PNS Flashcards
1
Q
Individual axons within a nn (myelinated or not) are wrapped in what?
A
Endoneurium, the inner most layer of a nerve.
2
Q
What does Endoneurium consist of?
A
A mesh of collagen fibers, fibroblast & Macrophages.
3
Q
Groups of Axons held to gather by their Endoneurium are held together in bundles called What?
A
Fasicles, These are wrapped in “Perineurium”.
4
Q
What is the thicker layer of CT & Consist of what?
A
Up to 15 layers of fibroblast within a network of collagen fibers.
5
Q
What is the Cervical Plexus?
A
C1 - C5, It supplies skin and mm of the Head, Neck & Superior part of the Shoulders and Chest.
6
Q
What is the Nerve that arises from the Cervical Plexus and supplies the Diaphragm?
A
This is the “Phrenic Nerve”.
This supplies Motor fibers of the Diaphragm.
7
Q
What are the nn’s and interventions of the Cervical Plexus?
A
Superficial (Sensory) branches
Deep (Largely Motor) Branches
8
Q
What is involved in the Superficial (Sensory) Branches of the cervical plexus?
A
Nerves:
Lessor Occipital, Greater Auricular, Transvers Cervical, Superclavicular.
9
Q
What is involved in the Deep (Largely Motor) Branches of the Cervical plexus?
A
Nerves:
Ansa Cervicalis, Phrenic, Segmental Branches.
10
Q
When sensory impulses reach the lower part of the brain stem elicit complex reflexes Such as?
A
When the sensory impulsulses reach this area of the brain stem Reflexes such as:
Changes in HR and breathing occur.
11
Q
What are Sensory modalities?
A
Each Unique type of sensation is called a “Sensory Modality”.
12
Q
What happens when sensory impulses reach the Cerebral cortex?
A
When this happens we become consciously aware of the sensory Stimuli and can precisely locate and identify specific sensations such as touch…
13
Q
How many sensory neuron carries how many sensory modalities?
A
One sensory nerouns carry info for only one sensory modality.
14
Q
What are the 2 Sensory modalities classes grouped into?
A
General Senses & Special senses.
15
Q
What is involved in “General Senses”?
A
Refer to both Somatic & Visceral Sensations.
16
Q
What is involved in “Special Senses”?
A
This includes sensations modalities of smell, taste, vision, hearing & Balance.
17
Q
What are Somatic Senses?
A
These are referring to:
Tactile Sensations Such as Touch, pressure and vibrations.
Thermal sensations, Pain & proprioceptive sensations.
18
Q
What are Visceral Sensations?
A
They provide info about conditions within Internal organs.
For Ex:
Pressure, stretch, Chemicals, Hunger and Temp.
19
Q
What is the process of sensation?
A
Stimulation of Receptors, Transduction of Stimulus, Generation of nn impulses (Action Potentials), Integration of Sensory input.
20
Q
What occurs during the first step of “Process of Stimulation”?
A
Stimulus of Receptors:
Stimulation must occur within the nn’s receptive field.
21
Q
What occurs within the Second step of the “Process of Stimulation”?
A
Transduction of Stimulus:
Sensory receptors transduce (Converts) in a stimulus into a graded potential.
each type of sensory receptor exhibits selectively, it can transduce only one type of stimulus.
22
Q
What occurs within the third step of the “Process of Stimulation”?
A
Generation of nn impulses:
When graded potentials in sensory neurons reach a threshold, this triggers an action potential which propagate towards the CNS.
23
Q
What occurs within the fourth step of “Process of Stimulation”?
A
Integration of Sensory input:
A particular region of the CNS receives and integrates the sensory nn impulses.
24
Q
What is a characteristic that most sensory receptors have?
A
Adaptation, in which the generated action potential or receptor potential decreases in amplitude during maintained / consistent stimulus.
25
What is a characteristic that most sensory receptors have?
Adaptation, in which the generated action potential or receptor potential decreases in amplitude during maintained / consistent stimulus.
26
What happens during "Adaptation" of sensory receptors?
This causes the frequency of the nn impulses in the first order neuron to decrease.
Because of Adaption the perception of a sensation may fade or disappear even if the stimulus persist.
27
What is the Lumbar Plexus?
L1 - L4, Passing outward between the Superficial and deep heads of Psoas major and anterior to the QL.
28
Where does the Lumbar plexus dived into anterior & Posterior divisions?
Between the heads of Psoas major the Roots of the lumbar plexus split into anterior and posterior division.
