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87 Cards in this Set

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2 places where the median nerve is subject to entrapment/compression
1-carpal tunnel
2-pronator teres
what is the significance of loss of sensation in the distrib. of the palmar cutaneous branch of the median nerve??
loss of sensation in this distrib. would indicate that the entrapment is pronator teres syndrome since the palmar cutaneous branch does not go through the carpal tunnel.
when median neuropathy is suspected based upon history and sensory exam findings, how would the results of muscle testing help you id pronator teres syn. vs. carpal tunnel syn.??
in p.t.syn. you would see partial weakness of wrist flexors and full weakness of finger flexors. (this weakness is not exhibited in carpal tunnel syn.)
2 sites of entrapment of ulnar nerve
1-in medial epicondylar groove
2-in cubital tunnel
entrapment sites of radial nerve
1-in axilla (crutch palsy)
2-in triangular interval
3-in spiral groove of humerus (sat. night palsy/honeymooner's palsy)
4-in supinator muscle
entrapment site of axillary nerve
1-quadrangular space
entrapment site of musculocutaneous N.
1-coracobrachialis m.
entrapment site of sciatic N.
1-piriformis m.
entrapment site of lat. femoral. cutaneous N.
1- under inguinal lig. (meralgia paresthetica)
entrapment site of common peroneal N.
@ fibula neck
entrapment site of tibial N.
@ medial ankle
tarsal tunnel syndrome
area of skin where there is least overlap between the radial nerve's sensory territory and that of other adjacent peripheral nerves?
dorsal web of hand
radial entrapment site that would result in motor weakness, but not sensory loss?
entrapment of the superficial radial branch (branches proximal to the supinator muscle) will spare all sensory branches of the radial N. and result in motor weakness of the hand.
what pattern of weakness would suggest myopathy?
weakness in the pelvic and shoulder girdles would suggest myopathy. (proximal extremities)
gower's sign is...
when a pt uses their hands to walk up the legs in rising from a seated position due to weakness of the pelvic girdle musculature. (seen in pts with duchenne's muscular dystrophy)
trendelenberg's sign is....
caused by gluteus medius weakness, causes inability of supporting leg to hold body weight. + for trendelenberg's sign if the straight leg/hip buckles due to muscle weakness.
what special studies should be performed to further evaluate suspected myopathy?
serum studies (elevated CPK)
muscle biopsy
what is a group of muscle diseases that have a genetic etiology?
muscle dystrophies & duchenne's is the most lethal.
3 NMJ diseases & whether they are pre or post junctional...
lambert eaton syn.- prejunctional
botulism- prejxnal
myasthenia gravis-postjxnal
where is the most common site of initial weakness in myasthenia gravis?
bulbar innervated muscles, esp. the extraocular muscles and levator palpabrae. this results in DIPLOPIA and PTOSIS
sudden onset of weakness in the LLE would be most suggestive of a CVA involving the ________ artery on the ______ side.
anterior cerebral
(CVAs of the ACA result in LE weakness and assc. UMN signs contralaterally).
what are the sensory findings assc. with a L brown sequard syn @ T10?

also should be able to illustrate.
1-loss of tactile sensation (vibration and JPS) ipsilaterally below T10
2-loss of P & T contralaterally below T10
3-loss of all sensory @ T10
when a brown sequard syn. exists on the L at T10, which lower ext. would present weakness?
is this UMN of LMN weakness?
what reflex findings would indicate a UMN lesion?
hyperreflexia in deep tendon
pathological reflexes (like babinski)
what change in m. tone would be assc. with a UNM lesion?
hypertonicity, spasticity
what is the significance of clonus?
it is indicative of an UMN lesion and is a quick stretch of the spastic muscles resulting in repetitive contractions. it is a manifestation of increased DTR/muscle stretch activity- a hypersensitivity.
weakness/fasiculations would be more suggestive of an _____ lesion?
would UMN or LMN lesion be assc. with greater amts. of atrophy?
a pt. presents with L hemiplegia w/ sparing of the upper part of the face. where is the most likely site of lesion?
R internal capsule (results in weakness of the entire contralateral face excepting the forehead)
id 2 lesion lites that can cause paraplegia
any spinal cord transection below T1
a LMN lesion like polyneuropathy
radial N.
triceps, wrist extensors, finger extensors
median N.
wrist flexors, finger flexors, opponens pollicis
axillary N.
deltoid, teres minor
musculocutaneous N.
coracobrachialis and biceps
ulnar N.
interossei, opponens digiti minimi
Peroneal N.
inversion and eversion of the foot, heel walk and extensor hallicus longus
Femoral N.
extension of the knee
obturator N.
adduction of the hip
sensory distrib., radial N.
post. arm, forearm, posterolateral hand and 3.5 fingers
sensory distrib., median N.
lateral palm and 3.5 fingers
sensory distrib., axillary N.
lateral arm
sensory distrib., musculocutaneous N.
lateral forearm
sensory distrib., ulnar N.
ant. and post. medial hand and 1.5 fingers
sensory distrib., peroneal N.
lateral shin and top of foot
sensory distrib., femoral N.
ant. thigh , medial shin(via saphenous N.)
sensory distrib., obturator N.
medial thigh (mid-lower)
DTR assc. with the following p. nerve weakness:
triceps, wrist extensors and finger extensors
& brachioradialis
(radial N.)
