69 Questions
What is the name of the Professor who published the nerve injury classification in 1942?
H.J. Seddon
Which type of nerve injury involves wallerian degeneration of the distal nerve segment?
Axonotmesis
What term refers to a transient block where pressure, compression, or entrapment can cause injury to thickly myelinated large-diameter nerves?
Neuropraxia
What type of nerve injury is characterized by axonal regeneration and the maintenance of supportive structures?
Axonotmesis
In nerve entrapment classifications, which injury type involves a lesion in continuity and affects both myelinated and unmyelinated fibers?
Axonotmesis
Which treatment options are typically used for neuropraxia injuries to allow the nerve to glide and function without inhibition?
Decompression
What is the primary focus of peripheral nerve surgery according to the text?
Management of entrapment neuropathies
According to rule #2 mentioned in the text, what should be done in cases where there are both central and peripheral nervous system issues?
Treat the peripheral pathology first
What is the relationship between the peripheral nervous system (PNS) and the central nervous system (CNS) based on the text?
There is a bidirectional impact between PNS and CNS
What condition is likely to improve once the underlying etiology is treated according to rule #3?
Peripheral neuropathic symptoms
In peripheral nerve anatomy, what does 'nerve entrapment' refer to?
Impingement of a peripheral nerve by an anatomic structure
What is the significance of always treating structural and metabolic issues first, as per rule #3?
It leads to a decrease in peripheral neuropathic symptoms
What type of injury is indicated by a 6th degree injury, such as neuroma in continuity?
Incomplete recovery
Which injury type never shows sensory or motor recovery?
4th degree injury
What does a positive Babinski sign indicate during a neurological examination?
UMN lesion
In a neurological exam, what does the Mulders click test assess?
Sharp/dull discrimination
Which lab parameter is NOT commonly included in a nerve-related workup?
Albumin levels
What is the purpose of an epidermal nerve fiber density (ENFD) test in small-fiber neuropathy?
Assessing small nerve fiber count
What type of nerve injury is defined by complete disruption of a nerve as well as associated connective tissue, often resulting from conditions like gunshots or surgical trauma?
Neurotmesis
In Sunderland's nerve injury classification, which degree reflects a lesion where only the epineurium remains intact, necessitating surgical repair?
Fourth degree (Class II)
At what rate does nerve fiber regeneration typically occur?
1 mm per day
Which classification system expanded Seddon's classification by introducing 5 degrees of nerve injury?
Sunderland's classification
What type of nerve injury is characterized by axon severance without breaching the endoneurium, leading to Wallerian degeneration?
Axonotmesis
Which nerve injury classification degree requires surgical repair due to complete transection of the nerve?
Fifth degree (Class III)
Which anatomical location is the primary site for a nerve biopsy to diagnose Small Fiber Neuropathy (SFN)?
Lower leg/calf
What is the main outcome of an Epidermal Nerve Fiber Density biopsy?
Diagnosing Small Fiber Neuropathy
What are some examples of conditions that can lead to Small Fiber Neuropathy according to the text?
Diabetes, vitamin deficiency, autoimmune disease
Which metabolic condition is particularly mentioned in relation to peripheral nerve changes in diabetic patients?
Diabetes mellitus
What is the impact of increased water content within a nerve on the nerve volume?
Increased nerve volume
What is the function of axoplasmic flow in maintaining and rebuilding the nerve?
Transporting lipoproteins
What is the potential effect of increased external pressure on nerve physiology?
Decreased blood flow
In diabetic patients, what criteria are typically considered for nerve decompression?
Positive Tinel's sign, pain, well-controlled blood sugar levels
What is the presentation associated with superficial peroneal nerve entrapment?
Pain in the top of the foot
For which condition is the common digital nerve decompression usually recommended?
Morton's neuroma
What principle is emphasized by rule #2 in the text?
Look up for more proximal etiology
In peripheral nerve injuries, which rule recommends treating structural and metabolic issues first?
Rule #3
What is the common type of pathology that rule #3 suggests treating first?
Diabetes
What types of conditions can lead to peripheral nerve pain?
Metabolic disorders
In peripheral nerve anatomy, what is the significance of entrapment and impingement?