This gives rise to Peripheral branches of the plexus.
29
What does the Lumbar plexus supply?
The Anterolateral abdominal wall, External genitals & Part of the lower limbs.
30
What are the Nerves and innervations of the lumbar plexus?
Iliohypogastric, Ilioingual, Genitofemoral, Lateral cutaneous nn of the thigh, Femoral, Obturator.
31
What are conditions of the PNS?
ERB's Palsy, Sciatic nn Lesions, TOS, Ulnar nn Lesion, Radial nn Lesion, Bell's palsy, DDD/Herniation.
32
What is ERB's Palsy?
Weakness of the mm's innervated by the Brachial Plexus, most often C5 & C6 nn roots, due to an overstretch from Neck to Shoulder.
33
What are Sciatic nn Lesions?
Disease or damage involving the Sciatic nn.
| It may present itself as pain local to the hip or down the leg as Sciatica.
34
What are Ulnar nn Lesions?
A compression or impingement of the ulnar nn caused by an abnormal tissue growth / space occupying lesion.
Further causes may include: Fractures, dislocations, surgical complications, prolonged compression, repetitive action & trauma.
35
What are Radial nn Lesions?
A injury to the Radial nn, resulting in motor loss, weakness, sensory loss, sensory impairment, or pain along with autonomic Dysfunction.
36
What is Bell's palsy?
A condition involving a lesion of the Facial nn (VII). it results in Flaccid paralysis of the facial mm for expression on the same side as the lesion.
37
What is DDD/Herniation?
DDD is degeneration of the Annular fibers.
| Degeneration of the disc is normal with age because of wear and tear.
38
How long could it take for a Newborn to recover from ERB's palsy?
Up to 2 years and the affected arm may be smaller than the opposite one.
39
How long could it take for a Newborn to recover from ERB's palsy?
Up to 2 years and the affected arm may be smaller than the opposite one.
The size difference would be permanent.
40
How long could it take for a Newborn to recover from ERB's palsy?
Up to 2 years and the affected arm may be smaller than the opposite one.
The size difference would be permanent.
41
If an adult develops ERB's palsy how would the heal from it?
If the nn's were completely ruptured they wouldn't heal on their own.
If only a stretch injury they would heal on their own.
42
What would special conditions for treatment on a client with ERB's palsy include?
Affected arm may need pillowing or support on the table.
| Do not lay the client on the affected side.
43
What would special conditions for treatment on a client with ERB's palsy include?
Affected arm may need pillowing or support on the table.
| Do not lay the client on the affected side.
44
What are CI's for a client with ERB's palsy?
Don't treat until 3 weeks after surgery.
Don't treat the area the rupture or tear occurred until cleared by a doctor.
Don't use joint play or excessive movement of the affected joint.
No Hydro of the affected area until Autonomic & Vasomotor control has returned.
45
How would you test for ERB's palsy?
Dermatomes C5-T1.
46
What would you focus on during treatment of a client with ERB's palsy?
Comp Structures, Keeping ROM of the unaffected arm.
| If the condition is due to compression of the nn form scar tissue then this should be the main focus.
47
When a person has Paralysis of the posterior thigh mm's or sensory loss down the leg what could the client be presenting with?
Sciatic nn lesion.
48
What are specific structures affected by a Sciatic nn lesion?
Innervating and affecting:
| Semimembranosis, Semitendonosis, Bicep Femoris, Piriformis along with leg mm's in severe cases.
49
What would a complete lesion of the Sciatic nn cause?
This would cause foot drop.
| movement below the knee is lost.
50
What would CI's be for a client that has a Sciatic nn lesion?
Do not traction or excessively move the joints.
Avoid Frictions of Compromised tissue.
No Hydro on limb until Autonomic and Vasomotor control have returned.
51
What wold you do in a massage for a client that has a Sciatic nn lesion?
The client can be side lying or prone & Supine is best for after reinervation has occurred but not before.
Pillow to allow for passive drainage of Edema.
Decrease Edema, work on unaffected proximal mm's, Encourage motor re-education of affected mm's & maintain the strength of the weal mm's.
52
What is a cause for Bell's palsy?
Compression from edema, Conditions affecting Parotid gland, Compression from inflammation secondary to trauma.
A chill or Draft.
53
What are Symptoms for Bell's palsy?
There's usually a rapid onset of Unilateral weakness followed by Flaccid paralysis of the mm's of facial expression.
54
What condition the client likely have if they can't raise one eyebrow or has incomplete closure of one eye?
They could be presenting with Bell's palsy.
