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Neuro

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Neuropathy
Clinical Presentation
Nerve supply
Mechanisms of Injury
Treatment (specific tx)
Claw Hand   ulnar nerve injury; 4th 5th digits of hand remain partially extended when attempting to make a fist; SYMPTOMS- muscle wasting at hypothenar & inteross. spaces; altered sensation, anhidrosis (diminished/absent sweating), vasomotor changes   ulnar nerve (medial cord C8 & T1 ventral rami) supplies FLEXOR CARPI ULNARIS, MOST SMALL HAND MUSCLES & SKIN OVER MEDIAL HAND & FINGERS)   fracture of med. epicondyle, mid-forearm or Colle's; elbow dislocation; post-sx complication; leprosy; compression from handcuffs, motorcycling; repetitive strain; contusion or laceration at wrist or hand   towel roll on palmar side to support hand/digits; tx C/spine -> unaffected arm -> affected arm; PROM (flex. & adduct. of MCP, extens. 4th & 5th IPs); AFROM (later stage 75% regeneration, have them push objects away using 4th & 5th digits)  
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Dorsal Scapular Nerve injury   affected scapula located further down midline than unaffected side; SYMPTOMS- paralysis of rhomboids   dorsal scapular nerve (C4 & C5 ventral rami) supplies RHOMBOIDS & part of LEVATOR SCAPULAE   (blank)   (blank)  
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Sciatic Nerve injury (aka Piriformis Syndrome)   pain in low back or hip radiating down posterior thigh and into leg;   largest & broadest, sciatic nerve (L4-S3 ventral rami) supplies muscles of posterior thigh, skin & muscles of leg & foot)   compression of piriformis muscle; herniation of lumbar IV disc which compresses & compromises either L5 & S1 nerve root   focus on glutes, greater trochanter (spoking); TP -> piriformis, glute max, min & med), hold/relax -> seg. stretch to glute med. then heat; jt play (anter. glide to hip/sacrum; friction anywhere along piriformis followed by ice. End with thorough flush  
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Winged Scapula   injury to long thoracic nerve; scapula prominent when patient presses hands against wall; medial border moves lateral & posterior; arm unable to abduct above horizontal position   long thoracic nerve (C5, C6, C7 ventral rami) supplies serratus anterior   (blank)   (blank)  
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Musculocutaneous Nerve injury   weakened elbow flexion; SYMPTOMS- paralysis of coracobrachialis, biceps & brachialis; loss of sensation on lateral surface of forearm   musculocutaneous nerve (C5, C6, C7 spinal nerves) supplies all mm in anterior compart. - coracobrachialis, biceps & brachialis. Terminal branch -> lateral antebrachial cutaneous nerve which supplies lateral side of forearm   uncommon but may be inflicted by weapon   (blank)  
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Obturator Nerve Injury   painful spasms of adductor mm of thigh; sensory deficits in medial thigh region   obturator nerve (L2, L3, L4) supplies ADDUCTOR muscles of thigh   pelvic surgery   (blank)  
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Saphenous Nerve Injury   pain radiates along medial border of foot   saphenous nerve arise from femoral nerve (L2, L3, L4 ventral rami) & it's the terminal cutaneous branch, which supplies skin & fascia of anteromedial aspect of KNEE, LEG & FOOT   (blank)   (blank)  
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Hand of Benedicton   median nerve injury; 2nd & 3rd digits of hand remain partially extended when attempting to make a fist; flaccidity in opponens pollicis thus unable to oppose esp. medial rotation; atrophy of forearm flexors & thenar mm; causalgia (burning sensation)   median nerve (C6,C7 spinal nerves is lateral cord + C8,T1 spinal nerve is medial cord) supplies skin over lateral hand bisecting 4th digit, FLEXORS of forearm EXCEPT FLEX. CARPI ULNARIS & ulnar 1/2 of FDP   perforating wound in elbow region -> fracture or dislocation @ elbow, wrist or carpal bones (lunate & scaphoid). Compression-> fibrosis & hypertonicity: CTS/Pronator Teres synd.. Trauma-> traction, contusion, laceration at wrist & hand   elevate limb above heart. MLD. Towel roll <-> first 2 digits to increase adduction  
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Thoracodorsal Nerve Injury   inability to pull themselves up using arms; SYMPTOMS-> paralysis of latissiumus dorsi   thoracodorsal nerve (C6,C7,C8 spinal nerves) supplies latissimus dorsi   vulnerable during sx of inferior axilla   (blank)  
