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Definition and symptoms of peripheral neuropathy

-Peripheral neuropathy affects about 20 million people in the US
-Develops from damage to the peripheral nervous system
Symptoms: range from numbness/tingling, paresthesia (prickling sensation/pins + needs), muscle weakness
-pain, allodynia -may affect internal organs (autonomic system: digestion, urination, etc.)
-may lead to paralysis, muscle sweating, organ dysfunction and failure


Possible causes of peripheral neuropathy

Physical injury/trauma
-repetitive stress
-cumulative damage from repetitive use
-compression injury or entrapment neuropathies

Diseases or disorders
-metabolic, endocrine (diabetes mellitus, hypothyroidism, etc.)
-autoimmune disease (lupus, rheumatoid arthritis, Sjogren’s system, etc.)
-others: kidney disease, cancer, neuromas, infections, toxins, alcohol abuse, etc.


Types of Peripheral Neuropathy

Mononeuropathy- damage to a single peripheral nerve (median nerve in CTS)
Polyneuropathy- involves multiple nerves throughout the body; malfunctions at the same time
-e.g., Guillain-Barre syndrome, diabetic neuropathy, Charcot-Marie-Tooth disease

Parts of the nerve may be damaged
-axonal damage, myelin sheet damage, both
Types of nerves may be damaged
-motor nerve damage
-sensory nerve damage
-autonomic nerve damage


Brachial Plexus injury (definition, causes, types)

Brachial plexus- network of nerves that originate in the cervical region
Branches form most of the other nerves in the upper limbs, including the shoulder
Radial, median, and ulnar nerves originate in the brachial plexus


Brachial Plexus Injury Causes

Brachial plexus injury (BPI)- an umbrella term for a variety of conditions that impair the brachial plexus nerve network; majority of injuries caused by trauma

Causes include:
-high-speed vehicular accidents, motorcycle -blunt trauma
-stab/gunshot wounds -inflammatory process (brachial plexitis)
-compression -neuropathies
-obstetric brachial plexus palsy


Brachial Plexus Injury types: Avulsion

nerve has been pulled out from the spinal cord and no chance to recover


Brachial Plexus Injury types: Rupture

nerve has been stretched or partially torn, but not at the spinal cord


Brachial Plexus Injury types: Neuropraxia

nerve has been stretched or compressed but is still attached (not torn) and has excellent prognosis but rapid recovery (transient)


Brachial Plexus Injury types: Axonotmesis

axons have been severed; prognosis moderate


Brachial Plexus Injury types: Neurotmesis

entire nerve has been divided; prognosis very poor


Definition of soft tissue injury

Soft tissue injury generally refers to musculoskeletal tissue other than bone
-Includes muscle, blood vessels, ligaments, tendons, cartilage, skin, etc.


contusions caused by...


sudden forceful muscle injury caused by an impact of a blunt object or force

symptoms: history of blunt trauma weakness and/or pain to muscle group
-tightness/swelling of muscle
-inability to fully flex muscle
-palpable hematoma in muscle tissue



muscle-tendon unit; “pulled muscle”
-caused by pulling or twisting injury, overuse/overstressed from heaving lifting or exertion, or by sudden stretch of a contracting muscle
symptoms: pain, muscle spasms, muscle weakness, stiffness, swelling and local tenderness
prevention: proper stretching, warm up, avoid over exertion


sprains involve the? are caused by? result in? symptoms?

involves the joint ligament and capsule; caused by excessive move of the joint, resulting in torn or stretched ligaments
symptoms: pain, rapid swelling, tenderness, discoloration, limited joint movement


elbow injuries

olecranon fracture- removeable cast for 3-6 weeks, depending on fracture and repair
ROM starting in the 1st week, CPM (continuous passive movement)
progressive strengthening program
precautions: no lifting or carrying with involved arm or driving until healed (6 weeks)
Progressive lifting and carrying after 6 weeks


lateral epicondylitis

“tennis elbow”
overuse or cumulative trauma, wear & tear, but can occur without injury
ECRB (extensor carpi radialis brevis) tendon inflammation and pain
common overuse syndrome between ages 30-50
symptoms: pain to lateral epicondyle area when gripping, weak grip;
worse with hand and forearm activity, and gripping


wrist injuries

wrist sprains & scaphoid- scaphoid is a retrograde blood supply; 70-80% of blood supply comes from the dorsal carpal branch of the radial artery; 20-30% of total supply come from the palmar and superficial palmar branches (radial artery) & doesn’t reach the proximal pole

Scaphoid fracture- blood flow characteristics present a problem w/ a scaphoid fracture
-with blood flow disruption, healing can be slow or not heal at all

Signs: presents with deep, dull pain in the radial side of the wrist usually worsens with gripping/squeezing
Swelling is typically present and bruising is visible
-tenderness to palpation of anatomical snuffbox


Shoulder Injuries: dislocation

anterior dislocation accounts for 95% of cases

Displaced joint, usually the result of a traumatic injury (forced out of socket)
may involve injury to nerve and blood vessels
May need x-ray for diagnosis


AC-joint injury

types 3-6; deltoid and trapezius muscles detached


chronic shoulder instability

shoulder is the most moveable joint in your body, and because of that, one of the most unstable
injury may not be complete dislocation, partial dislocation is called subluxation
once the ligaments, tendons, and muscles around the shoulder become loose or torn from repeated injury, dislocations can reoccur

Chronic shoulder instability is the persistent inability of these issues to keep the arm centered in the shoulder pocket


Shoulder bursitis/rotator cuff tendonitis/impingement syndrome treatment

occurs when the bursa and rotator cuff tendons are inflamed
often result of injury that set off inflammation

Symptoms: shoulder pain with overhead activities, at the lateral/superior aspect, catching/grating when arm is raised or rotated


rotator cuff tear

result of injury, chronic tendinopathy, or a combination of both
If a tear is suspected, ultrasound or MRI is usually recommended to confirm the tear
Initially, smaller tears are treated conservatively, with rest, ice stretching, and strengthening exercises


Dupuytren’s disease

abnormal thickening of the fascia tissue in the palm, can extend to the fingers
-characterized by firm pits, nodules, and cords that may pull the fingers into flexion at the MP joints
-tendons not involved, may involve skin


Boutonniere deformity

caused by forceful blow to bent finger (jammed finger)
-rupture of central slip causes the extrinsic extension mechanism from the extensor digitorum communis (EDC) to be lost
-prevents extension at the PIP joint
-weakening of triangular ligament causes intrinsic muscles of the hand (lumbricals) to act as flexors at the PIP joint
-lumbricals also extend the DIP joint without an opposing or balancing force
-palmar migration of collateral bands and lateral bands causes lumbricals pull to become unopposed


Skier’s (snow)/ Gamekeeper’s thumb

injury to the ulnar collateral ligament of the thumb MP joint



may be simple, aligned and stable
other fractures are unstable and the bone fragments tend to displace/shift

Comminuted fractures (bone is shattered into many pieces) usually occur from a high energy force and are often unstable

Open (compound) fracture occurs when a bone fragment breaks through the skin; there is some risk of infection with compound fractures


may be a family trait and harmless, but if it develops, it may be associated with lung disease -inflammatory bowel disease -heart disease -liver disease -AIDS



associated with; cardiovascular disease, collagen vascular disease, prednisone use, cardiac failure, COPD, etc.

absent lunula may indicate...

red lunula

anemia or malnutrition


may be a sign of:
-anemia -congestive heart failure -liver disease -malnutrition

pale nails


may indicate
-Raynaud’s disease, respiratory disorders, cardiovascular disorders

bluish nails (cyanosis)