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PCE - Neuromusculoskeletal > Nerve compression/entrapment, peripheral nerve injuries > Flashcards

Nerve compression/entrapment, peripheral nerve injuries Flashcards

1
Q

What is radiculopathy

A

pain due to nerve root compression

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2
Q

Radiculopathy S&S

A

Pain
Tingling
Dec. nerve conduction = mm weakness, sensation changes, reduced reflexes

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3
Q

What causes thoracic outlet syndrome

A

Impingement of..

  • Brachial plexus
  • Vagus nerve
  • Subclavian artery/vein
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4
Q

What are common impingement sights in thoracic outlet syndrome

A

o superior thoracic outlet
o scalene triangle
o btw clavicle + 1st rib
o btw pec minor + thoracic wall

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5
Q

TOS S&S

A
  • Pain in arms/hands, neck, axilla, pecs, upper back
  • Tingling
  • Vascular - one hand colder than other
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6
Q

TOS Ax -

A
  • Adson
  • Allen/wrights
  • Military test
  • Costoclavicular test
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7
Q

TOS Rx:

A
  • Postural re-education
  • Functional training to restore normal muscle balances: endurance, strength, power, and coordination
  • Biomechanical faults: joint restrictions
  • Manipulations (typically 1st rib) to diminish pain and soft tissue guarding - treat symptoms
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8
Q

Ulnar nerve entrapment: Location

A

Cubital tunnel

Tunnel of guyon (less common)

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9
Q

Ulnar nerve entrapment: Cause

A
  • Direct trauma

- Compression due to thickened retinaculum or hypertrophy of FCU

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10
Q

Ulnar nerve entrapment: S&S

A
  • Medial elbow pain

- Parasthesias in ulnar distribution

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11
Q

Ulnar nerve entrapment: Test

A

Posterior Tinels sign

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12
Q

Median nerve entrapment: Location

A

Within pronator teres
Under FDS
Carpal tunnel

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13
Q

Median nerve entrapment in forearm: Cause

A

Repetitive gripping activities

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14
Q

Median nerve entrapment in forearm: S&S

A
  • aching pain
  • Weakness in forearm muscles
  • Paraesthesias in median distribution
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15
Q

Median nerve entrapment in forearm: test

A

Tinels sign in forearm

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16
Q

Carpal tunnel cause

A

compression due to inflammation of flexor tendons and/or median nerve with repetitive wrist motions (ie. gripping), pregnancy, diabetes or rheumatoid arthritis

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17
Q

Carpal tunnel test:

A

Phalens
Tinels
Reverse phalens?

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18
Q

Carpal tunnel S&S

A

Altered sensory function in median nerve distribution
o burning, tingling, pins and needles, numbness (especially at night)
o Decreased vibration, 2-pt discrimination
Atrophy/weakness of thenar muscles (thumb to 3rd finger) + lateral 2 lumbricals

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19
Q

Radial nerve entrapment - which segment of nerve is typically entrapment

A

distal branches - poster interosseous nerve

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20
Q

Radial nerve entrapment - Location

A

Radial tunnel

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21
Q

Radial nerve entrapment - Cause

A

Overhead activities (throwing0

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22
Q

Radial nerve entrapment - S/S

A

Lateral elbow pain, pain over supinator muscle, parasthesias in radial nerve distribution

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23
Q

Radial nerve entrapment - test

A

Tinels sign

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24
Q

Radial nerve entrapment - RX

A

o rule out cervical spine dysfunction, thoracic outlet syndrome, etc.
o rest + avoid exacerbating activities in initial stages (activity modifications)
o control inflammation and/or pain with NSAID’s, modalities, soft tissue techniques
o correct muscle imbalances with exercise (strengthening, flexibility, coordination)
o protective padding and night splints (to maintain slackened position)
o address predisposing factors
o medications (acetaminophen, NSAID’s, etc)

25
Q

Neuropathy def.

A

Any nerve disease characterized by decrease in neural function

26
Q

Traumatic peripheral nerve injury - S&S

A
  • Motor, sensory, autonomic changes

- pain

27
Q

Traumatic peripheral nerve injury - Dx

A

MRI

Nerve conduction test used to confirm

28
Q

Traumatic peripheral nerve injury - types

A
  • Neuropraxia
  • Axonotemesis
  • Neurotemesis
29
Q

Neuropraxia:

  • Def:
  • Result:
  • Recovery:
A
  • Compression of the nerve
  • RESULT: segmental demyelination & transient disruption
  • RECOVERY: fast, good prognosis (min - wks), as edema resolves
30
Q

Axonotemesis

  • Def:
  • Result:
  • Recovery:
A

• Disruption of axon, myelin sheath still intact, likely CRUSH INJURY
• RESULT: prolonged disruption, may cause paralysis of the motor, sensory, and autonomic
• RECOVERY: fair prognosis (months), Wallerian degeneration
o Axon re-growth: 1mm/day, upper arm 4-6 months (up to 2 yrs), lower arm 7-9mo, up to 4 yrs

31
Q

Neurotemesis

  • Def:
  • Result:
  • Recovery:
A
  • Completely severed axon and sheath

* RECOVERY: only w/ surgery with variable success - may never recover

32
Q

What is wallerian degeneration

A

Process occurs with laceration or crushing of a nerve - axon separated from cell body (axonotmesis)
o Degeneration occurs distal to site of injury (within 24-36 hours)
o Can affect PNS (Schwann cells) and/or CNS (oligodendrocytes)

