Neuropath - Class 3

taylormaloney's version from 2017-01-17 19:05

Section 1

Question Answer
Define Neuropraxia relating to Compression Syndromes.Compression or entrapment nerve injuries.
General prognosis regarding function?Usually a rapid and complete return to function.
There is a _____________block in the peripheral nerve.Local conduction block.
Does this type of pathology result in structural damage ?No, no structural damage to either the axon or tissues distal to lesion.
What is the cause of compression syndromes in peripheral nerves?External Forces. Internal Forces. Systemic Conditions.
What type of external forces?Pressure from casting, splinting, crutches etc.
What type of internal forces?Structural abnormalities, trauma/overuse, poor posture or limb positioning.
What type of systemic conditions?Pregnancy, diabetes, RA w/ systemic edema, and Neuromuscular disorders.

Section 2

Question Answer
Explain the pathophysiology for compression syndromes.Nerve entrapment-> Inflammatory response -> Intraneural edema -> Impaired nerve transmission.
What are the symptoms of Compression Syndromes?Pain, numbness, tingling, muscle weakness, limbs which 'fall asleep'.
What factors influence the extent of the injuries?Severity of lesions, structure of nerve.
What major factor influences the recovery time for compression syndromes?The amount of time it takes to relieve the pressure of the compressed region.
Common compression syndromes entrapment within arm/hand.Carpal tunnel syndrome, TOS.
Lower Limb entrapment?Piriformis Syndrome ( Sciatica ).

Section 3

Question Answer
What is the most common entrapment neuropathy in the USA?Carpal Tunnel Syndrome.
Caused by...?Compression of median N within carpal tunnel in wrist.
CTS is characterized by..Pain, Tingling, Numbness, Parasthesia, and Muscle Weakness in regions supplied by median N.
What are the risk factors associated w/ CTS?Occupational risk, Rheumatoid Tenosynovitis, edema, pregnancy, hypothyroidism, and wrist fractures such as Colle's fracture.
Which symptoms appear first in CTE, Motor or Sensory?Sensory symptoms appear first.
What is the 'hallmark' symptom of CTE?Nocturnal wrist pain, and/or painful numbness.
Is the pain bilateral or unilateral. 50 % of time it is bilateral.
Where may this pain refer to?Shoulder, arm, neck.
What are the motor symptoms relating to CTE?Thenar weakness (advanced cases), escalation to atrophy, loss of grip strength.
Explain how the motor and sensory symptoms combineLoss of grip strength + inability to pinch + sensory loss= clumsiness of hands.

Section 4

Question Answer
How is CTE diagnosed?History, Clinical Manifestations, and Special tests.
What special tests can be used to aid in the diagnosis of CTE?Phalens Test, Tinel's Sign.--- Positive result = pain/numbness/parasthesia.
How is CTE treated?There is no one treatment, usually by wrist splints, ergonomic changes, and steroid injections. Possibly surgery if req'd.

Section 5

Question Answer
What is TOS?tAn entrapment syndrome characterized by the compression of fibres from the brachial plexus within the Thoracic Outlet as well as all the vascular structures.
Where is the thoracic outlet located?Between base of the neck and the armpit.
What 3 categories can TOC be split into?Neurogenic- brachial plexus. Vascular Group- Subclavian artery and/or vein. And Disputed Non-specific TOS- chronic pain and symptoms of brachial plexus.
What are the risk factors associated with TOS?Postural changes, trauma to shoulder girdle, Congenital factors and systemic immune/metabolic disorders.
What is the pathogenesis of TOS?Chronic compression of nerve roots-> edema and ischemia in nerves -> neuropraxia (w/ axons preserved) -> Segmental demyelination.
What is the potential outcome if the compression remains untreated?Neuropraxia leading to axonotmesis leading to wallerian degeneration.
What are the sensory signs and symptoms of nerve compression?Pain + Parasthesia.
What are the motor signs and symptoms of nerve compression?Muscle weakness. Severe cases leading to muscle atrophy.
What are the potential vascular symptoms relating to compression?Coldness, edema, cyanosis, and fatigue in hands/arms.
How is TOC diagnosed?Provocative testing, radiographic tests, and electrophysiological tests.
What options must be eliminated before concluding TOC?Cervical Radiculopathy, Cervical Spondylosis, Reflex Sympathetic Dystrophy, Raynaud's Disease.
How may TOC be treated?Physiotherapeutic exercises, analgesics, and surgery if necessary.
What is the prognosis for TOS?Post surgery- 70% good to excellent results.
If muscle atrophy is present before surgical treatment of TOS, what might this mean for muscle strength?No improvement in muscle strength.

