Peripheral Neuropathy and Carpal tunnel syndrome

Question 1

What are some mechanisms of peripheral neuropathy

Answer 1

Demyelination
Axonal damage
Nerve compression
Vasa Nervorum infarction
Wallerion degeneration (a nerve is cuts and distally it dies)

Question 2

What are causes of demyelination peripherally?

Answer 2

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

Question 3

What is damage to a single nerve called?

Answer 3

Mononeuropathy

Question 4

What is damage to several individuals nerves called?

Answer 4

Polyneuropathy

Question 5

What is mononeuropathy multiplex?

Answer 5

Damage to at least 2 different areas of the PNS. Many causes like DMT2, AIDS and leprosy.
Symptoms include tingling, numbness, pain and paralysis

Question 6

Carpal tunnel syndrome is caused by pressure on the _____ nerve passing through the carpal tunnel

Answer 6

median

Question 7

What are the roots of the median nerve?

Answer 7

C6-T1

Question 8

What are risk factors for carpal tunnel syndrome?

Answer 8

Female
Hypothyroidism
Acromegaly
Pregnancy
Rheumatoid arthritis
Obesity

Question 9

What are symptoms of carpal tunnel syndrome?

Answer 9

Weakness of grip
Aching hand/forearm
Paraesthesia of hand
Wasting of thenar eminence
Pain bad at night

Question 10

How do you diagnose carpal tunnel syndrome?

Answer 10

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

Question 11

How do you treat carpal tunnel syndrome?

Answer 11

Wrist splint at night
Steroid injection
Surgical decompression

Question 12

How does radial nerve palsy present?

Answer 12

Wrist drop (radial nerve innervates extensor arm muscles)

Question 13

What are the radial nerve roots?

Answer 13

C5-T1

Question 14

What are the ulnar nerve roots?

Answer 14

C8 and T1

Question 15

How do you treat radial nerve palsy?

Answer 15

Splint and simple analgesia

Question 16

How does ulnar nerve palsy present?

Answer 16

Claw hand (4th and 5th fingers flexed)

Question 17

How do you treat ulnar nerve palsy?

Answer 17

Splints and simple analgesia

Question 18

A lesion at which level causes sciatica?

Answer 18

L5/S1

Question 19

What may cause a lesion of L5/S1 to give sciatica?

Answer 19

Intervertebral disc herniation or prolapse
Piriformis syndrome (muscle presses on sciatic nerve)
Tumour
Pregnancy

Question 20

What are symptoms of sciatica?

Answer 20

Pain from buttock down lateral leg to little toe
Weak plantarflexion
Absent ankle jerk

Question 21

How do you diagnose sciatica?

Answer 21

Can’t do straight leg raise test without pain
MRI cord to confirm

Question 22

How do you treat sciatica?

Answer 22

Analgesia and physiotherapy
Neurosurgery

Question 23

What is the distribution in polyneuropathy?

Answer 23

Glove and stocking, mostly peripheries affected

Question 24

What commonly causes motor polyneuropathy?

Answer 24

Guillain-Barre syndrome

Question 25

What commonly causes sensory polyneuropathy?

Answer 25

Diabetic neuropathy

Question 26

What are some causes of polyneuropathy?

Answer 26

Guillain-Barre syndrome
Diabetic neuropathy
Vasculitis
Malignancy
B12 deficiency
Rheumatoid arthritis

Question 27

How do you diagnose polyneuropathy?

Answer 27

Find underlying cause:
Bloods
Serology
ESR/CRP

Question 28

How do you treat polyneuropathy?

Answer 28

Analgesia and treat underlying cause