PNS Flashcards
what should your neuro ROS include?
headache
dizziness or vertigo
seizures, tremors, involuntary movements
weakness
numbness
fainting (syncope or near syncope)
3 most common PNS complaints?
pain, weakness, numbness/tingling
shoulder nerve levels
flexion/abduction C4-5
elbow nerve levels
flex = C5 (musculocutaneous n)
extend = C7 (radial)
wrist nerve levels
flexion = C7 (median, ulnar)
extend = C6 (radial)
finger nerve levels
flex (grip C8, median & ulnar)
(abduct T1 ulnar)
hip nerve levels
flex = L2-4 (femoral, L1-3 nerve roots)
extend = L5 (inferior gluteal)
knee nerve levels
flex = S1 (sciatic)
extend = L3 (femoral)
ankle nerve levels
dorsiflex L4 (deep peroneal)
plantarflex S1 (tibial)
toe nerve levels
dorsiflex L5 (deep peroneal)
motor strength exam
0 = no movement
1 = muscle twitch without joint movement
2 = movement with gravity eliminated
3 = full strength against gravity only
4 = partial strength against resistance
5 = full strength against resistance
what must the sensory exam include?
dermatomal AND peripheral cutaneous
dysesthesia
all types of abnormal sensation including pain regardless of stimulant being present or not
paresthesia
mostly numb, tingling, pins & needles without pain or apparent stimulus
anesthesia
absence of sensation
hypesthesia or hypoesthesia
reduced sensitivity
hyperesthesia
increased sensitivity
hyperalgesia
significant pain in response to mildly painful stimulus
allodynia
non painful stimulus, perceived as painful on the skin
5 types of sensation
- pain
- temperature
- light touch
- proprioception (position)
- vibration
discriminative sensory exam
- stereognosis (identify object by feel)
- 2 point discrimination
- number identification
DTR levels
biceps C5-6
brachioradialis C5-6
triceps C6-7
Patellar L2-4
Achilles S1
grading of DTRs
0 = absent
1+ = diminished
2+ = normal/average
3+ = mildly over active
4+ = highly over active
examples of common PNS pathology
ischemia, bleed, infection, mass, compression, nerve disorder, neuromuscular disorder, muscular disorder, idiopathic
UMN sign
-paralysis of movement, not muscle
-atrophy from disuse, slight
- spasticity, hypertonic
-DTR increased (loss of superficial reflexes)
-Babinski upgoing
LMN sign
- paralysis from muscle atrophy
-wasting pronounced - flaccid, hypotonic (fasciculations may be present)
- DTR low or absent
anterior horn lesion
polio, ALS
-fasciculation & weakness in segmental path
-sensation intact
-weak DTR
spinal nerve root lesion
herniated disc
-weakness then atrophy
-dermatomal sensory changes
-weak DTR
peripheral mononeuropathy (lesion)
carpal tunnel syndrome, Bell’s Palsy
-weakness in specific peripheral nerve distribution
-sensory loss in corresponding nerve distribution
-weak DTR
peripheral polyneuropathy
diabetes, alcoholic neuropathy
-distal weakness
-stocking glove distribution sensory loss
-weak DTR
NMJ lesion
myasthenia gravis
-muscular fatigability
-sensation intact
-DTR intact
muscular lesion
muscular dystrophy
-weakness, usually in proximal muscles
-sensation intact
-DTR intact or possibly decreased
Adson’s test
thoracic outlet syndrome
-ext R, abduct & extend arm while palpating pt’s radial pulse –if diminished = positive
Roo’s test
thoracic outlet syndrome
-arms at goal post, hold for 2 mins, if weak or numbness occur then positive
Erb’s Palsy
C5-6 lesion leaves arm in waiter’s tip position
-upper brachial plexus injury
Klumpke’s Palsy
C8-T1 palsy = claw hand position
-lower brachial plexus injury
Long thoracic nerve injury
winging of scapula
C5-7
Median nerve injury/lesion causes
-crush injury
-pronator syndrome (pronator teres compressing nerve)
-carpal tunnel syndrome (entrapment of medial nerve in tunnel)
-wrist slashing
-palm injury/laceration
ape hand deformity
median nerve injury
-C5-6 & C8-T1
-actively attempting a fist & wasting of thenar eminence
tinel’s sign
-hit wrist with reflex hammer, hitting median nerve, positive if pain or numb
phalen’s test
reverse prayer, pain and numbness d/t median nerve
prayer test
put hands in prayer position, pain or numbness d/t median nerve
median nerve: anterior interosseous neuropathy
pinch grip = “ok” sign –can’t perform
causes of ulnar n. injury/lesion
- fx of humerus near medial epicondyle
- cubital tunnel syndrome at elbow
- laceration near wrist
- entrapment at Guyon’s canal
claw hand deformity
ulnar n injury
C8-T1
can’t straighten 4th & 5th digits
tinel’s sign at elbow
“funny bone”
hit with hammer, causes pain and pins at 4th & 5th digits
radial nerve injury causes
- fx of humerus near radial groove
- “saturday night palsy” – compression by sleeping with arm under head
wrist drop
radial n injury
C5-T1
sciatic n injury
-disc compression L4/L5 nerve roots
-piriformis syndrome
-posterior hip dislocation
sciatica & steppage gait
superior gluteal n injury
-trauma
-hip replacement surgery
-following IM injection in butt
*trendelenburg gait
lateral femoral cutaneous n injury
- compression at iliac crest (belt, seatbelt, large pannus)
-numbness over lateral thigh
common fibular n injury
-impingement by piriformis
-proximal fibular fx
-stretched from varus stress (with LCL)
-compressed by casting
-surgery
-paralysis of DF & everters, loss sensation anterolateral leg & dorsum of foot,
*foot drop w/ high steppage gait & foot slap
superficial fibular/peroneal n injury
-proximal fibular fx
-stretched with varus stress
-compressed by casting
-paralysis of foot everters
-NO foot drop
-loss sensation of anterolateral leg & dorsum of foot
deep fibular/peroneal n injury
-anterior compartment syndrome
-anterior tarsal tunnel syndrome
-pes cavus (high arch)
-tight shoelaces or trauma
-weak DFs, foot drop*
medial plantar n injury
-entrapment in longitudinal arch
-Jogger’s foot = valgus hindfoot & pes planus
-aching pain in arch & burning/paresthesia in medial plantar surface
