Test 3: Peripheral Neuropathies Flashcards
characteristcs of peripheral neuropathies
can affect one or many nn
can affect just motor, just sensory, or both motor and sensory
nn can be damaged in a variety of ways
UMN vs LMN S&S with progressive damage?
describe mononeuropathies
most common type of nn injury
usually some sort on nn entrapment
median nn entrapment is most common
describe polyneuropathies
many etiologies
DM is most common in US
leprosy is most common world wide
4 ways nn is classified when damaged
- neuronal degeneration = degeneration of motor and sensory cell bodies and subsequent axons
- wallerian degeneration = damage to axon at specific point below cell body with degeneration distal to injury
- axonal degeneration = diffuse axonal damage
- segmental demyelination = injury to myelin sheath w/o injury to axon
common CN injuries
trigeminal neuralgia
Bell’s Palsy
Ramsay Hunt Syndrome
common compression injuries of nn
median
ulnar
radial
femoral
sciatic
fibular
tibial
types of autoimmune neuropathies
GBS
CIDP
paraneoplastic neuropathy
infections polyneuropathies
HIV related polyneuropathies
lyme disease
leprosy
toxic and metabolic neuropathies
alcohol neuropathies
B12 deficiency
B6 deficiency
neuropathies associated with systemic disease
diabetic neuropathy
hypothyroidism
RA
sarcoidosis
idiopathic polyneuropathy
critical illness polyneuropathy
example of hereditary polyneuropathy
charcot marie tooth
median nn neuropathy characteristics
implicated with carpal tunnel
can get impinged anywhere on path though
medical management = carpal tunnel release
PT exam median nn pathology
nn root issue? cervical issue?
- myotomes
- dermatomes
first rib elevated?
scalenes compression?
pronator teres compression?
carpal tunnel testing
- Phalens
- Tinnels sign
ULNT
PT intervention for nn
create space, movement, blood flow to nn
space = treat anything compression (i.e. rib, mm, etc)
movement = nn glides/flossing
blood flow = cardio/aerobic; bringing nutrients to nn
strengthen and work on functional tasks once nn is ready
med dx of sciatic nn problems
physical exam
MRI
EMG
PT exam of sciatic nn
splits at knee to tibial and common fib
can be anywhere along path
- lumbosacral roots
- piriformis
tests
- palpate piriformis
- slump or SLR
- PAs
- etc
what is Bell’s Palsy
CN VII dysfunction
idiopathic acute unilateral facial paralysis
some have it preceded with:
- exposure to cold
- facial numbness and stiffness
- jaw pain
- decreased hearing/hyperacusis
med management for Bell’s palsy
corticosteroids for a week
eye protection bc eyelids dont work
sx decompression but data is mixed and high risk of hearing damage
prognosis = 70-90% improve w/o treatment; 90% get better with corticosteroids
PT role Bell’s palsy
restrain facial mm for function
eye protection
describe diabetic neuropathy
most common neuropathy in US
most common presentation of this is distal sensorimotor neuropathy
often one of first S&S of diabetes
- can progress to hands
- usually lose pain and temp first, then proprioception, and then weakness/atrophy
several other subtypes; one involves ANS
diagnostic testing for diabetic neuropathy
glucose testing
EMG and nn conduction test
stocking glove presentation
medical management of diabetic neuropathy
optimize glucose control
diabetic foot care edu
meds can be used in setting of painful neuropathy
PT exam for diabetic neuropathy
sensory screen
- pain and temp
- then proprioception
- then light touch
balance
skin
neuropathic pain
foot and arch integrity
treatment for diabetic neuropathy
skin edu and foot care
balance = uptrain vestibular and vision
maintain strength
desensitization strategies for nn pain
exercise
- helps control blood glucose and improve functional outcomes
- watch for hypoglycemia; ex is like taking insulin; want to know when they last ate/had insulin
HIV related polyneuropathies
HIV associated sensory neuropathy
affects mostly pts with low CD4 counts
can impact 3% of pts with HIV regardless of CD4 counts
most common neuro complication for those with HIV and AIDS
ca also get neuropathy from antiviral drugs in certain combos
causes pain and numbness
PT implications with HIV-SN
desensitization techniques for pain
exercise as tolerated
balance training
describe alcohol related polyneuropathy
gradual onset distal to proximal symmetric sensory loss
weakness is late complication
begins months to years of alcohol abise
decreased DTRs
most common neuro disease associated with chronic alcoholism
ensuing deficiency in thiamine and B12 bc of alcohol
diagnosed with nn conduction studies
dx of exclusion
medically treated with sobriety and vitamin supplementation
describe B12 deficiency
found in most animal products
low levels lead to neuropathy, myelopathy, dementia, and magaloblastic anemia
often distal numbness and gait instability
not caught early = distal weakness as well
reduced proprioception and vibration sense
dx = check serum B12, nn conduction
med treatment = B12 supplementation
PT implications for alcohol and B12 related neuropathies
MMt
sensation
gait
support for etoh rehab
strengthen as able
functional task
fall risk - balance - compensation vs remediation
brace as needed
desensitization techniques
describe idiopathic polyneuropathy
25% pts have no other identified reason for neuropathy and therefore have idopathic
usually happens in 6th decade
slow progression over years
distal sensory or sensory motor systems most common
degeneration of axons w/o inflammatory process
no clear med treatment
PT implications for idiopathic polyneuropathy
desensitization strategies for pain
balance
gait
skin check
describe critical illness polyneuropathy
weeks to months of having critical illness
dx of exclusion
high mortality
may have co-occuring critical illness myopathy
often with pts who have been vented through several rounds steroids, potentially neurotoxic drugs, and vasopressors in ICU
often in setting of hyperglycemia
S&S of CIP
distal or generalized weakness
distal sensory loss
areflexia
CIP medical management
nn conduction to reveal axonal polyneuropathy
glucose control
treat underlying illness that resulted in critical care
prevent/treat secondary complications of bedrest/ICU
improves over months if pt survives
only 50% completely recover
PT implications for CIP
will treat a lot especially in ICU
these type dx are why ICUs need PT
- prevent secondary comp
- make recovery possible
early mobility
exercise
functional mobility treatment
desensitization for pain control
types of charcot marie tooth
types I and II have these S&S:
- progressive distal weakness, atrophy, sensory loss over several years
- foot drop most common
- hammer toes and pes cavus
- type IA most common
hereditary
can progress into hands and forearms
weakness and gait deviation are common
often have podiatrist managing; may need sx
PT management of charcot marie tooth
strength
balance
gait
functional tasks