Section 6

Question Answer
Define Compartment syndromeA painful condition that occurs when pressure within the muscles builds up to dangerous levels.
What are the two types of Compartment syndromes?Acute and Chronic.
Acute Compartment Syndrome->Medical emergency, usually caused by severe injury. May lead to irreversible muscle damage if untreated.
Chronic Compartment Syndromes-> 'Exertional compartment syndrome', usually not medical emergency. Most often caused by athletic exertion.

Section 7

Question Answer
Anterior Compartment of Leg- Fascial Compartment..Is MOST affected by compartment syndrome. (45%)
Ant Comp of Leg- cause?Severe Trauma.
What are some predisposing factors of Ant Comp of Leg?Anatomical Configuration, muscle balances and muscle tightness, improper footwear.
What is contained within the anterior compartment?Muscles that dorsiflex the foot- Tib Ant, EHL, EDL, Fib T. Ant Tibial Artery and Veins. and the Deep peroneal nerve.
What are some signs and symptoms of Ant Comp Synd?Bleeding and muscle swelling, severe pain. Shiny skin which is firmer and hotter than surrounding areas. Decreased/altered sensation. Motor Loss with pain during passive stretch.
What acts as a late sign of compart synd? What may take place if the nerve damage is permanent?Numbness/Paralysis. Muscle Necrosis.
How would acute compartment syndrome be treated?Surgical procedure to open fascial restrictions. Called - Fasciectomy.

Section 8

Question Answer
Chronic Compartment Synd most often caused by ...Athletic Exertion.
What are the symptoms of Chronic Compartment Syndrome?Pain and cramping during exercise, subsiding after activity.
What is the mechanism of chronic compartment synd?Exercise caused increase in size of muscle, which increases pressure within compartment. Ischemia within muscle, pain from excessive lactic acid limits activity.
What other symptoms may be present with chronic compartment synd?Numbness/difficulty moving/visible muscle bulging.
How is Chronic Compartment syndrome treated?Physical therapy, orthotics, anti inflammatories, and fasciectomy if necessary.

Section 9

Question Answer
Define Morton NeuromaMorton nerve entrapment, benign tumor t.hat grows around the nerve
What are the characteristics of Morton's Neuroma?Benign growth of nerve tissue in foot involving the common digital nerve. Not considered a true tumour - perineural fibroma. Usually located betweeen 3rd and fourth toes.
What are the other characteristics of Morton's Neuroma?Common neural condition, painful, usually women 5:1, usually ages 45-60 years old, usually only one nerve affected.
What are the potential causes of Morton's Neuroma?Nerve irritation, pressure, injury, and inflammatory conditions.
Describe the pathogenesis of Morton's neuroma.Entrapment causes thickening of endoneurium, hyalization or endoneural vessels, thickened perineum, and demyelination of axons.
What are the clinical manifestations of Morton's Neuroma?Pain on weight bearing (usually shooting pain, occasionally dull pain) usually between 3rd + 4th toes. Burning sensation, numbness, parasthesis.
What might Morton's Neuroma feel like to someone who has it?As though something is inside the ball of the foot.
How is Morton's Neuroma diagnosed?History/Special Testing / Sonography / MRI/
What must be eliminated before a conclusive diagnosis?Metatarsal Stress Fractures, MetaT phalangeal derangement, Metatarsalgia.
Generally affecting those with a ____________ lifestyle.Active.
How might Morton's neuroma be treated?Orthotics/insoles, change of shoes, massage, injection, and surgery ( neural decompression or neurectomy) if necessary.