Neurologic Exam Week 3

What is the term for less than normal pain sensation?

Hypoalgesia

What is the term for more than normal pain sensation?

Hyperalgesia

What is the term for lack of pain sensation?

Analgesia

Hypoalgesia, hyperalgesia, and analgesia can all refer to results of which test?

a. cotton wisp

b. tuning fork

c. pinwheel

d. muscle tests

c. pinwheel

What is the term for loss of vibration sensation?

Pallenthesia

What is the term for less than normal light touch sensation?

Hypothesis

What is the term for more than normal light touch sensation?

Hyperesthesia

What is the term for no light touch sensation?

Anesthesia

What test do hypoesthesia, hyperesthesia, and anesthesia refer to?

Cotton wisp

T or F: Radiculopathies will present with positive spinal orthopaedic tests

True

Where do issues of radiculopathy typically begin?

Proximally and move distal

What are the potential causes of radiculopathy?

Disc lesion

IVF stenosis

Space occupying lesion

Which spinal nerves are most commonly affected by radiculopathy?

C6/7

Where does the spinal cord end?

L1-L2

What symptoms initially present from cauda equina syndrome?

Bowel and urinary retention

What symptoms present later in cauda equina syndrome?

Bowel and urinary incontinence

Which reflex will be absent in cauda equina syndrome?

Anal wink

What is the cause of cauda equina syndrome?

Central disc herniation of the lumbar spine

T or F: peripheral neuropathy is associated with positive spinal orthopaedic tests

False

What is an example of pseudohypertophy?

Duchenne's muscular dystrophy

What causes enlargement in pseudo hypertrophy?

Fat infiltration of muscles

What is an example of physiologic hypertrophy?

Hittin' the gym

What is the origin of the axillary nerve?

C5-6

What type of injuries can lead to axillary nerve entrapment?

Shoulder dislocation (anterior)

Fracture of humeral head

Which nerves are affected by crutch palsy?

Radial

Axillary

Entrapment of which nerve can lead to loss of roundness of the shoulders?

Axillary

Which muscles are innervated by the axillary nerve?

Teres minor

Deltoid

What is the origin of the musculocutaneous nerve?

C5-C6

Which muscles are innervated by the musculocutaneous nerve?

coracobrachialis

brachialis

biceps brachii

What type of injury can lead to entrapment of the musculocutaneous nerve?

Shoulder injury (due to malposition of the coracobrachialis)

Which muscles can cause entrapment of the musculocutaneous nerve when hypertrophied?

Biceps

Brachialis

What is the origin of the radial nerve?

C5-T1

Which muscles are innervated by the radial nerve?

BEEEST:

Brachioradialis

Extensor radialis

Extensor Ulnaris

Extensor pollicis

Supinator

Triceps

What is the unique symptom of radial nerve entrapment?

Wrist drop

What are the possible mechanisms of radial nerve entrapment?

Saturday night palsy

Honeymoon palsy

Crush palsy

Supinator entrapment

What is the AKA of supinator entrapment?

Posterior interosseous nerve syndrome

What are the unique symptoms of posterior interosseous nerve syndrome?

Causes weak thumb and finger extension, but spares wrist extension and all sensation

What is the origin of the median nerve?

C5-T1

Which muscles are innervated by the median nerve?

PPFFFF:

pronator quadratus

pronator teres

flexor carpi radialis

flexor digitorum superficialis of the first 3 fingers

flexor digitorum profundus of the first 3 fingers

flexor pollicis

Which landmark does the median nerve pass through at the elbow?

Cubital fossa

How many branches of the median nerve are there before it enters the carpal tunnel?

2

What are the 2 branches of the median nerve?

Anterior interosseous nerve

Palmar cutaneous branch

What is the function of the anterior interosseous nerve?

innervates deep forearm muscles, terminates proximal to the carpal tunnel

What is the function of the palmar cutaneous branch?

sensory innervation to the skin of the palm

T or F: the palmar cutaneous branch does not enter to carpal tunnel, thus sparing palm sensation with carpal tunnel syndrome

True

T or F: The thenar aspect of the palm will show numbness with carpal tunnel syndrome, while the fingers of the lateral hand will not

False (thenar is not numb, fingers are)

What can cause flexor retinaculum compression?

