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Kin 242 Final Exam Notes

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KIN 242
Laura Middleton

Kin 242 Introduction to Movement Disorders Pre-midterm Final Exam Content PERIPHERALNEUROPATHY Damage to nerves of the peripheral nervous system Results from damage to myelin and/or neuron (axon) DIABETIC NEUROPATHY 60-70% of all diabetics have some degree of neuropathy Symptoms Can affect any combination of peripheral nerve types: o Sensory o Motor o Autonomic nerves Symptoms are dependent on nerve(s) affected Symptoms progress gradually Sensory Symptoms: Paresthesia: numbness / tingling of extremities Dysesthesia: unpleasant sensations o burning/ pins & needles / electric shock Symmetrical, glove-stocking distribution Longer neurons are affected more severely (toes first) Loss of proprioception: o Sense of where a limb is in space Motor Symptoms motor symptoms usually occur later in progression Weakness (can be focal or extensive) o Poor fine motor coordination, foot slapping & toe scuffing, dysphagia: swallowing difficulty Fasciculation: small, local muscle twitch Balance & Gait Contribution of Sensory Problems o Loss of sensation in lower limb o Can lead to ulcers/infections on feet/legs Contribution of Motor Problems o Loss of motor function can result in contractures of the toes, loss of the foot muscle function, and can lead to hammer toes. Collective influence of sensory and motor changes can lead to problems in the control of gait and balance o , Causes: Multi-factorial: Hyperglycemia can damage neurons and blood vessels by changing protein structures o Leads to demylenation Vascular and neural diseases are linked Vasoconstriction hypoxia nerve damage Diagnosis: Sensory Testing Monofilament, vibration testing Vibration Testing Nerve conduction velocity testing Large diameter fibres CARPALTUNNELSYNDROME Flexor tendon inflammation compresses median nerve in wrist o Leads to damage of neuron Sensory Symptoms: Paresthesia (numbness and pain) along median nerve distribution Palmar side of the thumb, index , middle, & half of ring finger May be unilateral or bilateral Severe pain at night: o May awaken with burning & aching pain, numbness, & tingling Motor Symptoms: Muscle weakness: o Thumb abduction because opposing muscle weak & atrophied (thenar atrophy) Hand stiffness and clumsiness: o Trouble gripping objects, dropping objects Diagnosis Sensory and motor evaluation Monofilament, 2-point discrimination* Stimulus Response Testing: o Nerve conduction velocity, reflex testing MRI to view status of nerve Provocative (Sensory) Tests Phalens test o positive if numbness in median nerve innervated thumb/fingers Tinels sign o positive if shooting electric-like pain in distal regions Stimulus Resonse Testing Compare to another nerve (ulnar) Diagnosis: Prolonged median nerve motor latency (M-wave) Normal median motor conduction velocity in forearm Slow median sensory conduction velocity across the wrist Normal motor and sensory nerve conduction velocity of the ulnar nerve (comparison) RADICULOPATHY Cause: Impingement of nerve at spinal root due to: o Nerve compression o Reduced blood flow damages myelin and neuron Symptoms: Pain o Radicular pain: pain in sensory distribution of spinal nerve Weakness, numbness Difficulty controlling specific muscles (within distribution) Symptoms may develop in extremities (referred pain) Treatment: Conservative: o Physical therapy o Medication (NSAIDs, steroid injection) o Spinal manipulation Surgical
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