Peripheral Nerve Surgery Evaluation and Management Quiz
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Questions and Answers

What is the name of the Professor who published the nerve injury classification in 1942?

  • J.K. Tolkien
  • H.J. Rowling
  • J.R.R. Martin
  • H.J. Seddon (correct)

    • Which type of nerve injury involves wallerian degeneration of the distal nerve segment?

  • Myelinosis
  • Neurotmesis
  • Neuropraxia
  • Axonotmesis (correct)

    • What term refers to a transient block where pressure, compression, or entrapment can cause injury to thickly myelinated large-diameter nerves?

  • Neurotmesis
  • Axonotmesis
  • Neuropraxia (correct)
  • Myelinopathy

    • What type of nerve injury is characterized by axonal regeneration and the maintenance of supportive structures?

    <p>Axonotmesis</p> Signup and view all the answers

    In nerve entrapment classifications, which injury type involves a lesion in continuity and affects both myelinated and unmyelinated fibers?

    <p>Axonotmesis</p> Signup and view all the answers

    Which treatment options are typically used for neuropraxia injuries to allow the nerve to glide and function without inhibition?

    <p>Decompression</p> Signup and view all the answers

    What is the primary focus of peripheral nerve surgery according to the text?

    <p>Management of entrapment neuropathies</p> Signup and view all the answers

    According to rule #2 mentioned in the text, what should be done in cases where there are both central and peripheral nervous system issues?

    <p>Treat the peripheral pathology first</p> Signup and view all the answers

    What is the relationship between the peripheral nervous system (PNS) and the central nervous system (CNS) based on the text?

    <p>There is a bidirectional impact between PNS and CNS</p> Signup and view all the answers

    What condition is likely to improve once the underlying etiology is treated according to rule #3?

    <p>Peripheral neuropathic symptoms</p> Signup and view all the answers

    In peripheral nerve anatomy, what does 'nerve entrapment' refer to?

    <p>Impingement of a peripheral nerve by an anatomic structure</p> Signup and view all the answers

    What is the significance of always treating structural and metabolic issues first, as per rule #3?

    <p>It leads to a decrease in peripheral neuropathic symptoms</p> Signup and view all the answers

    What type of injury is indicated by a 6th degree injury, such as neuroma in continuity?

    <p>Incomplete recovery</p> Signup and view all the answers

    Which injury type never shows sensory or motor recovery?

    <p>4th degree injury</p> Signup and view all the answers

    What does a positive Babinski sign indicate during a neurological examination?

    <p>UMN lesion</p> Signup and view all the answers

    In a neurological exam, what does the Mulders click test assess?

    <p>Sharp/dull discrimination</p> Signup and view all the answers

    Which lab parameter is NOT commonly included in a nerve-related workup?

    <p>Albumin levels</p> Signup and view all the answers

    What is the purpose of an epidermal nerve fiber density (ENFD) test in small-fiber neuropathy?

    <p>Assessing small nerve fiber count</p> Signup and view all the answers

    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?

    <p>Neurotmesis</p> Signup and view all the answers

    In Sunderland's nerve injury classification, which degree reflects a lesion where only the epineurium remains intact, necessitating surgical repair?

    <p>Fourth degree (Class II)</p> Signup and view all the answers

    At what rate does nerve fiber regeneration typically occur?

    <p>1 mm per day</p> Signup and view all the answers

    Which classification system expanded Seddon's classification by introducing 5 degrees of nerve injury?

    <p>Sunderland's classification</p> Signup and view all the answers

    What type of nerve injury is characterized by axon severance without breaching the endoneurium, leading to Wallerian degeneration?

    <p>Axonotmesis</p> Signup and view all the answers

    Which nerve injury classification degree requires surgical repair due to complete transection of the nerve?

    <p>Fifth degree (Class III)</p> Signup and view all the answers

    Which anatomical location is the primary site for a nerve biopsy to diagnose Small Fiber Neuropathy (SFN)?

    <p>Lower leg/calf</p> Signup and view all the answers

    What is the main outcome of an Epidermal Nerve Fiber Density biopsy?

    <p>Diagnosing Small Fiber Neuropathy</p> Signup and view all the answers

    What are some examples of conditions that can lead to Small Fiber Neuropathy according to the text?

    <p>Diabetes, vitamin deficiency, autoimmune disease</p> Signup and view all the answers

    Which metabolic condition is particularly mentioned in relation to peripheral nerve changes in diabetic patients?

    <p>Diabetes mellitus</p> Signup and view all the answers

    What is the impact of increased water content within a nerve on the nerve volume?

    <p>Increased nerve volume</p> Signup and view all the answers

    What is the function of axoplasmic flow in maintaining and rebuilding the nerve?

    <p>Transporting lipoproteins</p> Signup and view all the answers

    What is the potential effect of increased external pressure on nerve physiology?

    <p>Decreased blood flow</p> Signup and view all the answers

    In diabetic patients, what criteria are typically considered for nerve decompression?

    <p>Positive Tinel's sign, pain, well-controlled blood sugar levels</p> Signup and view all the answers

    What is the presentation associated with superficial peroneal nerve entrapment?

    <p>Pain in the top of the foot</p> Signup and view all the answers

    For which condition is the common digital nerve decompression usually recommended?

    <p>Morton's neuroma</p> Signup and view all the answers

    What principle is emphasized by rule #2 in the text?

    <p>Look up for more proximal etiology</p> Signup and view all the answers

    In peripheral nerve injuries, which rule recommends treating structural and metabolic issues first?

