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82 Cards in this Set

  • Front
  • Back
What causes traction?
Stretch of the nerve
What is the effect of traction?
causes mechanical deformation of the neural process.
What causes compression?
Blunt trauma, prolonged pressure.
What is the effect of compression?
Causes ischemia and mechanical deformation of the neural process.
What causes severance/laceration?
Cut of the nerve and surrounding connective tissue coverings.
What is the result of neurapraxia?
Schwann cell splits longitudinally, myelin herniates outwar, producing inflammation, swelling and a block.
What part of the nerve is damaged in a neurapraxia?
Axon and endoneurium intact.
What is the MOI of a neurapraxia?
Usually compression but can also be mild traction or metabolic/toxin related.
What is the proximal and distal effects of a neurapraxia?
Proximal and distal conduction is intact, "falling asleep" sensation.
What is the recovery prognosis of a neuropraxia?
Recovery within minutes to several months. Transient (not permanent).
What is the result of axonotmesis?
Axon is disrupted but endoneurium is intact.
What is the MOI of axonotmesis?
Commonly compression or traction.
What is the effects of axonotmesis?
Distal conduction is distrupted.
What is the prognosis for axonotmesis?
Recovery normally occurs but may take months to a year depending on the loation and degree of injury.
What is the result of neurotmesis?
Disruption of axon and endoneurium. Nerve and all connective tissue coverings are completely disrupted.
What is the MOI of neurotmesis?
Usually laceration, severe traction, severe compression or burn.
What is the prognosis of neurotmesis?
Recovery potential is poor without surgery, questionable even with surgery.
What is the recovery steps for neurapraxia?
The myelin damage and swelling will reverse over a course of minutes to weeks.
When does chromatolysis occur?
Swelling occurs within six hours after injury.
When does wallerian degeneration begin?
Starts several hours after injury.
What happens during wallerian degeneration?
Neural process and myelin distal to the injury site break up into little particles.
What do schwann cells do during wallerian degeneration?
Schwann cells along the disintegrating neural process rapidly divide and line the interior of the remaining endoneurium.
When is neural conduction lost during wallerian degeneration?
Lost within 48-96 hours.
When does retrograde degeneration occur?
If the severity of the injury is high, more severe axonotmesis and all neurotmesis.
What is different about retrograde degeneration in comparrison to wallerian degeneration?
Neural process proximal to the injury site breaks up.
How far does retrograde degeneration progress proximal to nerve injury?
The disintegration may be just to the next node of ranvier or if the injury is very severe, even more proximally.
During recovery, what occurs with the neural process?
Neural process regrows in response to chromatolysis. Little neural buds form and grow out distally from the remaining neural process. Bud finds the endoneurium tube lined with schwann cells and uses that as a guide in growth.
When does regrowth occur during the recovery stage?
Can begin within 24 hours or be delayed for weeks.
What is the growth rate of a neural process during recovery?
Can be variable with the average being 1.5mm per day.
Prognosis for compression neurapraxia and mild axontomesis.
90% recover within 4 months.
Prognosis for axontomesis.
20-50% of the neurons injured will die.
Prognosis for surgically repaired neurotmesis.
Problems with nerves growing to wrong effectors. Muscle atrophy and fibrosis occuring before nerve regrowth, scar tissue blocking regrowth.
What is the mechanism for carpal tunnel syndrome?
Repetitive use of hands.
What is the location of carpal tunnel syndrome?
Median nerve at the wrist.
What are the symptoms of carpal tunnel syndrome?
Pain in wrist and palm, muscle wasting proximal to thumb.
What is the mechanism for tardy ulnar palsy?
Boney growth after fracture, valgus deformity of elbow.
What is the location of tardy ulnar palsy?
Ulnar nerve at the elbow (funny bone).
What are the symptoms of tardy ulnar palsy?
Clawing of the fourth and fifth digit, palm muscle wasting.
What is the mechanism of Thoracic outlet syndrome?
Decreased space in thoracic outlet between clavicle and first rib, due to cervical rib, overhead repetive use, heavy backpacks, or slouched posture.
What is the location of thoracic outlet syndrome?
Brachial plexus and vasular tissue in thoracic outlet.
What are the symptoms of thoracic outlet syndrome?
Pain in UE radiating to hand, numbness in hand.
What is the mechanism of saturday night palsy?
Typically alcohol related, UE in awkward position during sleep.
What is the location of saturday night palsy?
Radial nerve compressed against humerus.
What are the symptoms of saturday night palsy?
Numbness on posterior hand, weakness of UE extensors.
What is the mechanism of crutch palsy?
Radial nerve is compressed in the axilla.
What is the mechanism for Sciatica?
Herniated intervertebral disk, dislocated hip, spinal OA, pressure from the uterus during pregnancy, spasm of piriformis muscle.
What is the location of sciatica?
Sciatic nerve or spinal nerves contributing to it in the lumbosacral region or pelvis.