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Axillary Nerve Injury   absence of rounded contour of shoulder (flattened appearance). SYMPTOMS-> atrophy of deltoids & loss of sensation on lateral side of prox. arm   Axillary nerve (C5,C6 spinal nerves) supplies TERES MAJ., DELTOID & SHOULDER JT   damage during dislocation of shoulder or fracture of prox. humerus   (blank)  
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Drop Foot   injury to common peroneal nerve; foot & toes drag on floor when walking; loss of ankle dorsiflex.& foot eversion. SYMPTOMS-> paralysis of all mm in anterior & lateral leg, loss of sensation on anterolat. leg & dorsum of foot; steppage gait for clearance   common fib. nerve is LATERAL branch of sciatic nerve @ 1/2 way down thigh (L4-S3). It supplies extensor & abductor mm, knee jt & skin of distal 3rd of anterior leg, dorsum of foot & all digits   most commonly injured due to its superficial position   (blank)  
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Wrist Drop   radial nerve injury; inability to extend wrist & digits @ MCP jts. Minimal sensory loss. SYMPTOMS -> elbow flexed, hand pronated, thumb adducted   Radial nerve (C5-T1) arise from posterior cord of brachial plexus. It supplies all extensor mm of upper limb-> triceps, anconeous, all extensors   fracture on humeral body & is at superficial cutaneous branch of radial nerve   towel roll under wrist & in elbow crease. Treat C/spine -> unaffected arm -> affected arm. PROM in early stage for wrist extension, fingers & thumb. AFROM in later stage (75% regeneration) of piano playing exercise  
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Superior Gluteal Nerve Injury   gluteus medius limp (Trendelenburg gait). Weakened thigh abduction, severely impaired medial thigh rotation   Superior gluteal nerve (L4,L5,S1) supplies glute med, glute min & tensor fascia lata   (blank)   (blank)  
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Tibial Nerve Injury   inability to plantarflex ankle &/or flex toes. SYMPTOMS-> paralysis of flexor mm, intrinsic mm of sole of foot & loss of sensation on sole of foot   Tibial nerve (L4-S3) is medial terminal branch of sciatic nerve. It supplies posterior muscles of leg & knee jt & skin of lateral side of leg & ankle   uncommon but can be injured by deep lacerations or wounds   (blank)  
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Tarsal Tunnel Syndrome   entrapment of tibial nerve in ankle.   re: tibial nerve injury   caused by edema & tightness in ankle involving synovial sheaths of tendons of mm in posterior leg compartment.   (blank)  
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Entrapment of Superficial Branch of Fibular Nerve   SYMPTOMS-> pain along lateral side of leg & dorsum of ankle & foot; possible numbness & paresthesia w/ increased activity. Paralysis of all mm in anterior & lateral leg (nerve severed); loss of sensation on anterolat. leg & dorsum of foot   Superficial fibular nerve supplies FIBULARIS LONGUS & BREVIS, DISTAL 3RD OF ANTERIOR LEG, DORSUM OF FOOT & ALL DIGITS EXCEPT LATERAL SIDE OF 5TH & 1ST INTERDIGITAL CLEFT   recurrent stretching of nerve - chronic ankle sprains   (blank)  
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Pronator Teres Syndrome   entrapment of median nerve @ elbow. SYMPTOMS-> Pain & tenderness in prox. aspect of anterior arm   median nerve (C6-T1) supplies skin over lateral hand bisecting 4th digit & forearm flexors EXCEPT Flexor Carpi Ulnaris   entrapment of median nerve   (blank)  
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Cubital Tunnel Syndrome   entrapment of ulnar nerve   re: claw hand   ulnar nerve compression in cubital tunnel. Tendinous arch joining humeral/ulnar heads of attachments of Flexor Carpi Ulnaris   (blank)  
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Carpal Tunnel Syndrome   entrapment of median nerve. SYMPTOMS-> paresthesia, hypoesthesia, anesthesia in lateral 3 & 1/2 digits; progressive loss of coordination & strength in thumb; eventually radiates into forearm & axilla   re: pronator teres syndrome   lesion reduces size of carpal tunnel   (blank)  
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Guyan's Canal Syndrome   entrapment of ulnar nerve AT WRIST   re: ulnar nerve   compression of ulnar nerve   (blank)  
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