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OS IV Exam II SG > UE & LE Compression Neuropathy (Lecture + Lab) > Flashcards

UE & LE Compression Neuropathy (Lecture + Lab) Flashcards

1
Q

Pathologic changes that occur with neuropathy

A

Microvascular compression —> ischemia

Thickened epineurium

Myelin thinning distortion

Microtubule closure

Axonal degeneration

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2
Q

Etiologies of nerve entrapment

A

Increased muscle mass by repetitive activity

Space occupying lesions (cysts or tumors)

Inflammation of surrounding tissues (leads to venous congestion in epineurial and perineurial vascular plexuses —> endoneurial edema -> nerve anoxia)

Posttraumatic conditions — hematoma, fracture, or compression

Systemic causes — pregnancy, hypothyroid, diabetes

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3
Q

3 categories of nerve injury

A

Neuropraxia (1st degree)

Axonotmesis (2nd degree)

Neurotmesis (3rd, 4th, or 5th degree)

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4
Q

Category of nerve injury involving focal damage of myelin fibers around axon while connective tissue sheath remains intact; limited course (days to weeks); least severe

A

Neuropraxia

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5
Q

Category of nerve injury in which there is some disruption to the axon itself but myelin sheath remains intact; regeneration is possible, but prolonged (months) without a full recovery

A

Axonotmesis

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6
Q

Describe 3rd degree neurotmesis and possibility of recovery

A

Disruption of axon and endoneurium

Recovery through axonal regeneration cannot occur as intraneural fibrosis occurs

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7
Q

Describe 4th degree neurotmesis and possibility of recovery

A

Disruption of axon, endoneurium, and perineurium (nerve fasciculi); large areas of intraneural scarring at injury site —> precluded axon from advancing distal to level of injury

No improvement in function — surgery is used to restore normal continuity

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8
Q

Describe 5th degree neurotmesis and possibility of recovery

A

Disruption of axon, endoneurium, perineurium, and epineurium; substantial perineural hemorrhage and scarring occur

Surgery is required to restore neural continuity

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9
Q

Conservative treatment options for compression neuropathy

A

Activity modifications, use of antiinflammatories, splinting, and/or injections

PT, OMM, pain management

Conservative tx should be pursued for 3-6 months (except with cubital tunnel syndrome — fix right away even in mild cases to avoid nerve damage)

Surgical release is considered when non-operative management fails

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10
Q

Motor, sensation, and reflex associated with C5 nerve root

A

Motor — deltoid, biceps

Sensation - lateral arm

Reflex - biceps

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11
Q

Motor, sensation, and reflex associated with C6 nerve root

A

Wrist extension, elbow flexion

Sensation - radial forearm, thumb, index finger

Reflex - brachioradialis

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12
Q

Motor, sensation, and reflex associated with C7 nerve root

A

Wrist flexion, elbow extension, finger extension

Sensation to middle finger

Triceps reflex

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13
Q

Motor and sensation associated with C8 nerve root

A

Motor - finger flexion

Sensation ulnar forearm, small finger

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14
Q

Motor and sensation associated with T1 nerve root

A

Motor - finger abduction

Sensation - medial arm

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15
Q

Possible sites of radial nerve entrapment

A

High on the humerus
Radial tunnel
At the wrist

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16
Q

Motor and sensory functions of radial n

A

Motor to triceps brachii, anconeus, wrist extensors

Sensation to majority of dorsum of hand (via posterior interosseous)

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17
Q

Symptoms and treatment of radial nerve compression high on the humerus d/t fracture or compression at spiral groove

A

Wrist drop, weakness of elbow flexion, possible tricep involvement, +/- tricep reflex diminished, pain/numbness

Tx: function returns in 4-5 mos

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18
Q

What causes supinator syndrome, which involves pain and tenderness 5cm distail to lateral epicondyle as well as wrist drop or pain with resisted supination?

A

Compression of posterior interosseous branch of radial nerve as it passes under the supinator m. at the arcade of frohse (purely motor branch)

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19
Q

4 possible sites of median nerve entrapment

A

Ligament of struthers

Pronator syndrome — between superficial and deep heads of pronator teres m.

