Term
| organization of a peripheral nerve |
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Definition
axon surrounded by edoneurium - Schwann cells/myelin sheath
bundle of axons = fascicle
fascicle surrounded by perineurium
bundle of fascicles surround by epineurium = peripheral nerve |
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Term
Seddon's injury severity classification
"best" --> worst |
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Definition
neuropraxia
axonotmesis
neurotmesis |
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Term
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Definition
trauma to nerve that is not sufficient to disrupt the axon
damage to myelin sheath producing electrical dysfunction - slowed or blocked conduction
focal conduction block, focal demyelination
usually complete recovery in 2-3 weeks |
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Term
neuropraxia
clinical presentation |
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Definition
| loss of motor function with preservation of sensation (pain & light touch) |
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Term
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Definition
nerve injury resulting in disruption of the axon; endoneurium remains intact
nerve conduction immediately lost
nerve sheaths distal to injury do not degenerate immediately and remain as empty tubes in which regeneration can occur (~1mm/day)
good but variable recovery |
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Term
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Definition
most severe nerve injury
disruption of the nerve axons and the supporting nerve sheaths
nerve conduction immediately lost
recovery impeded for discontinuity/scar, spontaneous recovery very unlikely |
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Term
| peripheral nerve injury management |
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Definition
severe/neuronotmesis:
if sharp - early surgical repair with direct anastomosis
if blunt - identify if exposed, delay repair
milder injury:
-clinical exam and delayed reassessment (clinical + EMG) |
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Term
| common site of peripheral nerve injury |
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Definition
radial nerve
ulnar nerve
median nerve
sciatic nerve
peroneal nerve |
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Term
| common radial nerve injury |
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Definition
radial nerve compressed in axilla from crutches use
fracture of humerus - spiral groove |
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Term
| common ulnar nerve injury |
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Definition
| ulnar nerve susceptible to trauma at the elbow at the olecranon notch - repeated minor trauma |
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Term
| common median nerve injury |
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Definition
| median nerve injured in distal radius (wrist) fractures |
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Term
| common sciatic nerve injury |
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Definition
| misplaced buttock injections |
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Term
| common peroneal nerve injury |
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Definition
| proximal fibular fractures |
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Term
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Definition
| can occur after both sharp and blunt trauma |
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Term
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Definition
upper brachial plexus injury
C5, C6 myotomes and dermatomes
"useful hand at the end of a useless arm" - waiter's tip hand |
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Term
| mechanism of Erb's Palsy injury |
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Definition
| forceful separation of head and shoulder |
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Term
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Definition
lower plexus injury
C8, T1 (variable C7)
"useless hand and the end of a useful arm"
claw hand |
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Term
| mechanism of Klumpke's Palsy injury |
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Definition
forceful shoulder/arm separation/abducted
-trauma during childbirth
-trying to grab hold while falling |
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Term
| treatment of brachial plexus injuries |
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Definition
obvious sharp injuries repaired immediately
blunt injuries and stretch injuries are managed expectantly to allow for spontaneous recovery |
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Term
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Definition
entrapment of median nerve just distal to the wrist
less acute injury to peripheral nerve |
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Term
carpal tunnel syndrome
etiology & contributing factors |
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Definition
repetitive motion(typing!)
obesity, pregnancy
mucopolysaccharide storage disesases
acromegaly |
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Term
carpal tunnel syndrome
clinical presentation |
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Definition
nocturnal dysesthsia that imporves with hand shaking
daytime pain in wrist with activity
weak grip from thenar atrophy of opponens pollicus |
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Term
carpal tunnel syndrome
diagnostic signs |
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Definition
Phallens Sign = exacerbation of symptoms with forced flexion of the wrist (narrow tunnel)
Tinel's Sign = paresthesias with percussion of carpal tunnel |
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Term
carpal tunnel syndrome
diagnostic tests |
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Definition
electromyogram (EMG) and nerve conduction velocity tests
exclude C6 radiculopathy
measure rate of conduction through tunnel |
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Term
carpal tunnel syndrome
treatment options |
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Definition
if mild:
-activity modification
-bracing/splinting
if severe:
-surgical decompression of tunnel |
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Term
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Definition
| nerve dysfunction in the pattern of one peripheral nerve or specific brachial plexus component |
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Term
mononeuropathy
differential diagnosis |
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Definition
DB
infections
neoplastic
toxic/metabolic
inflammatory
inherited (Charcot Marie Tooth) |
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Term
| *imaging "red flags" for patient presenting with back pain* |
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Definition
major trauma
minor trauma in older/osteoporotic pt
steroid use
osteoporosis
>70 years old
fever, chills, weight loss
RF for spinal infection (IVDA, UTI, immunosup)
pain worse when supine or at night
<20 years
hx of cancer
unexplained weight loss
progressive neuro deficit
bowel/bladder changes |
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Term
| classification of degenerative spine disease |
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Definition
divided clinically into:
spondylosis
degenerative disk disease |
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Term
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Definition
the process of bony degeneration and overgrowth with age and wear and tear
produces a narrowing of the available space for the nervous system due to overgrowth of the affected bone
typically affects multiple roots, cauda equina, or spinal cord
injury to nerves by compression |
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Term
| degenerative disk disease |
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Definition
either a bulge int he intervertebral disk or outright herniation of a disk fragment (with or without spondylosis)
can produce either nerve root or spinal cord depression depending on level and location
injury by both compression and inflammation |
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Term
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Definition
*dysfunction of a nerve root*
symptomatic nerve root compression, either by spondylosis, disk herniation, etc... |
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Term
radiculopathy
*signs and symptoms* |
