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What are the different type of neuropathies?
- lower motor neurons (has axons that travel to peripheral nerves)
- radicules (nerve roots)
- plexus (sacral, lumbar, and brachial)
- peripheral nerves (some mixed others carry only one fiber type)
What are general signs and symptoms of neuropathies?
- parasthesia, hyperesthesia, numbness
- organ or gland dysfunction (ileus, impotence, irregular BP, incontinence)
What is the difference between parasthesia and hyperesthesia?
parasthesia is unusual sensations and hyperesthesia is heightened sensation
What are general causes of neuropathies?
- space occupying lesions (tumors, discs)
- autoimmune disorders
- genetic diseases
- systemic diseases (kidney failure, diabetes, hypothyroidism, toxic substances)
What does hypothyroidism cause (general)?
decreases conduction velocity of nerves so patients move slower
What is increased itching of the skin a sign of?
How is diagnosis of neuropathies made?
- complete physical exam and history
- radigraphic procedures
What are general treatment procedures of neuropathies?
- treat underlying disease
- healthy life style plan
- control pain
- assistive devices
- possible surgery
What are some lower motor neuron disorders?
- poliomyetlitis (viral)
- spinal musclular atrophy (inherited)
- amyotrophic lateral sclerosis (unknown cause)
What is post-polio syndrome?
- The patient is functional, but weakness and pain gradually starts to set in years after the illness.
- becoming more rare because those patients will now be over 60 years old
- now occurs in third world country
What are the three forms of Spinal Musclular Atrophy and their time of onset?
- infantile: onset first month of life
- intermediate: onset first year
- juvenile: onset after 5 years
What chromosome does spinal musclular atrophy deal with?
- chromosome 5
- recessive trait
What is Wernig Hoffman Disease?
- spinal muscular atrophy- type 1 infantile
- weakness starts right after birth and child often dies before age 3
- child often dies from respiratory failure
What is the functional ability of individuals with the intermediate form of spinal muscular atrophy?
- weakness occurs after the first year
- cognitively the child seems fine, but disabled in terms of motor ability
What muscles does the juvenile form of spinal muscular atrophy affect?
- proximal muscles
- (weakness begins in childhood)
What are some characteristics of amyotrophic lateral sclerosis?
- lower and upper motor neuron involvement
- onset 30-60 years of age
- respiratory failure in several years
What are sign and symptoms of amyotrophic lateral sclerosis?
- difficulty swallowing- so will choke***
What is amyotrophic lateral sclerosis sometimes called?
Lou Gehrigs disease
What is shingles (general)?
sensory condition affecting the dorsal root ganglion
What are some characteristics of shingles?
- reactivation of varicella zoster virus
- causes blisters and pain in dermatomes
- antiviral drugs and vaccines
- have to have chicken pox first
What is a radiculopathy?
disorder of spinal nerve roots
What are some causes of radiculopathies?
- herniated disc
- herpes zoster, arachnoiditis
- cervical rib
What are signs and symptoms of radiculopathies?
- paresis in myotome
- diminished or absent reflexes
- sensory loss in a dermatome (numbness/parasthesia)
- pain in dermatome
Avulsion of nerve roots usually occurs where during a breech birth?
- C5 and C6- Erbs Paralysis
- C8-T1- Klumpke's paralysis (function of hand)
What are some causes of plexus involvement?
- birth trauma
- physical trauma
- radiation therapy
- chronic compression
When will symptoms from thoracic outlet syndrome be noticeable?
- elevating arms
- when driving, one hand will be gripping the steering wheel tightly
What occurs with thoracic outlet syndrome?
the collar bone and upper ribs compress the scalene muscles which compresses the brachial plexus
What can cause lumbar-sacral plexus?
- hip dislocation
- abdominal surgery
What are the three types of peripheral neuropathy?
- mononeuropathy multiplex
What is affected in a mononeuropathy?
What is affected in a mononeuropathy multiplex?
several nerves, but symptoms are asymmetric
What is affected in a polyneuropathy?
several nerves, but symptoms are symmetric
What are some causes of peripheral neuropahty?
- toxic agents (chemotherapy, arsenic)
- vascular (diabetes)
- metabolic (kidney failure)
What is Wallerian Degeneration?
the death process of a cell
What is the rate at which nerves grow?
What are the three types of peripheral nerve damage and the difference?
- neuropraxia: conduction block at site of injury, recovers in a few days
- axonotmesis: nerve fibers disrupted but neural sheaths intact, recovery occurs 1mm/day
- neurotmesis: severed nerve, distal segment degenerates, no recovery without surgery
What happens with the facial nerve damage?
- Bell's palsy
- ipsilateral facial weakness
- unknown cause and prognosis varies- some recover completely, others don't
What are the causes of radial nerve damage?
- pressure in axilla
What are signs and symptoms of radial nerve damage?
- loss of elbow, wrist, and finger extension
- loss of sensation on dorsum of hand- radial side
What are causes of ulnar nerve damage?
- entrapment at elbow
- compression at elbow
What are symptoms of ulnar nerve damage?
- weak wrist flexion, atrophy of hypothenar eminence, paralysis of 4th and 5th lumbricals
- pain, parasthesia, numbness of medial hand
Which is more commonly injured the radial or ulnar nerve?
ulnar nerve becase it is more exposed at the elbox compared to the radial nerve that's protected
What nerve is damaged with Bishops hand?
What nerve is damaged with a true Claw hand?
median and ulnar
What nerve is damaged with an Ape's hand and where is there atrophy?
- median nerve
- thenar eminence
What are causes of median nerve damage?
- carpal tunnel syndrome (butchers, pregnancy, typists)
What are signs and symptoms of median nerve damage?
- weak wrist flexion, grip opposition of thumb (especially pinch)
- sensory loss of radial side of hand
- parasthesisia that worsens at night
What are causes of sciatica?
injury to lumbar plexus, hip, or abdomen
What are signs and symptoms of sciatica?
- weakness in knee flexion
- weak hip adduction
- flail ankle
- pain that goes down below knee into foot***
What is the causes and signs and symptoms of peroneal nerve damage?
- injury at fibular head
- weakness of everters and DF
- drop foot
What are the causes and signs and symptoms of tibial nerve damage?
- injury below the knee, diabetes***
- weakness of PF
- sensory loss to back of leg and sole of foot
What is tarsal tunnel syndome?
caused by entrapment, which increases with flat feet and activity
What is a sign and symptom of tarsal tunnel syndrome?
- burning in sole of foot
- only small diameter fibers can still send messages so perception of pain is a lot higher than it actually is
What happens with diabetic neuropathy?
- sensory fibers degenerate
- injury occurs but the patient can't feel it so an ulcer develops
- poor blood supply to the area of injury keeps it from healing
- amputation may result