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114 Cards in this Set
- Front
- Back
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What may causae tenderness in neck and interscapular area?
history of headaches, sleeping difficulty |
peripheral nerve injury in UE
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What should you watch out for in adhesive capsulitiis, if Pt states exercise makes it worse?
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superscapular nerve impinged in notch
ENMG for suprascapular nerve vs C56/upper trunk would be helpful |
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What to watch out for in complaint of shoulder arthritis pain?
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is pain coming from shoulder joint arthritis?
nerve entrapment? (SupScap nv, upper trunk, C4-6) |
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what to watch out for with diabetic referred for foot drop strengthening?
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if mono-neuritis, strengthening can not be expected today
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Whta to suspect in hip pain, s/p hip replacement?
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Pain may come from S1 nreve/ dermatome
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How long does terminal sprouting take?
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6 month
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How long does axonal regrowth take?
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1mm / day
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When do you use e-stim for denervation?
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stim to prevent collagen crosslink
stop during nacent growth (reconnect) |
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In GBS, how to predict prognosis?
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if 2 weeks later, they hit a floor in loss of str, and then improve, prognosis is good
--- if after a mont (>21 days), no sign of dernervation, then no axonotmesis, then prognosis is good. |
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for Charcot Marie Tooth, is weakness sensory or motor?
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both
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What may causae tenderness in neck and interscapular area?
history of headaches, sleeping difficulty |
peripheral nerve injury in UE
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What should you watch out for in adhesive capsulitiis, if Pt states exercise makes it worse?
|
superscapular nerve impinged in notch
ENMG for suprascapular nerve vs C56/upper trunk would be helpful |
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What to watch out for in complaint of shoulder arthritis pain?
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is pain coming from shoulder joint arthritis?
nerve entrapment? (SupScap nv, upper trunk, C4-6) |
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what to watch out for with diabetic referred for foot drop strengthening?
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if mono-neuritis, strengthening can not be expected today
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Whta to suspect in hip pain, s/p hip replacement?
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Pain may come from S1 nreve/ dermatome
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How long does terminal sprouting take?
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6 month
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How long does axonal regrowth take?
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1mm / day
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When do you use e-stim for denervation?
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stim to prevent collagen crosslink
stop during nacent growth (reconnect) |
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In GBS, how to predict prognosis?
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if 2 weeks later, they hit a floor in loss of str, and then improve, prognosis is good
--- if after a mont (>21 days), no sign of dernervation, then no axonotmesis, then prognosis is good. |
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for Charcot Marie Tooth, is weakness sensory or motor?
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both
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in charcot marie tooth, can muscles be expected to recover?
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no
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in charcot marie tooth, direction of degeneration?
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distal to proximal
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what may be another disorder instead of CMT?
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diastematomyelia
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What is diastematomyelia?
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abnormal congenital structure, in vertebral canal, fibrous, cartilaginous, or bony
stork legs, may have intrinsic minus hand S2-4 problems, sexual /urinary / bowel problems |
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How to distinguish diastematomyela from CMT?
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diastematomyelia has S2-4 sexual urinary bowel problems
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What is post-polio symptom?
What can cause symptoms like it? |
increasing weakness and loss of endurance, due to giant motor units.
inflammatory overuse can lead to this. Sensory functions are good. |
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Can you use estim with terminal sprouting? axonal regrowth?
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no ES with TS
ES with AR, but discontinue when renervation begins |
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What are some possibilities besides carpal tunnel syndrome?
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C78, T1 raidculopathy
Radial compression |
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What are some possibiltiies besides lateral epicondylitis?
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peripheral entrapment, esp if pain worse at night
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What are some characteristics of erb's palsy?
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brachial plexus C5-6 involvement
deltoid involvemtn NO rhomboid involvement (pre-plexus) |
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how little mmHg can cause neuropraxia?
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20-35mmHg on peripheral nerve
10mmHg at spinal nerve |
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describe double crush syndrome?
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compromise of nerve at more than 1 site makes nerve metabolically more vulnerable at other sites
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what can cause multiple site nerve lesions?
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systemic disease
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what nerve is likely to be harmed during hip surgery?
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peroneal portion of sciatic nerve, leading to foot drop
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what is sunderland's classification of nerve injury?
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1) neuropraxia
2) axonotmesis 3) loss of continuity of axon and endoneureum 4) loss of fasciular continuity 5) loss of nerve trunk continuity |
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What is nissl degeneration?
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retrograde degeneration of axon back to cell body that can kill cell body
death of cell body prevents re-generation |
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What are cellular changes in axonal severance?
