PNS Pathology Flashcards by Annesa T

Why does the brain interpret an over activity of sympathetic fibers as pain?

Unable to distinguish between increased autonomic fibers and pain receptors

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A sudden onset of intense burning pain with swelling and poor vasomotor control is? What is this associated with and what does it seem top lead to?

Causalgia
Traumatic nerve injury
Over activity of sympathetic fibers

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Mononeuropathy is?

Involving one peripheral nerve (polyneuropathy is more than one)

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What’s the difference between peripheral neuropathy and myopathy?

Peripheral is damage to peripheral nerves where as myopathy involves pathology of the motor end plate of a peripheral nerve or the muscle itself

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Sensory loss is _____ while sensory impairment is _____.

Dysesthesia is also known as_____ what’s another word for this?

Anesthesia
Paresthesia
Pain/ Algia

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Where are UMN lesions located?

Brain

Spinal cord tracts (white matter)

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LMN lesions are located in _____?

Spinal cord (anterior grey horn) 
Nerve roots (radiculopathy) 
Along the length of axon in PNS (LMN)

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In a ______ lesion you will experience spastic paralysis. What other symptoms will you see?

Upper Motor neuron (UMN)
Hypertonic muscles
Loss of control
Disuse atrophy (maybe)

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Describe symptoms of a lower motor neuron lesion

Flaccid paralysis
Atonicity and atrophy
Loss of POWER

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Sensory involvement of PNS pathology can be due to ….?

Lesions at dorsal root ganglion

Lesions associated with 1st order sensory neurons

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If specific dermatomal patterns are presenting what would you presume is involved

Dorsal root ganglion

Sensory branch of specific spinal nerve

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Motor involvement in PNS pathologies is characterized by: ____

What disorders can cause them?

Paresis (weakness)
Flaccidity (loss of motor)

> cell bodies of LMN in spinal cord or in cranial nerve nuclei
axons if lower motor neurons
myopathies (motor end plate/ motor unit fibers)

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With neuropathies muscle weakness is ______ and in myopathies it is _____.

Distal

Proximal

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Explain the pathophysiology of CRPS

Sympathetic nerve dysfunction leading to vasomotor instability (vasospasm)

Pain syndrome follows trauma

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What stage of Causalgia does the following scenario describe

Hardened Edema;affecting my mobility
Skin becomes thin and glossy and cool
Sweaty

Stage 2

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How does stage one and stage two differ? How are they the same?

Stage 1 Edema is soft and local
Limb is warm and dry (sympathetic hypo activity) burning pain distal

Stage 2= Edema is hard burning pain worsens
Skin thin glossy cool and sweaty ( paradox sympathetic hyperactivity)

Same: hyperalgesia

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What is the atrophic stage of CRPS?

Third stage
Pain spreads proximal
Edema hardens further
Skin now becomes cyanotic (still same appearance as stage 2)
Contracture form
Atrophy of digits in affected limb (fingers or toes)
Bony demineralization and ankylosis

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Charcot-Marie tooth disease 
most common what?
Who
When 
What is it? What nerve  what happens
What deformities are present

Most common inherited disorder if motor/sensory nerve
-Autosomal dominant anyone affected
Early childhood onset
Segmental demyelination of peroneal nerve
Creates hypertrophic Schwann cell onion bulb
Affects legs feet 1st then progresses to hands forearms
Foot drop gait
Pes cavus
Hammer toes

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What is a nerve lesion

Any injury to a nerve resulting in damage to the tissue

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What are two responses to nerve injury

Segmental demyelination

Wallarian degeneration

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What’s another name for segmental demyelination

Neurapraxia

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What can cause wallarian degeneration

Laceration
Stretching
Crushing

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3 degrees of compression injuries

Neurapraxia 1st degree

endoneurium and axon intact good prognoses
temporary loss motor

Axonotmesis

second degree
wallerian degeneration
endoneurium intact
muscle atrophy
sensation motor autonomic loss

Neurotmesis

wallerian degeneration
loss endoneurium

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Difference between nerve compression and nerve entrapment

Compression between two bones and entrapment between soft tissues

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Entrapment syndrome of the brachial plexus

Thoracic outlet syndrome

What artery may be involved in TOS

Subclavian

Possible entrapment sites of TOS

Scalene triangle ( between middle and anterior) Costoclavicular space Subpectoral space

Pathogenesis of TOS

Compression brachial plexus Leads to ischemia Edema = segmental demyelination Axons intact (neurapraxia) Will eventually lead to axonotmesis

Signs symptoms TOS

Usually unilateral Paresthesia fingers hands forearm and arm *** especially ulnar border ring finger and little finger Aggravated by lifting and overhead activities and mvmt of head

Sciatica is due to a prolapse at _____ roots causes weak ____ of foot d/t a weak _____ muscle

L4/L5 Inversion Tibialis posterior

L5 dermatome will create loss of

Lateral sensory aspect high on lower leg

If an injury occurs proximal to the elbow before the radial nerve branches _____ changes will occur.