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Definition
pain in the distribution of that nerve root
dermatomal sensory disturbance
weakness of muscle innervated by that nerve root
HYPOactive muscle stretch reflexes of that same muscle - LMN pattern |
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Term
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Definition
*clinical pattern that results from spinal cord compression*
dysfunction (usually focal) of the spinal cord |
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Term
myelopathy
*signs and symptoms* |
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Definition
effects all levels of function AT and BELOW the level of the insult
multiple (usually contiguous) myo/dermatomes
LMN pattern AT level of lesion (HYPOactive)
UMN pattern BELOW level of lesion (HYPERrelfexia)
typically have gait disturbances |
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Term
spinal epidural abscess
presentation |
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Definition
usually caused by hematogenous spread
excruciating back pain or neck pain
fever
tenderness to pressure or motion of the spine in the areas of the abscess
pus can act as an expanding mass - may get symptoms of root an cord compression
can have rapid progression to paralysis once neuro symptoms are present
inflammatory changes in the local blood supply can cause local spinal cord ischemia |
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Term
spinal epidural abscess
location |
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Definition
| most common - thoracic spine > lumbar spine > cervical spine |
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Term
spinal epidural abscess
treatment |
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Definition
urgent surgical decompression - symptomatic compression, diagnosis, spinal stabilization
long term antibiotics
spinal stabilization |
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Term
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Definition
congenital lesion from failure of folding of the spinal cord and separation during development
inner aspect of spinal cord is exposed at the skin surface; boney spine does not cover the lesion |
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Term
myelomeningocele
prevention |
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Definition
myelomeningocele is a folate dependent process
folate supplements recommended for all women of child-bearing age
increased incidence in women taking anticonvulsants-->reduce amount of circulating folate |
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Term
myelomeningocele
associated malformations |
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Definition
(amniotic fluid and CSF are in continuity)
hydrocephalus
large ventricles
Chiari II malformation |
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Term
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Definition
brainstem abnormality
bottom part of cerebellum slips donw into cervical spine
breathing/swallowing difficulties |
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Term
myelomeningocele
treatment |
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Definition
early/immediate closure of the spinal defect to protect the tissue and prevent infection
treatment of hydrocephalus in most cases` |
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Term
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Definition
lifelong difficulties with ambulation and toileting
cognitive difficulties common |
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Term
| syringomyelia (in setting of Chiari malformation) |
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Definition
fluid build up in the middle of the spinal cord from a malformation at the cranial-cervical junction
tonsillar herniation of cerebellum causes obstructed CSF flow; tonsil is pulsatile with and causes excessive CSF pulsation into spinal subarachnoic space --> drives CSF into middle of the spinal cord |
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Term
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Definition
| stable spine = capable of protecting the spinal cord from injuring during daily activity |
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Term
| treatment of unstable spine |
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Definition
initial - immobilize head, neck and back until a specific clinical/radiographic assessment can be perfomed
tx involves reduction of any residual deformity present
-removal of compressive bony injuries
-realignment of dislocated bones
stabilization of the spine to restore integrity
-usually need operative repair with instrumentation across the fracture segment to stabilize injury while an induced bony fusion occurs |
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Term
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Definition
damage to anterior spinal artery or front of spinal cord
loss of function of the anterior 2/3 of cord
(poor prognosis for recovery) |
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Term
anterior cord syndrome
clinical presentation |
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Definition
below level of lesion:
-preservation of dorsal column function bilaterally: proprioception
-bilateral loss of motor function
-bilateral loss of painful touch |
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Term
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Definition
damage to one side of the spinal cord
1/2 of cord injured
somewhat better prognosis than anterior cord syndrome |
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Term
Brown-Sequard syndrome
clinical presentation |
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Definition
below level of lesion:
-ipsilateral loss of proprioception
-ipsilateral loss of motor function
-contralateral loss of painful touch |
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Term
Brown-Sequard syndrome
clinical presentation |
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Definition
below the level of lesion:
-ipsilateral loss of proprioception
-ipsilateral loss of motor function
-contralateral loss of painful touch ( few segments below) |
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Term
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Definition
caused by loss of function of the middle of the spinal cord at the level of injury
damage to central gray matter of cord, crossing spinothalamic tract fibers, medial fibers of the corticospinal tract
common in elderly patients who have cervical spinal stenosis from spondylosis
best prognosis of the 3 spinal cord injury syndromes |
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Term
central cord syndrome
clinical presentation |
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Definition
bilateral dysethestic touch AT level of lesion and JUST ABOVE & BELOW level of lesion
in cervical region, "magician's cape" numbness and bilateral burning of the hands
relative loss of upper limb motor function with preservation of lower limb motor function |
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Term
| conus medullaris syndrome |
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Definition
*early bladder symptoms*
rarely painful
saddle anesthesia with sensory dissociation
symmetric motor loss
only sacral reflex affected |
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Term
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Definition
*late bladder symptoms*
radicular - usually painful
saddle, often asymmetric, no dissociation
motor asymmetry
lumbar and sacral affected |
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Term
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Definition
loss of blood pressure resulting from interruption of the sympathetic outflow for the spinal cord to the vasculature
pt's need IV fluids and pressors to restore vascular flow |
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Term
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Definition
classic presentation of lumbar spinal stenosis
(mimics vascular claudication from lower extremity arterial insufficiency)
leg pain in dermatomal distribution
pain with standing or walking
relieved by bending forward or sitting
-postures reduce the degree of compression
pain persists through first 15-20 minutes of rest
very specific clinical symptom of spinal stenosis |
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Term
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Definition
disease marked by neurofibromas
generally benign tumors that involve the entire nerve
tumor and normal nerve are mixed together (resection often sacrifices function) |
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