Test 3: Peripheral Neuropathies

Question 1

characteristcs of peripheral neuropathies

Answer 1

can affect one or many nn

can affect just motor, just sensory, or both motor and sensory

nn can be damaged in a variety of ways

UMN vs LMN S&S with progressive damage?

Question 2

describe mononeuropathies

Answer 2

most common type of nn injury

usually some sort on nn entrapment

median nn entrapment is most common

Question 3

describe polyneuropathies

Answer 3

many etiologies

DM is most common in US

leprosy is most common world wide

Question 4

4 ways nn is classified when damaged

Answer 4

1. neuronal degeneration = degeneration of motor and sensory cell bodies and subsequent axons
2. wallerian degeneration = damage to axon at specific point below cell body with degeneration distal to injury
3. axonal degeneration = diffuse axonal damage
4. segmental demyelination = injury to myelin sheath w/o injury to axon

Question 5

common CN injuries

Answer 5

trigeminal neuralgia
Bell’s Palsy
Ramsay Hunt Syndrome

Question 6

common compression injuries of nn

Answer 6

median
ulnar
radial
femoral
sciatic
fibular
tibial

Question 7

types of autoimmune neuropathies

Answer 7

GBS
CIDP
paraneoplastic neuropathy

Question 8

infections polyneuropathies

Answer 8

HIV related polyneuropathies
lyme disease
leprosy

Question 9

toxic and metabolic neuropathies

Answer 9

alcohol neuropathies
B12 deficiency
B6 deficiency

Question 10

neuropathies associated with systemic disease

Answer 10

diabetic neuropathy
hypothyroidism
RA
sarcoidosis
idiopathic polyneuropathy
critical illness polyneuropathy

Question 11

example of hereditary polyneuropathy

Answer 11

charcot marie tooth

Question 12

median nn neuropathy characteristics

Answer 12

implicated with carpal tunnel

can get impinged anywhere on path though

medical management = carpal tunnel release

Question 13

PT exam median nn pathology

Answer 13

nn root issue? cervical issue?
- myotomes
- dermatomes

first rib elevated?
scalenes compression?
pronator teres compression?
carpal tunnel testing
- Phalens
- Tinnels sign

ULNT

Question 14

PT intervention for nn

Answer 14

create space, movement, blood flow to nn

space = treat anything compression (i.e. rib, mm, etc)

movement = nn glides/flossing

blood flow = cardio/aerobic; bringing nutrients to nn

strengthen and work on functional tasks once nn is ready

Question 15

med dx of sciatic nn problems

Answer 15

physical exam
MRI
EMG

Question 16

PT exam of sciatic nn

Answer 16

splits at knee to tibial and common fib

can be anywhere along path
- lumbosacral roots
- piriformis

tests
- palpate piriformis
- slump or SLR
- PAs
- etc

Question 17

what is Bell’s Palsy

Answer 17

CN VII dysfunction

idiopathic acute unilateral facial paralysis

some have it preceded with:
- exposure to cold
- facial numbness and stiffness
- jaw pain
- decreased hearing/hyperacusis

Question 18

med management for Bell’s palsy

Answer 18

corticosteroids for a week
eye protection bc eyelids dont work

sx decompression but data is mixed and high risk of hearing damage

prognosis = 70-90% improve w/o treatment; 90% get better with corticosteroids

Question 19

PT role Bell’s palsy

Answer 19

restrain facial mm for function

eye protection

Question 20

describe diabetic neuropathy

Answer 20

most common neuropathy in US

most common presentation of this is distal sensorimotor neuropathy

often one of first S&S of diabetes
- can progress to hands
- usually lose pain and temp first, then proprioception, and then weakness/atrophy

several other subtypes; one involves ANS

Question 21

diagnostic testing for diabetic neuropathy

Answer 21

glucose testing
EMG and nn conduction test
stocking glove presentation

Question 22

medical management of diabetic neuropathy

Answer 22

optimize glucose control

diabetic foot care edu

meds can be used in setting of painful neuropathy

Question 23

PT exam for diabetic neuropathy

Answer 23

sensory screen
- pain and temp
- then proprioception
- then light touch

balance

skin

neuropathic pain

foot and arch integrity

Question 24

treatment for diabetic neuropathy

Answer 24

skin edu and foot care

balance = uptrain vestibular and vision

maintain strength

desensitization strategies for nn pain

exercise
- helps control blood glucose and improve functional outcomes
- watch for hypoglycemia; ex is like taking insulin; want to know when they last ate/had insulin

Question 25

HIV related polyneuropathies

Answer 25

HIV associated sensory neuropathy affects mostly pts with low CD4 counts can impact 3% of pts with HIV regardless of CD4 counts most common neuro complication for those with HIV and AIDS ca also get neuropathy from antiviral drugs in certain combos causes pain and numbness

Question 26

PT implications with HIV-SN

Answer 26

desensitization techniques for pain exercise as tolerated balance training

Question 27

describe alcohol related polyneuropathy

Answer 27

gradual onset distal to proximal symmetric sensory loss weakness is late complication begins months to years of alcohol abise decreased DTRs most common neuro disease associated with chronic alcoholism ensuing deficiency in thiamine and B12 bc of alcohol diagnosed with nn conduction studies dx of exclusion medically treated with sobriety and vitamin supplementation

Question 28

describe B12 deficiency

Answer 28

found in most animal products low levels lead to neuropathy, myelopathy, dementia, and magaloblastic anemia often distal numbness and gait instability not caught early = distal weakness as well reduced proprioception and vibration sense dx = check serum B12, nn conduction med treatment = B12 supplementation

Question 29

PT implications for alcohol and B12 related neuropathies

Answer 29

MMt sensation gait support for etoh rehab strengthen as able functional task fall risk - balance - compensation vs remediation brace as needed desensitization techniques

Question 30

describe idiopathic polyneuropathy

Answer 30

25% pts have no other identified reason for neuropathy and therefore have idopathic usually happens in 6th decade slow progression over years distal sensory or sensory motor systems most common degeneration of axons w/o inflammatory process no clear med treatment

Question 31

PT implications for idiopathic polyneuropathy

Answer 31

desensitization strategies for pain balance gait skin check

Question 32

describe critical illness polyneuropathy

Answer 32

weeks to months of having critical illness dx of exclusion high mortality may have co-occuring critical illness myopathy often with pts who have been vented through several rounds steroids, potentially neurotoxic drugs, and vasopressors in ICU often in setting of hyperglycemia

Question 33

S&S of CIP

Answer 33

distal or generalized weakness distal sensory loss areflexia

Question 34

CIP medical management

Answer 34

nn conduction to reveal axonal polyneuropathy glucose control treat underlying illness that resulted in critical care prevent/treat secondary complications of bedrest/ICU improves over months if pt survives only 50% completely recover

Question 35

PT implications for CIP

Answer 35

will treat a lot especially in ICU these type dx are why ICUs need PT - prevent secondary comp - make recovery possible early mobility exercise functional mobility treatment desensitization for pain control

Question 36

types of charcot marie tooth

Answer 36

types I and II have these S&S: - progressive distal weakness, atrophy, sensory loss over several years - foot drop most common - hammer toes and pes cavus - type IA most common hereditary can progress into hands and forearms weakness and gait deviation are common often have podiatrist managing; may need sx

Question 37

PT management of charcot marie tooth

Answer 37

strength balance gait functional tasks