Muscle and sensory

Damage distal to the elbow of the radial nerve affecting the deep branch will cause what symptoms

Atrophy and motor weakness

What does the superficial radial nerve innervate

Lateral 1/2 of for sum of hand and lateral 3 1/2 fingers except for tips (median nerve )

Complete severance of radial nerve will result in

Wrist drop deformity

Posterior interosseous syndrome is associated with what nerve

Radial nerve paralysis

What is the area of isolated sensation distribution

Web of the thumb

Pathway of radial nerve

Begins post cord (c5-t1) Triangular interval Spiral groove deep to lat head triceps Anterior arm through lateral inter muscular septum Anterior to lat epicondyle deep brachioradialis origin Pierces supinator splits into deep and superficial

Sites of impingement

Triangular interval Spiral groove Deep to brachioradialis Supinator (supinator syndrome )

Names for radial nerve lesions

Crutch palsy Saturday night palsy Wrist drop Supinator syndrome

What ultt is used to assess radial nerve

``` Ultt 3 Depression 10degrees abd Pronation Wrist flex Ulnar deviation Elbow extension ```

Homecare for radial nerve lesion

Stretch wrist flexors Strengthen extensors Avoid overuse supinator

Complete ulnar nerve lesion result in what deformity

Claw hand / bishops hand Cubital tunnel syndrome Tardy ulnar palsy

Specify what fractures are likely to cause radial nerve lesions and ulnar nerve lesions

Spiral groove fracture radial | Colles fracture ulnar

Describe where sensation would be lost in an ulnar nerve lesion

Medial 1/3 of ant and post hand and medial 1 1/2 digits

What is cubical tunnel syndrome due to

Prolonged flexion of elbow Dull ache will radiate upward Possible wasting of hypothenar and adductor muscles of thumb (medial lumbricales) palmar interossei

List 3 median nerve lesions

Carpal tunnel syndrome Pronator terres syndrome Median nerve palsy

Colles fractures have potential to damage what two nerves

Median | Radial

Causes of carpal tunnel can be

Rheumatoid arthritis Pregnancy(8 months) Fracture colles Repetitive flexion and extension

Pathogenesis of carpal tunnel

High tissue pressure in carpal tunnel | Tingling/pain increases with wrist flexion or at night (ischemia) wrist flexed positions ( side lying)

Where is the pain referral pattern for carpal tunnel

Distal forearm or wrist Radiates to thumb index and middle (median n distribution ) May radiate to arm shoulder and neck

What deformities follow median nerve palsy

Ape hand deformity Lack of opposition hard to grab objects Thumb becomes in same plane as fingers

What fractures specifically cause damage to the median nerve?

Supra condylar (humeral) or of wrist and carpal bones

Carpal bones significant in median nerve palsy are.....

Scaphoid | Lunate

What compression syndromes lead to median nerve palsy

Carpal tunnel | Pronator terres syndrome

Median nerve damage at the elbow cause loss of sensation where...

Distal ip jts of index and middle finger

Where may sensation be damaged or altered in median nerve damage local to wrist

Thumb index 3rd and 1/2 4th digit on palmar surface and middle and distal phalanx on extensor surface as well as distal 2/3 of Palm

How do the deformities differ. between median nerve palsy and median nerve damage at the wrist

Ape hand at the wrist | Partial fist median nerve elbow

What pathway of pain occurs in Pronator terres syndrome

Pain ant forearm with elbow mvmt but NOT with wrist mvmt

List 3 important characteristics of Pronator terres syndrome and the nerve involved

Pain is gradual and insidious onset No nocturnal pain Numbness in thumb and index finger Decreased grip stength Median nerve

If carpal tunnel syndrome, is caused by rheumatoid arthritis what is contraindicated

Frictions | Vigorous joint play (if ligamentous instability is present )

Explain pathway median nerve

``` Medial cord and lateral cord c8-t1 Travels with brachial artery Passes through cubital fossa Between 2 heads Pronator terres Deep to flexor digitorum superficialis Between FCR FDS tendons Palmar cutaneous branch innervates thenar eminence ```

What 3 tendons do the medial nerve pass through the carpal tunnel with

Flexor digitorum superficialis Flexor digitorum profundus Flexor pollicis longus

Where are the common impingement sites of the median nerve

Btwn heads of Pronator terres Deep to flexor digitorum superficialis In the carpal tunnel

ULTT1 and 2 are used to assess what nerve? How do they differ

Median nerve primarily (2 also tests musculocutaneous) 10degrees abd with lateral rotation (2) 110degeees abduction

CTS can be confused or present with what other conditions

C6/C7 radiculopathies TOS Pronator terres syndrome

When CTS is present with other conditions it's termed what

A double crush syndrome

Upper brachial plexus lesion affecting C5-C6

Erbs duchenne palsy

Erbs duchenne palsy is accompanied by what deformity

Waiters tip deformity

Describe waiters tip deformity

Shoulder add and internal rotation

What is horners syndrome and what is it associated with

``` Sympathetic nerve function loss to the orbit of the eye Klumpkes paralysis (lesion C8-T1) ```

Describe the clinical manifestations of horners syndrome

Constriction of pupils miosis Prosis(drooping of upper eyelid) Enophthalmos (eyeball moves into orbital cavity) Reduces perspiration

PNS Pathology Flashcards

(72 cards)