Neuropraxia definition and recovery?
Involves focal damage of myelin fibers around an axon but the CT sheath remains intact
Limited course of days to weeks, it is the least severe (1st degree)
Axonotmesis definition and recovery?
Some disruption to axon but myelin sheath is intact
Regeneration is possible but prolonged and without full recovery
3rd degree neurotmesis?
disruption of axon and endoneurium, recovery through axonal regenration cannot occur as fibrosis occurs
Neurotmesis 4th degree?
Disruption of axon and endoneurium and perineurium
no improvement in function and surgery is used to restore neural continuity
Neurotmesis 5th degree?
Complete disruption of axon endoneurium, perineurium, and epineurium
surgery is required to restore neural continity
Patient has 1/4 bicepital reflex and is having trouble with the first few degrees of abduction, flexion of forearm, and parasthesia to the lateral arm. What nerve root is damaged?
C5
Patient has brachioradialis reflex 1/5, wrist extension is diminished, and parasthesia to the thumb and index finger. What nerve root is damaged?
C6
Patient has 1/4 triceps reflex, difficulty with elbow extension and wrist flexion and middle finger parasthesia. what nerve root is damaged?
C7
Describe the 3 stages of a herniated disc.
- Protrusion: only few cartilage rings ar torn and there is no leakage of central material
- Extrusion: cartilage rings torn in small area nucleus pulposus is flowing toward the outer layers of the disc
- Herniation: terailng of outer cartilage rings allowing for flow of NP posterior and lateral towards vertebral foramen
Describe spurling and what does positive mean?
- extending and rotating neck to the sx side looking for exacerbation of pain
- positive indicates a cervical radiculopathy
Describe adson’s and what does positive test mean?
- Elevate chin and rotate head to the affected side taking a deep breath, look for the radial pulse to stop on the affected side
- thoracic outlet syndrome
Hoffmann test and positive result?
- firmly grasping middle finger and quickly snapping or flipping the dorsal surface looking for quick flexion of thumb and index finger
- cervical myelopathy
Describe radial nerve motor and sensory fxn.
- motor to triceps, anconeus and wrist extensors
- sensory to majority of dorsum of hand via posterior interosseous
- thumb index middle and part of ring finger (not tips)
What are the three sites for radial nerve entrapment?
- High on humerus usually secondary to humeral fracture or compression near spiral groove
- Radial tunnel due to repetitive rotatory movements
- pain is 5 cm distal to the lateral epicondyle
- heavy labor
- At wrist
Sx of radial nerve entrapment?
- wrist drop
- weak elbow flexion
- possible tricep involvement
- pain/numb
- fx returns 4-5 months
Median nerve entrapment syndromes?
- pronator syndrome
- anterior osseous syndrome
- carpal tunnel syndrome
Patient has achy pain in th emid proximal forearm and tingling in the first three fingers. They have diminished resisted forearm pronation. What is their likely profession and what is the syndrome?
- repetitive pronation seen in pianists, fiddlers, baseball players, dentists, weight lifters
- Pronator syndrome
13 yo patient just had an arm cast removed and he is now having difficulty flexing his wrist. He cannot make an “OK” sign with his fingers and he denies any sensory changes. What is the syndrome and how is it treated?
- Anterior interosseous syndrome (median nerve)
- treated with elbow splinting in 90 degree of flexion for 12 wks
What is the most common compression syndrome?
Carpal tunnel syndrome (Median nerve)
35 yo female has ocmplains of nighttime numbmeess and tingling of her right lateral 3.5 digits. She notices she has been dropping things more often and has pain near her wrist. When you examine her right hand you notice thenar atrophy compared to the left, what is happening? What are a few things that can cause this and how do you diagnose it?
- Carpal tunnel
- caused by repetitive motion jobs with wrist flexion and also pregnancy
- dx with EMG
What speciality tests can be done for carpal tunnel
Phalen and tinnels
Two sites of entrapment for ulnar nerve?
- cubital tunnel
- guyons canal
Baseball player comes in with parasthesia of his 4th and 5th fingers. He is having medial elbow pain with radiation to those fingers. What is this, what specialty test can be done, and what sign would be positive?
- Cubital tunnel syndrome (ulnar nerve)
- Tinnels at the elbow
- Fromen’ts sign
- patient has to flex their thumb in order to grab something btw their first and second fingers
- contracts the flexor pollicis longus (median n.) due to a weak dorsal interosseous and ADP muscle
- patient has to flex their thumb in order to grab something btw their first and second fingers
Where are the sites of comrpession for thoracic outlet syndrome
- scalene triangle
- costoclavicular passage
- pec mnor at coracoid process
