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PHTH 7212 Pathophysiology > pns injuries of the ue powerpoint from dr shappy > Flashcards

pns injuries of the ue powerpoint from dr shappy Flashcards

1
Q

What is a GTO

A

Golgi tendon organ, a proprioceptor that monitors level of tension in the muscle. Found in the tendon.

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2
Q

muscle Spindles

A

-serve as mechanoreceptors- lie parallel to muscle fibers; respond to muscle stretching

A type of proprioceptor

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3
Q

Afferent neuron

A

carries info towards brain

(sensory)

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4
Q

Efferent neuron

A

carries signals to tissues

(motor)

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5
Q

3 Layers of connective tissue covering a nerve fiber

A

Epineurium

Perineurium

Myelin sheath (like insulator on an extension cord)

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6
Q

What can cause Peripheral nerve response to injury? (5)

A
  1. Compression/Trauma
  2. Heredity
  3. Infections
  4. Toxin
  5. Metabolic
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7
Q

What are two Peripheral Nerve break down responses to injury?

A

Demylination - typically segmental

or

Degeneration - more severe (Anterograde/Wallerian)

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8
Q

Compression of a nerve can start the inflammation process due to ____________.

A

Lack of oxygen

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9
Q

Saturday night palsy

A

Radial nerve compression against the spiral groove of the humerus -> weak wrist and finger extension, weak brachioradialis reflex, normal triceps

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10
Q

Erbs Palsy

A

Superior Brachial Plexus injury. Caused by excessive separation of the head and neck such as falling with shoulder on ground, or excessive stretching during baby delivery

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11
Q

Demyelination is typically _____.

A

segmental

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12
Q

Is nerve demyelination or degeneration more severe?

A

degeneration

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13
Q

What are two names for the same type of nerve degeneration?

A

Anterograde degeneraton

Wallerian degeneration

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14
Q

wallerian degeneration

A

Changes that occur in a axon that has been injured. It is degeneration that occurs distally, specifically to the myelin sheath and axon.

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15
Q

PN Regeneration

A

a slow process, axonal sprouting - can get lost and not find correct endoneurial tube

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16
Q

What is an endoneurial tube, and what is its role in axon regeneration?

A

Endoneurial tube consists of endoneurium, Schwann cells, and myelin sheath that serve to guide axon growth.

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17
Q

PN reinnervation

A

can occur when adjacent neuron innervates muscle fibers of injured neuron, collateral sprouting

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18
Q

What are two Peripheral Nerve break down responses to injury?

A

Regeneration - axonal sprouting that re-connects original nerve (slow and can get lost)

Or

Reinnervation - adjacent neuron innervates muscle fibers of injured neuron through collateral sprouting

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19
Q

what are some other ways besides a strain, sprain, or fracture that a peripheral nerve can be injured?

A
  1. metabolic,
    • such as Na imbalance
  2. genetic
  3. chemical, such as
    • bug bite
  4. Virus
  5. Surgery
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20
Q

describe what is going on in the picture

A
  1. Injury
  2. nerve retracts (anterograde/wallerian degeneration) & rest of the nerve dies. Atrophy very quick.
  3. Regeneration: Sprouting. (in this case it is finding the cone). Lots of atrophy happens quickly.
  4. nerve continues to heal. Oligodendrocytes regenerate myelin. Innervated muscle hypertrophy
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21
Q

describe the picture

A
  1. nerve is cut with scapule
  2. separation (we don’t have specifics for this)
  3. Wallerian degeneration - retraction of nerve and break down of part distal to cut
  4. after 72 hrs axonal sprouting and macrophages clear out old dying part of nerve in inflammatory process.
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22
Q

Three classifications of nerve injury

A
  1. Neuropraxia - caused by mild ischemia
    • segmental demyelination blocking conduction
  2. Axonotmesis - prolonged compression & necrosis
    • axon damage connective tissue intact
  3. Neurotmesis - complete severance of axon & disruption of connective tissue
    • gun shot, stab (can be surgical) or avusion
    • muscle fiber atrophy due to loss of trophic substance
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23
Q

Neuropraxia

A

A segmental demyelination blocking conduction caused by mild ischemia

usually takes only minutes to get better (hopefully not hours)

one of three classifications of nerve injury

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24
Q

Axonotmesis

A

Axon damaged, but connective tissue intact

Cone doesn’t need to develop because there is not wallerian degeneration

one of three classifications of nerve injury

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25
Q

Neurotmesis

A

Complete severance of axon and disruption of connective tissue

  • gun shot, stab (can be surgical) or evulsion
  • muscle fiber atrophy due to loss of trophic substances (nutrients from nerve)

one of three classifications of nerve injury

26
Q

Trophic substances

A

growth and survival factors

27
Q

Five classifications of neuropathy

A
  1. Mononeuropathy - single peripheral nerve injured
  2. Polyneuropathy - several peripheral nerves injured
  3. Radiculoneuropathy or Radiculopathy - nerve root injury
  4. Polyradiculitis - infection creating inflammation of several nerve roots
  5. Myopathy - motor endplate injury
28
Q

mononeuropathy

A

single peripheral nerve injured (may not even know you are injured)

can be mild to severe

29
Q

Polyneuropathy

A

several peripheral nerves injured

does not mean all types of nerves are involved. It just means more than one nerve is involved

can be mild to severe

30
Q

the other name for radiculoneuropathy

A

radiculopathy

31
Q

the other name for radiculopathy

A

radiculoneuropathy

32
Q

Radiculoneuropathy/Radiculopathy

A

a nerve root injury

can be mild to severe

33
Q

Polyradiculitis

A

infection creating inflammation of several nerve roots

can be mild to severe

34
Q

Myopathy

A

motor endplate injury

can be mild to severe

35
Q

myelopathy

A

any pathologic condition of spinal cord; usually from compression, toxic, or altered metabolic states