33
Q

How does healing occur following wallerian degeneration

A

o Macrophages remove debris

o Proximal part - sprouting -> grow (~1mm/day) + prune off -> myelin regrowth

34
Q

What is segmental demyelination

A 
Myelin breakdown (demyelination) for few segments, but axons are preserved
o Mostly reversible because Schwann cells make new myelin -> restore function 
- Some axons may be permanently lost
35
Q

Example of segmental demyelination

A

Guillain-barre Syndrome

36
Q

What is Guillain-barre Syndrome

A

o Immune system attacks nerves - 1st s&s - weakness + tingling -> entire body paralysis
o Hospital: most recover, may have slight weakness/tingling/fatigue

37
Q

What is distal axonal degeneration? What is a suspected cause? Where does it develop?

A

• Degeneration of axon cylinder and myelin possibly d/t inability of neuronal body to keep up w/ metabolic demands of axon
• Develops: most distal part of axon then proximal
o IF abnormality persists - axon dies ‘backwards’

38
Q

distal axonal degeneration S&S

A

Characteristic distal sensory loss + weakness

39
Q

What is myasthenia Gravis?

What may it be caused by?

A

• Autoimmune attack of ACh receptors at the NMJ
o signal can’t travel from nerve to muscle
• May be precipitated by stressful life events, viral infections,
pregnancy, autoimmune disorders, etc.

40
Q

Myasthenia Gravis Effects:

A

o progressive muscle weakness

  • Dec cardiorespiratory function
  • atrophy
  • fatigue
41
Q

Myasthenia Gravis Rx

A

Medication: prevent ACh breakdown @ NMJ - remaining receptors will eventually activate, or plasmapheresis
PT
- Activity within tolerance
- Prevent 2° conditions

42
Q

What is Charcot Marie tooth disease

A

Hereditary condition of PNS

43
Q

What is the result of Charcot Marie tooth disease

A

Extensive demylination of motor & sensory nerves of the hands and feet

44
Q

Charcot Marie tooth disease S&S

A

o Distal, symmetric muscle weakness - slow progression
 Foot intrinsic atrophy
 Dec. DF, EVER mm
o Dec. deep tendon reflexes
o Pes cavus (high arch, doesn’t flatten with weight bearing)
 Problems controlling gait and balance with lack of sensory info from foot
o Hammer toes
o Lose wrist/finger extension (radial/ulnar nerve)

45
Q

Charcot Marie tooth disease Rx

A

o No treatment to change disease course
o Contracture management: stretching, splinting, exercise, IMS, etc.
o Foot care education (prevent damage to skin, joint, muscle, connective tissues)
o Identify & retrain muscle imbalance

46
Q

What is Bell’s Palsy?

What is it caused by?

A

Facial nerve palsy

Cause by latent herpes virus - Virus causes inflammatory response over facial nerve

47
Q

Bell’s Palsy S&S

A

Unilateral facial paralysis
 Weakness in muscles of facial expression
 Inability to close one eye, wink, or whistle
 Drooping of mouth
 Tears, salivation

48
Q

Bell’s Palsy Rx

A
  • corticosteroids, e-stim?, protect eye (patch + eyedrops) until eye closure possible, massage (treat compensatory changes), PROM/AROM of facial muscles (eg. raise eyebrows, wrinkle forehead, flare nostrils, smile, practice vowel sounds, etc.)
  • most recover spontaneously
49
Q

What may cause TOS

A

Chronic compression - edema + ischemia of nerve roots - neuropraxia + Wallerian deg

50
Q

ROS Risk Factors

A

Posture
Growth
Trauma
Body comp

51
Q

TOS S&S

A
  • Paresthesia
  • UE weakness + pain, hand fatigue
  • Neck pain: may radiate into face, scapula, ant chest
  • Raynaud’s disease ( Dec. UE artery size) + venous compromise, coldness
  • Edema
52
Q

TOS Rx

A

Correct posture; surgery (if vasculature gets compromised)

53
Q

What is Diabetic Neuropathy

A

Peripheral nerve disorder in diabetes - occurs w/o any other neuropathy cause

54
Q

Diabetic Neuropathy Pathology

A

Chronic metabolic disturbance - affects nerves + schwann cells
- Results in a loss of both myelinated and unmyelinated axons

55
Q

Diabetic Neuropathy S&S

A
  • Symmetric + distal sensory loss pattern
  • Painless paresthesia
  • Minimal motor weakness
56
Q

Diabetic Neuropathy Rx

A
  • Control hyperglycemia
  • Skin care
  • Amputation
57
Q

Neural Tissue dysfuntion/neurodynamic dysfunction S&S

A
  • history of inc speed/repetition of sport or work
  • pain distribution does not match myotome/dermatome
  • stretching does not feel good
  • aggravated in neural tension positions
  • Does not describe/point to pain area well
  • recurrent injury that does not change w/ rehab
58
Q

What is a Keloid scar

A
  • thick scar (hyperproliferation)

- extends beyond margins of original wound

59
Q

What is a Hypertrophic scar

A
  • Thick scar
  • Does not extend beyond boundary of original wound but has excess tissue amount than what is needed to replaced damaged dermis (contraction phase did not occur)

PCE - Neuromusculoskeletal (8 decks)

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