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CHT Prep > Medbridge + ASHT nerve compression > Flashcards

Medbridge + ASHT nerve compression Flashcards

(54 cards)

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1
Q

what is Epineurium?

A

thick sheath of connective tissue that cushions the nere and facilitates nerve gliding, outermost covering

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2
Q

what is Perineurium?

A

surrounds the fascicles, provides a barrier to prevent toxins from getting in. Surgical repair of nerve lacerations involved repair at the fascicles

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3
Q

what is endoneurium?

A

surrounds each individual axon. Consists of arteriae nervorum: intrinsic blood supply to the nere fibers (vasa nervorum) and Neri Nervorum: intrinsic n. supply to nerve fibers

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4
Q

what are Mechanisms of nerve injury?

A

mechanical: traction, compression, laceration, combination thermal/electrical: chemical, ischemic, radiation, injection Secondary injuries: infection, scarring, fracture callus, ischemia

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5
Q

what is Neurapraxia?

A

acute compression results in local contusion. Conduction block. Mild neuropraxia leads to transient ischemia. Epineurium, perineurium, endoneurium intact. Excellent prognosis

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6
Q

what is Axonotmesis?

A

loss of axonal continuity. Connective tissue intact but degeneration of injured axon distal. recovery prolonged but good bc endoneurial tubes are intact so no miswiring.

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7
Q

what is Neurotmesis?

A

most severe nerve injury - complete transection. all axons and connective tissue severed. No spontaneous recovery, requires surgery.

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8
Q

what is Nerve injury classification from least to most severe?

A

Neurapraxia/Sunderland 1, axonotmesis/Sunderland 2, neurotmesis/Sunderland 3 4 5

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9
Q

what is Wallerian degeneration?

A

distal axon fragments and myelin sheath disintegrate

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10
Q

what is Speed of axon regeneration?

A

1mm/day

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11
Q

what are factors that influence nerve regeneration?

A

scar tissue, inaccurate alignment of fascicles with surgical repair, delay in reconstruction (atrophy), age, proximal injury

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12
Q

what is the speed of motor endplate degradation ?

A

1% per week Need 50% to function ~ 1 year/12 months time

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13
Q

what is the Maximum distance from injury to motor end plates to restore function?

A

35 cm. Sensory lasts longer than motor (365 days at 1mm/day)

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14
Q

what are C-fibers?

A

No myelin sheath, small (1 micron) . transmit burning pain at 2m/second (slow-moving)

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15
Q

what are A-delta fibers?

A

have myelin sheath, 2-5 microns in diameter, transmit temperature sensation at 20m/second

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16
Q

what are A-beta fibers?

A

have myelin sheath, 10-15 microns diameter, transmit light tough sensation at 60m/sec. Supply end organs: pacinian, meissner, merkel cell

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17
Q

what are A- alpha fibers?

A

have myelin sheath, 15-20 microns diameter, transmit motor function at 60 m/sec

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18
Q

what are Pacinian corpuscles?

A

quick adapting, deep pressure nerve ending respons to high vibratory stimulus 256 cycles. sense vibration and fine textures

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19
Q

what are Meissner corpuscle?

A

quick adapting, responds to moving touch and vibration (256). Involved in skin movement, object handling detection

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20
Q

what are Merkel cell neurite complex?

A

slow adapting, responds to constant touch NOT vibration

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21
Q

Semmes-weinstein Monofilaments

A

Normal 2.83,
Diminished light touch 3.61,
diminished protective 4.31,
loss of protective 4.56,
deep pressure only 6.65

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22
Q

why does low frequency vibration return poorly after nerve repair?

Study These Flashcards
A

Pacinian corpuscles reinnervate poorly

23
Q

Classification of nerve repair

Study These Flashcards
A

Primary repair <1 week,

delayed primary repair after 3-4 days,

secondary repair >1 week

24
Q

when to start sensory reeducation?

Study These Flashcards
A

when any of the following are present:
1. +protective sensation
2. 30 cps vibration
3. moving touch sensation
4. touch perception in fingertips
5. 4.31 semmes-weinstein

