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Nerve pain and injuries Flashcards

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1
Q

peripheral nerve lesions have what mechanisms of injury

A

mechanical (compression)
crush and percussion (fx, compartment syndrome)
laceration
penetrating
stretch
high velocity trauma
cold

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2
Q

When treating someone with peripheral nerve damage, all areas of ….

A

face, trunk and extremities should be assessed.

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3
Q

allodynia

A

sensation of pain in response to stimulus that would not typically produce pain

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4
Q

analgesia

A

absence of pain while remaining conscious

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5
Q

anesthesia

A

absence of touch sensation

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6
Q

causalgia

A

constant, relentless, burning hyperesthesia and hyperalgesia that develops after a peripheral nerve injury

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7
Q

dyesthesia

A

distortion of any of the senses, especially touch

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8
Q

hyperesthesia

A

heightened sensation

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9
Q

hyperpathia

A

extreme exaggerated response to pain

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10
Q

hypesthesia

A

diminished sensation of touch

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11
Q

neuralgia

A

severe and multiple shock-like pain that radiate from a specific nerve distribution

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12
Q

pallanesthesia

A

loss of vibratin sensation

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13
Q

paresthesia

A

abnormal sensations such as tingling, pins and needles or burning sensations

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14
Q

double crush syndrome

A

two separate lesions along same nerve that create more severe symptoms than if only one lesion existed

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15
Q

mononeuropathy

A

an isolated nerve lesion; associated conditions include trauma and entrapment

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16
Q

neuroma

A

abnormal growth of nerve cells; associated conditions include vasculitis, AIDS, and amyloidosis

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17
Q

polyneuropathy

A

diffuse nerve dysfunction that is symmetrical and typically secondary to pathology and not trauma
examples Guillain-Barre syndrome, peripheral neuropathy, use of neurotoxic drugs and HIV

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18
Q

Wallerian degeneration

A

degeneration that occurs distally, specifically to myelin sheath and axon

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19
Q

Mildest form of nerve injury

A

neurapraxia

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20
Q

What is neurapraxia?

A

conduction block usually due to myelin dysfunction

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21
Q

In neurapraxia, is nerve conduction preserved?

A

yes, proximal and distal to the lesion

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22
Q

Are the nerve fibers damaged in neurapraxia? or degneration?

A

no no

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23
Q

Symptoms of neurapraxia?

A

pain, minimal muscle atrophy, numbness or greater loss of motor and sensory function, diminished proprioception

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24
Q

Recovery time period for neurapraxia?

