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PHTH 7212 Pathophysiology > pns injuries of the ue powerpoint from dr shappy > Flashcards

pns injuries of the ue powerpoint from dr shappy Flashcards

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1
Q

What is a GTO

A

Golgi tendon organ, a proprioceptor that monitors level of tension in the muscle. Found in the tendon.

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2
Q

muscle Spindles

A

-serve as mechanoreceptors- lie parallel to muscle fibers; respond to muscle stretching

A type of proprioceptor

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3
Q

Afferent neuron

A

carries info towards brain

(sensory)

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4
Q

Efferent neuron

A

carries signals to tissues

(motor)

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5
Q

3 Layers of connective tissue covering a nerve fiber

A

Epineurium

Perineurium

Myelin sheath (like insulator on an extension cord)

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6
Q

What can cause Peripheral nerve response to injury? (5)

A
  1. Compression/Trauma
  2. Heredity
  3. Infections
  4. Toxin
  5. Metabolic
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7
Q

What are two Peripheral Nerve break down responses to injury?

A

Demylination - typically segmental

or

Degeneration - more severe (Anterograde/Wallerian)

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8
Q

Compression of a nerve can start the inflammation process due to ____________.

A

Lack of oxygen

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9
Q

Saturday night palsy

A

Radial nerve compression against the spiral groove of the humerus -> weak wrist and finger extension, weak brachioradialis reflex, normal triceps

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10
Q

Erbs Palsy

A

Superior Brachial Plexus injury. Caused by excessive separation of the head and neck such as falling with shoulder on ground, or excessive stretching during baby delivery

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11
Q

Demyelination is typically _____.

A

segmental

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12
Q

Is nerve demyelination or degeneration more severe?

A

degeneration

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13
Q

What are two names for the same type of nerve degeneration?

A

Anterograde degeneraton

Wallerian degeneration

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14
Q

wallerian degeneration

A

Changes that occur in a axon that has been injured. It is degeneration that occurs distally, specifically to the myelin sheath and axon.

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15
Q

PN Regeneration

A

a slow process, axonal sprouting - can get lost and not find correct endoneurial tube

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16
Q

What is an endoneurial tube, and what is its role in axon regeneration?

A

Endoneurial tube consists of endoneurium, Schwann cells, and myelin sheath that serve to guide axon growth.

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17
Q

PN reinnervation

A

can occur when adjacent neuron innervates muscle fibers of injured neuron, collateral sprouting

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18
Q

What are two Peripheral Nerve break down responses to injury?

A

Regeneration - axonal sprouting that re-connects original nerve (slow and can get lost)

Or

Reinnervation - adjacent neuron innervates muscle fibers of injured neuron through collateral sprouting

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19
Q

what are some other ways besides a strain, sprain, or fracture that a peripheral nerve can be injured?

A
  1. metabolic,
    • such as Na imbalance
  2. genetic
  3. chemical, such as
    • bug bite
  4. Virus
  5. Surgery
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20
Q

describe what is going on in the picture

A
  1. Injury
  2. nerve retracts (anterograde/wallerian degeneration) & rest of the nerve dies. Atrophy very quick.
  3. Regeneration: Sprouting. (in this case it is finding the cone). Lots of atrophy happens quickly.
  4. nerve continues to heal. Oligodendrocytes regenerate myelin. Innervated muscle hypertrophy
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21
Q

describe the picture

A
  1. nerve is cut with scapule
  2. separation (we don’t have specifics for this)
  3. Wallerian degeneration - retraction of nerve and break down of part distal to cut
  4. after 72 hrs axonal sprouting and macrophages clear out old dying part of nerve in inflammatory process.
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22
Q

Three classifications of nerve injury

A
  1. Neuropraxia - caused by mild ischemia
    • segmental demyelination blocking conduction
  2. Axonotmesis - prolonged compression & necrosis
    • axon damage connective tissue intact
  3. Neurotmesis - complete severance of axon & disruption of connective tissue
    • gun shot, stab (can be surgical) or avusion
    • muscle fiber atrophy due to loss of trophic substance
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23
Q

Neuropraxia

A

A segmental demyelination blocking conduction caused by mild ischemia

usually takes only minutes to get better (hopefully not hours)

