REVIEW DSA Compression Neuropathy

Question 1

define neuropathy

Answer 1

functional or pathological changes in PNS

Question 2

define compression neuropathy

Answer 2

process where nerve becomes entrapped as it passes through narrow tunnel or passage

Question 3

what are the biomechanical causes of neuropathy? (4)

Answer 3

space occupying lesions: herniated discs, cysts

degenerative: foraminal stenosis

post-traumatic: fracture, hematoma, compression

mechanical: muscle spasm, pinching

Question 4

list the systemic causes of neuropathy (3)

Answer 4

pregnancy

hypothyroidism

diabetes

Question 5

describe the 3 layers of a nerve

Answer 5

epineurium: fascicles, blood vessels, connective tissue

perineurium: covers fascicles / groups of axons

endoneurium: covers myelin sheath over axons

Question 6

what are the pathological changes associated with neuropathy (4)

Answer 6

epineurium thickening

myelin thinning disortion

microtubule closure

axonal degeneration

Question 7

List the 5 degrees of compression nerve injuries according to Sutherland’s Classification

Answer 7

1st: neuropraxia: focal damage of myelin; connective tissue sheath intact

2nd: axonotmesis: axon injury; myelin sheath intact

3rd: disruption of axon & endoneurium

4th: disruption of axon, endoneurium & perinerium

5th: disruption of axon, endoneurium, perineurium, epineurium

Question 8

list the 3 common sites for radial nerve entrapment

Answer 8

high on humerus

radial tunnel

at the wrist

Question 9

describe symptoms and treatment of high humeral radial nerve entrapment

Answer 9

Sx: wrist drop, weak elbow flex, possible tricep reflex diminshed, pain / numbness

Tx: restored fxn 4-5months

Question 10

describe the symptoms for radial tunnel radial nerve entrapment

Answer 10

Sx: pain & tenderness 5cm distal to lateral epicondyle

wrist drop or pain w/ resisted supination

Question 11

describe symptoms of radial nerve entrapment at the wrist

Answer 11

pinching of nerve during forearm pronation, sensation changes over posterolateral hand

Question 12

pain with resisted forearm pronation and finger cramping indicates which nerve damage?

Answer 12

median n.

Question 13

anterior interosseous syndrome is an injury in what nerve?

what is the testing?

Answer 13

median n.

have pt. make “OK” sign

Question 14

Pt. has parasthesia of their 4th and 5th digits, medial elbow pain with decreased intrinsic m. strength, sx are reproduced with elbow flexion and wrist extension, what sign do you expect to be positive? how do you treat?

Answer 14

ulnar n. entrapment (cubital tunnel syndrome)

+ Tinel’s sign, + Froment’s sign

tx: padded elbow sleeve to limit terminal elbow flexion and provide cushioning

Question 15

what causes carpal tunnel syndrome?

Answer 15

medial n. entrapment as it passes under flexor retinaculum

Question 16

What sx do you see with carpal tunnel syndrome?

diagnosis?

Answer 16

nighttime numbness of lateral 3.5 digits, tingling, wrist pain, thenar atrophy

dx: EMG

Question 17

what is thoracic outlet syndrome?

symptoms?

Answer 17

compression of the brachial plexus &/or subclavian vessels

Stx: weakness, paresthesia of medial arm / forearm / hand

Question 18

what are the sites of compression in thoracic outlet syndrome? (3)

Answer 18

scalene triangle

costoclavicular passage

pec minor attachment at coracoid process

Question 19

what tests are done for thoracic outlet syndrome?

Answer 19

Question 20

what is the cause of meralgia paresthetica?

Answer 20

compression of lateral femoral cutaneous n. under inguinal ligament at inguinal canal

Question 21

what are causes of meralgia paresthetica? (4)

Answer 21

intense athletics

obesity

tight belt / clothing / seat belt (MVA)

anatomic anomaly

Question 22

what are the symptoms of meralgia paresthetica? (3)

Answer 22

numbness or burning pain anterolateral thigh

hyperesthesia (skin sensitivity) + trophic skin changes

(+) Tinnel sign 1cm inferomedial to ASIS

Question 23

where does compression in the common fibular nerve (L4-S2) occur?

Answer 23

as nerve winds around fibular neck and enters fibular tunnel

Question 24

what are causes of common fibular nerve compression? (4)

Answer 24

bedridden

time spent in squatting “strawberry picker”

ankle sprain

lithotomy childbirthing position

Question 25

what is tarsal tunnel syndrome?

Answer 25

compression of posterior tibial nerve in tarsal tunnel behind medial malleolus

Question 26

list causes of tarsal tunnel syndrome (4)

Answer 26

50% idiopathic

lesion (cyst, lipoma etc.)

trauma

autoimmune / congenital / diabetes

Question 27

symptoms of tarsal tunnel syndrome?

treatment?

Answer 27

plantar surface pain

vague burning / tingling/ numbness

tx: MFR, HVLA

Question 28

define anterior tarsal tunnel syndrome

symptoms?

Answer 28

compression of deep fibular nerve at inferior extensor retinaculum

Stx: dorsomedial foot pain, worst at rest, weakness of extensor digitorum brevis

Question 29

etiology of anterior tarsal tunnel syndrome? (4)

Answer 29

trauma

talonavicular dysfunction

prolonged plantar flexion

compression from shoes