Study of Nerve Irritation and Compression: Key Terms and Definitions in Pain Mechanisms

C4 IVF and C4 disc affect _______ nerve root

C5

T7 IVF and T7 disc affect _______ nerve root

T7

L5 IVF and L4 discs affect _______ nerve root

L5

subluxations always have....

nerve irritation

3 multiple choice options

with Nerve irritation - sensory, motor and DTR will exhibit ________ findings

normal

hyperesthesia and paresthesia is associated with nerve ________

irritation

anesthesia and hypesthesia is associated with nerve ________

compression

with nerve compression, if patient reports numbness or tingling that travels down the extremity, is this true numbness?

yes

with nerve irritation, dual head instrument moves ______ from involved side

-increase sympathetic = vasoconstriction

-hypothermia over innervated area

away

with nerve compression, dual head instrument moves ______ from involved side

-decrease sympathetic fxn = vasodilation

-hyperthermia over innervated area

toward

with nerve compression - sensory, motor and DTR will exhibit ________ findings

abnormal/decreased

(autonomics first, then light touch, sharp pain, temp, position, vibration)

once nerve compression is relieved.....

autonomic nervous system - skin temp first (them vibratory/position, pain and temp, then light touch)

decreased sensation

hypoesthesia

hypoesthesia represents nerve root _________

-instrument break to same side

-decreased sympathetic function

-vasodilation

compression

increased sensation

hyperesthesia

if sensation is increased and if sensation is dermatomal, this would represent nerve root ________

-instrument break to opposite side

-increased sympathetic fxn

-vasoconstriction

irritation

abnormal sensation

-i.e. numbness, tingling, burning

-bilateral on sensory exam

paresthesia

absent sensation

anesthesia

injury or localized inflammation

nociceptive pain

lightly myelinated, relay a sharp stinging sensation to nociceptive

-specific neurons located at margin of dorsal horn (alert to presence of pain but not intensity)

type A (fast pain fibers)

aching, burning type of pain and these fibers transmit via dorsal horn and thalamus

type C

pain generated and sustained by the nervous system

-either PNS or CNS

-typically chronic pain

neuropathic pain

neuropathic pain examples

-diabetes

-postherpetic neuralgia

-phantom limb

-trigeminal neuralgia

what nerve conveys sensory fibers to PLL, dura and outer border of annulus?

recurrent nerve of luschka, sinuvertebral nerve

nociception is the transmission and modulation of ________ stimuli

noxious

types of nociceptive pain

radicular, somatic, visceral

pain which occurs when nerve roots are irritated

radicular

pain that happens when any of the pain receptors in your tissues, such as muscle, bone or skin are activated

somatic

what joints are void of nociceptors?

-articular cartilage

-inner annulus

-nucleus of IVD

-synovial membranes

the nociceptive system is ________ in the normal joint

inactive

-to activate you must first have noxious stimuli

types of noxious stimuli

mechanical, thermal, chemical

noxious mechanical stimuli may be caused by...

acute trauma or associated with repetitive micro trauma

noxious thermal stimuli may be due to...

excessive heat or cold

what type of noxious stimuli is traditionally overlooked by most primary care physicians?

chemical

substance which excite nociceptors

potassium, histamine, serotonin, plasma kinins, prostaglandins, substance P

nociceptive impulses travel along slightly myelinated ________ fibers (pain, sharp stinging) and along unmyelinated _______fibers (burning, achy pain)

A delta ; C

disc protrusion that does not compress the nerve root directly can cause an inflammatory response and ________ _______ by chemically induced inflammatory neural pain (nerve irritation)

secondary radiculitis

Discogenic pain is associated with activities which increase the pressure within the IVD such as.....

sitting, bending forward, coughing and sneezing (can increase low back discogenic pain)

in a typical chiropractic patient, it is more common to have _________ area noted on pain evaluation

hyperalgesia/hyperesthesia (nerve irritation)

T4

motor: intercostal

sensory: nipple

reflexes:none

T7

motor: rectus abd. sup.

sensory: xiphoid

reflexes: superficial

T10

motor: rectus abd, inf.

sensory: umbilicus

reflexes: superficial

T12

motor: rectus abd. inf

sensory: groin

reflexes: superficial

Cauda equina syndrome

-bilateral leg pain

-bowel and bladder incontinence

-sensory exam: S3-5 is decrease/absent (light or sharp touch)

-medical emergency

sacral sparing syndrome (syrinx)

-bilateral leg pain

-bowel and blader fxn normal (maybe some leakage)

-sensory exam S3-5 bilaterally

MC causes of lumbar radiculopathy

-disc herniation

-synovial cyst

-spinal stenosis

risk factors for lumbar radiculopathy

men MC, age 44, nontraumatic onset, driving occupations, frequent lifting/twisting, smoking