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Hand and Upper Extremity Conditions > Peripheral Nerve Problems > Flashcards

Peripheral Nerve Problems Flashcards

1
Q

Seddon’s Classification - PN (3)

A
  1. neuropraxia
  2. axonotmesis
  3. neurotmesis
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2
Q

Neuropraxia

A

injury - mild

recovery

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3
Q

Axonotmesis

A

injury - severe
regeneration - 1mm/day
recovery

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4
Q

Neurotmesis

A

injury
degeneration
neuroma formation

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5
Q

Sunderland’s Classification PN - Degree 1

A

structures remain intact

local conduction block and dymyelination

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6
Q

Sunderland’s Classification PN - Degree 2

A

axonal disruption with distal (Wallerian) degeneration

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7
Q

Sunderland’s Classification PN - Degree 3

A

disruption of axons and endoneurial tubes

fascicles remain intact

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8
Q

Sunderland’s Classification PN - Degree 4

A

disruption of axons, endoneurial tubes
only epineurium intact
loss of fascicular integrity

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9
Q

Sunderland’s Classification PN - Degree 5

A

complete nerve transection

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10
Q

Radial Nerve Palsy

A

most commonly injured peripheral nerve
fx of humerus (1:10 have radial nerve complications)
elbow dislocation
Monteggia fx-dislocation

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11
Q

High Radial Nerve (4)

A
  1. triceps
  2. anconeus
  3. brachioradialis
  4. ECRL
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12
Q

Low Radial Nerve (9)

A
  1. ECRB
  2. supinator
  3. EDC
  4. EDM
  5. ECU
  6. APL
  7. EPL
  8. EPB
  9. EIP
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13
Q

High Median Nerve (7)

A
  1. PT
  2. FCR
  3. PL
  4. FDS
  5. FDP (index and long)
  6. FPL
  7. PQ
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14
Q

Low Median Nerve (4)

A
  1. OP
  2. FPB (superficial head)
  3. APB
  4. Lumbricals (index and long)
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15
Q

High Ulnar Nerve (2)

A
  1. FCU

2. FDP (ring and small)

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16
Q

Low Ulnar Nerve (8)

A
  1. ADM
  2. ODM
  3. FDM
  4. Lumbricals (4 and 3)
  5. 3 palmar interossei
  6. 4 dorsal interossei
  7. FPB (deep head)
  8. Add Pol
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17
Q

ape hand deformity

A

median nerve injury

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18
Q

claw hand deformity

A

ulnar nerve injury

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19
Q

wrist drop deformity

A

radial nerve injury

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20
Q

anterior interosseous syndrome

A

entrapment of motor branch of median nerve

unable to make “ok” sign

21
Q

Froment’s sign

A

flexion of the IP with lateral pinch
FPL attempts to compensate for paralyzed or weak adductor pollicis and FPB
ulnar nerve

22
Q

Wartenberg’s sign

A

unable to adduct the 5th finger due to weak interosseous muscle
ulnar nerve

23
Q

elbow flexion test

A

provocative test for ulnar nerve compression

elbow flexed and wrist in neutral for up to 5 minutes

24
Q

Wallerian degeneration

A

breakdown of the axon distal to the site of injury

occurs 48-96 hours after injury

25
Q

atrophy due to PN injury

A

30% weight loss of tissue in first month
50-60% by two months
60-80% by four months

26
Q

primary nerve repair

A

occurs within the first week of injury

27
Q

delayed or secondary nerve repair

A

performed a week or more after injury

28
Q

nerve graft

A

down when repair cannot be done with undue tension of the nerve’s cut ends

29
Q

neurolysis

A

surgical dissection and exploration of a damaged nerve to release from restrictions or adhesions

30
Q

nerve decompression

A

involves cutting tissue that constrict the nerve or physically moving the nerve

31
Q

orthoses: high radial nerve injuries

A

wrist immobilizations
low profile mobilization
tenodesis mobilization

32
Q

low radial nerve injury (PIN)

A

nerve divides in forearm into a superficial sensory branch and a motor branch (PIN) *paralysis or paresis of ulnar wrist extension, digit extension, thumb extension, and radial ABduction
*may have dorsal wrist pain

33
Q

low radial nerve injury (radial tunnel syndrome)

A

compression in proximal forearm

  • dull aching and burning in lateral forearm
    • EMG result
  • orthosis: long arm, elbow flexion, wrist extension, forearm supination
34
Q

low radial nerve injury (superficial sensory branch)

A

compressions can occur with pronation from the BR and ECRL and at the distal forearm due to lack of excursion of the nerve during repetitive wrist flexion and ulnar deviation
*spontaneous recovery common

35
Q

postop management: radial nerve laceration repair (above elbow/below axilla)

A 
static orthosis
elbow 90 deg flexion
forearm neutral
wrist extension
MP 10-20 deg flexion
*4 weeks: elbow to 60 deg
*5 weeks: elbow to 30 deg
*6 weeks: discontinue
36
Q

postop management: radial nerve decompression

A

dynamic wrist and MP extension orthosis for function

37
Q

high median nerve palsy (pronator syndrome)

A

compression of the nerve between the 2 heads of pronator teres muscle or under the proximal edge of the FDS arch

38
Q

provocative tests for pronator syndrome

A

resistive elbow flexion or isolated resistive to the long finger FDS

39
Q

orthoses: anterior interosseous syndrome

A

figure 8 splints

40
Q

low median nerve palsy (carpal tunnel syndrome)

A

most common nerve entrapment in the UE

  • paresthesia in the thumb, index, middle, and radial half of ring finger
  • pregnancy induced CTS
  • orthoses: wrist neutral
41
Q

postop management: high median nerve injuries

A 
orthosis
blocking with the wrist in 30 deg flexion for 4-6 weeks
*4 weeks: wrist to 20 deg
*5 weeks: wrist to 0-10 deg
*6 weeks: discontinue
42
Q

postop management: median nerve laceration at wrist

A

usually tendon involvement at well so patient education is important

43
Q

postop management: decompression of high median nerve injuries

A

rarely done

try conservative measures first

44
Q

postop management: decompression of low median nerve injuries (CTR)

A

carpal tunnel release
transection of the transverse carpal ligament
many don’t need postop therapy
may do wrist orthosis for positioning

45
Q

high ulnar nerve compression (cubital tunnel syndrome)

A 
night orthosis
elbow 30-70 deg
forearm and wrist neutral
digits free
*may need anti-clawing orthosis
46
Q

low ulnar nerve injuries

A

compression at guyon’s canal due to tumor, lipoma, or ganglion
fracture of the hook of the hamate
anti-claw orthosis

47
Q

postop management: ulnar nerve laceration repair (elbow to wrist level)

A 
dorsal blocking orthosis
wrist 20-30 deg flexion
MP 45 deg extension
*increase wrist extension at 3 and 5 weeks
*6 weeks: discontinue
48
Q

postop management: high ulnar nerve decompression

A

cubital tunnel release
transposition: subQ or submuscular
long arm orthosis

49
Q

postop management: low ulnar nerve decompression

A

recommend due to high incident of space occupying lesions
bulky dressings used
full ROM usually allowed

Hand and Upper Extremity Conditions (27 decks)

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