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(3) Neurological Examination > S3_L3: Peripheral Nerve Injury > Flashcards

S3_L3: Peripheral Nerve Injury Flashcards

1
Q

Motor fibers and skeletal muscles are innervated by what neurons?

A

Alpha and Gamma

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2
Q

A loose collection of collagen and elastin fibers that support the fascicles of a peripheral
nerve and serves as the outermost covering of a neuron. This structure protects the whole nerve bundles by acting as a shock absorber of stress.

A

epineurium

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3
Q

The (1)____ contains the axon and Schwann cell in a grouped arrangement. These fascicles are in turn contained by the (2)____ which maintains a positive intrafascicular pressure.

A
  1. endoneurium
  2. perineurium
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4
Q

TRUE OR FALSE: The peripheral and central nervous system are a continuous
tract.

A

True

Source: Butler, 1991

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5
Q

During movement, tension is placed on the nerve bed causing nerve gliding towards the moving joint. This is referred to as?

A

convergence

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6
Q

During movement, tension is relieved causing nerve gliding away from the moving joint. This is referred to as?

A

divergence

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7
Q

TRUE OR FALSE: The nervous system is structurally and functionally continuous seen in connective tissue and for impulse transmission, the chemical flow of neurotransmitters, and the provision of feedback to other connective tissue in the body.

A

True

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8
Q

Nervous system mobility is allowed without undue stress because the arrangement of the spinal cord, nerve roots, and plexus allows mobility. The nerves themselves are wavy and can straighten when tension is applied, and the connective tissue around the nerves absorb tensile forces before the nerve itself stretches.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false

A

C. Both statements are true

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9
Q

TRUE OR FALSE: In peripheral nerve injury, there’s only one nerve affected, but not to the point of the whole structure of the nerve coming from a segment of the spinal cord, affecting other regions of the body.

A

True

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10
Q

Differential diagnosis of tissues based on stretch or tension

  1. Dull, then sharp pain
  2. Burning, bright, lightning-like pain
  3. Cramping, dull, aching pain

A. Contractile tissue
B. Inert tissue (Ligaments)
C. Neurogenic tissue
D. A and B only
E. All of the above

A
  1. B
  2. C
  3. A
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11
Q

Differential diagnosis of tissues based on stretch or tension

  1. Intermittent symptoms
  2. No tingling felt
  3. Longer symptom duration

A. Contractile tissue
B. Inert tissue (Ligaments)
C. Neurogenic tissue
D. A and B only
E. All of the above

A
  1. D
  2. D
  3. C
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12
Q

Differential diagnosis of tissues based on stretch or tension

  1. Soft tissue stretch
  2. Muscle spasm resistance to stretch
  3. Boggy, hard capsular resistance to stretch

A. Contractile tissue
B. Inert tissue (Ligaments)
C. Neurogenic tissue
D. A and B only
E. All of the above

A
  1. C
  2. A
  3. B
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13
Q

Peripheral nerves are a unique type of ___ tissue – these tissues are not contractile but are necessary for the normal functioning of voluntary muscles

A

inert

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14
Q

Enumerate the 5 forces / conditions that nerves are most commonly affected by.

A
  1. Pressure
  2. Friction
  3. Traction
  4. Anoxia
  5. Cutting
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15
Q

Once the nerve cannot accommodate anymore the tensile load, this will now lead to biomechanical injury. The most common biomechanical injury results from these 3 forces placed on the nerve.

A

friction, compression, and stretch

Note: Secondary injury can be from blood or edema

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16
Q

If lesion occurs at level of spinal artery (as the nerve exits), it is referred to as:

A

nerve root avulsion (especially if there’s fracture on the level of spinal column)

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17
Q

Compression at the level of spinal cord is referred to as:

A

myelopathy

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18
Q

Lesion of the nerve as it exits at the intervertebral foramina (with associated pathologic conditions like compression of nerve root) is referred to as:

A

radiculopathy

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19
Q

nerve injury that happened at level of brachial plexus is referred to as:

A

plexopathy

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20
Q

TRUE OR FALSE: Peripheral nerve injury happens between the level of plexuses and muscle fiber while it is sending signals, it’s where the common injury like friction, compression, and stretch happens.

