PNI and REHABILITATION Flashcards
motor [efferent] fibers
they provide voluntary muscle function by transmitting impulses from CNS to skeletal muscle
Sensory [afferent] fibers
provide transmission of sensory impulses from the environment to the CNS
Autonomic [efferent] fibers
controls trophic functions
types of damages
Wallerian degeneration
axonal degeneration
segmental demyelination
Wallerian degeneration
due to nerve axon damage and disruption of its integrity
can regenerate if nerve sheath is preserved
axonal degeneration
retrograde damage to cell body or axon
can be reversed if no deteriorating of axon integrity
segmental demyelination
myelinated fibers are damaged by surrounding schwan cells and/ or myeline sheath without damage to peripheral nerve axon
-complete reversal when the cause is removed
Seddon classification
neuropraxia
axonotmesis
neurotmesis
Neuropraxia
non degenerative
due to pressure
schwan membrane and axon are intact
partial loss of sensation
Axonotmesis
axon distraction
intact schwan membrane
degenerative lesion
motor and sensory impairment
neurotmesis
both nerve and schwan cell are devastated
very weak regeneration
there may remain scar tissue
degeneration
retrograde degeneration occurs when nerve injured
occurs within 14-21 days
neural mechanisms of regeneration
collateral reinnervation
axonal regeneration
reorganization of nervous system
lesion of cervical plexus
it innervates deep muscles of the neck
phrenic nerve lesion are common
unilateral lesion=paresis of hemidiaphragm
bilateral= dyspnea
lesion of brachial plexus
C5-T1
causes of brachial plexus lesion
tumor
accidents
trauma
obstetric
radiation
obstetric brachial plexus symptoms and risk factors
loss of strength
reflex changes
atrophy
loss of sensation
high birth weight
birth related
Erb’s palsy
occurs in brachial plexus lesion at level C5-6
it has waiters tip hand classical sign
klumpkle
lower brachial lesion C8-T1
claw hand and Horne’s syndrome
N. Thoracicus longus
injuries due to continuous pressure
S.A paralysis
Scapula Lata can be seen
Axillary nerve
weak ER of arm
teres minor and deltoid paralysis
humerus damage
radial nerve
Saturday night paralysis
extensor paralysis
Medial nerve
lesion of brachial plexus and cervical cord
thenar muscle atrophy
monkey hand deformity
carpal tunnel syndrome
Phalen test
ulnar nerve
claw hand
hypothenar atrophy
cubital tunnel syndrome
Tinel test
lumbar plexus
deep
can be damaged in fracture, dislocation or bullet wounds
iliopsoas paralysis
Femoral nerve
quadriceps paralysis
hard to walk forward
anterior thigh atrophy
sensory impairment
obturator nerve
weak hip add and ER
sacral plexus
very rare
hip Abd weakness
Trendelenburg gait
ischial nerve
knee flexion disappear
all leg and foot muscles paralysis
Achilles and plantar reflex are lost
sensory impairment
atrophy
nerve peroneus communis
drop foot deformity
stepping walk
tibialis nerve
no plantarflexion and inversion
phases of treatment
paralysis
recovery
peripheral neuropathy common causes
diabetes mellitus in developed countries
leprosy in all over the world
entrapment neuropathy
compression of peripheral nerves in fibrosseous funnel located at transition point from one segment of the body to another
common features of entrapment neuropathy
dysesthesias
burning
prickling
pain
subjective feeling of swelling
Tinel’s findings
neuropathic pain
pain due to damage of PNS or CNS
occurs spontaneously.
about EMG
measure of function of muscles
test the speed which nerve carry stimuli
determine ability of nerve to send or receive impulse
classification of neuropathy
mononeuropathy
polyneuropathy
multiple mononeuropathy
mononeuropathy
carpal tunnel syndrome
cubital tunnel syndrome
radial nerve entrapment
sciatic nerve entrapment
peroneal nerve entrapment
sciatic nerve entrapment
piriformis syndrome
peroneal nerve entrapment
fibular tunnel syndrome
steppage walk
polyneuropathy
diabetic neuropathy
Guillain barre syndrome
Charcot Marie tooth disease
Guillain Barre syndrome
acute inflammatory demyelinating polyneuropathy
start at lower extremities
sudden and rapid
respiratory support is important
Charcot Marie tooth disease
peroneal muscles are affected
drop foot
uneven walking
multiple mononeuropathy
two or more nerves are affected separately
leprosy
Lyme disease
pressure sensitivity paralysis
sensory training
preventive re-education
discriminant retraining
hereditary chronic demyelinating polyneuropathy
refrum disease
leukodystrophy
CMT diseases
acquired chronic demyelinating polyneuropathy
chronic inflammatory demyelinating polyradiculoneuropathy
multifocal motor neuropathy
chronic axonal polyneuropathy
diabetes mellitus
nutritional deficiency
chronic renal failure
drug and toxins use
malignant disease
axonal form of CMT
hyperesthesia desensitization
vibration
fabrics
immersion in objects
massage
continuous pressure