    <p>Rule #3</p> Signup and view all the answers

    What is the common type of pathology that rule #3 suggests treating first?

    <p>Diabetes</p> Signup and view all the answers

    What types of conditions can lead to peripheral nerve pain?

    <p>Metabolic disorders</p> Signup and view all the answers

    In peripheral nerve anatomy, what is the significance of entrapment and impingement?

    <p>They cause compression of nerve trunks</p> Signup and view all the answers

    What should be the approach when dealing with combined central and peripheral issues according to the text?

    <p>Treat central issues first</p> Signup and view all the answers

    What is the typical cause of neuropraxia (transient block) based on Seddon's classification?

    <p>Contusion</p> Signup and view all the answers

    Which nerve injury classification by Seddon involves damage to both the myelin and axon with Wallerian degeneration of the distal nerve segment?

    <p>Axonotmesis</p> Signup and view all the answers

    What is the typical result of axonotmesis (lesion in continuity) proximally according to Seddon's classification?

    <p>Neurotransmitter production</p> Signup and view all the answers

    What is the essential factor determining functional recovery in cases of axonotmesis (lesion in continuity) with regards to the proximity of the lesion?

    <p>Distance to end organ</p> Signup and view all the answers

    Which type of nerve injury involves the regeneration and growth of new axons due to the maintenance of supportive structures?

    <p>Axonotmesis</p> Signup and view all the answers

    What intervention is typically used to allow the nerve to glide and function without inhibition in cases of neuropraxia?

    <p>Decompression</p> Signup and view all the answers

    What is the main symptom associated with a 6th degree nerve injury (neuroma in continuity)?

    <p>Neuropathic pain</p> Signup and view all the answers

    Which of the following nerve injury degrees is associated with total nerve transection?

    <p>5th degree (neurotmesis)</p> Signup and view all the answers

    What does a positive Babinski sign in an adult indicate during a neurological examination?

    <p>Upper motor neuron lesion (UMN)</p> Signup and view all the answers

    What is the characteristic outcome for a 4th-degree nerve injury (axonotmesis) according to the text?

    <p>No sensory or motor recovery</p> Signup and view all the answers

    What is typically indicated by a positive Tinel's sign moving distally during nerve injury recovery?

    <p>Incomplete recovery progression</p> Signup and view all the answers

    Which clinical indicator is used to confirm sensory nerve involvement in the lower extremities?

    <p>Semmes Weinstein monofilament test</p> Signup and view all the answers

    In Sunderland's nerve injury classification, which degree indicates a nerve fiber disruption but with the endoneurium, epineurium, and perineurium remaining intact?

    <p>Third degree</p> Signup and view all the answers

    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?

    <p>Neurotmesis</p> Signup and view all the answers

    What type of nerve injury classification refers to the condition where nerve regeneration occurs at a rate of approximately 1mm/day?

    <p>Second-degree axon severance</p> Signup and view all the answers

    Which nerve injury type requires surgical intervention and may involve procedures such as neurectomy, excision, or graft implantation for repair?

    <p>Third-degree nerve fiber disruption</p> Signup and view all the answers

    Which nerve injury degree in Sunderland's classification indicates a conduction deficit without axonal interruption, similar to Seddon's neuropraxia?

    <p>First degree</p> Signup and view all the answers

    What is the name of the nerve procedure that involves nerve fiber regeneration at a rate of approximately 1mm/day?

    <p>End-to-side neurorraphy</p> Signup and view all the answers

    What are the primary criteria typically considered for nerve decompression in diabetic patients?

    <p>Well-controlled A1C levels and positive Tinel’s sign over an entrapped nerve</p> Signup and view all the answers

    Which of the following is a common presentation associated with common peroneal (fibular) nerve entrapment?

    <p>Weakness of EHL and positive Tinel’s sign at the lateral malleoli</p> Signup and view all the answers

    What distinguishes deep peroneal (fibular) nerve from other nerve decompression procedures?

    <p>Frequent correlation with ankle exostosis for entrapment</p> Signup and view all the answers

    Which symptom is typically associated with superficial peroneal nerve entrapment?

    <p>Pain in the dorsum of the foot and inability to tolerate a shoe on the foot</p> Signup and view all the answers

    What is commonly associated with the failure to tolerate a shoe on the top of the foot in anterior tarsal tunnel syndrome?

    <p>Lesions at the 1st and 2nd metatarsal bases</p> Signup and view all the answers

    Which nerve decompression procedure is generally not undertaken due to the absence of natural entrapment sites?

    <p>Saphenous nerve</p> Signup and view all the answers

    When considering common peroneal (fibular) nerve decompression, where is a provocation sign typically diagnostic of entrapment found?

    <p>10-15 cm proximal to the lateral malleoli</p> Signup and view all the answers

    Which criterion is primarily aimed to improve balance and sensation in the management of superficial peroneal nerve decompression?

    <p>Response to nerve block</p> Signup and view all the answers

    What is a diagnostic characteristic of the superficial peroneal (fibular) nerve that can help identify entrapment?

    <p>Pain in the dorsum after prior lateral ankle sprain</p> Signup and view all the answers

    During common digital nerve decompression, what symptom is often reported by patients?

    <p>Pain radiating to the digits</p> Signup and view all the answers

    What distinguishes tarsal tunnel (tibial nerve and branches) decompression among other nerve decompression procedures?

    <p>Specifically decreased 2-point discrimination on plantar hallux pulp</p> Signup and view all the answers

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