A

True

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21
Q

Examples of PNI:
1. Pressure on the (1)___ nerve in the carpal tunnel
2. Traction to the (2)___ nerve at the head of the fibula during a lateral ankle sprain
3. Friction to the (3)___ nerve in the cubital tunnel

A
  1. median
  2. common peroneal
  3. ulnar
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22
Q

Examples of PNI:
1. Anoxia of the anterior tibial nerve in a (1)___ syndrome
2. Cutting of the radial nerve with a fracture of the (2)___.
3. Cooling, freezing, and thermal or electrical injury may also affect peripheral nerves

A
  1. compartment
  2. humeral shaft
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23
Q

Enumerate the 4 common sites of nerve injury

A
  1. Tunnels (where they are compressed)
  2. Branches of nervous system
  3. Points where nerve is relatively fixed when passing close to rigid structures (e.g. in between 2 bones contacting with one another)
  4. At specific tension points
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24
Q

Nerve injury that affects conducting tissues or
connective tissues of the nerve

A

Intraneural

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25
Q

Nerve injury that affects the nerve bed, adhesions of epineurium to another tissues, and swelling of tissue adjacent to a nerve.

A

Extraneural

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26
Q

Classification of nerve injury

  1. worst type of nerve injury
  2. most common
  3. only the axon was severely damaged that resulted in degeneration

A. Neuropraxia
B. Axonotmesis
C. Neurotmesis

A
  1. C
  2. A
  3. B
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27
Q

Classification of nerve injury

  1. Superficial nerves are exposed to this type of
    compression or injury
  2. Whole nerve is destroyed or cut
  3. Feels numbness that will resolve by flicking or after a few days

A. Neuropraxia
B. Axonotmesis
C. Neurotmesis

A
  1. A
  2. C
  3. A
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28
Q

Classification of nerve injury: A transient physiological block caused by ischemia from pressure or stretch of the nerve with no Wallerian degeneration
A. Neuropraxia
B. Axonotmesis
C. Neurotmesis

A

A. Neuropraxia

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29
Q

Classification of nerve injury: Internal architecture of nerve is preserved but
axons are so badly damaged that Wallerian
degeneration occurs
A. Neuropraxia
B. Axonotmesis
C. Neurotmesis

A

B. Axonotmesis

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30
Q

Classification of nerve injury: Structure of nerve is destroyed by cutting, severe scarring, or
prolonged severe compression
A. Neuropraxia
B. Axonotmesis
C. Neurotmesis

A

C. Neurotmesis

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31
Q

Classification of nerve injury

  1. Proprioception affected
  2. No or minimal muscle wasting
  3. Sensation is restored before motor function

A. Neuropraxia
B. Axonotmesis
C. Neurotmesis

A
  1. A
  2. A
  3. B
32
Q

Classification of nerve injury

  1. Recovery time: months and only with surgery
  2. Recovery time: minutes to days
  3. No pain (anesthesia)

A. Neuropraxia
B. Axonotmesis
C. Neurotmesis

A
  1. C
  2. A
  3. C
33
Q

Axons regenerate at the rate of ____

A

1 inch/month or 1 mm/day

Note: Axonotmesis recovery time is months

34
Q

TRUE OR FALSE: A stretch of the peripheral nerve beyond 10%-20% of its resting length increases the risk of axonotmesis. This is the common mechanism of injury during joint
dislocations.

A

True

Source: De Lisa

35
Q

TRUE OR FALSE: The best predictor of outcome for regeneration is two-point discrimination which positively correlates with a return
of function.

A

True

36
Q

TRUE OR FALSE: A nerve percussion sign is indicative of demyelination/remyelination.

A

True

Note: When the nerve percussion sign progresses from a proximal location in the nerve to more distal segments, healing is
taking place by regenerating sprouts & incomplete myelination.

37
Q

TRUE OR FALSE: The best diagnostic tool to confirm and stage an entrapment neuropathy is the electrodiagnostic evaluation.

