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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)
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What are general signs and symptoms of neuropathies?
- parasthesia, hyperesthesia, numbness
- weakness
- organ or gland dysfunction (ileus, impotence, irregular BP, incontinence)
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What is the difference between parasthesia and hyperesthesia?
parasthesia is unusual sensations and hyperesthesia is heightened sensation
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What are general causes of neuropathies?
- injury
- infection
- space occupying lesions (tumors, discs)
- autoimmune disorders
- genetic diseases
- systemic diseases (kidney failure, diabetes, hypothyroidism, toxic substances)
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What does hypothyroidism cause (general)?
decreases conduction velocity of nerves so patients move slower
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What is increased itching of the skin a sign of?
renal failure
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How is diagnosis of neuropathies made?
- complete physical exam and history
- radigraphic procedures
- electromyography
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What are general treatment procedures of neuropathies?
- treat underlying disease
- healthy life style plan
- control pain
- assistive devices
- possible surgery
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What are some lower motor neuron disorders?
- poliomyetlitis (viral)
- spinal musclular atrophy (inherited)
- amyotrophic lateral sclerosis (unknown cause)
- trauma
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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
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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
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What chromosome does spinal musclular atrophy deal with?
- chromosome 5
- recessive trait
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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
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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
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What muscles does the juvenile form of spinal muscular atrophy affect?
- proximal muscles
- (weakness begins in childhood)
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What are some characteristics of amyotrophic lateral sclerosis?
- lower and upper motor neuron involvement
- 3-8/100,000
- onset 30-60 years of age
- respiratory failure in several years
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What are sign and symptoms of amyotrophic lateral sclerosis?
- weak
- atrophy
- fasiculations
- difficulty swallowing- so will choke***
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What is amyotrophic lateral sclerosis sometimes called?
Lou Gehrigs disease
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What is shingles (general)?
sensory condition affecting the dorsal root ganglion
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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
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What is a radiculopathy?
disorder of spinal nerve roots
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What are some causes of radiculopathies?
- herniated disc
- stenosis
- herpes zoster, arachnoiditis
- tumor
- avulsion
- cervical rib
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What are signs and symptoms of radiculopathies?
- paresis in myotome
- diminished or absent reflexes
- sensory loss in a dermatome (numbness/parasthesia)
- pain in dermatome
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Avulsion of nerve roots usually occurs where during a breech birth?
- C5 and C6- Erbs Paralysis
- C8-T1- Klumpke's paralysis (function of hand)
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What are some causes of plexus involvement?
- birth trauma
- physical trauma
- radiation therapy
- chronic compression
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When will symptoms from thoracic outlet syndrome be noticeable?
- elevating arms
- when driving, one hand will be gripping the steering wheel tightly
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What occurs with thoracic outlet syndrome?
the collar bone and upper ribs compress the scalene muscles which compresses the brachial plexus
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What can cause lumbar-sacral plexus?
- pregnancy
- hip dislocation
- abdominal surgery
- tumors
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What are the three types of peripheral neuropathy?
- mononeuropathy
- mononeuropathy multiplex
- polyneuropathy
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What is affected in a mononeuropathy?
one nerve
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What is affected in a mononeuropathy multiplex?
several nerves, but symptoms are asymmetric
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What is affected in a polyneuropathy?
several nerves, but symptoms are symmetric
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What are some causes of peripheral neuropahty?
- trauma
- toxic agents (chemotherapy, arsenic)
- infections
- neoplastic
- vascular (diabetes)
- metabolic (kidney failure)
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What is Wallerian Degeneration?
the death process of a cell
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What is the rate at which nerves grow?
1mm/day
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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
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What happens with the facial nerve damage?
- Bell's palsy
- ipsilateral facial weakness
- unknown cause and prognosis varies- some recover completely, others don't
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What are the causes of radial nerve damage?
- fracture
- pressure in axilla
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What are signs and symptoms of radial nerve damage?
- loss of elbow, wrist, and finger extension
- pain
- parasthesia
- loss of sensation on dorsum of hand- radial side
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What are causes of ulnar nerve damage?
- fractures
- entrapment at elbow
- compression at elbow
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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
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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
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What nerve is damaged with Bishops hand?
ulnar nerve
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What nerve is damaged with a true Claw hand?
median and ulnar
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What nerve is damaged with an Ape's hand and where is there atrophy?
- median nerve
- thenar eminence
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What are causes of median nerve damage?
- carpal tunnel syndrome (butchers, pregnancy, typists)
- trauma
- compression
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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
- pain
- parasthesisia that worsens at night
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What are causes of sciatica?
injury to lumbar plexus, hip, or abdomen
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What are signs and symptoms of sciatica?
- weakness in knee flexion
- weak hip adduction
- flail ankle
- pain that goes down below knee into foot***
- paresthesia
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What is the causes and signs and symptoms of peroneal nerve damage?
- injury at fibular head
- weakness of everters and DF
- drop foot
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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
- pain
- paresthesia
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What is tarsal tunnel syndome?
caused by entrapment, which increases with flat feet and activity
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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
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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
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