55
What could you do to test for Bell's palsy?
AF rom testing of facial mm's, raising eyebrows, bringing them together, flaring nostrils...
The testing is positive if the client can't perform or has a hard time making these expressions.
56
What is the first part of the Spinal Disc to wear away?
The Posterolateral portion of the disc fibers weakens first because of the functional movements of the Spine.
57
What does Acute injury to the Spinal Disc involve?
If the herniation/Bulge occurs enough Posteriolateraly.
| Pain sensitive structures such as nn roots and Ligaments can be compressed.
58
What does Herniation of the Disc mean?
This refers to the term of Disc injury that results from rupture of the Annular fibers.
59
What are things that can cause a Disc Rupture/Herniation?
A combination of Flexion & Rotation under load.
60
When bulging/Herniation of a disc occurs in the spine and presses on ligaments or nn roots what kind of symptoms can occur?
Things such as Paresthesia, pain & possible motor weakness.
61
What are the Stages of Acute Herniation of a Disc?
Protrusion, Prolapse, Extrusion, Sequestration.
62
What occurs in the first stage of Acute Disc Herniation?
Protrusion:
| Disc bulges, usually posterolaterally, with Annular Fibers still intact.
63
What is the Second stage of Acute Disc herniation?
Prolapse:
| only the outer most Annular fibers hold the nucleus of the disc in place.
64
What is the third stage of Acute disc herniation?
Extrusion:
| The Annular fibers are pierced, allowing the nucleus to enter the Epidural space.
65
What is the Fourth Stage of Acute disc herniation?
Sequestration:
| Fragments of the nucleus and annular fibers are found outside the Disc.
66
What are the Stages of Chronic DDD?
Dysfunction - Instability - Stabilization stage.
67
What occurs in the Dysfunction stage of Chronic DDD?
Biomechanical changes over many years result in weakness, Bulging & minor tears in the Annulus which heal slowly.
This stage is considered reversible.
68
What occurs in the instability Stage of Chronic DDD?
posterior annular fibers and the joint capsule become lax causing vertebral segment to become hyperbole.
nn entrapment may occur.
The body may try to stabilize the condition with peripheral osteophytes.
Tissue change at this Stage is considered permanent.
69
What occurs in the Stabilization stage of Chronic DDD?
Loss of Disc material and decreased disc hight, intervertebral foramen narrows, joint capsules and posterior ligaments fibroses.
70
At what Stage of DDD may degeneration spread o other vertebral levels?
This may occur in the Stabilization stage of DDD.
71
When are you most likely to have acute Disc herniation?
Acute herniation can occur at any stage of DDD but most likely during the End of Dysfunction and beginning of Instability.
72
What are symptoms of Acute Disc herniation?
With herniation where the nucleus is still contained within the Annulus, pain is worse in the morning.
Pain that is Deep & poorly localized.
One serve strain or repeated minor strains may cause it.
Sustained flexion may also cause an acute rupture.
73
How would you test for DDD?
AF & PR rom of either C-Spine or L-spine may reveal reduced ROM in both.
74
What ROM is most restricted?
In both cervical and Lumbar, Extension in most restricted.
75
What Special test can be used to find out if a client has an Acute disc herniation/Rupture of the C-Spine?
Test such as:
| ULTT's, Spurlings, Valsalvas and Deep tendon Reflex can give a positive result.
76
What Special test could be used to find out if a client has a disc herniation/Rupture of the L-Spine?
Test such as:
| Slumps, Valsalvas, kemps, Kernigs, SLR & Deep tendon reflex may give a positive result.
77
What are test that can be used for any Disc herniation?
Myotomes & Dermatomes.
78
If a client has a Acute poteriolateral disc herniation what would you do for treatment?
Legs in extension with no pillow under the knees.
| Reduce Edema & Spasm in mm's that cross the affected area & gentle facial work can be done shortened fascia.
79
What does the Iliohypogastric nn innervate?
Anterolateral abdominal wall, Skin of inferior abdomen and Buttock.
80
What does the Ilioingual nn innervate?
mm's of Anterolateral abdominal wall, skin of superior and medial aspect of thigh, root of the penis in males and in females the labia majora and mons pubis.
81
What does the Genitofemoral nn innervate?
Cremaster mm, skin over middle anterior surface of thigh, scrotum & Labia majora.
82
What does the Lateral cutaneous nn of thigh innervate?
Skin over lateral, anterior & posterior aspects of the thigh.
83
What does the Femoral nn innervate?