A

True

38
Q

Facial Nerve (Bell’s Palsy) site of mechanism of injury or compression

A

As it emerges from the stylomastoid foramen

39
Q

The following are the correct joint positioning for ULNT/ULTT 1, EXCEPT:
A. Shoulder depression and abduction (110°)
B. Elbow extension
C. Forearm supination
D. Wrist, fingers, and thumb extension
E. Cervical contralateral side flexion
F. None of the above

A

F. None of the above

40
Q

The following are the correct joint positioning for ULNT/ULTT 2, EXCEPT:
A. Shoulder external rotation, depression and abduction (10°)
B. Elbow extension
C. Forearm supination
D. Wrist, fingers, and thumb flexion
E. Cervical contralateral side flexion
F. None of the above

A

D. Wrist, fingers, and thumb flexion

41
Q

The following are the correct joint positioning for ULNT/ULTT 3, EXCEPT:
A. Shoulder medial rotation, depression and abduction (110°)
B. Elbow extension & forearm pronation
C. Wrist flexion and radial deviation
D. Fingers and thumb flexion
E. Cervical contralateral side flexion
F. None of the above

A

C. Wrist flexion and radial deviation

It should be ulnar deviation

41
Q

The following are the correct joint positioning for ULNT/ULTT 4, EXCEPT:
A. Shoulder lateral rotation, depression and abduction (10° to 90°), hand to ear
B. Elbow flexion, forearm supination or pronation
C. Wrist extension and radial deviation
D. Fingers and thumb extension
E. Cervical contralateral side flexion
F. None of the above

A

F. None of the above

42
Q

Nerve Bias

  1. Radial nerve
  2. Median nerve, anterior interosseous nerve, C5, C6, C7
  3. Ulnar nerve, C8, and T11 nerve roots
  4. Musculocutaneous nerve
  5. Axillary nerve, median nerve

A. ULNT/ULTT 1
B. ULNT/ULTT 2
C. ULNT/ULTT 3
D. ULNT/ULTT 4

A
  1. C
  2. A
  3. D
  4. B
  5. B
42
Q

Considered as the gold standard of low back functional outcome tools

A

Oswestry low back pain disability questionnaire

43
Q

The theory of this lesion is that, whereas
compression or pathology at one point along a peripheral nerve or nerve root may not be sufficient to cause signs and symptoms, compression or pathology at two or more points may lead to a cumulative effect that results in apparent signs and symptoms

A

Double-crush syndrome or double-entrapment neuropathy

44
Q

Signs and symptoms of mixed peripheral nerve lesions

  1. Nail changes (striation, ridges, dry, brittle,
    abnormal curving, luster lost)
  2. Fibrosis, contractures, and adhesions
  3. Disuse osteoporosis of the bone
  4. Ulceration
  5. Loss of pilomotor response

A. Motor
B. Sensory
C. Sympathetic

A
  1. B
  2. A
  3. A
  4. B
  5. C
45
Q

Signs and symptoms of mixed peripheral nerve lesions

  1. Skin maybe scaly early, then thin, smooth, shiny later
  2. Shallower skin creases
  3. Loss of vasomotor tone: war flushed
    (early); cold and white (later)
  4. Growth affected

A. Motor
B. Sensory
C. Sympathetic

A
  1. B
  2. B
  3. B
  4. A
45
Q

Special test considerations
1. Patient’s ability to (1)___
2. Presence of pain and the patient’s perception of the pain
3. Presence of (2)___
4. (3)___ of the clinician
5. Ability and confidence of the clinician

A
  1. relax
  2. patient apprehension
  3. skill
46
Q

Test to confirm a tentative diagnosis given by the doctor, make a differential diagnosis, differentiate between structures, understand unusual signs, and unravel difficult signs and symptoms

A

Provocative test

47
Q

This test is applied whenever provocative tests are given to enhance/see the symptoms for
confirmatory diagnosis.

