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1022 THEORY > Week 6 Upper nerve injuries > Flashcards

Week 6 Upper nerve injuries Flashcards

1
Q

what is nerve injury

A

a nerve is no longer able to transmit an action potential

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2
Q

peripheral nerve injury

A
  • stretch related, lacerations 撕裂伤, compression (external or internal)
  • associated with # of UL (95%)
  • male:female - 2.2:1
  • dominant hand injury 慣用手受傷 > non dominant hand
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3
Q

three types of nerve injury seddon

classification of peripheral nerve injury

A

neurapraxia (sunderland I)
axonotmesis (sunderland II, III, IV)
neurotmesis (sunderland V)

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4
Q

pathophysiological basis of sunderland I, II, III, IV, V

A

I:
- local myelin damage
- axons preserved 保留
- no degeneration

II:
- axon degeneration
- endoneural tube preserved

III:
- axon degeneration
- loss of endoneural tube continuity
- perineurium intact

IV:
- axon degeneration
- endoneural tube and perineurium disrupted 保留
- epineurium intact

V:
- complete loss of neural continuity

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5
Q

diagnosis of a peripheral nerve injury

A
  • physical assessment findings of nerve disruption (motor, sensory, reflex loss)
  • imaging (MRI, CT)
  • Peripherial nerve system:
    –> pain, often burning or crutching
    –> hyperaesthesia or anaesthesia
    感覺過敏或麻醉
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6
Q

causes of brachial plexus - upper trunk injury - children

A
  • most common neurapraxia in childbirth –> traction on neck
  • damage to C5, 6 roots
  • Erb’s palsy
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7
Q

treatment of brachial plexus - upper trunk injury - children

A
  • Priority to maintain PROM abduction and ER
  • may consider surgery if no change over 3 months
  • In infants 在嬰兒中
  • Healing occurs 1-2 mm per day
  • Wide range of degree of damage – 80-90% regain full functioning upper
    limb 損傷程度範圍廣泛 – 80-90% 恢復全功能
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8
Q

causes of brachial plexus - upper trunk injury - adults

A

trauma 創傷
inflammation
tumor 瘤
radiation

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9
Q

what loss of sensation to expect in brachial plexus - upper trunk injury?

sensation think about dermatomes

A

C5/6 ventral rami - affect lateral upper arm and forearm and thumb

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10
Q

what muscles will be affected by brachial plexus - upper trunk injury?

muscles think about myotomes

A

C5/6 ventral rami
- shoulder abduction and ER (C5)
- elbow flexion, wrist extension, forearm supination (C6)

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11
Q

what peripheral nerves affected in brachial plexus - upper trunk injury? (contains C5,C6 fibres)

A

dorsal scapular (C5)
suprascapular (C5, 6)
axillary (C5,6)
musculocutaneous (C5, 6, 7)

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12
Q

what typical presentation due to unopposed muscle action of the UL? (brachial plexus in upper trunk injury)

A

loss of shoulder Abd, ER, elbow F, wrist E, scapular retraction

= rests in Add, IR, elbow E, +/- wrist flexion
(waiter tip)

just opposite

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13
Q

causes of brachial plexus - lower trunk injury (C8-T1)

A
  • fall, arm forced into extreme abduction
  • Klumpke’s palsy (rare)
  • C8 and T1 nerve roots are not well secured
  • rare injury
    .
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14
Q

what is the sensory deficit in brachial plexus - lower trunk injury? (dermatomes C8, T1)

A

ulnar border of arm, forearm and hand

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15
Q

what is the motor loss in brachial plexus - lower trunk injury? (myotomes)

A
  • mainly control in fingers and wrist
  • may develop ‘claw hand’
  • Horner’s syndrome - disruption of T1 sympathetic fibers on ventral ramus
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16
Q

brachial plexus - complete lesion

A
  • rare
  • loss of all sensation and motor control
  • varying global areas of loss if less severe 如果不那麼嚴重的話，損失的範圍也不同
  • tendon transfer surgery used to recover some function if possible 如果可能的話，肌腱轉移手術用於恢復部分功能
  • assessment for phrenic nerve function (as it may affect diaphragm)
17
Q

what is thoracic outlet syndrome (TOS)

A

a group of distinct disorders that affect neurovascular structures between the base of the neck and axilla

18
Q

TOS can result from injury, disease, or a congenital abnormality:

A
  • more common in women than in men
  • soft tissue (70%):
    –> hypertrophy of scalenes
    –> ligamentous/ fibromuscular bands
  • osseous
    –> cervical rib
    –> poor healing # clavicle
    –> AC/SC joint dislocation/ injury
  • other features:
    –> poor posture
    –> obesity
    –> chronic lung disease
    –> fluid retention
19
Q

symptoms of thoracic outlet syndrome (TOS)

