Peripheral Nerve entrapments (Pod med) Flashcards Preview

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Flashcards in Peripheral Nerve entrapments (Pod med) Deck (31):
1

 

Name the nerves on the foot?

 

2

 

Know the names of these nerves?

 

 

 

3

 

Name the dermatomes in the foot?

1?

2?

3?

4?

5?

6?

7?

 

 

 

 

 

1. Saphenous nerve

2. Deep peroneal nerve

3. Superficial peroneal nerve

4. Medial plantar nerve

5. Lateral plantar nerve

6. Calcaneal branch 

7. Sural nerve

 

4

 

Name the dermatome nerves in these areas?

 

5

 

Know the sagittal dermatome areas:

 

6

 

What is tarsal tunnel sydrome?

Entrapment of the 1? around the 2?

Caused generally by 3?

Indications 4?

worst at 5?

6? bilateral or unilateral 

 

 

 

1. tibial nerve

2. medial malleolus and in the tarsal tunnel

3. proliferation or oedema of the connective tissues within the tarsal tunnel, reducing the tunnel volume.

4. diagnosis with insidious onset of heel pain, radiating to the plantar and at times proximally. 

5. At night.

Later stage muscle wasting can be found in AbH.

6. Generally unilateral.

 

7

 

What are the risk factors for Tarsal tunnel syndrome?

 

Varicoities, heel valgus/everted heel 

 

8

Less common nerve entrapments

Deep peroneal nerve (dpn) entrapment (anterior tarsal tunnel syndrome ATTS)/ Why 1? Look at what 2?

Superficial peroneal nerve (spn) entrapment

Causes 3?

Positive test when 4?

Sural nerve entrapment

Compression from 5?

 

 

 

1. Talonavicular joint ossicles impingmentin sports people. Tarsometatarsal pain when stretched over osteophytes in older. 2. Look at shoes, lacing technique

3. Trauma, local masses i.e. ganglion

4. Palpating in active dorsiflexion and eversion of the foot against resistance causes pain.

5. other disorder ie, styloid fracture, malleolus fracture, ankle trauma leading to muscle hypertrophy and fascial scarring.

 

9

Less common nerve entrapments

Saphenous nerve entrapment 

•More proximal entrapment 1?

•Completely sensory!! If not think radiculopathy.

Medial plantar nerve entrapment (syn: joggers foot)

Causes 2?

Foot conditions 3?

Entrapment of the first branch of the lateral plantar nerve (Baxter’s nerve)

Sings 4?

management 5?

 

1. around knee or from gastrocswith medial knee and calf pain experienced with paraesthesia of the dorsum medial foot through to 1stray.

2. Athletes with intermittent medial midfoot pain, high arched orthotics causing impingement

3. Valgus hindfoot, positive Tinel’s, pain on ankle eversion and worse on tip toe.

4. Heel pain radiating into the ankle without paraesthesia’s.

5.Cushioning heel cup orthoses with NSAID’s.

 

10

 

What are the common observations and simple assessments for nerve entrapments?

Muscle 1?

Foot 2?

Oedema or lesion causing 3?

Muscle 4?

Balance-single leg and double heel raise

Monofilament/vibration 

Cold/heat perception tests

 

1. tonicity-?unilaterally similar

2. alignment-?muscular weakness

3. causing ^ pressure

4. strength-?muscular deficit

 

11

 

What is the straight leg raise test :

Positive on reproduction 1? when 2? . Can rule out radiculopathy!

Tightness of 3?

Dorsiflex and evert/invert depending on medial or lateral nerve specification

 

 

 

1. of neural symptoms 2. less than 40degrees and is indicative of herniated disc

3.hamstrings able to be assessed for contribution

12

 

Reflexes and clonus

Patella reflex-when absent consider 1?

Achilles reflexes-when absent consider 2?

Sciatic nerve pathology such as disc herniation at 3? level

Clonus is a series of 4?

Could be a 5?