They cause compression of nerve trunks
What should be the approach when dealing with combined central and peripheral issues according to the text?
Treat central issues first
What is the typical cause of neuropraxia (transient block) based on Seddon's classification?
Contusion
Which nerve injury classification by Seddon involves damage to both the myelin and axon with Wallerian degeneration of the distal nerve segment?
Axonotmesis
What is the typical result of axonotmesis (lesion in continuity) proximally according to Seddon's classification?
Neurotransmitter production
What is the essential factor determining functional recovery in cases of axonotmesis (lesion in continuity) with regards to the proximity of the lesion?
Distance to end organ
Which type of nerve injury involves the regeneration and growth of new axons due to the maintenance of supportive structures?
Axonotmesis
What intervention is typically used to allow the nerve to glide and function without inhibition in cases of neuropraxia?
Decompression
What is the main symptom associated with a 6th degree nerve injury (neuroma in continuity)?
Neuropathic pain
Which of the following nerve injury degrees is associated with total nerve transection?
5th degree (neurotmesis)
What does a positive Babinski sign in an adult indicate during a neurological examination?
Upper motor neuron lesion (UMN)
What is the characteristic outcome for a 4th-degree nerve injury (axonotmesis) according to the text?
No sensory or motor recovery
What is typically indicated by a positive Tinel's sign moving distally during nerve injury recovery?
Incomplete recovery progression
Which clinical indicator is used to confirm sensory nerve involvement in the lower extremities?
Semmes Weinstein monofilament test
In Sunderland's nerve injury classification, which degree indicates a nerve fiber disruption but with the endoneurium, epineurium, and perineurium remaining intact?
Third degree
Which classification represents the most severe nerve injury involving nerve division and complete disruption of the nerve, associated with conditions like lacerations, gunshots, and surgical trauma?
Neurotmesis
What type of nerve injury classification refers to the condition where nerve regeneration occurs at a rate of approximately 1mm/day?
Second-degree axon severance
Which nerve injury type requires surgical intervention and may involve procedures such as neurectomy, excision, or graft implantation for repair?
Third-degree nerve fiber disruption
Which nerve injury degree in Sunderland's classification indicates a conduction deficit without axonal interruption, similar to Seddon's neuropraxia?
First degree
What is the name of the nerve procedure that involves nerve fiber regeneration at a rate of approximately 1mm/day?
End-to-side neurorraphy
What are the primary criteria typically considered for nerve decompression in diabetic patients?
Well-controlled A1C levels and positive Tinel’s sign over an entrapped nerve
Which of the following is a common presentation associated with common peroneal (fibular) nerve entrapment?
Weakness of EHL and positive Tinel’s sign at the lateral malleoli
What distinguishes deep peroneal (fibular) nerve from other nerve decompression procedures?
Frequent correlation with ankle exostosis for entrapment
Which symptom is typically associated with superficial peroneal nerve entrapment?
Pain in the dorsum of the foot and inability to tolerate a shoe on the foot
What is commonly associated with the failure to tolerate a shoe on the top of the foot in anterior tarsal tunnel syndrome?
Lesions at the 1st and 2nd metatarsal bases
Which nerve decompression procedure is generally not undertaken due to the absence of natural entrapment sites?
Saphenous nerve
When considering common peroneal (fibular) nerve decompression, where is a provocation sign typically diagnostic of entrapment found?
10-15 cm proximal to the lateral malleoli
Which criterion is primarily aimed to improve balance and sensation in the management of superficial peroneal nerve decompression?
Response to nerve block
What is a diagnostic characteristic of the superficial peroneal (fibular) nerve that can help identify entrapment?
Pain in the dorsum after prior lateral ankle sprain
During common digital nerve decompression, what symptom is often reported by patients?
Pain radiating to the digits
What distinguishes tarsal tunnel (tibial nerve and branches) decompression among other nerve decompression procedures?
Specifically decreased 2-point discrimination on plantar hallux pulp
Test your knowledge on the evaluation and management of entrapment neuropathies in peripheral nerve surgery, including understanding the microscopic anatomy of peripheral nerves, dermatomes of the lower extremity, classification systems of nerve injuries, and principles of evaluation and treatment for nerve pain.
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