Anterior interosseous syndrome — just distal to pronator teres, innervates flexors

Carpal tunnel syndrome — flexor tendons under flexor retinaculum

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20
Q

What compression neuropathy?:

Repetitive pronating motions like pianists, fiddlers, baseball players, dentists, weight trainers; c/o achy pain in mid/proximal forearm, aggravated by repeated lifting - may have sensory abnormality in radial 3.5 digits and dx based on pain with resisted forearm pronation

A

Pronator syndrome

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21
Q

T/F: anterior interosseous syndrome has no sensory symptoms

A

True

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22
Q

Etiologies of anterior interosseous syndrome

A

Trauma

Cast pressure

Bulky tendinous origin of ulnar head of pronator teres

Soft tissue masses

Fibrous bands

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23
Q

Tx for anterior interossous syndrome

A

General tx, and elbow can be splinted in 90 degrees of flexion for up to 12 wks

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24
Q

Pt unable to hold “Ok” sign

A

Anterior interosseous syndrome

[due to weak flexion ability of index finger’s DIP and thumb’s IP]

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25
Q

Gold standard for diagnosing carpal tunnel

A

EMG

[others include phalens, tinel’s, and 2-point discrimination where pt is unable to distinguish 2 points on a caliper if closer than 5 mm]

26
Q

Tx for carpal tunnel syndrome

A

Rest from repetitive motions if possible, self-stretching

Wrist splinting with 30 degrees of hand extension, usually at night

NSAIDs

Steroid injections if failure of conservative measures

Surgical release if failure other tx

27
Q

General functions of median n

A

Forearm flexion and pronation

Wrist flexion and radial deviation

Thumb abduction and opposition

Index and middle finger abduction and flexion

28
Q

2 sites of ulnar nerve entrapment

A

Cubital tunnel (medial epicondyle, medial trochlea, olecranon, ulnar collateral ligament)

Guyon’s canal

29
Q

What compression neuropathy?

Baseball pitchers, prolonged elbow flexion during sleep, external compression against surface, thickened retinaculum

Leads to paresthesia to 4th and 5th digits; medial elbow pain radiating to hand with decreased intrinsic muscle strength (can’t turn a key in door); +tinels at elbow; symptom reproduced with elbow flexion and wrist extension

A

Cubital tunnel syndrome

30
Q

What is froment’s sign and what does it indicate

A

Pt must flex thumb in order to pinch paper between 1st and 2nd digits; must contract FPL (supplied by median n.) due to weak 1st dorsal interosseous and ADP muscles

Indicates cubital tunnel syndrome

31
Q

Tx for cubital tunnel syndrome

A

General tx and padded elbow sleeve to limit terminal elbow flexion and provide cushioning

32
Q

General ulnar nerve function

A

Innervates skin and muscles of ulnar side of forearm and hand (flexors)

Deep branch in hand —> motor innervation for interosseous mm and adductor policis

Superficial branch in hand —> sensory to ring and pinky

33
Q

3 major sites of compression involved in TOS

A

Scalene triangle

Costoclavicular passage

At the pec minor attachment at coracoid process

34
Q

Motor and sensation associated with L1 and L2 nerve roots

A

Hip flexion

Sensation to inguinal crease (L1) and anterior thigh (L2)

35
Q

Motor and sensation associated with L2 and L3 nerve roots

A

Knee extension

Sensation to anterior thigh (L2), anterior thigh just above knee (L3)

36
Q

Motor, sensation, and reflex associated with L4

A

Ankle dorsiflexion

Sensation to medial leg and foot

Reflex — knee jerk (patellar)

37
Q

Motor and sensory functions of L5 nerve root

A

Extensor hallucis longus

Sensation to lateral leg, foot dorsum

38
Q

Motor, sensory, and reflex associated with S1

A

Ankle plantarflexion

Sensation to lateral foot, plantar foot

Reflex = ankle jerk (achilles)

39
Q

Nerve roots associated with common fibular nerve

A

L4-S2

40
Q

Etiologies of common fibular nerve compression

A

Leg hooked over a rail (i.e, bedridden, comatose, postop)

“strawberry pickers palsy” — time spent in squatting position

Lithotomy position during childbirth

Idiopathic

41
Q

What compression neuropathy?

Pain along proximal third of lateral leg, foot drop with slapping gait, sxs exacerbated during plantarflexion and inversion of foot

A

Common fibular nerve

42
Q

OMT for common fibular nerve neuropathy

A

Posterior fibular head HVLA or ME

ME on gastroc/soleus, biceps femoris

43
Q

Nerve roots associated with deep fibular nerve

A

L4-S2

44
Q

What is anterior tarsal tunnel syndrome?

