Test 2 Flashcards
Define Epinephrine
Also known as adrenaline; is a hormone and a neurotransmitter. Epinephrine and norepinephrine are two separate but related hormones secreted by the medulla of the adrenal glands.
Define Perineurium
A tough connective tissue that isolates the fascicle both physically and chemically.
Peripheral nerves are divided into fascicles by the perineurium.
What the names of Class I, II and III Peripheral Neuropathies?
Class I: Neuropraxia
Class II: Axonotmesis
Class III: Neurotmesis
What are the symptoms of Class I?
Involves one form of local blockage and conduction slows down across that point in the nerve.
Examples: Bell’s palsy, Saturday night palsy, Carpal tunnel syndrome and Cast palsy (pressure over the peroneal nerve at the fibula head)
** Normally get full return without any damage
What are the symptoms of Class II?
The neural tube is intact, but axonal damage has occurred with Wallerian Degeneration distal to the lesion. This may be a progressive condition as a result of long-standing neurapraxia or it may occur from a traumatic lesion. PT uses russian stimulation to help activate muscle.
Examples: Wallerian degeneration (muscle loss)
- *Nothing says it will return 100%
- Recovery 1-4mm per day
What are the symptoms of Class III?
Involves TOTAL loss of axonal function with disruption of the neural tube.
Example: Severed Nerve
**Recovery is dependent on proper orientation of axons as they regenerate
Define Necrosis
The death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply.
*What are the forms of Thoracic Outlet Syndrome?
- Anterior scalene tightness: compression of the interscalene space between the anterior and middle scalene muscles. Probably caused from nerve root irritation, spondylosis or facet joint inflammation leading to a muscle spasm.
- Costoclavicular approximation: compression in the space between the clavicle and the 1st rib. Probably from postural deficiencies or carrying heavy objects.
- Pectoralis minor tightness: compression beneath the tendon of the pec minor under the caracoled process. Probably a result of repetitive movements of the arms above the head.
What are the symptoms of Thoracic Outlet Syndrome?
Swelling of arm or hand
Cyanosis of hand
Feeling of heaviness of arm or hand
Pulsating lump above clavicle
Deep “toothache” like pain in neck and shoulder
Parasthesia along inside forearm and palm
Muscle weakness or atrophy
Difficulty with Fine Motor
Pain in arm or hand
Tingling and numbness in neck, shoulder, arm or hand
What are the common causes of:
- Long Thoracic Nerve
- Axillary Nerve
- Ulnar Nerve
- Long Thoracic Nerve: (Serratus Anterior) leading to scapular winging is often caused by closed trauma through compression, stretching, traction, direct extrinsic force, penetrating injury
- Axillary Nerve: Shoulder Dislocation or Improper use of crutches.
- Ulnar Nerve: In some people, the nerve slides out from behind the medial epicondyle when the elbow is bent, Leaning on your elbow for long periods of time, Fluid buildup in the elbow can cause swelling, and a direct blow.
What are the 3 Major Plexus and what levels are they?
Cervical Plexus ( C1 - C4 )
Brachial Plexus ( C5 - T1 )
Lumbosacral Plexus ( L1 - S5 )
How rapid is nerve healing for Class I-III?
- Class I regeneration 0-3 months
- Class II regeneration occurs at 1-4mm/ day maximum
- Class III regeneration only with approximation
Where does Axonal Budding occur?
Axonal sprouting is a process where fine nerve processes - sprouts - grow out from the intact axons to reinnervate denervated muscle fibers. Thereby the sprouting sustains the nerve supply to muscles and, in turn, the ability to move.
Loss of sensation is apparent by what?
- Damage to posterior horn of the spinal cord
- Afferent nerve cell damage
Define the Cervical Plexus
C1-C4
- Injury to this area will affect breathing
- C2:nSCM
- C3/C4: branches to trapezius, levator, and middle scalene
- Phrenic Nerve: C3-C5- motor supply to diaphragm
Define the Brachial Plexus
C5-T1
- Plexus runs from neck to axilla passing between clavicle and 1st rib
- Cord runs from the nerves to the arms: median, ulnar, radial, and musculocutaneous nerves
- Musculocutaneous nerve arises first
Define the Lumbosacral Plexus
L1-S5 -Divided into three parts: • Lumbar • Sacral • Pudendal (Coccygeal region)
What are the symptoms of an Upper Motor Neuron Lesion?
- Spasticity present
- No muscle atrophy
- No fascicultations or fibrillations
- Hypereflexive
- Babinksi and Clonus present
What are the symptoms of a Lower Motor Neuron Lesion?
- Flaccid
- Marked muscle atrophy
- Fasciculations or fibrillations present
- Babinski and Clonus absent
Describe level of Function from:
C1 - T1
- C1-C3: Facial muscles **Need a ventilator
- C4: Diaphragm and Traps/ little bit of deltoids
- C5: Deltoids and Biceps
- C6: Wrist extensors
- C7: Triceps
- C8-T1: Hand and fingers
Define Dermatomes
Area of the skin supplied with sensory fibers of a spinal nerve
-Clinical Implication: nerve root impingement and corresponding dermatome
What damage occurs with Median Nerve Damage?
- Aching pain in the forearm exacerbated by repetitive use
- Sensory sx: paresthesia and dysesthesia
- Positive Tinel’s Sign
What damage occurs with Radial Nerve Damage?
- High radial nerve lesions typically present with weakness of wrist extension and finger extension at the spiral groove distal to the innervation of the triceps
- Occasional crutch palsy: injured at the axilla present with more triceps weakness