Flexors of the hip and Extensors of the knee, Skin over the anterior and medial thigh, medial leg and foot.
84
What is the largest nn arising from the Lumbar plexus?
The Femoral nn, distributed to flexor mm's of the hip joint and extensors of the knee joint.
Skin over the anterior and medial thigh, medial leg and foot.
85
What does the Obturator nn innervate?
Adductor mm's of the hip and skin over medial aspect of the thigh.
86
What does the Lessor occipital nn innervate?
Skin of scalp posterior and superior to the ear.
87
What does the Greater Auricular nn innervate?
Skin of anterior, inferior and over ear and over parotid glands.
88
What does the transverse cervical nn innervate?
Skin over anterior and lateral aspect of the neck.
89
What does the Supraclavicular nn innervate?
Skin over superior portion of chest and shoulders.
90
What are the Ansa Cervicalis?
There's a Superior root and a Inferior root.
The Superior root - Infrahyoid & Geniohyoid
Inferior root - Infrahyoid
91
What does the Phrenic nn innervate?
The Diaphragm.
92
What does the Segmental branches nn innervate?
Deep mm's of the Neck, Lev Scapula & middle Scalene.
93
Where is the Ulnar nn most vulnerable?
At the Superior, posterior Elbow and wrist at Pisiform.
94
Within Ulnar nn lesions, How would the lesions at the Elbow present themselves?
Total paralysis of the nn including branches of the nn, Shows wasting along the medial side of the forearm.
Weakness of flexion on 4th - 5th fingers.
95
Within the Ulnar nn, How would the lesions affected at the Wrist present themselves?
If the lesion is just proximal to the wrist, causes impaired sensation on palmar aspects of hands and fingers and mm weakness.
96
What would you do for a massage if a client presents with an Ulnar nn lesion?
Massage Ci's will be situational and depend on the location of the lesion and cause of each case.
Main goal is to position and pillow the affected arm in a way that the lesion is not compressed further.
97
What does it mean for a nn lesion to be complete or partial?
A complete nn lesion is when, All fibers within the nn are affected.
A partial nn lesion is when, Only some fibers of the nn are affected.
98
What are causes for a radial nn lesion?
Fractures of the Humerus & upper 1/3 of the Radius.
Dislocation of the head of the Radius, Humeralunlar & radioulnar joint.
Post surgical complications.
Supinator Syndrome.
99
What is Supinator Syndrome?
This is a Possible cause for a Radial nn lesion.
100
What is Supinator Syndrome?
This is a Possible cause for a Radial nn lesion.
| Fibrosis where the radial nn penetrates the supinator mm due to overuse.
101
When someone has a Radial nn lesion and presents with Wrist Drop, what is happening?
The hand hangs in flexion b/c the wrist flexors are unopposed due to flaccid wrist flexors.
102
How does Compression of the Radial nn causing a lesion often occur?
Primarily at the Axilla from overuse of crutches Or when the arm is wrapped over the back of a chair or table edge.
Possibly compressed during sleep of complete fatigue.
103
How does Compression of the Radial nn causing a lesion often occur?
Primarily at the Axilla from overuse of crutches Or when the arm is wrapped over the back of a chair or table edge.
Possibly compressed during sleep of complete fatigue.
104
How would you treat a Radial nn lesion caused by Fractures or dislocation?
Surgery may be necessary as you would not be able to relieve the compression with massage.
105
What are things to consider when treating a client with a Radial nn lesion?
Seated / supine for treatment of Radial nn lesion.
A pillow is placed under the elbow and on the abdomen.
As sensory functions return modified hydro can be used
The treatment would be in the context of a relaxation massage.
And treatment of comp structures.
106
When can a client with a radial nn lesion start having treatment with hydro?
This can occur when they start to get Autonomic / sensory functions return.
This would be modified hydro, such as a cool or tepid wash in segmental fashion.
107
What are the symptoms of Sciatic nn lesions?
May include Sciatica or pain localized to the Hip.
Paresis or Paralysis of posterior thigh mm's & mm's innervated by the peroneal and tibial nn's, and sensory loss involving the lateral and posterior thigh, posterior and lateral leg, & Sole of the foot.
108
What would you do as a massage for a client with a Sciatic nn lesion?
The client can be in prone or side-lying. Supine is best for after rein nervation has occurred but not before.
Use pillow for passive Edema drainage.
The goals:
Decrease edema, Decrease hypertonicity of mm's proximal to affected mm's.
encourage motor re-education of the affected mm's & maintain the strength of weak mm's.
