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35 Cards in this Set
- Front
- Back
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Spinal Nerve Injury
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1. identifiable levels due to motor and sensory deficits in a dermatomal and myotomal distribution
2. should see corresponding diminished DTR's 3. lower motor neuron lesion |
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Spinal Nerve injury: include dermatome, myotome and reflex (when applicable)
Spinal Level C4 C5* C6* |
C4:
Dermatome: top of shoulder Myotome: diaphragm C5: Dermatome: lateral arm Myotome: GH abduction Reflex: biceps C6 Dermatome: thumb Myotome: elbow flexion reflex: forearm (Brachioradialis) |
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Spinal Nerve injury: include dermatome, myotome and reflex (when applicable)
Spinal Level C7* C8 T1 |
C7:
dermatome: middle hand myotome: elbow extension reflex: triceps C8: dermatome: little finger myotome: finger flexion T1: dermatome: medial forearm myotome: finger adduction |
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Spinal Nerve injury: include dermatome, myotome and reflex (when applicable)
Spinal Level L2 L3 L4* |
L2:
dermatome: anterior thigh myotome: hip flexion L3: dermatome: knee myotome: quadriceps L4: dermatome: medial leg, great toe Myotome: anterior tibialis reflex: patellar |
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Spinal Nerve injury: include dermatome, myotome and reflex (when applicable)
Sinal Level L5 S1* S2 |
L5:
dermatome: lateral leg, mid foot myotome: ext. halluces longus S1: dermatome: lateral foot myotome: peroneus longus reflex: Achilles S2: dermatome: posterior leg and thigh myotome: foot intrnsics |
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Although compressive and peripheral neuropathies may coexist, there are differences in:
Location Uni/Bilateral Onset Tinel's Injection Response |
Peripheral:
Location: stocking/glove Uni/Bilateral: usually bilateral, symmetric Onset: slow, progressive Tinel's: usually negative Injection Response: no response Compressive: Location: anatomic (peripheral nerve) Uni/Bilateral: may be unilateral, asymmetric Onset: slow, progressive Tinel's: often positive Injection Response: often relieved by transient |
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spinal cord injury:
Presentation of motor vs. sensory deficits |
Motor: present w/upper motor neuron deficits
sensory: levels different from level of injury |
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Upper Extremity Nerves:
Brachial Plexus: upper root vs. lower root lesions |
Upper root lesion: proximal effects: C5-6 -> Shoulder
Lower root: distal effects: C8-T1 -> hand |
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Thoracic Outlet Syndrome: Etiology
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Compression of brachial plexus, subclavian v&a via 1st rib, clavicle, scapula and scalene mm.
affected in varying degrees |
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Name 3 potential compression sites of thoracic outlet syndrome
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1. interscalene triangle
2. costoclavicular space 3. retro-pectoral space |
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Thoracic outlet syndrome diagnosis (7)
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1. vague complaints
2. nocturnal paresthesias 3. anterior chest and upper arm discomfort 4. numbness involving medial forearm, ring and small fingers 5. may not have motor deficits 6. worsening symptoms w/overhead use of arms 7. symptoms of arterial compression or venous occlusion w/exercise |
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Erb-Duchenne Palsy
1. injured nerve? presentation 2. causes? (2) |
1. Injury to C5 & C6 roots
-Waiter's tip position: arm adducted, medially rotated, forearm extended, wrist and finger flexed: -sensory loss in dermatomal pattern extending down anterolateral aspect of extremity to include the thumb 2. causes -delivery -fall on neck |
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Klumpke's Palsy
1. nerve injured? presentation 2. causes? (2) |
1. injury to C8 & T1 nerve roots
-Claw Hand Deformity: paralysis of intrinsic hand muscles, weakness of long finger flexors and extensors -Sensory Loss in dermatomal pattern along medial aspect of extremity including 4th and 5th digits 2. Causes -fall w/grabbing above (hangin form tree) -pull on arm at delivery |
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Long Thoracic Nerve
Presentation Causes (3) |
1. Presentation: Winged Scapula
-due to loss of innervation of serratus anterior -difficulty elevating UE above horizontal 2. Causes chest surgery, mastectomy, poorly fit crutches |
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Axillary Nerve
Path Muscles innervated (2) Presentation (2) Causes (3) |
1. Path: nerve goes through quadrangular space
2. Deltoid and teres minor 3. Can't fully abduct arm and numbness over deltoid 4. Causes: injury to axilla crutches POSTERIOR SHOULDER DISLOCATION |
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Musculocutaneous Nerve
1. path 2. presentation (3) 3. causes (3) |
1. nerve goes through coracobracihalis m.
