Upper - Clinical Flashcards
what is neurapraxia
slow nerve propagation
what is axon-otmesis
initially no/weak innervation but this slowly comes back as axon regenerates slightly
what is neur-otmesis
permanent loss of innervation
what is an MRC grade
measures nerve damage
press wire into finger until it bends and depending on which wire is used determines the grade
what is the difference between a lesion higher up in the radial nerve vs the lower region
high lesion affects upper arm - loss of active extension and altered sensation
low lesion - affects wrist and loss of sensation around hand
what is carpal tunnel syndrome
can’t feel fingers but can feel palm - palmar cutaneous branch doesn’t go through carpal tunnel
what are the two tests for carpal tunnel
tinels - light tapping of median nerve to stimulate pins and needles
phalens - flexed elbow table and hands drooped to max flexion then dorsal hands pushed together
what is the difference in a higher up lesion of the median nerve compared to a low lesion
upper arm - high - loss of wrist flexion, loss of circle sign, thumb weakness, loss of opposition
low lesion - wrist - thumb weakness, loss of opposition altered sensation normal thenar sensation
what is paraethesia in the little finger
altered sensation ie tingling which would signal entrapment of the ulnar nerve
what would ulnar nerve paralysis mean and how do you test for it
lumbrical muscle to ring and little fingers only - bend the fingers as flexors act unopposed
fromonts test
what would a high lesion in the ulnar nerve mean compared to low lesion
high - upper arm - hand weakness, FDP to ring and little finger weakness = claw hand
low lesion in wrist - hand weakness, normal FDP, altered sensation in the palm
what is the neural movement of the thumb
radial - extension
median - flexion and opposition
what are three congenital nerve injuries
obstetric brachial plexus palsy
CLLP - congenital lower lip palsy
Hereditary neuropathy with liability to pressure palsy
how do you examine for hip fracture
LOOK, FEEL, MOVE symmetry muscle wasting scars pain, temperature, palpate hip joint
what is the management for hip fracture
blood test, ECG, pain management, X ray, surgery, associated factors
what are the 4 vascular interventional radiology techniques
duplex scanning
MR angiography (MRA)
CT angiography (CTA)
catheter angiography
what is duplex scanning
no ionising radiation
velocity measurements
operator dependant
good overview of obstructions
what is MR angiography
non-invasive no ionising radiation availability overestimates stenoses unsuitable for patients with claustrophobia, pacemakers
what is CT angiography
assessment of aortic aneurysms, bleeding and peripheral vessels, thrombosis
what is catheter angiography
best, comprehensive
invasive - complications
contrast based - iodinated contrast
what is digital subtraction angiography
fluroscopy technique used in intervention radiography to clearly visualise blood vessels in a bony or dense soft tissue environment
what is interventional radiology
use of imaging techniques to effect treatment rather than just diagnosis
what are two types of peripheral vascular disease
acute limb ischaemia - any sudden decrease in limb perfusion causing potential threat to limb viability
caused by thrombosis, embolism, rare causes
chronic limb ischaemia - intermittent claudication, rest pain, tissue loss (ulceration or gangrene)
how would you treat aneurysmal disease
vascular surgery
describe the process of fracture healing
haematoma forms in the fracture - bone healing cells move in - transformations into rigid tissue - calcifies forming bone
what is temporary external fixation
for systemic and local damage control
systemic control - restore physiological function before reconstruction of the bone
local control - immobilise the bone whilst salvaging local soft tissue injury
what is definitive external fixation
for healing purposes
fixes in 3 dimensions
holds bone in place for healing