A

Deep fibular nerve compression at inferior extensor retinaculum

Caused by trauma (i.e., recurrent ankle sprains, soccer players), talonavicular dysfunction, prolonged plantar flexion, and/or compression from shoes

45
Q

What neuropathy?:

Pain over dorsomedial aspect of foot and worse at rest; weakness of extensor digitorum brevis

A

Anterior tarsal tunnel syndrome

46
Q

Tx for anterior tarsal tunnel syndrome

A

Remove compressive forces

MFR of extensor retinaculum

Traction tug of talonavicular joint

Hiss whip for navicular, cuneiforms, 1st and 2nd metatarsal

47
Q

Nerve roots associated with posterior tibial n

A

L4-S2

48
Q

T/F: Tarsal tunnel syndrome = anterior tarsal syndrome

A

False!

Anterior tarsal syndrome = compression of deep fibular n. at inferior extensor retinaculum

Tarsal tunnel syndrome = compression of posterior tibial n. in tarsal tunnel behind medial malleolus with overlying flexor retinaculum

49
Q

What neuropathy:

Pain on plantar surface of foot, vague burning, tingling, or numbness on plantar aspect of foot; gait seldom affected; affects the nerve whose function is motor to plantar foot mm and sensation to plantar aspect of foot and toes

A

Tarsal tunnel syndrome (posterior tibial n)

50
Q

Etiologies of tarsal tunnel syndrome

A

Idiopathic in 50% of cases

Space occupying lesion (synovial cyst, ganglion from tendon sheath, lipoma, tenosynovitis)

Trauma to medial malleolus, distal tibia, or calcaneus (MVAs)

Congenital

Autoimmune (RA, ankylosing spondylitis)

Diabetes

Lifestyle (long periods of standing)

51
Q

2 OMT techniques used in tarsal tunnel syndrome

A

MFR

HVLA

52
Q

Nerve roots associated with lateral femoral cutaneous n

A

L2, L3

[sensory only of anterolateral thigh down to knee]

53
Q

What is meralgia paresthetica?

A

Compression of lateral femoral cutaneous n. under inguinal ligament at inguinal canal

54
Q

What neuropathy?

Numbness or burning pain on anterolateral thigh, hyperthesia to the point of not placing things in pockets, trophic skin changes, +tinel sign 1cm medial and inferior to ASIS

A

Meralgia paresthetica (lateral femoral cutaneous n)

55
Q

Etiologies of meralgia paresthetica

A

Very intense athletes

Obesity

Tight girdle/belt, tight clothing

Seat belt misplacement or post-accident

Anatomic anomaly (i.e., runs through sartorius)

56
Q

What part of a nerve contains the fascicles, blood vessels, and CT?

A

Epineurium

57
Q

Fascicles of a nerve are covered by ____ and contain groups of axons

A

Perineurium

58
Q

Axons are covered in a myelin sheath which are in turn covered by ____

A

Endoneurium

59
Q

Most commonly cervical discs rupture ___________, causing compression of the nerve root as it exits the intervertebral foramen

A

Postero-laterally

60
Q

New York GianTS’ Defensive end, Jason Pierre-Paul (JPP) Comes to you after 4 weeks of having a club cast on his forearm complaining of an abnormal and dull feeling in his right arm.

Which of the following are you most likely to find?

A. Weakness of long flexor muscle of thumb
B. Weakness of long extensor muscle of thumb
C. Weakness of abductor m. of thumb
D. Weakness of adduction muscle of thumb

A

A. Weakness of long flexor muscle of thumb

61
Q

Michael Phelps, an Olympic Swimmer, presents to your clinic complaining of weakness and paresthesia of the medial arm and forearm. He states he noticed it shortly after his last Olympic games when he was training extremely hard and did repetitive butterfly strokes for months. He states that butterfly requires repetitive overhead motion.

Which of the following sites of compression would occur while performing adson’s test and looking toward the tested arm?

A. Scalene muscle(s) 
B. Sternoclavicular joint 
C. Sternocleidomastoid muscle 
D. Rib 1 
E. Pectoralis Minor
A

D. Rib 1

OS IV Exam II SG (21 decks)

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