2. presentation: -anterior arm muscles weakened -weak arm and elbow flexion -numbness over lateral forearm 3. causes -injury to axilla -crutches -ANTERIOR SHOULD DISLOCATION |
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Radial Nerve Injury
Causes: 3 Symptoms: 3 |
Causes:
1. compression lesion in axilla from crutches 2. midshaft humeral and radial head fractures 3. entrapment in lateral intramus. septum of arm Symptoms 1. paralysis of extensor muscles of upper extremity distal to site of injury 2. sensory loss along posterior aspect of arm, forearm and lateral 3 digits 3. wrist drop |
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Posterior Interosseous Nerve Syndrome
Location of entrapment presentation (2) |
1. Entrapment of radial nerve just distal to the area of bifurcation at the elbow
-supinator muscle 2. weakness and pain but no sensory disturbance loss of active finger extension and weakness of wrist extension: WRIST Drop |
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Wartenberg's Syndrome
Entrapment where? Presentation: 2 |
1. entrapment of superficial branch of radial nerve by fascia between ECRL and BR
2. parasthesia in superficial radial n. distribution positive Tinel's over SRN |
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Ulnar Nerve
1. causes 2. symptoms (3) |
1. compression w/in medial trochlear groove, flexor carpi ulnaris or wrist in Guyton's canal
2. symptoms: a. weakness of ulnar half of FDP, FCU, palmar & dors. inter., medial 2 lumbricales, adductor pollicis and hypo thenars b. looks like claw hand -guttering, hypothenar atrophy and hyperextended 4/5th MP and distal IP joints 3. sensory loss to palmar & dorsal surface of medial 1/3rd of hand and medial 1.5 digits |
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Cubital Tunnel Syndrome
Sites of compression: 3 Signs and Symptoms: 4 |
1. compression at
a. medial trochlear groove b. deep fascia of FCU c. deep flexor-pronator aponeurosis 2. signs and symptoms a. numbness along little and ulnar half of ring finger b. weakness w/grip + interossei testing 3. intrinsic wasting 4. pain along medial elbow w/ + hyperflexion |
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Ulnar Tunnel Syndrome
Compression: 1 Signs and Symptoms: 4 |
1. compression w/in Guyon's Canal
2. S&S a. wrist pain w/numbness and tingling in the ring and little fingers: volar b. hyperflexion or hyperextension can exacerbate symptoms c. intrinsic hand weakness with guttering d. positive froment's test |
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Median Nerve Path
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1. travels down medial arm to cubital fossa
2. enters forearm medial to brachial artery 3. gives off no branches in upper arm 4. passes through the two heads of pronator teres 5. gives off anterior interosseus branch as it passes deep to pronator teres |
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median nerve compression (3)
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Proximal Compression
1. most proximal site is supracondylar process where the nerve is compressed as it passes under lig. of struthers above elbow 2. accessory bicipital aponeurosis 3. b/w 2 heads of pronator teres: most common site prox. a. pronator syndrome b. anterior interossesous nerve palsy |
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Proximal median nerve injury symptoms
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1. weakness of all superficial flexors of forearm & a ahnd, LATERAL 1/2 of flexor dig. prof., thenar, 1st2nd lumbricales
2. sensory loss of palmar surface of later 3.5 fingers, palm and dorsal distal phalanx and 1/2 middle phalanx 3 Papal sign: when trying to flex fingers |
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Anterior Interosseous Syndrome
Less than 1% of all peripheral neuopathies |
1. cant flex thumb or distal phalanx of 2nd and 3rd digits
2. patients cant doe the "OK" sign |
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Distal Median Nerve Injury
Carpal Tunnel Syndrome symptoms (5) |
Compression o f median nerve
Pain and paresthesia on palmar radial aspect of hand Symptoms: 1. weakness/wasting of thenar m., 1&2 lumbricales 2. APE hand 3. inability to oppose thumb w/fingers 4. sensory loss to palmar surface of lateral 3.5 digitis 5. thenar sensation is preserved |
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Lateral Femoral Cutaneous Nerve Injury
causes (2) symptoms: 1 |
Causes:
1. traction, compression or entrapment caused by excessive lumbar lordosis 2. forced extension of thigh symptoms: constant pain over lateral aspect of thigh |
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Lumbosacral trunk injury (L4-L5)
causes: 3 symptoms: 3 |
causes:
1. disk herniation: anterior 2. compression by L5 ligament 3. excessive or abnormal bone growth or position symptoms 1. weakness of quads and extensor halluces longus 2. diminished patellar reflex 3. sensory loss over L4/5 dermatomes |
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Superior Gluteal nerve Injury (L4-S1)
causes: 5 symptoms: 3 |
causes
1. sponylolisthesis, injection, trauma, ligament or m. hypertrophy symptoms 1. weakness of gluteus medius and minimus, and tensor fascia lata musles 2. results in trendelenburg sign 3. no sensory deficits |
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Inferior Gluteal nerve injury: L5-S2
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causes:
1. spondylolisthesis, injections, trauma, ligament or muscle hypertrophy symptoms 1. weakness of gluteus max m. = pronounced weakness in hip extension 2. difficulty standing form siting position or walking up stairs 3. no sensory deficits |
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femoral nerve injury: L2-L4
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causes:
1. pelvic surgery 2. vascular condition 3 trauma symptoms: 1. quadriceps weakness 2. pain and/or sensory loss of anteromedial aspect of thing and leg 3. decrased patellar reflex |
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sciatic nerve injury L4-S3
4 causes 2 symptoms |
causes
1. trauma 2. piriformis hypertrophy 3. ligament hypertrophy 4. injections in the medial/inferior quadrant of gluteal region symptoms: 1. weakness or paralysis of all LE muscles except those in anteromedial thigh 2. sensory loss in lateral half of leg and all of the foot |
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Tibial nerve L4-S3
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causes:
1. compression in belly of soleous m. 2. compression posterior to media malleolus and flexor retinaculum symtpoms: 1. weakness of long flexors of toes and plantar m. of foot 2. sensory deficits on plantar surface of foot |
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Common Peroneal Nerve: L4-S2
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causes
1. entrapment of nerve w/in belly of piriformis m. 2. trauma to lateral aspect of knee symptoms 1. decreased dorsiflexion, toe extension and eversion of foot = FOOT DROP 2. sensory deficits over dorsum of foot |