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distal fragmentation of axon/myelin
cell body swelling schwann cell proliferation macrophage + schwann cells phagocytose debris schwann cells line up in bands of Bungner and axon axon grow towards periphery |
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How long until wallerian degeneration starts?
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hours
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What produces nerge growth factor?
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Schwann cells, after stimulated by interleukin 1 from macrophage
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how does axonal regrowth affect nerve velocity
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slower conduction due to schwann cell proliferation
dec. distance between nodes of ranvier dec. efficiency in saltoatory conduction |
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how fast does denervated muscles atrophy?
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75% in 4 weeks
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what kind of protein is primarily lost in denervated muscles?
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greater loss of contractile than structural
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what are changes in denervated muscle?
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fiber atrophy
dec in glycogen store dec mitochondria efficiency dec capillary density ATCH receptors appear along length of sarcolemma end plates degen inc muscle stiffness |
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what are fibrillations?
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spontaneous electrical activity of denervated muscle
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what are purposes of fibrillations?
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stimulates terminal sprouting from neighbors
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difference for ROM between passive ROM and EStim
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passive ROM is not in 3 dimensions
ES only way to completely maintain intramucluar CT |
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Axonal regrowth faster or myelin regrowth
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myelin lags behind AR
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what is a biggie about time of reconnection between axon twig and motor end plate?
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volitational overuse can impede or prevent reinnervation
(as can ES) |
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how many times more fibers can MU adopt in terminal sprouting?
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5x
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what are signs and effects of giant motor unit?
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rapid firing, no time out for MU to rest, rapid faigue
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wBS?hat is myelodysplasia
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failure of tube to close
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what is arthrogryposis?
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webbing of joints, sometimes w/out full supply of anterior horn cell
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what is spinal muscular atrophy?
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inherited condition of absence or loss of anterior horn cells
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what is ALS?
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problem with anterior horn cell
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what is GBS
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a polyradiculopathy or polyneuropathy affecting myeline or axonal problem
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what is charcot marie tooth?
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hereditary disease of peripheral nerve
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what is myasthenia gravis?
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NMJ receptor problem of ACH
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what is Eaton-Lambert Syndrome (or myasthenic syndrome)
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inadequate ACH release in nerve terminal
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FCU is mostly what nerve?
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C8,
but may have a little C7 or T1 |
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Thenar eminence muscles are mostly what nerve?
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Lots of C8 and T1,
but some people have C6 thumb! |
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Tib anterior is what nerves?
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L45 for most
L4 predominant in some |
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Gastroc is what in lateral and what nerve in medial head?
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Lat: L51
Medial: S12 |
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Bicep femoris long and short and what nerves?
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Long: S12 from tib, prox
Short: L5S1 from Fib , above knee |
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What is Martin-Gruber anastomosis?
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Median and Ulnar nerve linked in forearm
results in all median or all ulnar hand |
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What is Riche-Cannieu anastomosis?
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Linkage of median and ulnar in HAND
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What is Rauber's anastomosis?
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AI Median and PI radial joined in forearm
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Where is EDB supplied?
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by branch of deep fibular posterior to lateral malleolus
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How to manage demyelination?
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do not strengthen
avoid overuse joint ROM as needed orthosis consider ES to maintain muscle in prolonged demyelination |
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How long to recover from demyelination?
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weeks to months
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How to manage partial axonotmesis?
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no strengthen
joint ROM as needed orthosis DO NOT ES |
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what does it mean when patients have sudden marked improvement in str after time of denervation?
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perhaps a case of partial axonotmesis with neuropraxia, and NP has cleared
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What does burning pain 1-4 weeks after injury indicate?
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pain in complete axonotmesis/complete denervatoin associated with wallergian degeneration
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how to manage complete axonotmesis?
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maintain mobility of IM CT until reinnervation
modulate pain Joint ROM skin care orthosis reschedule to observe for nascents by IMEMG |
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Aspects of prior partial denervation (1+ year)
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reinervation by TS complete
may never get stronger rapid fatigue giant MU weakness do not overwork |
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Aspects of prior partial denervation (6mo)
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2-3mo of strengthening possible at 6month
fewer and large MU rapid fatigue do not overwork |
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Aspects of rootlet avulsion
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can kill AHC by retrograde degeneration
avulsion of 1 segment: partial dn avulsion of multiple segments: complete dn common to have elective limb amputation |
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How to deal with post polio patient?
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post polio syndrome is overuse so do not oversue, minimal or no strengthening goals
TS occured within 6mo of onset |
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how to treat GBS?
