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Year 2: Neuromuscular > Test 3: Peripheral Neuropathies > Flashcards

Test 3: Peripheral Neuropathies Flashcards

1
Q

characteristcs of peripheral neuropathies

A

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?

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2
Q

describe mononeuropathies

A

most common type of nn injury

usually some sort on nn entrapment

median nn entrapment is most common

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3
Q

describe polyneuropathies

A

many etiologies

DM is most common in US

leprosy is most common world wide

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4
Q

4 ways nn is classified when damaged

A
  1. neuronal degeneration = degeneration of motor and sensory cell bodies and subsequent axons
  2. wallerian degeneration = damage to axon at specific point below cell body with degeneration distal to injury
  3. axonal degeneration = diffuse axonal damage
  4. segmental demyelination = injury to myelin sheath w/o injury to axon
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5
Q

common CN injuries

A

trigeminal neuralgia
Bell’s Palsy
Ramsay Hunt Syndrome

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6
Q

common compression injuries of nn

A

median
ulnar
radial
femoral
sciatic
fibular
tibial

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7
Q

types of autoimmune neuropathies

A

GBS
CIDP
paraneoplastic neuropathy

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8
Q

infections polyneuropathies

A

HIV related polyneuropathies
lyme disease
leprosy

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9
Q

toxic and metabolic neuropathies

A

alcohol neuropathies
B12 deficiency
B6 deficiency

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10
Q

neuropathies associated with systemic disease

A

diabetic neuropathy
hypothyroidism
RA
sarcoidosis
idiopathic polyneuropathy
critical illness polyneuropathy

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11
Q

example of hereditary polyneuropathy

A

charcot marie tooth

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12
Q

median nn neuropathy characteristics

A

implicated with carpal tunnel

can get impinged anywhere on path though

medical management = carpal tunnel release

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13
Q

PT exam median nn pathology

A

nn root issue? cervical issue?
- myotomes
- dermatomes

first rib elevated?
scalenes compression?
pronator teres compression?
carpal tunnel testing
- Phalens
- Tinnels sign

ULNT

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14
Q

PT intervention for nn

A

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

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15
Q

med dx of sciatic nn problems

A

physical exam
MRI
EMG

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16
Q

PT exam of sciatic nn

A

splits at knee to tibial and common fib

can be anywhere along path
- lumbosacral roots
- piriformis

tests
- palpate piriformis
- slump or SLR
- PAs
- etc

17
Q

what is Bell’s Palsy

A

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

18
Q

med management for Bell’s palsy

A

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

19
Q

PT role Bell’s palsy

A

restrain facial mm for function

eye protection

20
Q

describe diabetic neuropathy

A

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

21
Q

diagnostic testing for diabetic neuropathy

A

glucose testing
EMG and nn conduction test
stocking glove presentation

22
Q

medical management of diabetic neuropathy

A

optimize glucose control

diabetic foot care edu

meds can be used in setting of painful neuropathy

23
Q

PT exam for diabetic neuropathy

A

sensory screen
- pain and temp
- then proprioception
- then light touch

balance

skin

neuropathic pain

foot and arch integrity

24
Q

treatment for diabetic neuropathy

A

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

25
Q

HIV related polyneuropathies

A

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

26
Q

PT implications with HIV-SN

A

desensitization techniques for pain

exercise as tolerated

balance training

27
Q

describe alcohol related polyneuropathy

A

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

28
Q

describe B12 deficiency

A

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

29
Q

PT implications for alcohol and B12 related neuropathies

A

MMt
sensation
gait
support for etoh rehab
strengthen as able
functional task

fall risk - balance - compensation vs remediation

brace as needed

desensitization techniques

30
Q

describe idiopathic polyneuropathy

A

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

31
Q

PT implications for idiopathic polyneuropathy

A

desensitization strategies for pain
balance
gait
skin check

32
Q

describe critical illness polyneuropathy

A

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

33
Q

S&S of CIP

A

distal or generalized weakness
distal sensory loss
areflexia

34
Q

CIP medical management

A

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

35
Q

PT implications for CIP

A

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

36
Q

types of charcot marie tooth

A

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

37
Q

PT management of charcot marie tooth

A

strength
balance
gait
functional tasks

38
Q
A

Year 2: Neuromuscular (20 decks)

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