Peripheral Neuropathy and Carpal tunnel syndrome Flashcards
What are some mechanisms of peripheral neuropathy
Demyelination
Axonal damage
Nerve compression
Vasa Nervorum infarction
Wallerion degeneration (a nerve is cuts and distally it dies)
What are causes of demyelination peripherally?
Guillain-Barre syndrome
B12 deficiency
Charcot-Marie-Tooth Disease
Diabetic neuropathy
Alcoholic neuropathy
Toxic neuropathy (eg chemotherapies)
Viruses
Lead/mercury exposure
Note: MS is only demyelination of CNS
What is damage to a single nerve called?
Mononeuropathy
What is damage to several individuals nerves called?
Polyneuropathy
What is mononeuropathy multiplex?
Damage to at least 2 different areas of the PNS. Many causes like DMT2, AIDS and leprosy.
Symptoms include tingling, numbness, pain and paralysis
Carpal tunnel syndrome is caused by pressure on the _____ nerve passing through the carpal tunnel
median
What are the roots of the median nerve?
C6-T1
What are risk factors for carpal tunnel syndrome?
Female
Hypothyroidism
Acromegaly
Pregnancy
Rheumatoid arthritis
Obesity
What are symptoms of carpal tunnel syndrome?
Weakness of grip
Aching hand/forearm
Paraesthesia of hand
Wasting of thenar eminence
Pain bad at night
How do you diagnose carpal tunnel syndrome?
Phalen test:
Flex fist at wrist for 1 minutes, positive if paraesthesia and pain
Tinel test:
Tapping wrist causes tingling
Electromyography if tests are uncertain
How do you treat carpal tunnel syndrome?
Wrist splint at night
Steroid injection
Surgical decompression
How does radial nerve palsy present?
Wrist drop (radial nerve innervates extensor arm muscles)
What are the radial nerve roots?
C5-T1
What are the ulnar nerve roots?
C8 and T1
How do you treat radial nerve palsy?
Splint and simple analgesia
How does ulnar nerve palsy present?
Claw hand (4th and 5th fingers flexed)
How do you treat ulnar nerve palsy?
Splints and simple analgesia
A lesion at which level causes sciatica?
L5/S1
What may cause a lesion of L5/S1 to give sciatica?
Intervertebral disc herniation or prolapse
Piriformis syndrome (muscle presses on sciatic nerve)
Tumour
Pregnancy
What are symptoms of sciatica?
Pain from buttock down lateral leg to little toe
Weak plantarflexion
Absent ankle jerk
How do you diagnose sciatica?
Can’t do straight leg raise test without pain
MRI cord to confirm
How do you treat sciatica?
Analgesia and physiotherapy
Neurosurgery
What is the distribution in polyneuropathy?
Glove and stocking, mostly peripheries affected
What commonly causes motor polyneuropathy?
Guillain-Barre syndrome
What commonly causes sensory polyneuropathy?
Diabetic neuropathy
What are some causes of polyneuropathy?
Guillain-Barre syndrome
Diabetic neuropathy
Vasculitis
Malignancy
B12 deficiency
Rheumatoid arthritis
How do you diagnose polyneuropathy?
Find underlying cause:
Bloods
Serology
ESR/CRP
How do you treat polyneuropathy?
Analgesia and treat underlying cause
