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Disorders of the Peripheral Nervous System
Presented By:
Joseph S. Ferezy, D.C.
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Disease of Peripheral Nerves
Neuropathy – Functional Or Pathological Change In The PNS
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Classification
Mononeuropathy– One Peripheral Nerve– Usually Identifiable Trauma
Wrist Drop Foot Drop CTS Ulnar Nerve Palsy
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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.
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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
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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
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Neuralgia
Nerve Pain
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The Cervical Plexus
See Other Lecture
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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
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Bikele's Sign
Pain on Elbow Extension With the Arm in Hyperabduction
May Be Present With Injury or Meningitis.
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Brachial Plexus Injuries
The Most Common Form of Injury Is From Birth Trauma.
Two Types Are Described:– Upper Plexus(Erb-Duchenne)– Lower Plexus (Klumpke)
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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)
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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)
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The Thoracic Nerves
Horner's Syndrome Beevor’s Sign
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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
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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)