PNS exam

Question 1

primary presentation of PNS disorder

Answer 1

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….)

Question 2

dysesthesia

Answer 2

all types of abnormal sensation including pain regardless of stimulant

Question 3

paresthesia

Answer 3

tingling, pins and needles, WITHOUT pain and WITHOUT stimulus

Question 4

hyperesthesia

Answer 4

pain in response to touch (reproducing their DISCOMFORT)

Question 5

hypoesthesia

Answer 5

reduced sensation to touch

Question 6

hyperalgesia

Answer 6

severe pain in response to mildly painful stimulus

Question 7

allodynia

Answer 7

non-painful stimulus perceived as painful on the skin, often severe

Question 8

proximal weakness

Answer 8

combing hair, getting out of a chair, worse with repeated effort

Question 9

distal weakness

Answer 9

open a jar, writing, tripping `

Question 10

increased DTRs

Answer 10

CNS problems

Question 11

decreased DTRs

Answer 11

PNS problem

Question 12

brachioradialis

Answer 12

C5 and C6

point end into PROXIMAL muscle belly, flat end on distal tendon

Question 13

biceps

Answer 13

C5 C^

point end onto thumb lying over tendon

Question 14

triceps

Answer 14

C6C7

flat or point end on triceps tendon above olecranon

Question 15

patellar

Answer 15

L2,3,4

flat endo on patellar tendon

Question 16

Achilles

Answer 16

S1

flat end on tendon above calc

Question 17

plantar

Answer 17

babinski
L5-S1
downgoing is normal, toes curl

Question 18

upper motor neuron lesions

Answer 18

**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

Question 19

LMN lesions

Answer 19

flaccid paralysis 
muscle atrophy, wasting 
hyporeflexia 
normal superficial reflexes 
Polio, GBS, ALS

Question 20

dermatomes of the hand

Answer 20

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

Question 21

upper brachial plexus injury

Answer 21

from falls or birth injury that stretches C5 and C6 nerve root
causes waiter’s tip position

Question 22

upper brachial plexus injury

Answer 22

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

Question 23

Long thoracic n. injury

Answer 23

compression bw the clavicle and 1st rib

damage in the C5-7 region
causes weakness in serratus anterior —>wining of scapula

Question 24

median n injury

Answer 24

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

Question 25

anterior interosseus neuropathy

Answer 25

pronator teres impingement of anterior interosseous n.
trauma

test: pinch grip in “OK” sign

Question 26

ulnar n. injury

Answer 26

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

Question 27

radial n. injury

Answer 27

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

Question 28

sciatic n. injury

Answer 28

causes: disc compression on L4 or L5 root
piriformis syndrome, post hip dislocation, IM injection, trauma
causes sciatica or steppage gait

Question 29

trendelenburg gait

Answer 29

weak hip abductors and ext rotators (glut. med)

weal GM is on the standing side, cannot hold up opposite level

Question 30

lateral femoral cutaneous n injury

Answer 30

caused by compression at the iliac crest (belts, seats, bellies)

numbness over the lateral thigh (neuralgia paresthetica)

Question 31

common fibular n. injury

Answer 31

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

Question 32

superficial fibular injury

Answer 32

same causes as common fib

results in paralysis of everters, NO foot drop, just loss of sensation on anterior/lateral leg

Question 33

deep fibular injury

Answer 33

caused by anterior compartment syndrome, anterior tarsal tunnel syndrome, pes Cavus, tight shoe laces, trauma

causes weak dorsiflexors and foot drop