A

Tension test

48
Q

Site of entrapment

  1. Accessory rib
  2. Pancoast tumor
  3. Flexor retinaculum (carpal tunnel)
  4. Guyon’s canal
  5. Hypothenar eminence

A. Median nerve
B. Thoracic outlet syndrome
C. Radial nerve
D. Ulnar nerve
E. Cervical/thoracic neurovascular bundle
F. B and E only

A
  1. B
  2. B
  3. A
  4. D
  5. D
49
Q

Site of entrapment

  1. Elbow (ulnar sulcus, heads of the flexor
    carpi ulnaris, cubital tunnel)
  2. Scalene muscles
  3. Circumflex portion at midhumerus
  4. Arcade of Frohse
  5. Proximal to supinator
    margin

A. Median nerve
B. Thoracic outlet syndrome
C. Radial nerve
D. Ulnar nerve
E. Cervical/thoracic neurovascular bundle
F. B and E only

A
  1. D
  2. F
  3. C
  4. C
  5. C
50
Q

Site of entrapment

  1. Lancinate ligament (tarsal tunnel)
  2. Along the pelvis
  3. Fibular head
  4. Iliac crest and anterior superior iliac spine
  5. Exiting the pelvis

A. Lateral femoral cutaneous nerve or Meralgia Paresthetica (Bernhardt-Roth
Syndrome)
B. Peroneal nerve
C. Tibial nerve

A
  1. C
  2. A
  3. B
  4. A
  5. A
51
Q

Significance of tests for neurological symptoms

  1. Pinch Grip Test
  2. Chvostek test
  3. Wartenberg Sign
  4. Tinel Sign (at the Elbow)

A. Facial nerve injury
B. Ulnar nerve
C. Anterior interosseous nerve (branch of the
median nerve)
D. Median nerve

A
  1. C
  2. A
  3. B
  4. B
52
Q

Significance of tests for neurological symptoms

  1. Test for Pronator Teres Syndrome
  2. MacKinnon’s Scratch Collapse Test
  3. Elbow Flexion Test
    or Cubital tunnel compression test

A. Facial nerve injury
B. Ulnar nerve
C. Anterior interosseous nerve (branch of the
median nerve)
D. Median nerve

A
  1. D
  2. B
  3. B
53
Q

Significance of tests for neurological symptoms

  1. Egawa’s Sign
  2. Carpal Compression Test
  3. Flick Maneuver
  4. Ninhydrin Sweat Test

A. Relief of nerve compression
B. Ulnar nerve
C. Positive test for nerve
lesion, autonomic problem
D. Median nerve
E. Nerve denervation

A
  1. B
  2. D
  3. A
  4. C
54
Q

Significance of tests for neurological symptoms

  1. Reverse Phalen’s test
  2. Tinel’s sign (at wrist)
  3. Froment’s “Paper” Sign
  4. Phalen’s (Wrist Flexion) Test
  5. Wrinkle (Shrivel) Test

A. Relief of nerve compression
B. Ulnar nerve
C. Positive test for nerve
lesion, autonomic problem
D. Median nerve
E. Nerve denervation

A
  1. D
  2. D
  3. B
  4. D
  5. E
55
Q

Significance of tests for neurological symptoms

  1. SLR (basic) or Lasègue’s Test
  2. SLR 2
  3. SLR 3
  4. SLR 4
  5. Homan’s Sign
  6. Dorsiflexion-eversion test

A. Sural nerve
B. Common peroneal nerve
C. Sciatic and tibial nerves
D. Positive sign of tarsal
tunnel syndrome
E. Deep vein thrombophlebitis

A
  1. C
  2. C
  3. A
  4. B
  5. E
  6. D
56
Q

The following are components in SLR (basic) or Lasègue’s Test, except:
A. Hip flexion
B. Knee extension
C. Ankle dorsiflexion
D. None of the above

A

D. None of the above

57
Q

The following are components in SLR 2, except:
A. Hip flexion
B. Knee extension
C. Ankle dorsiflexion
D. Eversion
E. Extension of toes
F. None of the above

A

F. None of the above

58
Q

The following are components in SLR 3, except:
A. Hip flexion
B. Knee extension
C. Ankle dorsiflexion
D. Inversion
E. Extension of toes
F. None of the above

A

E. Extension of toes

No movement is done on toes

59
Q

The following are components in SLR 4, except:
A. Hip flexion
B. Knee extension
C. Ankle plantarflexion
D. Inversion
E. None of the above

A

E. None of the above

60
Q

This nerve is injured as it passes through the suprascapular notch under the transverse scapular (suprascapular) ligament or as it winds around the spine of the scapula under the spinoglenoid ligament in people who work with their arms overhead or in activities involving cocking and following through (e.g., volleyball
spiking, pitching)

A

Suprascapular Nerve
(C5 to C6)

61
Q

Site of entrapment of this nerve is through anterior dislocation of the shoulder or fracture of the neck of the humerus

A

Axillary (Circumflex)
nerve (C5 to C6)

NOTE: It is the most common injured nerve in the shoulder

62
Q

TRUE OR FALSE: The musculocutaneous
nerve (C5 to C6) may be injured by trauma
(e.g., humeral dislocation or fracture) or in conjunction with injury to the brachial plexus
or adjacent axillary artery.