36
Q

Signs and symptoms of pheripheral dysfunction

A
  • Sensory loss - tingling, numbness, burning, etc Motor loss - weakness, hypotonia or flaccid
    • pareis or paralysis - peripheral distribution
    • Weakness - myotome distribution or that of spinal nerve
  • Autonomic Loss - vascular, sweating, hair loss, skin
37
Q

Signs and symptoms of peripheral dysfunction: Sensory loss

A
  • Sensory loss- tingling, numbness, burning, etc.
    • Peripheral distribution
    • Nerve root- dermatome
      • Distal first- stocking glove distribution
38
Q

Signs and symptoms of peripheral dysfunction: Motor Loss

A

Motor loss- weakness, hypotonia or flaccid

  • Paresis or Paralysis- peripheral distribution
  • Weakness- myotome distribution of that spinal nerve
39
Q

hypotonia

A

low muscle tone

40
Q

Signs and symptoms of peripheral dysfunction: Autonomic Loss

A

• Autonomic loss- – Vascular, sweating, hair loss, skin

41
Q

If your pt has pronator teres syndrome, you can _________.

A

stretch pronator teres to get more room in pronator teres muscle

42
Q

Two common median nerve entrapments:

A
  1. Pronator teres syndrome
  2. Carpal Tunnel Syndrome
43
Q

Three Signs and symptoms of median nerve compression (carpal tunnel and pronator teres syndromes)

A
  1. Elbow pain - pronator teres syndrome (can be misdiagnosed as medial epicondylitis)
  2. Sensory issue - median nerve distribution
  3. Motor: Intrinsic hand muscles, Thenar Eminence.
44
Q

Treatment for Median Nerve compression

A
  1. Eliminate trauma - (computer/mouse)
  2. Soft Tissue Work
  3. Modalities
  4. Neural Gliding/flosing
  5. Stretching
  6. Strengthening

(also can use a cockup splint or brace)

45
Q

Carpal Tunnel surgery

A
  • Don’t cut median nerve!
  • do Scar Mobs afterwards
  • Used to use a scalpel but now they have a stitch- ripper thing.
  • Also endoscopic now
46
Q

Two common Ulnar nerve entrapments

A

Ulnar Groove Syndrome

or

Gyon Canal Syndrome

47
Q

Signs and symptoms for Ulnar entrapments

A
  • Medial elbow - groove for ulnar nerve swelling/tenderness (ulnar groove syndrome)
  • Sensory - ulnar nerve distribution of hand
  • Motor - intrinsic hand, hypothenar eminence
48
Q

Treatment for Ulnar Nerve entrapments

A
  1. Eliminate Trauma - bike handle bars for gyon’s
  2. Soft tissue work
  3. Modalities
  4. Neural gliding/flossing
  5. Stretching
  6. Strengthening

(stretch, strengthen, and functionally retrain)

49
Q

Two Radial Nerve Entrapments

A

Wartenberg’s Syndrome (entrapment of the superficial branch of the Radial nerve between brachioradialis and ECRL tendons during pronation)

Supinator Syndrome/Radial Tunnel Syndrome (entrapment of the deep branch of the radial nerve close to the supinator muscle)

50
Q

Wartenberg’s Syndrome

A

entrapment of the superficial branch of the Radial nerve between brachioradialis and ECRL tendons during pronation

Tell-tail sign is abduction of the fifth digit

51
Q

Supinator Syndrome/Radial Tunnel Syndrome

A

entrapment of the deep branch of the radial nerve close to the supinator muscle

52
Q

Tell tail sign of Wartenburg’s Syndrome

A

abduction of the fifth digit

53
Q

Signs and symptoms of Wartenburg’s Syndrome

A
  • Watch strap or Handcuff
  • Tight cast or splint
  • Paresthesia
    • Tingling, numbness, burning over radial distribution
  • Weakness?
    • No intrinsic muscle innervation
54
Q

Thoracic outlet syndrome (T.O.S) (outlet)

A

General term referring to compression of neurovascular structures as they exit the thoracic outlet (1st rib, clavicle, scalene muscles)

55
Q

What bad thing could happen from carrying ruck sacks, back packs, or golf bags?

A

Suprascapular Nerve

and/or

Axillary Nerve Compression

56
Q

paresis

A

partial or slight paralysis of muscles

57
Q

TOS Signs & Symptoms (sensory & motor)

A

Sensory:

  • Tingling, Numbness, Burning
  • Distribution of the Root, trunk, division, cord

Motor

  • Paresis or paralysis
  • Distribution of involved nerve
58
Q

Complex Regional Pain Syndrome (CRPS)/Reflex Sympathetic Dystrophy (RSD)/Causalgia

A
  • Pain- greater than expected for amount of trauma
  • Post injury, trauma, surgery
  • Vasomotor/thermal- temperature issues
  • Skin- Shinny, dry, sweaty, erythema, hair loss
  • Touch- Hypersensitive, Semmes Weinstein monofilament testing
59
Q

Two more names for Complex Regional Pain Syndrome

A

Reflex Sympathetic Dystrophy (RSD)

Causalgia

60
Q

Two more names for Reflex Sympathetic Dystrophy (RSD)

A

Complex Regional Pain Syndrome

Causalgia

61
Q

Two more names for Causalgia

A

Complex Regional Pain Syndrome

Reflex Sympathetic Dystrophy (RSD)

PHTH 7212 Pathophysiology (12 decks)

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