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47 Cards in this Set
- Front
- Back
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Purpose of Posterior Rami axons? |
Paravertebral muscles, posterior part of the vertebrae, overlying cutaneous areas |
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Purpose of Anterior Rami axons? |
Skeletal, Muscular, and cutaneous areas of the limbs and anterior and lateral trunk |
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Endo, Peri, Epi, and Mesoneurium? |
Endo: Axons Peri: Fascicles Epi: Encloses nerve trunk Meso: Surrounds Epi - allows nereve to slide away when palpated |
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What is the function of connective tissue |
Protects axons and glia Support mechanical changes in length during movement |
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What are the visceral peripheral nerves? |
Splanchinic nerves |
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Describe Somatic peripheral nerves |
Mixed Typically Cutaneous branches -Skin and subcutaneous tissues -Symp axons to sweat glands and arterioles Muscular branches -Muscles, tendons, and joints -Proprioception |
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Describe the cervical plexus |
Anterior Rami C1-4, deep to SCM Cutaneous: Post scalp to clavicle Muscular: Ant neck and diaphragm |
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Symptoms of Cervical Plexus injury |
Laterality -Unilateral paralysis of the diaphragm --Few symptoms except w/ exertion -Bilateral paralysis of diaphragm --Dyspnea w/ slight exertion - difficulty coughing Phrenic Neuralgia -Caused by neck tumors, AA, pericardial infections -Pain near free border of ribs, beneath clavicle, deep in neck |
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Know the Brachial Plexus |
K great |
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Injury to the long thoracic nerve (cause and SxS) |
Entrapment in the scalenes Compression under scap Compression and traction at inferior ange of scap during anesthesia SxS - scapular winging |
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Innervation of musculocutaneous nerve |
C5-6 Motor: coracobrachialis, biceps brachii, brachialis Sensory: Anterolateral aspect of forearm |
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Innervation of Axillary nerve |
c5 -6 Motor: Teres Minor, Deltoid Sensory: Lateral upper arm |
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Innervation of Radial Nerve |
C5-8, T1 Motor: Triceps, Anconeus, upper portion of extensor/supinator group (Pos Innteroseus innervates all ext except ECRB/L) Sensory: Posterior ascpect of arm, forearm, and radial half of hand |
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Symptoms of Radial Nerve Injury |
-Weak Grip -Week Thumb adduction -Inability to extend thumb/fingers -Wrist Drop -Absent Triceps reflex |
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Common Entrapment sites for Radial Nerve |
–Radial groove of humerus -triceps strength intact (or slightly weak), weakness of extensors except ECRL/B –Arcade of Fohse –wrist drop, unable to stabilize wrist for proper hand function, no sensory loss –Radial tunnel syndrome – distal border of supinator anterior tothe head of the radius; mimicstennis elbow –Wartenberg’s disease –compression under tendon of brachioradialis;sensory only; loss of sensation or night pain dorsum of wrist, thumb, and webspace |
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Innervation of Median Nerve |
C6-8, T1 Motor (AIN): FPL, medial portion of FDP, Pronator quadratus Sensory: Skin of palmar thumb, lateral and distal ends of 2.5 fingers, distal RU, CMC, and intercarpal joints |
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Common Entrapment sites for Median Nerve |
–Ligamentof Struthers – distal anteromedial humerus; pain and paresthesia of elbow andforearm, eventually motor affecting wrist/finger/thumb flexion –Pronator syndrome – pronation is weak; contraction ofpronator elicits symptoms ; sensory loss •AINcompression in pronator – nosensory loss –Carpal Tunnel Syndrome – atrophy and weakness of thenareminence and lateral two lumbricals |
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Symptoms of Median Nerve Injury |
-Paralysis of flexor/pronator muscles of forearm -Weak radian deviation -Ape Hand deformity -Loss of sensation over cutaneous distribution -Pain -Atrophy of thenar eminence -Skin of palm is cold, dry, discolored, chapped, or keratotic |
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What is Ape hand deformity |
–Inabilityto oppose or flex the thumb, or abduct in its own plane –Weakned gripwith tendency for thumb and index finger to extend and thumb to adduct –Inabilityto flex the distal phalanx of the thumb and index finger –Weaknessof middle finger flexion –Atrophyof thenarmuscles |
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Innervation of the Ulnar Nerve |
C7-8, T1 Motor: FCU, Ulnar hand of FDP, small muscles deep and medial to the long flexor tendon of the thumb, except first two lumbricals Sensory: Ulnar hand, posterior 5th finger, ulnar side of ring finger |
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Commone Entrapment sites of Ulnar Nerve |
–Cubitaltunnel – between two heads of FCU; Sxs inc when elbow flexed;weakness of FCU, ulnar FDP, hypothenar eminence, 3rd and 4th lumbricals;paresthesia of medial elbow and forearm and ulnar sensory distribution of hand •Tardyulnar palsy – symptoms begin long after patient has been injured –Guyon’scanal – only fingers have altered sensation; motor loss to hypothenar eminence,adductor pollicis,IOs, medial two lumbricals,palmaris brevis |
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Know the Lumbar Plexus |
K Great |
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Know the Sacral Plexus |
K Great |
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Femoral Nerve Entrapment |
By Iliopsoas hematoma --Direct blows to abdomen or hyperextension moment at the hip tears iliacus |
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Obturator Nerve Entrapment SxS |