A

True

63
Q

This condition’s site of entrapment is at the cubital tunnel (ulnar groove between medial epicondyle and olecranon).

A

Cubital Tunnel Syndrome

64
Q

“The patient flexes the middle digit and then
alternately deviates the finger radially and
ulnarly. The test is positive if the patient is unable to do this due to
affectation of dorsal interossei.”

What special test was described?

A

Egawa’s sign

64
Q

The examiner passively spreads the fingers
apart and asks the patient to bring them together again. The test is positive if: inability to squeeze the little finger to the
remainder of the hand.”

A

Wartenberg Sign

65
Q

Determine the corresponding dermatome of the following nerve roots

  1. Temple, forehead, occiput
  2. Deltoid, lateral aspect of arm and elbow
  3. Entire neck, posterior cheek, temporal
    area
  4. Vertex of Skull
  5. Shoulder (supraclavicular), clavicle, upper
    scapula

A. C1
B. C2

C. C3
D. C4
E. C5

A
  1. B
  2. E
  3. C
  4. A
  5. D
66
Q

Determine the corresponding dermatome of the following nerve roots

  1. Medial arm, Axillary area
  2. Medial forearm, Little finger
  3. Lateral aspect of forearm, thumb
  4. Index, Middle and Ring fingers
  5. Medial forearm, Medial elbow

A. C6
B. C7

C. C8
D. T1
E. T2

A
  1. E
  2. C
  3. A
  4. B
  5. D
67
Q

Determine the corresponding dermatome of the following nerve roots

  1. Abdomen and lumbar region
  2. Upper thorax (small strip of skin)
  3. Level of Umbilicus
  4. Costal margin
  5. Nipple line (strip of skin)

A. T3-T6
B. T4-T5

C. T5-T7
D. T8-T12
E. T10

A
  1. D
  2. A
  3. E
  4. C
  5. B
68
Q

Determine the corresponding dermatome of the following nerve roots

  1. Anterolateral aspect of the thigh
  2. Medial malleolus, medial leg
  3. Just above the inguinal line
  4. Lateral leg, dorsum of foot (1st to 3rd digits)
  5. Medial thigh, Medial knee, patellar area

A. L1
B. L2

C. L3
D. L4
E. L5

A
  1. B
  2. D
  3. A
  4. E
  5. C
69
Q

Determine the corresponding dermatome of the following nerve roots

  1. Groin, buttocks area
  2. Perineum, genitals, lower sacrum, perianal
    area
  3. Posterior knee, posterior thigh
  4. Posterior leg, calcaneus, 4th-5th digits

A. S1
B. S2

C. S3
D. S4-S5

A
  1. C
  2. D
  3. B
  4. A
70
Q

Determine the corresponding myotomal levels with the muscles innervated

  1. Neck lateral flexion
  2. Shoulder abduction
  3. Neck flexion, extension
  4. Shoulder shrug

A. C1-C2
B.
 C3
C. C4
D. C5

A
  1. B
  2. D
  3. A
  4. C
71
Q

Determine the corresponding myotomal levels with the muscles innervated

  1. Wrist ulnar deviation
  2. Hip flexors
  3. Elbow flexors, wrist extensors
  4. Finger abductors/adductors
  5. Elbow extensors, wrist flexors

A. C6
B.
 C7
C. C8
D. T1
E. L2

A
  1. C
  2. E
  3. A
  4. D
  5. B
72
Q

Determine the corresponding myotomal levels with the muscles innervated

  1. Toe extensors
  2. Ankle plantarflexors
  3. Knee extensors
  4. Knee flexors
  5. Ankle dorsiflexors

A. L3
B. L4

C. L5
D. S1
E. S2

A
  1. C
  2. D
  3. A
  4. E
  5. B

(3) Neurological Examination (8 decks)

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