Upper Limb Monoeuropathies Flashcards
What is a monoeuropathie
Singular injury or issue with a specific peripheral nerve
Caused by:
-Stretch (Overhead sport)
-Transecting injury (hold on a bus and it stops)
-Brachial plexus neuritides with isolated distal nerve involvement
-Entrapment (herniated disc, carpal tunnel, tight piriformis, tight pec min, tight scalenes)
-Direct compression (side sleep, A tight cast. A tight muscle)
Symptoms of monoeuropathies
Unilateral
Pain,
parasthesia
sensory loss
weakness
Atrophy can be due to a on loss or disuse over time
If bilateral this is an issue as we would think a spinal cord injury.
Could be caused by central disc bulge
Posterolateral disc bulge (unilateral)
Describe long thoracic neuropathies
C5-C7
No sensory. Motor to serratus anterior who’s role is hold scapula in its black in protection and abduction. Also leaves arm above 90 degrees
Trauma, scapula wall injury, thoracotomy, first rib resection, mastectomy
Scapula will wing in wall push up if serratus anterior and long thoracic nerve is affected
What is dorsal scapular neuropathies
C5 root
Innervates lev scap, rhomboid man and min
Stabilise scapular in abduction
Injury= winging in this movement
What is suprascapular neuropathies
C5 and C6
-15degreees abduction
Innervates supraspinatus and infraspinatus
Commonly injury is suprascapular notch
Injury mc blunt force trauma or forces ant roll of scap
What is axillary neuropathies
Post cord of brachial plexus
Innovates deltoid and Teres minor and sensory to lateral upper arm
Shoulder abduction is weakened plus lateral upper arm sensory deficit
Mc trauma, shoulder dislocation and humerous
What are median neuropathies
C6-c7 roots
Innervates lateral hand sensory and motor plus forearm
Proximinal lesions less common
Distal mc- specifically carpa tunnel
3x more common if f
Can affect both hands
Mc idiopathic
Linked to stress to the nerve, odema, ischemia, demyelination nand lng term axon loss
Associated with:
Pregnancy
Endocrine disorders (hypothyroidism, acromegaly, diabetes)
RA
Amyloidosis (protein causing inflammation of tendons)
MSK condition: mechanical entrapment or respective strain
Leads to:
• pain and paraesthesia in the hand or forearm.
• Spares the palmer cutaneous branch of the median nerve.
• Positive provocative tests – Tinnels and Phalen’s.
• EMG used diagnostically.
• If bilateral need to consider polyneuropathy or central causes such as
syringomyelia. (Infection)
• Rx. Conservative first then surgical decompres
Can be missed as tennis elbow.
What is ulnar monoeuropathes
Innovates intrinsic hand muscles
Flexor carpi Ulnaris and medial part of flexor digitorum
Sensation to medial one and a hacked dingers
Progressive motor deficit can lead to ‘claw hand’ ring and little finger cramp
Compression common at elbow or wrist
Cubical tunnel syndrome (distal to elbow)
Guyon canal distally (wrist)
3-6 months may indicate surgery
Burning sensation
Parasythia
Tingling
Numbness
Radial neuropathy
C5- T1 all three trunks
Posterior part of froarm and dorsal part of hand
Extensor muscles of arm, forearm, fingers
Dosral sensory component
Mc mid humeral compression ‘Saturday night palsy’ where when they sleep on their arm and they can’t lift or extend their wrist it will drop. Radial nerve in jury
Even at the wrist superficial (handcuffs can cause this or a tight splint)
Normally Monophasic and resolve conservatively
What is the posterior cutaneous
A branch of the radial nerve of arm
Very rare isolate dinjjry
Posterior forearm only
What is MS
A chronic immunologic diseases affecting CNS
Autoimmune disease where body T and B cells attacks oligodendrocytres (glial cells) which produce myelin causing inflammation and damage
Demyelination causes nerve damage and scarring
Relapsing remitting is mc. Periods of flare ups where symtomns worsen flowed by symptoms of remission
Primary Progressive MS= worsening of symptoms over time wouthut clear relapse or remission
