Disorders of the Peripheral Nervous System

Presented By:

Joseph S. Ferezy, D.C.

Disease of Peripheral Nerves

Neuropathy – Functional Or Pathological Change In The PNS

Classification

Mononeuropathy– One Peripheral Nerve– Usually Identifiable Trauma

Wrist Drop Foot Drop CTS Ulnar Nerve Palsy

Polyneuropathy

Diffuse And Symmetrical Damage To Many Peripheral Nerves Simultaneously

Glove And Stocking Distribution

– Nutritional– Diabetes Mellitus

– Uremia– Vasculitis– Drugs– Pernicious Anemia– Alcoholism– Heavy Metal Poisoning– Carcinoma– Vitamin B6 Excess– A.I.D.S.

Polyneuropathy

Usually Motor And Sensory Loss

Sensory Loss Only Suggests

– Nerve Root Avulsion– May Be Spinal Cord

Motor Loss Only Suggests

– Poliomyelitis– Polymyositis– Primary Myopathy– Myasthenia Gravis– Botulism– Tic Paralysis

Multiple Mononeuropathy (Mononeuropathy Multiplex)

Two Or More Separate Nerves Initial in Involved Nerve

– Pain– Paresthesia– Weakness

Multiple Nerves Can Become Involved– Metabolic (Diabetes, Uremia)– Familial Neuropathy– Underlying Malignancy Or Systemic Disease

Neuralgia

Nerve Pain

The Cervical Plexus

See Other Lecture

Brachial Plexus Injuries

Violent Pulling or Wrenching of the Arm Blows or Weight Upon the Neck, Operative Trauma Gunshot Wounds Stab Wounds Auto Accidents Fractures or Dislocations Tumors, Aneurysms (Subclavian) Infection Toxic Problems Thoracic Outlet Syndromes

Bikele's Sign

Pain on Elbow Extension With the Arm in Hyperabduction

May Be Present With Injury or Meningitis.

Brachial Plexus Injuries

The Most Common Form of Injury Is From Birth Trauma.

Two Types Are Described:– Upper Plexus(Erb-Duchenne)– Lower Plexus (Klumpke)

Brachial Plexus Injuries

Middle Plexus Long Thoracic Nerve (C5-7) Suprascapular Nerve (C5,6) Dorsal Scapular Nerve (C5,6) Thoracodorsal Nerve (C7,8) Anterior Thoracic Nerves (C5-8,T1)

Brachial Plexus Injuries

Medial Brachial and Antebrachial Cutaneous Nerves (C8,T1)

Musculocutaneous Nerve (C5,6) Axillary (Circumflex) Nerve (C5,6) Radial (Musculospiral) Nerve (C6-8,T1) Median Nerve (C6-8,T1) Ulnar Nerve (C8,T1)

The Thoracic Nerves

Horner's Syndrome Beevor’s Sign

The Lumbar Plexus

Ilioinguinal, Iliohypogastric, and Genitofemoral Nerves (T12,L1,2) Lateral Femoral Cutaneous Nerve (L2,3) Meralgia Paresthetica of Roth Femoral (Anterior Crural) Nerve (L2-4) Obturator Nerve (L2-4) Sacral Nerves

The Sacral Plexus

Superior Gluteal Nerve (L4,5,S1) Inferior Gluteal Nerve (L5,S1,2) Posterior Femoral Cutaneous(small Sciatic)

Nerve (S1-3) Sciatic Nerve (L4,5,S1-3) Common Peroneal (External Popliteal)

– Nerve (L4,5,S1,2)– Tibial (Internal Popliteal) Nerve (L4,5,S1-3)