25
Erb-Duchenne or Erb's Palsy
upper trunk of brachial plexus injury C5C6 nerve roots. weakness ABD and ER. waiter's tip position
26
Klumpke palsy
C8 and T1 nere roots (lower trunk of brachial plexus) rare, imitates ulnar n. lesion
27
High radial nerve injury (above elbow)
cause: crutches or saturday night palsy, tension due to humeral shaft fracture, tumors, windmill pitching. presentation: (triceps spared) weakness in wrist extension, supination, MP extension, thumb extension paresthesia: dorsum of hand
28
PIN compression sites
fibrous bands of tissue anterior to radiocapitellar joint, leash of henry: recurrent radial vessels at radial head, medial proximal edge of ECRB, proximal edge of superficial supinator known as arcade of Frohse, distal edge of supinator
29
PIN compression presentation
weakness: distal to supinator - wrist extension, MP extension, thumb extension. NO paresthesias functional movement: RD with wrist extension, inability to open hand for grasp
30
Radial tunnel syndrome presentation
1. pain in lateral proximal forearm 3-5cm distal to lateral epi, no weakness or sensory findings, pain at night and rest
31
Wartenberg syndrome
compression of superficial branch of radial nerve DRSN. Compression occurs at radial wrist as nerve exits between BR and ECRL tendons. R/O Dequervains (pain at rest and NO pain with APL/EPB strength testing)
32
Quadrilateral space syndrome
Quadrilateral space: humerus, long head of triceps, teres minor, teres major. Syndrome = occlusion of axillary nerve nad posterior humeral circumflex artery, occurs with shoulder ABD, extension, ER; presentation: shoulder pain and distal paresthesias, worse with overhead activity. high-level volleyball players. MRI shows atrophy of teres minor
33
Suprascapular n. palsy
cause: trauma, volleyball, stretching; presentation: paralysis of supraspinatus and infraspinatus> weakness in shoulder ABD and ER
34
suprascapular nerve entrapment at the spinoglenoid notch
cause: volleyball, stretching; presentation: paralysis of infraspinatus, weakness of ER, ache at posterolateral shoulder
35
Pronator syndrome entrapment sites
1. ligament of struthers 2. lacertus fibrosis/bicipital aponeurosis 3. between 2 heads of pronator teres 4. proximal edge of FDS arch
36
Pronator syndrome presentation
pain and parestesia median n. distribution + volar forearm, hand weakness, decreased sensation in palm, negative phalens, pain with activity NOT night
37
Carpal tunnel syndrome
weakness/atrophy of thenar m., pain and paresthesias, nocturnal pain, cold intolerance
38
Cubital tunnel potential sites of compression
1. between 2 heads of FCU 2. arcade of struthers
39
Cubital tunnel syndrome presentation
weakness of all ulnar n. muscles, mild clawing, sharp or aching pain on medial side of proximal forearm; Functional limitations: weak grip, altered pinch from ADP, inability to handle small objects with precision (interossei), inability to open hand for larger objects (IP flexion posturing)
40
Guyon's canal compression zones
Zone 1: proximal to tunnel and trifurcation of nerve. Both motor and sensory Zone 2: at level of hammate MOTOR ONLY Zone 3: distal to hamate SENSORY ONLY
41
Froment's sign
thumb IP flexion with lateral pinch on paper ulnar n.
42
Jeanne's sign
hyperextension of thumb MP joint with lateral pinch. Caused by ADP weakness which normally stabilizes ulnar n.
43
Wartenberg's sign
inability to AD digit 5 ulnar n.
44
Duchenne's sign
clawing of ring and small finger ulnar n.
45
Ulnar nerve anomalies (2)
Martin-Gruber anastomosis - motor finger from AIN conncted to ulnar n. in forearm. Riche-Cannieu anastomosis - motor fiber from ulnar n. connected to recurrent branch of median n. at level of wrist
46
Myotome testing
C2-4 shoulder shrug C5 shoulder ABD C6 elbow flex, wrist ext C7 elbow ext, wrist flex C8 thumb ABD T1 finger AB/AD
47
Sympathetic Dysfunction
vasomotor (blood flow), sudomotor (sweat), pilomotor (hairs of skin) , trophic changes (pitting of nails, hair changes, skin tone changes)
48
Order of sensory return
1. pain and temp - sharp/dull 2. vibration 30 cps 3. moving touch 4. constant touch - semmesweinstein 5. vibration 256 6. touch localization 7. 2 pt discrim 8. stereognosis
49
Masse's sign
arch flatening and loss of ulnar hand elevation (5th digit extension?) ulnar n.
50
Pollock's sign
ring and small DIP flexion loss ulnar n.
51
Thoracic outlet syndrome compression sites
1. scalene interval 2. costcoclavicular space( under clavicle) 3. subcoracoid space (under pec minor)
52
Thoracic outlet syndrome clinical provocation
1. adson's maneuver 2. wright's test 3. roo's test 4. halstead maneuver
53
TOS treatment
pt education/actviity modification, diaphragmatic breathing, postural exercises
54
Maudsley test
radial tunnel - resisted middle finger extension with elbow extension

CHT Prep (12 decks)

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