 

1. L2-L4 nerve root concern

 2. S1-S2 nerve root concern

3. L5-S1

4. involuntary, rhythmic, muscular contractions and relaxations

5. cerebellar concern, upper motor neuron lesion, hyperthyroidism, anxiety, previous stroke, multiple sclerosis, hepatic encephalopathy.

13

 

TINNEL's TEST 

Percussion along the 1?

Positive when 2?

When positive indicates the 3?

Check all potential nerves and mark each point that is positive-multiple is common

 

 

1. nerve pathways

2. Reproduction of symptoms experienced

3. local area of nerve irritation, damage or concern.

14

 

What could be done in terms of footwear and lacing for nerve entrapments?

            1? footwear with rocker bottoms.

Supportive 2?

3? for ankle support and midfoot relief.

 

 

1. MBT

2. High ankle cupping

3. Loop lock lacing

 

15

 

Prolotherapy 

Corticosteroid injection:

•‘Reza Special’ 1?

The action 2?

 

 

 

 

 

1. Kenacort1ml, dexamethasone 1ml, lignocaine 1% 1ml-inject up to 2ml depending on location.

2. Decreases inflammation, sensitisation AND healing

16

 

Prolotherapy 

Hydrodilation

Receipe 1?

Action 2?

 

 

 

 

 

1. Lignocaine 2% 5ml, saline 5ml-dependent on location 5-20ml

2. Separate tissues whilst desensitising nerve. Nociceptive reset ?

17

Prolotherapy 

Chemical desensitisation

Receipe 1?

Used to 2?

 

 

 

1. Dextrose up to 25% in lignocaine 2%-surrounding irritated nerve.

2. stimulate inflammatory pathway to repair tissues.

18

 

What are the actions of LLLT/PBMT?

1?

2?

3?

4?

 

 

 

1. Tissue repair

2. Inflammation

3. Oedema

4. Pain 

19

What are the branches of Sciatic nerve:

1?

2?

 

 

1. Tibial nerve

2. Common peroneal nerve

20

 

What are the branches of common peroneal nerve:

1?

2?

 

1. Superficial peroneal nerve 

2. Deep peroneal nerve

 

21

 

Where does Sural nerve come from?

 

 

Sural nerve has a branch from the tibial nerve and the common peroneal nerve

22

 

What is the lateral cutaneous nerve and where does it intervate in the leg?

 

Lateral cutaneous nerve is the first branch of the common peroneal nerve and it innervates the upper 2/3 of lateral leg

23

 

Where does the Sural nerve innervate?

 

Sural nerve innervate the lateral dorsal part of the foot

 

24

 

Where does the tibial nerve innervate?

 

 

Basically all the posterior muscle of the leg and foot

inclduing politeus 

except flexor digitorium brevis and flexor hallucis brevis

25

At which level does the tibial nerve divide into medial and lateral brnaches?

 

At the level of medial malleoli 

 

26

 

Know the motor of sensory innervation of the medial and lateral plantar nerves:

 

27

 

1. What is Baxter's nerve and what does it do?

2. How can it get trapped?

 

1. Baxter's nerve is the first branch of lateral plantar nerve and carries pain sensation to the plantar fasciitis. 

2. The Baxter nerve can get trapped between the abductor hallucis and quadratus plantea. 

 

28

 

What are the medial and lateral brnaches of superficial peroneal nerve and where does it innervate?

 

 

Medial branch: Medial dorsal cutaneous nerve

Lateral branch: Intermediate dorsal cutaneous nerve

 

29

 

Which part of the leg does the sepahneous nerve run?

 

Runs throught the medial part of the leg

30

 

Name the cutaneous nerve supply to the planat aspect of the foot from medial to lateral:

 

Sepahneous nerve

Medial plantar nerve

Lateral plantar nerve

Sural nerve

At the heel: Medial calcaneal branch

31

 

Name the cutaneous nerve supply to the lower leg and the dorsum of the foot from medial to lateral:

 

Saphenous nerve

Superficial peroneal nerve

Deep peroneal nerve

Sural nerve

Lateral cutaneous nerve