Prolonged wrist flexion

What is the name of the test where the patient uses the patient is unable to grip with their finger pads?

Median nerve pinch grip test

What is the origin of the ulnar nerve?

C8-T1

Which muscles are innervated by the ulnar nerve?

Flexor carpi ulnaris

Flexor digitorum superificialis

Flexor digitorum profundus

Last 2 interossei

Which landmarks do the ulnar nerve pass through?

Ulnar/cubital tunnel (funny bone)

Tunnel of guyon

What can cause tunnel of guyon entrapment?

history of biking/using handlebars or repetitive gripping activities

What is the name of the phenomenon where a patient will grip using their fingertips for grip because they are unable to use their finger pads?

Froment's sign

What is the most common cause of polyneuropathy?

Diabetes mellitus

What are the two plexus injuries caused by birthing trauma?

Erb's palsy

Klumpke's palsy

What is the name of an upper brachial plexus lesion?

Erb's palsy

What deformity is caused by erb's palsy?

Waiter tip

What is the term for a lower brachial plexus tear?

Klumpke's paralysis

What deformity is caused by klumpke's palsy?

Claw hand

Which nervous structures can be caused by pan coast tumor?

Brachial plexus

Cervical sympathetic chain

What can be caused by entrapment of the cervical sympathetic chain by a pan coast tumor?

horner's syndrome

(ptosis, miosis, and anhidrosis)

Which muscles are weakened by myasthenia gravis?

Levator palpebrae

Glenohumeral proximal muscles

What are the symptoms of sciatic nerve entrapment?

p/t/n in the glutes and posterior leg which will depend on the location of the entrapment

What pattern will sciatic nerve entrapment follow when caused by lumbar disc herniation/IVF stenosis?

Radicular pattern into the legs and feet

What pattern will sciatic nerve entrapment follow when caused by piriformis syndrome?

p/t/n in the glutes and posterior thighs

not below the knees

What is the AKA of sciatic nerve entrapment caused by lumbar disc herniation/IVF stenosis?

Sciatica

What stance do people with piriformis syndrome have?

Toeing out

What is the AKA of lateral femoral cutaneous nerve entrapment?

Meralgia parasthetica

What can cause neuralgia parasthetica?

wearing tight pants or a heavy utility belt

Where will symptoms of common peroneal nerve entrapment appear?

Upper lateral shin

Where will symptoms of superficial perineal nerve entrapment present?

Medial shin and top of foot

What can cause peroneal nerve entrapment?

Entrapment at the fibular head

Wearing tight shoes/heels

What is the term for injury to the spinal cord?

Myelopathy

Where can the tibial nerve become entrapped?

Popliteal fossa

Around the calcaneus/achilles tendon

Where will tibial nerve entrapment present?

heel

postero-medial calf/foot

bottom of the foot

Stroke of which artery can lead to Wallenberg syndrome?

PICA

What are the symptoms of wallenburg syndrome?

Ipsilateral pain and temperature loss to the face

Contralateral pain and temperature loss to the body

T or F: Wallenburg syndrome presents with loss of tactile sensation to ipsilateral face and contralateral body

False (pain and temperature loss)

What is the presentation of a syringomyelia?

Loss of pain and temperature sensation in a cape/shawl like pattern

What can cause a syringomyelia?

trauma (whiplash)

spinal cord tumors

What are the symptoms of brown sequard syndrome?

Ipsilateral tactile loss below the level of the lesion

Ipsilateral UMN symptoms below the level of the lesion

Contralateral pain and temp loss below the level of the lesion

Ipsilateral loss of all sensation at the level of lesion (due to dorsal horn involvement

Ipsilateral LMN symptoms at the level of the lesion (due to ventral horn involvement

What symptom results from damage to the dorsal horn in brown sequard syndrome?

Ipsilateral loss of all sensation at the level of lesion

What symptom results from damage to the ventral horn in brown sequard syndrome?

Ipsilateral LMN symptoms at the level of the lesion

Lesion to what part of the brain results in Hemi-sensory loss/hemianesthesia?

Thalamus

What are the symptoms of hemianesthesia?

Contralateral loss of all sensation to the face and body