Neural Entrapment

Question 1

Wallerian degeneration

Answer 1

Axons degenerate distal to the lesion to protect the nerve cell bodies.

Nerve cell bodies can regenerate axon but cannot regenerate the cell bodies

Question 2

Layers of nerve damaged vs severity

Answer 2

Epinerum damage = high severity

Endoneruium = low severity

Perineruium = moderate severity

Question 3

Reticolapathy

Answer 3

Damage to a nerve right when it comes out to form a root/ trunk.

Most severe damage

Question 4

Plexus apathy

Answer 4

Damage to a nerve once it is in a plexus (i.e not a root/trunk)

Question 5

Mononeruopathy vis polyneruopathy

Answer 5

Mono = one peripheral nerve is affected

Poly = multiple nerves are affected

Question 6

Myotomes

Answer 6

C5: abduction of shoulder and elbow flexion

C6: flexion of elbow, wrist extension and abduction of shoulder

C7: elbow and fingers extension, wrist flexion, abduction of shoulder

C8: elbow extension and finger flexion

T1: finger abduction and abduction

Question 7

Muscle strength testing scale

Answer 7

0: no contraction at all
1: weak contraction that is palpable
2: full ROM when gravity is eliminated
3: full ROM against gravity
4: full ROM against gravity and mild resistance
5: full ROM against gravity and maximal resistance

Question 8

Dermatome

Answer 8

C5: lateral shoulder

C6: thenar eminence

C7: index finger (variable)

C8: hypothenar eminance

T1: medial forearm

T2: axilla

Question 9

Cutaneous sensation of peripheral nerves

Answer 9

Axillary: Lateral deltoid/ shoulder

Musculocutaneous: Lateral forearm

Radial: dorsal webbing between thenar eminance and index finger

Ulnar: tip of hypothenar eminance

Median: tip of index finger

Question 10

Reflex ratings

Answer 10

0: no response
1: slight by depressed response
2: normal response
3: very brisk response
4: clonus response (repeating)

Question 11

Erb- duchenne palsy

Answer 11

Upper root nerve plexus damage (C5-C6)

Question 12

Klumpke paralysis

Answer 12

Lower root brachial plexus injury ( C8-T1)

Also produces Horners syndrome (T1) in eyes
- contraction of pupil, drooping eyelid and sunken eyeball

Question 13

Musculocutaneous nerve sensory branches

Answer 13

Lateral antebrachial cutaneous

• Elbow sensation and forearm sensation only*
• upper arm motor function only*

Question 14

Common ways of damage to the axillary nerve

Answer 14

Anterior dislocation of GH joint

Crutch usage

Fracture of the surgical head of the humerus

Improper IM injections

Question 15

Places of radial nerve damage

Answer 15

Axilla or proximal arm (Saturday nights palsy)

Radial groove fracture

Wrist fracture (posterior interosseous syndrome)

Question 16

locations of median nerve damage

Answer 16

Elbow via supracondyler fracture or pronator hypertonicity

Forearm: anterior interosseous syndrome

Wrist: carpel tunnel MOST COMMON

Question 17

Pronator Syndrome (median nerve palsy)

Answer 17

Flexion of PIP in 1-3 digits affected

Flexion of MIP in 2-3 digits affected

Sign of benediction and simian hand

Abnormal pinch sign (cant make ok sign and cant hold paper)

Can’t pronate

Question 18

Locations of ulnar nerve damage

Answer 18

Elbow: posterior to medial epicondyle of humerus

Cubital tunnel (funny bone) MOST COMMON

Wrist (handlebar neuropathy)

Hand (hook of hamate fracture)

Question 19

Difference between guyons canal syndrome and elbow neuropathys of the ulnar nerve

Answer 19

Elbow location = lose of sensation of medial palm and 4th/5th digits

• froments sign is key (cant use pads of fibers to grasp something, must use tips.)
• cant flex 4th and 5th digits

Guyons canal = ulnar claw w/ no radial deviation and can still flex fingers.