A

4-6 weeks

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25
What injuries are the most common with neurapraxia?
pressure injuries
26
If you fx the neck of the humerus, and/or have an anterior dislocation of the shoulder, what type of nerve injury do you most likely have?
axillary
27
If you fx the clavicle what type of nerve injury do you most likely have?
musculocutaneous
28
If you compress the nerve at the radial tunnel and/or fx the humerus what type of nerve injury do you most likely have?
radial
29
If you compress the nerve at the carpal tunnel and/or have pronator teres entrapment, what type of nerve injury do you most likely have?
median
30
If you compress the nerve in the cubital tunnel and/or have entrapment at Guyon's canal then what type of nerve injury do you most likely have?
ulnar
31
In the LE, many nerve injuries for women are secondary to ...
labor delivery or surgical procedures around the pelvis
32
If you have a THA, displace acetabular fx, anterior dislocation of the femur, hysterectomy, and/or appendectomy, what kind of nerve injury could you have?
femoral
33
If you have blunt force trauma to the butt, THA, and/or accidental injection to the nerve, which nerve could have the injury?
sciatic
34
If you have a fixation of the femur after fx or THA, which nerve is most likely injured?
obturator
35
If you have a femur, tibia or fibula fx and/or positioning during surgical procedures, which nerve is most likely injured?
fibular
36
If you have tarsal tunnel entrapment and/or popliteal fossa compression you most likely have what kind of nerve injury?
tibial
37
If you have a fx of the calcaneus or lateral malleolus what kind of nerve injury could you have?
sural
38
Who has better outcomes after peripheral nerve damage?
children
39
What also produces better outcomes for peripheral nerve damage?
earlier repair more distal the lesion
40
What is the middle ground for nerve injuries?
axonotmesis
41
Is axonotmesis reversible?
yes since they maintain an anatomical relationship to each other
42
What can occur with axonotmesis?
wallerian degneration
43
How fast does the nerve regeneration in axonotmesis?
distally 1mm/day
44
Recovery is.... in axonotmesis?
spontaneous and varies from spotty to no recovery. Surgery may be required.
45
Most common type of axonotmesis?
traction compression crush
46
What is the most severe type of nerve injury?
neurotmesis
47
Is neurotmesis reversible?
no
48
What happens physically with neurotmesis injury?
flaccid paralysis and wasting of the muscle occurs and total loss of sensation by that nerve all motor and sensory loss distal to the lesion becomes permanently impaired
49
How do you repair neurotmesis?
surgery and it could regenerate after that at about 1 mm/day with proximal recovery first and sensory recovery comes sooner than motor
50
What is the injury associated with neurotmesis?
complete transection of the nerve trunk
51
Peripheral nervous system pathology occurring in the anterior horn cell does what to: sensory? motor? signs? DTRs? examples?
sensory intact motor weakness and atrophy fasciculations decreased DTRs ALS, polio
52
Peripheral nervous system pathology occurring in the muscle does what to: sensory? motor? signs? DTRs? examples?
sensory intact motor weakness fasciculations are rare normal or decreased DTRs muscular dystrophy
53
Peripheral nervous system pathology occurring in the neuromuscular junction does what to: sensory? motor? DTRs? examples?
sensory intact motor fatigue is greater than actual weakness normal DTRs myasthenia gravis
54
Peripheral nervous system pathology occurring in the peripheral nerve or mononeuropathy does what to: sensory? motor? examples?
sensory loss along route of nerve motor weakness and atrophy in peripheral distribution may have fasciculations trauma
55
Peripheral nervous system pathology occurring in multiple nerves or polyneuropathy does what to: sensory? motor? DTRs? examples?
impaired sensory in stocking glove distribution motor weakness and atrophy; weaker distally than proximally; may have fasciculations decreased DTRs diabetic peripheral polyneuropathy
56
Peripheral nervous system pathology occurring in spinal roots and nerves does what to: sensory? motor? signs? DTRs? examples?
corresponding dermatomal deficits motor weakness in innervated pattern may have fasciculations decreased DTRs herniated disc
57
UMN disease is
in descending motor tracts within cerebral motor cortex, internal capsule or brainstem or spinal cord.
58
UMN symptoms
weakness of muscles involved, hypertonicity, hyperreflexia, mild disuse atrophy, and abnormal reflexes
59
Damaged tracts of UMN disease are in the ....
lateral white column of the spinal cord
60
Examples of UMN lesions
cerebral palsy hydrocephalus ALS CVA birth injuries MS Huntington's TBI pseudobulbar palsy brain tumors
61
LMN diseases are
lesions in nerves or axons at or below level of brainstem usually within the final common pathway.
62
In LMN diseases, what part of the spinal cord is affected?
ventral gray
63
Symptoms of LMN disease?
flaccidity weakness decreased tone fasciculations muscle atrophy decreased or absent reflexes
64
LMN examples
polio ALS guillain barre tumors in spinal cord trauma progressive muscle atrophy infection bells palsy carpal tunnel muscular dystrophy spinal muscular atrophy
65
UMN or LMN: hyperactive reflexes hypoactive reflexes mild atrophy fasciculations atrophy hypotonic to flaccid hypertonic
UMN LMN UMN LMN LMN LMN UMN
66
hypokinesia disorders
apraxia rigidity bradykinesia
67
hyperkinesia disorders
ataxia athetosis chorea tics tremors dysmetria dystonia
68
Athetosis
slow, twisting, writhing movements that are large in amplitude.
69
Where are athetoid movements primarily seen?
face tongue trunk extremities
70
When movements are brief in athetosis, they merge with what?
chorea
71
When movements are sustained in athetosis they merge with what?
dystonia and typically associated with spasticity
72
Athetosis is common in several forms of...
cerebral palsy secondary to basal ganglia pathology
73
Chorea is damage to
caudate nucleus
74
What is another form of chorea?
ballism large amplitude
75
Ballism produces.... secondary to damage in....
flailing movements in limbs subthalamic nucleus
76
Dystonia is...
sustained muscle contractions that cause twisting, abnormal postures and repetitive movements
77
In dystonia all.... are affected equally and involuntary movements are accentuated during ....
muscles volitional movement and with progression can produce overflow
78
Diagnoses that include dystonia are...
parkinsons cerebral palsy encephalitis
79
Tics are ...
sudden, coordinated movements at irregular intervals
80
What is an example of a pathology that presents with tics?
Tourettes
81
Resting tremors
at rest and may or may not disappear with movement. May increase with stress. Example: pill rolling in Parkinsons
82
Postural tremors
voluntary contraction to maintain posture. examples include rapid tremor associated with hyperthyroidism, fatigue or anxiety and benign essential tremor
83
Intention tremors
absent at rest, lesion of cerebellum or its efferent pathways and seen with MS.
84

NPTE (54 decks)

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