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can have neuropraxia, demyelination, partial axonotmesis or complete.
!! str, ES, gait, may impair or prevent recovery in partial denrevation! |
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What is a motor point?
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Most excitable spot on muscle
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What s muscle stimulation study trying to determine?
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Is muscle denervated TODAY?
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How does muscle stimulation study determine difference?
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Neurolimma must more excitable than sarcolemma.
Sarcolemma cannot accomodate Neurilemma can rasie threshold for depolarization with a slowly rising stimulus intensity |
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Is RD test qualitative or quantitave?
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Qualitative
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What do you need to perform RD test?
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a short <1ms pulse
a long 100 or 300ms pulse |
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How do muscle and nerve respond to RD test?
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Nerve can respond to both durations.
Muscle cannot respond to short duration. Muscle shows slow worm like response to long duration. |
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What is advantage of SD test over RD test?
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SD can detect partial denervation.
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What can't SD test detect?
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cannot detect prior denervatoin with terminal sprouting.
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What do you need to be able to do SD curve?
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range of pulse duration from 300ms to .01ms, with varying intensity.
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How to interpret results of SD curve?
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normal = chronaxie <1ms
complete denervation = chronaxie > 1ms partial denervation: <>1ms, with plateau |
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What are requirements for SD curve?
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individual pulses
duration .01ms to 300ms instant rise time .1mA resolution adequate amperage (0-80mA @ 1000 ohms) |
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How does accomodation curve work?
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Vary rise time and see accomodation if muscle is innervated.
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What does accomodation curve need?
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individual pulses
.1mA manipulatable rise time |
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How does frequency intensity curve work?
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as frequency increases, the rise time and udration becomes shorter
on the left nerve can accomodate on the right duration becomes too short for sarcolemma to rsepond at about 40-60cps |
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what diagnostic benefit is unique to intramuscular EMG?
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only IM EMG can see individual motor unit action potentials
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What is volume conduction?
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attenuation of high frequency components as signal moves through tissue (in skin electrodes)
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can skin electrodes detect indiviidulal muscles and minimal muap activity?
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no
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what are advantages of IM EMG?
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can detect all eMG singal including entire frequency range and low intesnity effort
can reveal EMG from specific muscle of interest can be used for surgical decision making |
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What is normal IM EMG insertional activity?
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burst of electrical activity 75-400ms
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Describe regular EMG MUAP
amp phase duration frequency |
200-1500uv amplitude
2-5 phases 2-15ms duration fire 5-10 / sec |
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what does reduced or absent insertional activity indicate?
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loss of sensity of sarcolemma with PROLONGED DENERVATION
FIBROTIC MUSCLE |
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what does prolonged or unusal insertional activity indicate?
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inability of muscle to relax (myotonic discharge)
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What do fibrillations indicate?
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denervated muscles, it's continuous immediately after 7-21 days, and only with provocation later on
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What do positive hsarp waves indicate?
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it means muscle membrane irritability
may be denervation or may juts be tight shoes? |
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What do fasciculations show?
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Early ALS
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What do large amplitude MUAPS show in diagnostic EMG?
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terminal sprouting (took 6 month to complete)
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What do low amplitude MUAPS show in diagnostic EMG?
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denervation happening now
or early reinnervation by axonal regrowth or myopathy |
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what does it mean when in diagnostic EMG it si difficult to recuirt MUAPS?
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neropraxia
or first muaps fatigued (in nascents) |
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What does it mean in diagnostic EMG if minimal efort results in barrage of low amplitude MUAPs?
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denervation happening now
or myopathy |
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What do full interference pattern indicate?
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normal
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What do partial intefernce or single motor unit inteference pattern indicate?
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reduced recruitment
(neropraxia, partial axonotmesis, result of TS, reinnervation now by AR, myopathy, or patient discomfort/confusion) |
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3 ways to stimulate?
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1) intraneural in AHC
2) intraneural in sensory body or afferent in muscle spindle 3) extraneural over peripheral nerve (potential for H reflex) |
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Preferentially recruit large or small diameter nerve fibers first?
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Large sensory first, larger than large motor (2nd)
Applied in H reflex, to rule out L5 |
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Why is H Reflex easily demonstrated with tibial nerve over knee record at soleus setup?
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soleus has large population of slow ox muscle fibers
motor axons are smaller than large sensory fibers coming from muscle spindle |
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how to minimize muscle fatigue?
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set minimal PRR that produce tetanus
choose non-aggressive duty cycle (1 on 3 or 5 off) |
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how to maximize comfort?
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300 microsecond
balanced pulsatile waveform |