A
  • aching pain 酸痛 lateral neck, shoulder, occiput, axilla, medial forearm and hand
  • hands may feel ‘clumsy’ 手可能會感覺“笨拙”
  • pain aggravated by driving, carrying heavy objects and overhead activities
  • unilateral/ bilateral
  • burning, pins and needles 針刺症狀 common symptom
  • symptoms may start distally or proximally
  • may present overnight as well as with activity
  • venous - feeling of heaviness and stiffness, swelling
  • arterial involvement: coolness and cold sensitivity even numbness
20
Q

diagnosis of thoracic outlet syndrome

A
  • nerve conduction tests (eg: test dermatomes, myotomes)
  • detailed assessment - cervical spine, shoulder, thoracic spine, detailed neurological, vascular assessment
  • X-ray may be recommended
  • MRI
  • ultrasound
21
Q

treatment of thoracic outlet syndrome

A
  • pain management
  • postural re-education
  • strengthening neck, shoulder, scapular muscles
22
Q

causes of axillary nerve injury (C5, 6)

A
  • badly adjusted crutch
  • downward displacement of humeral head
  • #SNOH
    .
23
Q

motor and sensory changes of axillary nerve injury (C5, 6)

A

motor:
paralysis 麻痺 of deltoid and teres minor –> damaged to shoulder abduction (+ER)

(deltoid wasting after injury)

sensory:
loss of skin sensation over the lower half of deltoid

24
Q

what is radial nerve (C5-T1)?

A
  • passes posteriorly, along the spiral groove of humerus
  • continuation of posterior cord
  • supplies triceps, extensor muscles of wrist, skin over posterior aspect arm and forearm
25
Q

what are the two disorders 疾病 of radial nerve injury?

A

crutch palsy
‘saturday night’ palsy

26
Q

crutch palsy vs saturday night palsy

A

crutch palsy:
- compression in axilla
- all motor and sensory branches lost (triceps, wrist extensors)

saturday night palsy:
- compression in the spiral (radial) groove
- not all triceps lost
- sensation lost over posterior arm
- usually transient 短暫的

27
Q

radial nerve injury

A
  • # SHAFT of humerus
  • most common peripheral nerve injury associated with # in the UL
  • varying loss of tricpes
  • ‘wrist drop’
  • return muscular function often within 4-8 months (depending on degree of damage)
  • With each injury lose motor control of wrist extensors +/- sensation dorsum hand 1st web space (每次受傷都會loss of motor control of wrist extensors)
28
Q

what is median nerve (C6-T1)?

A
  • motor supply to most muscles in anterior forearm
  • passes under flexor retinaculum at wrist to supply most muscles of the thumb and some intrinsics of hand
29
Q

what are the two disorders of medial nerve injury of elbow?

A
  • supracondylar humeral #
  • pronator syndrome
30
Q

what is supracondylar humeral fracture

A

displaced #s and other vascular structures at risk

  • 有骨折移位的風險
  • 其他有風險的血管結構
31
Q

what is pronator syndrome

A
  • compression between pronator teres
  • motor: loss finger F (1st and 2nd), weak wrist F, loss most thumb movements
  • sensory: loss lateral 3.5 digits and palm (base of thumb)
32
Q

what is the disorder of medial nerve injury - wrist?

A

carpal tunnel syndrome

33
Q

what is carpal tunnel syndrome

A
  • 10% population: repetitive occupational strain, pregnancy, RA
  • sensation loss lateral 3.5 digits (sensation over thumb often preserved)
  • wasted thenar muscles if severe
34
Q

what is ulnar nerve (C8, T1)?

A
  • wraps directly behind medial epicondyle of humerus
  • main nerve for intrinsic muscles of the hand
  • cutaneous supply medial 1.5 digits
35
Q

some risks of ulnar nerve injury

A
  • # medial epicondyle / # ulna
  • Cubital tunnel syndrome (b/w 2 heads FCU)
  • Guyon’s/ulnar canal syndrome (wrist)
  • Sensation to dorsum hand spared 倖免於難
  • When intrinsic muscles in the hand are lost “claw hand” 爪手
36
Q

management of neural injuries

A
  • young age have better sensory recovery
  • often ‘pins and needles’ and sensation recovers
  • less severe damage –> conservative management
37
Q

physiotherapy management of neural injuries

A
  • detailed assessment
  • consider pre or post surgery - goals will differ
  • protect joints and capsule
  • education (managing affected area especially if sensation lost)
  • aware of post-surgical complications: failure of nerve repair, neuroma, infection, scarring, joint contractures
  • regular re-assessment and outcome measures
38
Q

physiotherapy management of neural injury (aim)

A
  • reduce pain
  • reduce oedema
  • maintain passive joint ROM/ muscle length
  • maintain strength unaffected muscles

1022 THEORY (11 decks)

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