S3_L4: Peripheral Nerve Injury Flashcards by MindMed Official

Nerves are most commonly affected by what 5 mechanisms?

pressure
friction
traction
anoxia
cutting

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Most common biomechanical injury results from (1)____, (2)_____, and (3)_____.

friction
compression
stretch

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TRUE OR FALSE: As nerves regenerate, the person still experiences no sensitivity in the area that has previously been without sensation.

False

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Affects conducting tissues or connective tissues of the nerve

Intraneural

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Affects the nerve bed, adhesions of epineurium to another tissue, and swelling of tissue adjacent to a nerve.

Extraneural

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______ of the nerve is critical to neural function because it serves to dissipate tension within the neural system.

Excursion

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This is when tension is placed on the nerve bed, causing the nerve to glide towards the moving joint

convergence

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This is when tension is relieved, causing the nerve to glide away from the moving joint

Divergence

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TRUE OR FALSE: The more stress on the nerve, the greater manifestations

True

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Piriformis syndrome is also known as?

Fat Wallet Syndrome

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Determine the Sunderland Classification.

Axonal + Perineurium Disruption
Focal Conduction Block

A. 1st
B. 2nd
C. 3rd
D. 4th
E. 5th

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Determine the Sunderland Classification.

Axonal Disruption
Axonal + Endoneurium Disruption
Axonal + Epineurium Disruption

A. 1st
B. 2nd
C. 3rd
D. 4th
E. 5th

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TRUE OR FALSE: The more proximally located a nerve is, the shorter nerve regeneration.

False

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TRUE OR FALSE: The more proximal aspect of the nerve injury, the more disruption of its function and affects regeneration.

True

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TRUE OR FALSE: The more damage, the more tissue reaction and scarring.

True

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Regeneration of nerves occur at a rate of _____

1mm per day

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Categorize the nerves by their regenerative potential.

femoral nerve
ulnar nerve
radial nerve
tibial nerve

A. Excellent
B. Moderate
C. Poor

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Categorize the nerves by their regenerative potential.

median nerve
peroneal nerve
musculocutaneous nerve

A. Excellent
B. Moderate
C. Poor

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The mobilization exercise for CTS should be done _____ per day unless symptoms are exacerbated then the intensity and frequency should be reduced but not eliminated.

three or four times

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Which of the following are aggravating motions for CTS:

A. sustained wrist flexion
B. repetitive wrist flexion
C. sustained wrist extension
D. repetitive wrist extension

A, B, D

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Which of the following are aggravating motions for CTS:

A. gripping
B. pinching
C. creating a fist
D. ulnar deviation
E. radial deviation
F. pronation
G. supination

A, B, D

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Immobilization usually spans from a minimum of ____ to protect the nerve, minimize inflammation, and minimize compression or traction at the injured/repaired site.

3 weeks

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TRUE OR FALSE: Splinting is considered a first-time treatment option for severe carpal tunnel.

False

This is for mild to moderate CTS

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What indicates a poor prognosis for recovery in PNI pts?

(+) Bilateral Provocative Test

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process of retraining the brain to recognize a stimulus once the hypersensitivity diminishes

discriminative sensory re-education

Enumerate Seddons classification of nerve injury

1. Neuropraxia 2. Axonotmesis 3. Neurotmesis

Injury to the middle trunk of the brachial plexus affects which branch and nerve?

C7 and Radial N.

A blow to the shoulder, or chest wall, prolonged or traumatic traction of the shoulder or scapula, or furniture movers will result in what type of injury?

Long thoracic injury

The posterior triangle of the neck is formed by?

1. Sternocleidomastoid 2. Trapezius 3. Middle third of the clavicle

What is the 1st sensory sensation to return?

pain Source: Quizlet Peripheral Nerve Injuries and Therapeutic Management (Johnson)

What is the last sensory sensation to return?

vibration of 256 Hz Source: Quizlet Peripheral Nerve Injuries and Therapeutic Management (Johnson)

What is the sequence of sensory return?

