nerve graft

Answer 51

􏰀 Recommended where a gap is present between the proximal and distal ends 􏰀 Donor nerve harvest results in a sensory loss in the donor distribution