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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
Neuropathy def.
Any nerve disease characterized by decrease in neural function
26
Traumatic peripheral nerve injury - S&S
- Motor, sensory, autonomic changes | - pain
27
Traumatic peripheral nerve injury - Dx
MRI | Nerve conduction test used to confirm
28
Traumatic peripheral nerve injury - types
- Neuropraxia - Axonotemesis - Neurotemesis
29
Neuropraxia: - Def: - Result: - Recovery:
* Compression of the nerve * RESULT: segmental demyelination & transient disruption * RECOVERY: fast, good prognosis (min - wks), as edema resolves
30
Axonotemesis - Def: - Result: - Recovery:
• 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
Neurotemesis - Def: - Result: - Recovery:
* Completely severed axon and sheath | * RECOVERY: only w/ surgery with variable success - may never recover
32
What is wallerian degeneration
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
How does healing occur following wallerian degeneration
o Macrophages remove debris | o Proximal part - sprouting -> grow (~1mm/day) + prune off -> myelin regrowth
34
What is segmental demyelination
``` 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
Example of segmental demyelination
Guillain-barre Syndrome
36
What is Guillain-barre Syndrome
o Immune system attacks nerves - 1st s&s - weakness + tingling -> entire body paralysis o Hospital: most recover, may have slight weakness/tingling/fatigue
37
What is distal axonal degeneration? What is a suspected cause? Where does it develop?
• 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
distal axonal degeneration S&S
Characteristic distal sensory loss + weakness
39
What is myasthenia Gravis? | What may it be caused by?
• 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
Myasthenia Gravis Effects:
o progressive muscle weakness - Dec cardiorespiratory function - atrophy - fatigue
41
Myasthenia Gravis Rx
Medication: prevent ACh breakdown @ NMJ - remaining receptors will eventually activate, or plasmapheresis PT - Activity within tolerance - Prevent 2° conditions
42
What is Charcot Marie tooth disease
Hereditary condition of PNS
43
What is the result of Charcot Marie tooth disease
Extensive demylination of motor & sensory nerves of the hands and feet
44
Charcot Marie tooth disease S&S
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
Charcot Marie tooth disease Rx
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
What is Bell's Palsy? | What is it caused by?
Facial nerve palsy | Cause by latent herpes virus - Virus causes inflammatory response over facial nerve
47
Bell's Palsy S&S
Unilateral facial paralysis  Weakness in muscles of facial expression  Inability to close one eye, wink, or whistle  Drooping of mouth  Tears, salivation
48
Bell's Palsy Rx
- 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
What may cause TOS
Chronic compression - edema + ischemia of nerve roots - neuropraxia + Wallerian deg
50
ROS Risk Factors
Posture Growth Trauma Body comp
51
TOS S&S
- 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
TOS Rx
Correct posture; surgery (if vasculature gets compromised)
53
What is Diabetic Neuropathy
Peripheral nerve disorder in diabetes - occurs w/o any other neuropathy cause
54
Diabetic Neuropathy Pathology
Chronic metabolic disturbance - affects nerves + schwann cells - Results in a loss of both myelinated and unmyelinated axons
55
Diabetic Neuropathy S&S
- Symmetric + distal sensory loss pattern - Painless paresthesia - Minimal motor weakness
56
Diabetic Neuropathy Rx
- Control hyperglycemia - Skin care - Amputation
57
Neural Tissue dysfuntion/neurodynamic dysfunction S&S
- 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
What is a Keloid scar
- thick scar (hyperproliferation) | - extends beyond margins of original wound
59
What is a Hypertrophic scar
- 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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