Question 20

Difference between simian hand and sign of benediction

Answer 20

Simian hand = passive sign of distal (usually wrist) Medial neuropathies

Sign of benediction = active sign of proximal medial neuropathies

Question 21

Myotome for L2-L4

Answer 21

Hip flexion and adduction

Knee extension

Question 22

Myotome for L4 and L5

Answer 22

Dorsiflexion of foot

hip abduction( has S1 also)

Question 23

Myotome for S1

Answer 23

Plantar flexion and hip abduction

Hip abduction also includes L4-5

Question 24

Myotome for L4-S2

Answer 24

Knee flexion

Question 25

Dermatome of lower leg

Answer 25

L2: upper lateral thigh L3: Medial knee L4: Medial malleolus L5: medial foot S1: heel of foot S2: medial popliteal fossa

Question 26

Lower leg reflexes

Answer 26

Quads = L4 Achilles = S1

Question 27

Femoral neuropathy signs

Answer 27

Causes: - primarily by prolonged external rotation of hip and flexion of knee (like giving birth position) - also when using the saphenous vein for harvesting, femoral nerve may be knicked Sings: - diminished quadriceps reflex - leg drags and buckling of the knee, instability of the knee as well. - loss of sensation of anterior medial thigh

Question 28

Lateral femoral neuropathy

Answer 28

Causes - obesity, diabetic, pregnant, tight clothes (especially in lateral thigh) - often trapped between ASIS and inguinal ligament if it is entrapped Signs: - numbness on lateral thigh that gets worse at night and when hip is extended - use tinels test to determine

Question 29

Superior gluteal neuropathy

Answer 29

Causes: - injury, trauma, fracture/dislocation of greater trochanter - improper IM technique Signs: - pelvic sag via (+) trendleberg - cant abduct or internally rotate hip well

Question 30

Sciatic neuropathy

Answer 30

Causes: - piriformis Syndrome (hypertrophy of overuse) - trauma - athletes that utilize gluteal muscles a lot - improper IM technique Signs: - complete paralysis of all ankle movement and knee flexion - cant feel lower leg and foot

Question 31

Where on the butt and thigh should you inject into in order to avoid damage to the sciatic or gluteal nerves

Answer 31

Von hochstetter triangle - place palm on greater trochanter - place index finer on ASIS - place the middle finger on the iliac tubercle - between the fingers = OK

Question 32

Common fibular nerve neuropathy

Answer 32

*MOST COMMON LOWER LEG NEUROPATHY* Causes: - trauma (especially around fibular head) , overcrossed legs, bed ridden patients, rapid weight loss Signs: - weak in dorsiflexion, ankle eversion and toe extension - often say “ feel like i am tripping over my toes” - loss of sensation in the anteriolateral leg and dorsiflexion of foot

Question 33

Superficial fibular neuropathy

Answer 33

Causes: - compartment syndrome of lateral compartment and chronic ankle sprains Signs: - atrophy of the lateral compartment leg muscles - loss of sensation in dorsum of foot (except for webbing between 1st and 2nd toes - weakness in ankle eversion

Question 34

How do you distinguish the the difference between superifical and deep neuropathies?

Answer 34

Sensory of webbing between the 1st and 2nd digits =deep Entire rest of the dorsum of the foot = superficial

Question 35

Deep fibular neuropathy

Answer 35

Causes: tight shoe wear and braces of ankles - “ski-boot” neuropathy can occur dismally and results similarly Signs: - atrophy - loss of sensation of webbing between 1st and 2nd digits

Question 36

What kind of injection is corticosteroids?

Answer 36

IM but paraneural NOT intranerual

Question 37

Signs to consider aggressive/surgical treatment over conservative

Answer 37

Atrophy in affected area Active damage on a EMG Doesn’t respond at all to conservative treatments

Question 38

Most common nerve used for nerve grafting

Answer 38

Sural nerve