What are the symptoms of sciatica?
Pain radiates posteriorly into one or both legs to the lateral aspect of the foot.
What is the mechanism of compartment syndrome?
Penetrating injuries, contusion, improperly fitted cats and possibily exercise induced.
What is the location of compartment syndrome?
Internal or external pressure constricts the structures within the compartment made by the outermost connective tissue coverings containing muscles, nerves, arteries, and veins in the limbs.
What are the symptoms of compartment syndrome?
Pain, numbness and muscle weakness. If left untreated it could lead to permanent muscle and nerve tissue damage.
What is the treatment for compartment syndrome?
Emergency fasciotomy to release pressure. Non-emergency = RICEM and gentle strengthening, gait alteration.
What is the Etiology of diabetic neuropathy?
Reduced vascularization of nervous tissue. Occurs distally and proceed proximally. As nerve tissue dies, afferent and efferent information is not conducted.
What are the symptoms of diabetic neuropathy?
Numbness or loss of sensations, commonly seen in feet first, hands or eyes followed by pain and muscle weakness.
What is the prognosis of diabetic neuropathy?
Damage permanent and progressive unless diabetes is stabilized.
What is the etiology of alcoholic neuropathy??
Alcoholism itself or the nutritional deficit which accompanies it results in nervous tissue death.
What are the symptoms of alcoholic neuropathy?
Numbness, tingling, loss of sensation in feet followed by loss of muscle strength and atrophy. Commonly bilateral. Progresses proximally, can result in incontinence and impotence.
What is the prognosis of alcoholic neuropathy?
Damage permanent and progressive unless alcohol intact is stopped. Some recovery of nerve function may occur with termination of alcohol use.
What is the leading cause of peripheral neuropathy patients?
Diabetes and alcohol constitute 90% of all peripheral neuropathy patients.
What is the etiology of guillain-barre syndrome?
Unknown. Viral and bacterial infections, surgery and vaccinations have been associated with the development of this disease. Demyelinates peripheral nerves.
What are the symptoms of guillain-barre syndrome?
Progressive distal to proximal symmetrical weakness and sensory impairment. Can extend to full quadriplegia with respiratory and cranial nerve involvement. 20% require ventilator assistance for breathing.
How long does it take for symptoms of guillain-barre syndrome to peak?
About 2-4 weeks and then reverse over the course of moths to years.
Prognosis of guillain-barre syndrome?
Very good. Symptoms reverse over time.
What is the etiology of bell's palsy?
Herpes simplex virus attack of CNVII, can also occur when the nerve is compressed.
What are the symptoms of bell's palsy?
Unilateral weakness of facial muscles.
What is the prognosis for bell's palsy?
Good. 80% spontaneously recover within 6 months. Weakness of muscles may remain which respond to strengthening.
What is etiology of lead neuropathy?
Lead ingestion or inhalation causing disruption of the neurons organelles.
What are the symptoms of lead neuropathy?
Lower extremity weakness in children and upper extremity weakness in adults, sever exposure can lead to quadriplegia.
What is the prognosis of lead neuropathy?
Very good unless severe exposure, symptoms can reverse, vitamins may eliminate any residual weakness.
What is the etiology of Myasthenia Gravis?
Autoimmune disease that decreases the number and function of postsynaptic receptors for the neurotransmitter.
What are the symptoms of Myasthenia Gravis?
Muscle weakness, especially in eye, double vision and droopy eyelids. Can progress to entire body.
What is the prognosis of myasthenia gravis?
Slowly progressive with remissions. Rarely life threatening.
What is the mechanism of charcot-marie-tooth disease?
Inherited genetic disorder.
What are the types of charcot-marie-tooth disease?
Two types, one that effect myelin sheath and the other the neural process.
What is the location of charcot-marie-tooth disease?
Foot with progression to lower extremities depending on severity.
What are the symptoms of charcot-marie-tooth disease?
High arch, weakness in foot, especially in dorsiflexion. Can progress to weakness of lower extremities and hands. Mild sensory loss. Champagne glass deformity is more severe cases.
When is the onset of charcot-marie-tooth disease?
In adolescence/young adulthood.
What interventions are used to prevent deformities and contractures?
Passive or active assisted ROM exercises, correct positioning to avoid deformities, splinting.
What interventions are used to strengthen?
Maintain as much strength as possible to prevent atrophy of the muscles. Electrical stimulation has little effect. Biofeedback has been found useful in most patients.
What intervention are used to reduce edema?
RICEM, educate the patient to wear losse fitting clothing, make sure splint is not ill-fitting.
What are the effects of edema?
Tends to cause stiffness and chronic edema allows formation of collagen within muscle tissue leading to permanent stiffness within the muscle.
What interventions are used for sensory reeduction?
Started immediately. Desensitize using several modalities. Immerse sensitive area in a box of various materials, rub clothes of varying textures on area, contraindicated for open wounds and infections.