one of three classifications of nerve injury

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24
Q

Axonotmesis

A

Axon damaged, but connective tissue intact

Cone doesn’t need to develop because there is not wallerian degeneration

one of three classifications of nerve injury

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25
Neurotmesis
Complete severance of axon and disruption of connective tissue * gun shot, stab (can be surgical) or evulsion * muscle fiber atrophy due to loss of trophic substances (nutrients from nerve) one of three classifications of nerve injury
26
Trophic substances
growth and survival factors
27
Five classifications of neuropathy
1. Mononeuropathy - single peripheral nerve injured 2. Polyneuropathy - several peripheral nerves injured 3. Radiculoneuropathy or Radiculopathy - nerve root injury 4. Polyradiculitis - infection creating inflammation of several nerve roots 5. Myopathy - motor endplate injury
28
mononeuropathy
single peripheral nerve injured (may not even know you are injured) can be mild to severe
29
Polyneuropathy
several peripheral nerves injured does not mean all types of nerves are involved. It just means more than one nerve is involved can be mild to severe
30
the other name for radiculoneuropathy
radiculopathy
31
the other name for radiculopathy
radiculoneuropathy
32
Radiculoneuropathy/Radiculopathy
a nerve root injury can be mild to severe
33
Polyradiculitis
infection creating inflammation of several nerve roots can be mild to severe
34
Myopathy
motor endplate injury can be mild to severe
35
myelopathy
any pathologic condition of spinal cord; usually from compression, toxic, or altered metabolic states
36
Signs and symptoms of pheripheral dysfunction
* Sensory loss - tingling, numbness, burning, etc Motor loss - weakness, hypotonia or flaccid * pareis or paralysis - peripheral distribution * Weakness - myotome distribution or that of spinal nerve * Autonomic Loss - vascular, sweating, hair loss, skin
37
Signs and symptoms of peripheral dysfunction: Sensory loss
* Sensory loss- tingling, numbness, burning, etc. * Peripheral distribution * Nerve root- dermatome * Distal first- stocking glove distribution
38
Signs and symptoms of peripheral dysfunction: Motor Loss
Motor loss- weakness, hypotonia or flaccid * Paresis or Paralysis- peripheral distribution * Weakness- myotome distribution of that spinal nerve
39
hypotonia
low muscle tone
40
Signs and symptoms of peripheral dysfunction: Autonomic Loss
• Autonomic loss- – Vascular, sweating, hair loss, skin
41
If your pt has pronator teres syndrome, you can \_\_\_\_\_\_\_\_\_.
stretch pronator teres to get more room in pronator teres muscle
42
Two common median nerve entrapments:
1. Pronator teres syndrome 2. Carpal Tunnel Syndrome
43
Three Signs and symptoms of median nerve compression (carpal tunnel and pronator teres syndromes)
1. Elbow pain - pronator teres syndrome (can be misdiagnosed as medial epicondylitis) 2. Sensory issue - median nerve distribution 3. Motor: Intrinsic hand muscles, Thenar Eminence.
44
Treatment for Median Nerve compression
1. Eliminate trauma - (computer/mouse) 2. Soft Tissue Work 3. Modalities 4. Neural Gliding/flosing 5. Stretching 6. Strengthening (also can use a cockup splint or brace)
45
Carpal Tunnel surgery
* Don't cut median nerve! * do Scar Mobs afterwards * Used to use a scalpel but now they have a stitch- ripper thing. * Also endoscopic now
46
Two common Ulnar nerve entrapments
Ulnar Groove Syndrome or Gyon Canal Syndrome
47
Signs and symptoms for Ulnar entrapments
* Medial elbow - groove for ulnar nerve swelling/tenderness (ulnar groove syndrome) * Sensory - ulnar nerve distribution of hand * Motor - intrinsic hand, hypothenar eminence
48
Treatment for Ulnar Nerve entrapments
1. Eliminate Trauma - bike handle bars for gyon's 2. Soft tissue work 3. Modalities 4. Neural gliding/flossing 5. Stretching 6. Strengthening (stretch, strengthen, and functionally retrain)
49
Two Radial Nerve Entrapments
Wartenberg's Syndrome (entrapment of the superficial branch of the Radial nerve between brachioradialis and ECRL tendons during pronation) Supinator Syndrome/Radial Tunnel Syndrome (entrapment of the deep branch of the radial nerve close to the supinator muscle)
50
Wartenberg's Syndrome
entrapment of the superficial branch of the Radial nerve between brachioradialis and ECRL tendons during pronation Tell-tail sign is abduction of the fifth digit
51
Supinator Syndrome/Radial Tunnel Syndrome
entrapment of the deep branch of the radial nerve close to the supinator muscle
52
Tell tail sign of Wartenburg's Syndrome
abduction of the fifth digit
53
Signs and symptoms of Wartenburg's Syndrome
* Watch strap or Handcuff * Tight cast or splint * Paresthesia * Tingling, numbness, burning over radial distribution * Weakness? * No intrinsic muscle innervation
54
Thoracic outlet syndrome (T.O.S) (outlet)
General term referring to compression of neurovascular structures as they exit the thoracic outlet (1st rib, clavicle, scalene muscles)
55
What bad thing could happen from carrying ruck sacks, back packs, or golf bags?
Suprascapular Nerve and/or Axillary Nerve Compression
56
paresis
partial or slight paralysis of muscles
57
TOS Signs & Symptoms (sensory & motor)
Sensory: * Tingling, Numbness, Burning * Distribution of the Root, trunk, division, cord Motor * Paresis or paralysis * Distribution of involved nerve
58
Complex Regional Pain Syndrome (CRPS)/Reflex Sympathetic Dystrophy (RSD)/Causalgia
* Pain- greater than expected for amount of trauma * Post injury, trauma, surgery * Vasomotor/thermal- temperature issues * Skin- Shinny, dry, sweaty, erythema, hair loss * Touch- Hypersensitive, Semmes Weinstein monofilament testing
59
Two more names for Complex Regional Pain Syndrome
Reflex Sympathetic Dystrophy (RSD) Causalgia
60
Two more names for Reflex Sympathetic Dystrophy (RSD)
Complex Regional Pain Syndrome Causalgia
61
Two more names for Causalgia
Complex Regional Pain Syndrome Reflex Sympathetic Dystrophy (RSD)

PHTH 7212 Pathophysiology (12 decks)

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