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peripheral neuropathy Flashcards

1
Q

peripheral relay info to and from the

A

CNS

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2
Q

peripheral nerves include

A

sensory and motor (ANS)

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3
Q

symptoms of peripheral neuropathy

A

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

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4
Q

mononeuroapthy

A

damage to one peripheral nerve (median in CTS)

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5
Q

polyneuropathy

A

multiple peripheral nerves throughout body

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6
Q

examples of polyneuropathy

A

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

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7
Q

what parts of nerve may be damaged

A

axonal or myelin sheeth damage

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8
Q

what types of nerves may be damaged

A

motor
sensory
autonomic

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9
Q

these neuropathies are caused by?

A

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

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

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10
Q

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

A

Guyon’s canal

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11
Q

what medications cause peripheral neuropathy?

A

AIDS antiviral drug didanosine
antibiotics
gold compounds
chemotherapy drugs

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12
Q

carpal tunnel syndrome due to

A

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

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13
Q

sensations of median nerve compression/entrapment (which fingers)

A

tingling/numbness of thumb, index, and middle fingers

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14
Q

median nerve is formed by what roots of BP

A

C5-C7 lateral cord of BP

C8-T1 median cord of BP

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15
Q

median nerve innervation

A

2LOAF

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

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16
Q

conditions that may lead to carpal tunnel

A 
obesity
pregnancy
diabetes
arthritis
hypothyrodism
trauma
repetitive work or task (cummulative trauma)
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17
Q

transverse carpel ligament release is for

A

carpal tunnel (median nerve)

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18
Q

CTS diagnosis

A
  • 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

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19
Q

CTS symptoms

A

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

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20
Q

cubital tunnel syndrome has what symptoms

A

numbness and tingling along ulnar nerve

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21
Q

what is weak in cubital tunnel syndrome

A

weak grip

22
Q

most common site of ulnar nerve compression

A

elbow (cubital tunnel syndrome)

23
Q

ulnar innervation

A

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

24
Q

most common compressive neuropathy

A

carpal tunnel syndrome

25
Q

2nd most common compressive neuropathy

A

cubitial tunnel syndrome

26
Q

cubital tunnel syndrome affects what gender more

A

men

27
Q

cubital tunnel may causes what deformity

A

ulnar claw hand deformity

28
Q

cubital tunnel syndrome may be casued by

A 
- 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
29
Q

Work may aggravate cubital tunnel syndrome secondary

A

to repetitive elbow flexion and extension

30
Q

occupational implications for neuropathies

A

upper/lower extremity + hands

31
Q

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

A

sensory, motor, or both

32
Q

peripheral nerve injuries occur from

A

trauma (blunt or wound) or acute compression

33
Q

peripheral nerve injuries may result

A

demyelination or axonal degeneration

34
Q

neuropraxia is what level of severity?

A

lease severe nerve injury

35
Q

neuropraxia

what is blocked?

no what?

most common finding?

A

◦ 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

36
Q

axonotmesis

A

◦ 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

37
Q

neurotmesis

A 
- 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
38
Q

regeneration has to do with

A

peripheral nerve axons

39
Q

reinnervation occurs only if

A

◦ sensory fibers reach their sensory end organs

◦ motor fibers reach their muscle targets

40
Q

examples of reinnervation problems

A

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

41
Q

when do you indicate surgery for closed injuries

A

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

42
Q

majority of brachial plexus injuries caused by

A

trauma

43
Q

brachial plexus injuries caused by

A 
- motorcycle accidents
◦ Blunt trauma
◦ Stab or gunshot wounds
◦ Inflammatory (brachial plexitis)
◦ Compression (tumor)
◦ Neuropathies
◦ Obstetric brachial plexus palsy
44
Q

BP avulsion injury

A

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

45
Q

BP rupture injury

A

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

46
Q

BP neurapraxia injury

A

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

47
Q

axonotmesis

A

axons have been severed; prognosis moderate

48
Q

neurotmesis

A

entire nerve has been divided; prognosis very poor

49
Q

crash injury (BP) surgery indications

A

◦ 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

50
Q

how is BP nerve repaired?

A

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

51
Q

nerve graft

A

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

human conditions (28 decks)

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