Secondary progressive ms= relapsing remitting MS eventually leads to progression of symptoms even during periods without relapse
Causes disability
RF=
Genetics
Low vit D, viral infections like Epstein Barr
Further from equator
Age and gender/ 20-40 women> men
Symptoms: fatigue, numbness and tingling in limbs or face, trigeminal neuralgia, muscle weakness or spasms, double or blurred vision, cognitive change, bowel and bladder problems, pain, coordination and gait issues
Diagnosis:
Neuro exam where vision, coordination, strength and reflexes are checked
No treatment
How is MS classified
Clinical isolated syndrome
Initial inflammatory in CNS. Pt doesn’t fulfil MS criteria however high risk of doing so in 10 years
Radiologically isolated syndrome
Asymptomatic with incidental finding on imaging consistent with MS
Describe relapsing MS
85% of cases
Characterised by flare ups
Relapse followed by remission, partial or complete decrease in symptoms
Presentation depends on lesion location
20-40 and female
Describe progressive ms
Progressive worsening of neurological symptoms
Primar PMS= progressive with no preceding symptoms. Spinal cord> brain and less lesion and inflammation than RMS
SPMS=initially relapsing-remixing course followed by progressive neurological disability for 6 months independent from relapses
No remitting faze
What is optic neuritis
Inflammation of the optic nerve transmitting stimuli from eye to brain.
Causes sudden vision loss, pain, vision changes, reduced colour vision
Causes:
MS due to demyelination
Infections like herpes or mumps
neuromyelitis and Graves’ disease
Meds
What is acute myelitis
• What is brainstem, acute diencephalic and symptomatic cerebral syndromes?
What is cerebral malaria
Parasitic Infection caused by bug bites from infected mosquitos.
Affects the brain
Medical emergency
Swelling,l inflammation and damage to brain cells
What is shingles
Viral infection caused by a virus in the nerve roots along the nerve pathway to the skin
Reactivation of virus
Causes painful rash, pain and tingling, itching and sensitivity, fever and fatigue, headache
RF= age mc over 50
Weakened immune system
Previous chicken pot
describe the reflex grading system
0 = no response; always abnormal.
1+ = a slight but definitely present response; may or may not be
normal.
2+ = a brisk response; normal.
3+ = a very brisk response; may or may not be normal.
4+ = a tap elicits a repeating reflex (clonus); always abnormal.
Why do u get hyperrelfex
hyperrelfex is fue to UMNL
located in rain or spinal cord
affect motor and CNS
In an UMNL, the inhibitory control exerted by the brain on the spinal reflex circuits is impaired
Why is it important to consider the immunocompromised host when
assessing this subject area?
they make have a weakness mine system making them more vulnerable to infections
makes us crucial to be able to differentiate infections and underlying neurological conditions
altered immune response
difficulty diagnosing
medication affects
altered immune response
we don’t want it!
what is Poliomyelitis
polio, viral infection affects the CNS
leads to muscle weakness, paralysis and death
type 1 mc
fecal-oral through water or food or through droplets by sneeze or coughing
fever
fatigue
headache
sore throat
nausea
vomiting
muscle pain or stiffness
parlays
what is hIV
attacks immune system specifically CD4 T cells which fights infections
Over time, HIV can damage the immune system to the point that the body becomes vulnerable to opportunistic infections and certain cancers, leading to the Acquired Immunodeficiency Syndrome (AIDS).
it uses RNA as genetic material
2-4 weeks fever, swollen lymph, sore throat, rash, headache, muscle ache
chronic often aysmotimic mild symptoms such as low-grade fever, weight loss, fatigue, swollen lymph nodes, and chronic diarrhea.
AIDS is severe weight loss, fever, night sweats, fatigue, dire, pneumonia, tb, white spots or lesions around the mouth
spread by bodily fluid like sex, needles, blood, birth