Disability is minimal ER and adduction impaired Difficulty crossing legs Severe pain from groin to inner thigh |
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Sciatic Nerve Entrapment Neuropathy |
Hip movement affect on pain: If entrapped in piriformis inc with IR, dec with ER Plantar sensation: Impaired Atrophy: None Tenderness to palpation: No trunk tenderness, tender at entrapment site |
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Sciatic Nerve Radiculopathy |
Hip movement affect on pain: No change except with SLR Plantar sensation: No Change unless S1 Atrophy: Below L4, gluteal atrophy Tenderness to palpation: Trunk Tenderness |
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How is the common fibular nerve injured? |
Fibular fracture/dislocation Surgical procedure Application of skeletal traction Tight Cast |
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What is axoplasmic flow? |
Retrograde: carries chemical messages to cell body Anterograde: carries new structural and signaling component Becomes thick and resistant when stationary. |
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What happens with nerves are lengthened or shortened? |
Lengthened -Viscoelastic tubes stretch -Axons unfold -Tensile stress develops -Entire nerve slides relative to surrounding structures Shortened -Tensile stress released -Nerve slides relative to surrounding structures -Viscoelastic tubes recoil -Axons Fold |
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Describe the NMJ |
Motoraxons synapse with muscle fibers --Nosummation of action potentials required --Noinhibition possible; always excitatory -->Req ACh depol --> AP Evenwhen normal LMN inactive, small amount of ACh is released |
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Sensory signs of Peripheral Nerve Damage |
Dec or loss of sensation Abnormal sensation |
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Autonmoic Signs of Peripheral Nerve Damage |
Single nerve - lack of sweating, loss of sym control of smooth muscle fibers in arterial walls
Many Nerves - impotence, difficulty regulating bp, HR, sweating, bowel and bladder |
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Motor and Trophic Signs of Peripheral Nerve Damage |
Motor: Paresis or paralysis (atrophy > fibrillation) Trophic: -Atrophy -Brittle nails -Shiny Skin -Thickening of subcutaneous tissue -Poor healing -Infections -Neurogenic joint damage |
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Classification of neuropathies |
Mono: single nerve Multiple Mono: several nerves: assymetrical Poly: Many serves - typically distal and symmetrical (glove/stocking) |
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How do mononeuropathys occur |
Repetitive stimuli Prolonged compression Wounds Classification -Traumatic Myelinopathy -Traumatic Axonopathy -Severance |
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Describe Traumatic Myelinopathy |
Loss of myelin at the site of injury --Focal compression (nerve entrapment) Affects large diameter axons -Motor,discriminative touch, proprioception, phasic stretch reflex deficits,neuropathic pain -Autonomicfunction intact -Axonis not damaged Prognosis is good: remyelination occurs rapidly |
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Describe Traumatic Axonopathy |
Crush of nerve followed by wallerian degeneration distal to lesion --Due to dislocations and fractures Affects all size of axons -Atrophy and dec or loss of reflexes, somatosensation, and motor functions Prognosis good for complete - partial recovery |
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Describe severeance |
Nereves of physically divided by excessive stretching or laceration SxS -Immediate loss of sensation/paralysis -Wallerian degneration 3-5 days later -Sprouting in stump follows Prognosis - fair to poor -If nerve stumps apposed - may heal -Scarring interferes -Lack of guidance may allow sprouts to innervate incorrectly |
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SxS of hypoactive mononeuropathy |
Sensory: dec or lack of sensation Autonomic: flushing of skin, edema, sweating Motor: Paresis, paralysis, hypotonia, atrophy Reflexes: Dec or absent |
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SxS of hyperactive mononeuropathy |
Sensory: pain, allodynia, hyperesthesia Autonomic: Vasoconstriction, excessive sweating, perpetuation of pain Motor: Spasm, muscle fasciculations/fibrillations Reflexes: Normal |
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Describe Multiple Mononeuropathy |
Involves two or more nerves in different parts of the body -Diabetes -Vasculitis - restricted blood flow, weakening vessel walls Prognosis: Poor |
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Describe Polyneuropathy |
Stocking/Glove distribution Degeneration/demyelination or long axons -Symmetrical -Distal to proximal -Sensory motor and autonomic Caused by: -Toxins -Metabolic -Autoimmune Prognosis: Compensatory strategies |
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Describe a dysfunction at the NMJ |
Malfunction in communication between nerve and muscle fibers -Autoimmune -Toxins --Botulism prevents ACH release --Neurotoxic chemicals can breakdown ACh --Cholinergic Drugs can block transmission Prognosis: Variable |
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Describe Myopathy |
Dysfunction of muscle fibers -Genetic -Inflammatory -Idiopathic SxS -Sensation and autonomic function intact -Coordination, muscle tone, and reflexes unaffected until severe atrophy Prognosis: Variable |
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Peripheral Dysfunction SxS |
Distribution: Peripheral Pattern Nerve Conduction: slowed/blocked Muscle Tone: LMN - hypotonia Muscle Atrophy: Rapid muscle atrophy Phasic Stretch Reflex: Dec or absent Paraspinal sensation: Normal |
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CNS Dysfunction SxS |
Distribution: Derma/myotomal pattern Nerve Conduction:Normal Muscle Tone: UMN: hypertonia Muscle Atrophy: Progresses slowly (disuse) Phasic Stretch Reflex: Hyperactive or normal Paraspinal sensation: Involved |
