PNSpathologiestxupperextremity Flashcards
(26 cards)
pathway of the radial nerve
begins posterior cord (C5-T1)
travels through triangular space
deep to lateral head of triceps along spiral groove of the humerus
through lateral intermuscular septum to the anterior arm
anteriorly to lateral epicondyle and deep to brachioradialis
crosses elbow and divides at the supinator muscle
deep branch pierces supinator travels to poste compartment
superficial continues under brachioradialis crosses extensor retinaculum and provides sensory LATERAL 1/2 dorsum of hand EXCEPT FINGER TIPS (median n.)
Where are sites of impingement for the radial nerve?
triangular interval
spiral groove
deep to brachioradialis
as it pierces supinator (deep branch)
landmark the triangular interval:
between lateral and long head of the triceps brachii muscles
Causes of radial nerve impingement/pathology
Fractures (esp spiral groove of humerus) radial head dislocation (HR or HU joints) poor positioning during surgery crutch use(axilla compression) Saturday night palsy Supinator syndrome
what is supinator syndrome
compression due to overuse of supinator
CI`s radial n. tx
Neuritis
acute neuralgia
no massage 3 weeks post surgery
Frictions/deep pressure on flaccid tissue
Any massage on crush/severance injuries before neurologist ok’s it
tractioning (severance/crush)
Hydro(crush/severence) until sympathetic function returns
Jt play until tissue is reinnervated
rhythmic techniques (crush/severance) until control is regained of limb
What ULTT would you perform to asses a radial n. pathology how would you perform it?
ULTT3 SH depression Internal rotation wrist flex ulnar deviation finger and thumb flex elbow extension
Homecare for your client with a radial nerve lesion
Stretch wrist flex to avoid contracture
Avoid overusing supinator mucles(self massage)
Gentle light stroking distal to proximal self massage on wrist extensors
Treatment goals for a radial nerve lesion
What are you increasing,preventing,maintaining, releasing to decompress the nerve?
Improve mobility C5-T1
↓HT pec- /ant&middle scalenes
↑ fascial extensibility at triangular space and spiral groove
↓HT/TP brachioradialis/supinator
↑mobility / position of radial head
↑fascial extensibility of lateral intermuscular septum
Stimulate sensation in sensory distribution of radial n.
Improve tissue health of all muscles innervated by radial n.
←contractures on antagonists(flexors) through segmental fascial release
What disorder is a traction injury to the upper brachial plexus C5/6? What characteristics are common of this pathology?
Erbs palsy waiters tip (C5-C6) affected
List general conditions required and or present for peripheral nerve regeneration
1 Cell body intact
2 Adequate blood supply to ALL parts of neuron
3 NO infection present
4 Schwann cells must be available
5 Endoneurium and preferable epineurium still intact
6 End approximation is important
Under optimal conditions state recovery time for sciatic nerve/ median nerve/ bells palsy(CNVII)
Sciactic=6-8 months
Median= 3months
Bells palsy=6 weeks
Define walarian degeneration
Wallarian degeneration: occurs when a peripheral nerve is damaged and axon distal to the lesion site ties (from terminal brand to nearest proximal node of ranvier)
Define a neuroma:
Neuroma: tumor composed of nerve cells forming after complete or partial severance
Describe the way in which a neuroma develops when injury has occurred:
A proximal nerve stump develops and responds by sending sprouts toward the distal endoneurial tube which when they reach it provide a pathway for other fibers to follow (fibers are random)
What does treatment and symptoms look like if someone has a neuroma?
Continuous poorly localized pain with altered sensation and marked sensitivity to area local to neuroma (if symptomatic)
Tx= relaxation massage and local area may be a local CI of painful
AFROM and AAROM to prox and distal joints
Myotome “dance” for C1-T1:
NK flex(C1/2) Lat flex NK (c3) SH elevation(c4) SH abd(C5) Elbow flex/wrist ext(C6) Elbow ext/wrist flex(C7) Thumb ext/unlar dev (C8) Abd/Add of intrinsics (T1)
Myotome “dance” for L1-S2:
Hip flex(L1/2) Knee ext (L3) DF (L4) Big toe ext (L5) Ext all toes (L5/S1) PF(hip ext/ER)(S1) Knee flex (S2)
Principals for myotomal testing:
Jt neutral or resting position
NO direct pressure on joint
Resist with one hand stabilize with other
TEST: isometric contraction
Hold 5 seconds MIN
BILATERAL when able to
List the areas you test for sensory in a 1st scanning exam:
Head; C-spine; SH; upper chest; upper back ; arms down to finger
What reflex would you use to test the L3/4?
C7?
List at least 2 others youd do
Patellar reflex
Triceps
Biceps (C5)/ Brachioradialis (C6)
Achilles tendon (S1/S2)
Explain the positioning for the ULTT4…what is this testing for?
Shoulder depression (must be maintained throughout test) Abd 10-90⁰ ER Shoulder Supination Wrist extension and radial deviation Finger and thumb extension Elbow flexion last if possible
Ulnar nerve involvement/pathology/compression
Explain how to do Phalens test(what does this test for)
Push clts wrists together into flex (ext for reversed phalens) tests for median n.compression(CTS)
What pathologies is true CTS often confused with or present with
> C6/C7 radiculopathies (pain in Nk during AROM/PROM)
TOS
Pronator Terres Syndrome (Pain in elbow upon mvmt at pronator terres insertions)
**DOUBLE CRUSH when CTS occurs with one of these condition