DTR assc. w/ following p. nerve weakness:
biceps and coracobrachialis
biceps brachii (musculocutaneous)
DTR assc. w/ following p. nerve weakness:
hip flexion and knee extension
quadriceps (patellar tendon reflex)
(Femoral N.)
DTR assc. w/ following p. nerve weakness:
plantarflexors and evertors
what disorder is considered when weakness is present in both feet (& poss. both hands?)?
polyneuropathy. in a stocking & glove pattern. paresthesia & sensory alterations begin in feet & then manifest in hands.
what patterns of weakness would be suggestive of CNS lesion rather than PNS lesion?
CNS= loss of pain and temp sensation
loss of vibration & JPS
loss of tactile sensation
L4 dermatome
medial shin
L5 dermatome
lateral shin
S1 dermatome
lateral foot
dermatome of big toe
primarily L5
dermatome of middle finger
primarily C7
most common Cspinal NN to dvp radiculopathy
C6&7 (this could be due to C5&6 disc herniation)
most common low back spinal NN to dvp radiculopathy:
L5& S1 (could be due to L4&5 disc herniation)
(disc n-1)
other S&S assc. with numbness in the perianal region:
(AKA saddle anashtesia, a sign of cauda equina syn.)
urinary retention, fecal elim. problems & impotence caused by parasympathetic impairment)
mm. tests & DTR's
deltoid & biceps
mm.tests & DTRs
biceps and wrist extensors
mm. tests & DTRs
triceps, wrist flexors, finger extensors
mm.tests & DTRs
finger flexors
mm. tests& DTRs
interossei muscles-finger abduction & adduction
mm. tests & DTRs
iliopsoas: L1-3
cremasteric (superficial rflx)
mm. tests & DTRs
mm.tests. & DTRs
anterior tibialis (inversion w/dorsiflexion)
mm. tests & DTRs
dorsiflexors & EHL, E.dig longus
mm. tests & DTRs
plantarflexors, evertors (peroneus longus & brevis)
ortho exams for cervical radiculopathy:
bakody's sign
foraminal compression tests & variations: lat flexion (jackson's), ext, rot, max. cervical compression maneuver, modified spurlings, cervical distraction test.
-IVD prolapse: all above tests as well as foraminal compression test in flexion
-intrathecal P tests: valsalva maneuver and Nafzigger
ortho exams if low back radiculopathy is expected:
SLR, braggard's, bowstring, sitting laseque, bechterew's, neri's bowing, WLR, fajersztahn, kemp's, milgrim's, minor's sign
girth assessment:
measure UE 3" above & below elbow
LE 6" above & below knee
max normal variation is usually 1"
hand grip strength meter, tests finger flexion strength.
upper limit of dynamometer for normal variation due to hand dominance??
15 degrees
chaddock's rflx
LE, stroke below the lateral malleolus
UE, stroke ulnar side of forearm near wrist
gordons and shaeffers rflxes:
G= squeeze the gastrochnemius
S=squeeze the achilles tendon
rossolimo's reflex
tapping the ball of the foot
(response = flexion of foot)
hoffman's and tromner's reflexes:
H=flicking the 3rd finger downward
T=flicking the 3rd finger up
scale for grading muscle strength:
5=normal= full ROM against gravity w/full resistance
2=poor=complete ROM w/ NO gravity
0=zero=NO joint motion & no evidence of contractility
which gait tests would be helpful in assessing the motor fxns of the L5 &S1 spinal NN?
heel walk would assess L5(weak dorsiflexion)
toe walk for S1 (weak plantarflexors)
sensory level=
the dermatomal level that corresponds with a spinal nerve.
w/ eyes closed a pt is asked to id a familiar obj placed in hand.
ASTEREOGNOSIS= inability to correctly id
draw a # or letter in pts palm & ask them to id.
AGRAPHOGNOSIS= abnormal, + test, the pt cannot id the letter but can feel the touch.
double simultaneous stimulation test.
pt can differentiate b/n L & R stimulation separately but when performed simultaneously they only feel one side
=a lesion of the somatosensory assc. cortex opp. the side of extinguished sensation.
when a peripheral N or spinal N is compressed, which sensory fxns are usually more susceptible?
tactile sensations carried by larger diameter type II fibers. vibration sense, JPS, light touch & pinprick.
JPS test
checking the pts ability to indicate the direction of small passive mvmts of their jts.
+= side to side alteration or decreased sensitivity, requiring greater movement.