1. pain (1st) 2. vibration of 30Hz 3. moving touch (2-point discrimination) 4. constant touch 5. vibration of 256 Hz (last) Source: Quizlet Peripheral Nerve Injuries and Therapeutic Management (Johnson)

What is an axilla entrapment injury also known as?

crutch palsy

What is an mid-humerus entrapment injury also known as?

Saturday Night Palsy

What muscles are spared for a mid-humerus entrapment injury?

triceps

Is motor or sensory spared for Posterior Interosseous Nerve Palsy?

sensation

What is lost with Superficial Radial Nerve Palsy?

sensory only

What is a common presentation of a radial nerve injury?

wrist drop

Sensory impairment of the median nerve makes what impossible?

fine motor coordination

How often should you evaluate clients with peripheral nerve injuries?

initially then monthly Source: Quizlet Peripheral Nerve Injuries and Therapeutic Management (Johnson)

single most important factor influencing success of nerve recovery

age

Among sharp transections vs crush injuries prognosis for nerve, which is better?

sharp transections better

time limit for nerve repair

18 months

1. Winging of Scapula 2. Ape Thumb 3. Wrist drop 4. Claw Hand 5. Foot Drop A. Lateral Popliteal Nerve B. Ulnar Nerve C. Radial Nerve D. Median Nerve E. Thoracodorsal Nerve

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

This is caused by decreased blood supply to the forearm following immobilization of humeral fracture

Volkmann's Contracture

This is an injury to 5th & 6th brachial plexus nerve roots. Paralysis & atrophy in deltoid, brachialis, biceps & brachioradialis muscles occurs

Erb's Palsy

This is an injury to 8th cervical & 1st thoracic brachial plexus nerve roots. Paralysis of wrist flexors & intrinsic muscles of the hand occurs

Klumpke's Paralysis

Some of the nerve fibers in the injured nerve are damaged and others are unaffected. Some muscle power and sensation will be present below the level of the injury. Some of the nerve remains intact and, therefore, the chances of a full recovery being made are improved. What kind of lesion is this?

Incomplete lesions

All the nerve fibers in the injured section of nerve are damaged, causing total loss of muscle power and sensation below the level of the injury.

Complete injuries

Enumerate the actions of the UE during peripheral mobilization of the median nerve in proper sequence.

1. Make a fist 2. Open hand 3. Extend the hand 4. Extend the thumb 5. Supinate the hand 6. Further extend the thumb

Injury to the brachial plexus is common during?

child birth NOTE: this happens when the baby is forcefully taken out of the birth canal

Shoulder abduction and lateral rotation are impaired when this nerve is affected. What is the NERVE ROOT of the affected nerve?

C5&6 note: nerve affected is axillary nerve

this nerve pierces and innervates the coracobrachialis and then travels distally to innervate the biceps and brachialis muscles. what is this nerve?

musculocutaneous nerve

this upper extremity nerve has no proximal muscle innervation. it moves into the forearm between the two heads of the pronator teres muscle. what is this nerve?

median nerve

In the arm, it innervates the triceps, anconeus, and upper portion of the extensor and supinator group of the forearm. what is this nerve?

radial nerve

What is the NERVE ROOTS of the nerve that majority of the muscles at the anterior aspect of the thigh. Examples of its muscular innervation is the sartorius and quadriceps.

L2-4 Note: nerve being described is the femoral nerve

This nerve divides into common peroneal nerve and tibial nerve. It is derived from L4-S3.

Sciatic nerve

Piriformis syndrome may occur due to compression and irritation of this nerve. What is this?

Sciatic nerve

what is the nerve root of the nerve that innervates the tibialis anterior?

L4-S2

TRUE OR FALSE: in performing the desensitization technique, apply the stimulus several times so the pt will get used to a certain stimulus

True

TRUE OR FALSE: Pattern of recovery after nerve injury is pain (hypersensitivity), perception of slow vibration (30 cps), moving touch, constant touch, slow vibration (256 cps), and awareness from proximal to distal.

