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2013-10-09 18:49:12

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  1. 2 examples of causes ov NMJ dysfunctions
    • myesthenia gravis
    • botox
  2. pt has myopathy.
    What's still normal?
    What's involved?
    • sensation & the motor nerve (only muscle is affected)
    • muscle fibers
  3. basic diff of presentation in myopathies vs neuropathy
    • myopathy - starts prox
    • neuropathy - start distal
  4. temporal dispersion
    slower conduction, signal is spread out -- a sign of demyelination
  5. moter NCVs are measured w what unit?
    milivolts or 1/1000 volts
  6. amplifier's job
    amplify the electrical diff btwn active and reference electrode
  7. conduction velocity revelas
    • velocity of the fastest conducting fibers (it's not an averaging thing, it's looking at the fastest fibers)
    • amount of demyelination
    • MU innervation
  8. amplitude reveals
    • number of fibers conducting the AP
    • if axons are blocked or there's degen the amp will decrease
  9. median nerve, wrist --> APB,
    ulnar nerve, W --> ADM
    normal, borderline, prolonged latencies?
    • median:
    • normal < 4.0 ms
    • bord 4-4.2
    • prol >4.2

    • ulnar:
    • norm <3.4
    • bord 3.4-3.6
    • prol >3.6
  10. velocity norm, borderline, and low for median, ulnar, and radial nerves
    • norm >50m/s
    • bord 47.5-50 m/s
    • low <47.5
  11. radial n. latency
    • not done bc of variety of locations
    • but he has the value 40m/s in that box, tho the vel should be >50 m/sec
  12. temp's affect on NCV
    cold gives slower conduction vel
  13. which muscle for median nerve testing?
  14. APB attachments
    transverse carpal ligament, the scaphoid and trapezium --> radial base of proximal phalanx of thumb
  15. elecrode placements for median and ulnar n testing
    • active: over belly of muscle
    • reference: distal to muscle belly
    • ground: back of hand
  16. 1st site of stim for median nerve / APB
    wrist, btwn FCR and PL
  17. rule on cathode (-) and anode (+) placement
    cathode is always closest to the electrode
  18. 2nd site of stim for median nerve / APB
    prox to the first -- ant and just med tothe biceps tendon
  19. 3rd site of stim for median nerve / APB
    • more pros still
    • belly of bicep and a bit medial, over the nerve
  20. physical response when you hit the median nerve
    thumb jump, writs flex and pronate
  21. muscle for ulnar nerve test
  22. ADM attachments
    pisiform -->base of the proximal phalanx of the 5th digit on the ulnar or medial side
  23. 1st site of stim for ulnar n
    med or lat to flexor carpi ulnaris
  24. 2nd and 3rd site of stim for ulnar n
    • (must be done with elbow flexted 70-90 degrees to take the nerve off slack)
    • just distal to med condyle
    • just prox to it (bc the ulnar groove is such a common site for nerve compression, got to go right above)
  25. 4th site of stim for ulnar n
    medial upper arm
  26. main problems for median, ulnar, radial nerves
    • median: carpal tunnel, pronator teres
    • ulnar: ulnar groove in elbow
    • radial: compression in forearm, soft tissue damage, upper arm by spiral groove -- most common spot
  27. tinnel's sign when nerve is regenerating?
  28. radial nerve's test muscle?
    extensor indicis
  29. 1st site of stim for radial n
    prox forearm lat to extensor carpi ulnaris (this is vague, so we don't have a latency time norm)
  30. 2nd site of stim for radial n
    upper amr distal to spiral groove btwn brachioradialis and biceps
  31. 3rd site of stim for radial n