PNS exam Flashcards
primary presentation of PNS disorder
most common complaints are pain, weakness, paresthesia (numbness/tingling)
**ask about what has changed
often caused by ischemia, TIA, CVA, masses (impingement) or other disorders (MS….)
dysesthesia
all types of abnormal sensation including pain regardless of stimulant
paresthesia
tingling, pins and needles, WITHOUT pain and WITHOUT stimulus
hyperesthesia
pain in response to touch (reproducing their DISCOMFORT)
hypoesthesia
reduced sensation to touch
hyperalgesia
severe pain in response to mildly painful stimulus
allodynia
non-painful stimulus perceived as painful on the skin, often severe
proximal weakness
combing hair, getting out of a chair, worse with repeated effort
distal weakness
open a jar, writing, tripping `
increased DTRs
CNS problems
decreased DTRs
PNS problem
brachioradialis
C5 and C6
point end into PROXIMAL muscle belly, flat end on distal tendon
biceps
C5 C^
point end onto thumb lying over tendon
triceps
C6C7
flat or point end on triceps tendon above olecranon
patellar
L2,3,4
flat endo on patellar tendon
Achilles
S1
flat end on tendon above calc
plantar
babinski
L5-S1
downgoing is normal, toes curl
upper motor neuron lesions
**spasticity
loss of dexterity up-going babinski weakness w.o. atrophy hyperreflexia of DTRs **paralysis of movement, not musce e.g. stroke, MS, cerebral palsy, TBI, ALS
LMN lesions
flaccid paralysis muscle atrophy, wasting hyporeflexia normal superficial reflexes Polio, GBS, ALS
dermatomes of the hand
anterior fingers 1-3.5 and thenar= Median
anterior fingers 3.5-4 and hypothenar=ulnar
posterior 1-3.5 are radial
posterior 3.5-5 is ulnar
upper brachial plexus injury
from falls or birth injury that stretches C5 and C6 nerve root
causes waiter’s tip position
upper brachial plexus injury
from falling and holing on to something, or birthing injury, or TOS, that damages C8 and T1
weakness and numbness of the hands and arms due to compressed neurovascular supply
*Roo’s and Adson’s test
Long thoracic n. injury
compression bw the clavicle and 1st rib
damage in the C5-7 region
causes weakness in serratus anterior —>wining of scapula
median n injury
damage in the C6-T1 region proximally or distally
weakness in forearm pronation, atrophy of thenar muscles
paresthesias or loss to lateral palm, thumb, index
causes ape hand
**resisted pronation
anterior interosseus neuropathy
pronator teres impingement of anterior interosseous n.
trauma
test: pinch grip in “OK” sign
ulnar n. injury
fracture of the humerus near the medial epicondyle
cubital tunnel syndrome, entrapment at Guyon’s
damage in the C6-C8, causes claw hand due to weak wrist flexion and adduction
radial n. injury
fx of humerus, saturday night palsy
damage in the C7-T1 region
causes wrist drop, weak extensors, decreased sensation on posterior side of hand
Tinels sign
sciatic n. injury
causes: disc compression on L4 or L5 root
piriformis syndrome, post hip dislocation, IM injection, trauma
causes sciatica or steppage gait
trendelenburg gait
weak hip abductors and ext rotators (glut. med)
weal GM is on the standing side, cannot hold up opposite level
lateral femoral cutaneous n injury
caused by compression at the iliac crest (belts, seats, bellies)
numbness over the lateral thigh (neuralgia paresthetica)
common fibular n. injury
impingement by piriformis, fibular fx, varus stretch, compression by casting, surgery
causes paralysis of dorsiflexors and everter , loss of sensation on anterior leg and dorsum of foot
causes foot drop, high stepping gait, and foot slap
superficial fibular injury
same causes as common fib
results in paralysis of everters, NO foot drop, just loss of sensation on anterior/lateral leg
deep fibular injury
caused by anterior compartment syndrome, anterior tarsal tunnel syndrome, pes Cavus, tight shoe laces, trauma
causes weak dorsiflexors and foot drop