False 256 cps is already rapid vibration

What kind of ULTT Technique may be done in pts c CTS?

ULTT 1&2

What kind of ULTT Technique may be done in pts c De Quervain’s Tenosynovitis?

ULLT 3

What kind of ULTT Technique may be done in pts c medial epicondylitis?

ULTT 4

What kind of orthosis is recommended for pts c CTS?

static wrist orthosis at night positioned in neutral

The following are used to manage pain and edema in the acute phase, EXCEPT: A. TENS B. HVGS C. HMP D. Elevation E. None

C. HMP

Arrange the steps of discriminative sensory reeducation techniques in proper sequence. 1. ask pt to identify where touch occurred 2. localization of constant touch 3. apply a moving touch stimulus 4. use familiar household and personal care objects 5. identification of familiar objects 6. walk on various surfaces

312546

TRUE OR FALSE: mobilization of carpal bones may be done for CTS pts.

True

What SLR technique may be done for nerve mobilization in the LE when the sciatic nerve is affected?

SLR I

What SLR technique may be done for nerve mobilization in the LE when the common peroneal nerve is affected?

SLR IV

What SLR technique may be done for nerve mobilization in the LE when the sural nerve is affected?

SLR III

What SLR technique may be done for nerve mobilization in the LE when the tibial nerve is affected?

SLR II

What PKB technique may be done for nerve mobilization in the LE when the femoral nerve is affected?

PKB I

What technique may be done for nerve mobilization in the LE when the saphenous nerve is affected?

PKE

What PKB technique may be done for nerve mobilization in the LE when the lateral femoral cutaneous nerve is affected?

PKB II

what is the recommended parameters in PKB mobilization?

30 oscillations, 2-3 sets

TRUE OR FALSE: Retrograde massage may be done for Chronic Regional Pain Syndrome to control edema

True

TRUE OR FALSE: Patients with CRPS have an altered body perception of their affected limb and they are slower to “connect” with their affected limb before movement

True

This approach targets the activation of different brain regions in a graded manner. Treatment consists of three components that include left/right discrimination of the affected area, motor imagery rehearsal, and mirror therapy. What is this management technique?

graded motor imagery

What are the two extrinsic factors that affects the ability of a nerve to heal?

1. Medical and surgical treatment 2. Postoperative management

Initially, ______ exercises are the only resistance exercises done in CTS

gentle muscle-setting

TRUE OR FALSE: Desensitization techniques are done in the chronic phase of CTS

False

TRUE OR FALSE: Discriminative Sensory Reeducation is done at the 2nd phase of recovery in CTS

True

When is splinting or bracing done in pts c CTS

acute phase

TRUE OR FALSE: In desensitization techniques, the textures can be wrapped around dowel rods for finger manipulation or stroking along skin

True

_____ may be an increasingly valuable tool to promote peripheral nerve regeneration.

Stem cell therapy

The obturator nerve is derived from what roots?

L2-4

TRUE OR FALSE: If a cell body (soma) is damaged, the neuron cannot regenerate

True

In performing SLR 5, where will the s/sx present?

contralateral leg

enumerate the steps to perform nerve mobilization for tunnel of guyon syndrome.

1. wrist extension 2. wrist radial deviation 3. overpressure stretch to 4th and 5th digits 4. forearm pronation 5. elbow flexion

TRUE OR FALSE: intensity of a maneuver should be related to the irritability of the tissue, pt response, and change in sx. the greater the irritability, the greater the technique A. both statements are true B. both statements are false C. only the 1st statement is correct D. only the 2nd statement is correct

A. both statements are true

what is the most common sx of PNI?

pain

TRUE OR FALSE: every joint in the chain must be tested separately for range, mobility and sx provocation prior to whole nerve tension testing

True

Match the nerve bias 1. Slump test 1 2. Slump test 4 3. Slump test 3 4. Slump test 2 A. sciatic B. obturator C. common peroneal D. sural E. femoral

1. A 2. A 3. E 4. B