Deck 13: Peripheral Nerve Disorders and Management

Question 1

Following transverse carpal ligament surgery to release impingement of the median nerve in the carpal tunnel,your patient has increased sensation of tingling when the wrist is extended.The impairment and its intervention should be:

A) Joint adhesions: use joint-mobilization techniques.
B) Median nerve adhesions: use nerve-mobilization techniques.
C) Ligamentous stress from the surgery: use cross-friction massage.
D) Scar adhesions: mobilize the skin around the surgical site followed by range of motion exercises.

Answer 1

B

Question 2

Dominant signs of complex regional pain syndrome type I (reflex sympathetic dystrophy)that should alert you to the potential of this condition developing are:

A) Pain,osteoporosis,swelling,and paresthesias.
B) Pain,swelling,stiffness,and discoloration of the hand.
C) Pain,muscle atrophy,stiffness,and brittle nails.
D) Recent injury;pain;and red,hot,swollen tissue.

Answer 2

B

Question 3

The pain associated with CRPS type I (reflex sympathetic dystrophy)characteristically is:

A) Entirely psychogenic and responsive to antidepressants.
B) Intermittent and related to body and head position.
C) Out of proportion to the report of history of injury or precipitating event.
D) Always responsive to modalities,primarily cold and electrical stimulation.

Answer 3

C

Question 4

Your patient describes total numbness in the tips of the index and middle fingers that has been there for 2 months.Four months ago,he sustained a Colles' fracture.While immobilized in a cast,he had experienced periods of intermittent numbness and pain.You observe atrophy in the thenar eminence and ape hand deformity.This patient most likely sustained:

A) Mild compression of the median nerve and has excellent prognosis for full recovery.
B) Laceration of the median nerve with complete interruption;there is no chance of neurological recovery.
C) Chronic compression of the median nerve;there is a guarded prognosis;may require surgical intervention.
D) A stretch injury to the median nerve with adhesions preventing normal mobility;gentle nerve mobilization should alleviate the symptoms.

Question 5

On examination,your patient reports that he is an avid cyclist and over the past 2 months has been experiencing numbness of the little finger and the ulnar side of his ring finger that has become painful over the past week with an inability to effectively grasp the handlebars.One area of possible nerve compression producing these signs and symptoms is:

A) Carpal tunnel
B) Tunnel of Guyon
C) Thoracic outlet
D) Tarsal tunnel

Question 6

CRPS type I (reflex sympathetic dystrophy)is defined as an extremely painful multisymptom syndrome involving many systems that is:

A) Responsive and easily treated with modalities.
B) Primarily psychomotor,resulting in weight changes and depression.
C) Easily diagnosed with universal signs and symptoms.
D) Accompanied by dystrophic and vascular changes and hyperesthesia.

Question 7

Your patient complains of numbness in the hand and forearm whenever working for prolonged periods at the computer;the hand also develops a puffy sensation and occasionally turns blue.Adson's maneuver reproduces these symptoms.All of the following should directly help your patient with this problem and will be part of your treatment approach except:

A) Stretch the scalene muscles.
B) Teach posture correction.
C) Teach relaxed diaphragmatic breathing.
D) Apply mechanical traction at 20 lb for 20 minutes.

Question 8

Nonoperative management of carpal tunnel syndrome emphasizes:

A) Vigorous stretching to gain mobility of the structures in the carpal tunnel.
B) Activity modification and joint,nerve,and tendon mobilization.
C) Strengthening exercises,especially to the muscles of the thenar eminence.
D) Immobilization.

Question 9

Your patient experiences a tingling sensation in the upper extremity while in the following position: shoulder girdle depression;slight abduction of the shoulder;elbow extension;internal rotation of the arm;pronation of the forearm,wrist,finger;thumb flexion;and ulnar deviation of the wrist.Which peripheral nerve is being placed on a stretch?

A) Median
B) Radial
C) Ulnar
D) Musculocutaneous

Question 10

To effectively treat complex regional pain syndrome type I (reflex sympathetic dystrophy),a physical therapist:

A) Performs a sympathetic block prior to any manual or exercise interventions.
B) Utilizes an approach that manages the physical symptoms of pain,edema,stiffness,and muscle changes.
C) Bombards the autonomic nervous system with stimuli using desensitization techniques.
D) Avoids the "no pain,no gain" philosophy and encourages the patient to minimize activity if it causes discomfort.

Question 11

The chronic phase of recovery following nerve injury occurs when:

A) The patient has significant residual effects from lack of regeneration and must learn to compensate for lost function.
B) The nerve is regenerating,and strength and sensory recovery are emphasized in the rehabilitation program.
C) Innervation is complete and emphasis is placed on retraining and reeducation.
D) The surrounding connective tissue can withstand normal tensile stresses,and the patient can return to all functional activities.

Question 12

Following nerve injury,motor retraining exercises:

A) Begin as soon as signs of voluntary muscle action are detected.
B) Begin as soon as the patient tolerates electrical stimulation.
C) Are used to desensitize the areas of hypersensitivity.
D) Cannot be used until the chronic phase of healing in order to avoid further trauma to the nerve.

Question 13

You have been treating a patient with a diagnosis of thoracic outlet syndrome for 1 week;she describes increased burning pain over the past week.She also has ischemic symptoms in the upper extremity whenever she exercises or while engaging in simple functional activities.This means:

A) There could be progressive axonal disruption and compromise of the vascular supply;the physician should be notified.
B) The patient has not been compliant with instructions for posture and safe exercises.
C) The exercises have been too vigorous and should be decreased in intensity.
D) This is a typical reaction to exercises for thoracic outlet syndrome.

Question 14

Your patient injured her ulnar nerve falling up some steps and catching herself on the medial side of her hand 2 days ago.She currently has constant tingling and decreased sensation to pressure and touch in the little finger and ulnar half of the ring finger.Your intervention during the first week of treatment will be all of the following except:

A) Protect the nerve by immobilizing the wrist in a splint.
B) Teach active ROM to wrist and fingers.
C) Emphasize the importance of resistive exercises to prevent muscle atrophy.
D) Inform the patient about ways to protect the hand from further injury.

Question 15

Your patient sustained a traumatic injury to his shoulder 3 weeks ago.You have been treating him because of decreased shoulder ROM and strength and general lack of functional reaching and overhead use of the upper extremity.Today he reports that he has been experiencing increased pain,swelling,and stiffness down into his hand.

A) These signs are the result of a thoracic outlet syndrome;begin treating this region as well.
B) The patient is possibly developing reflex sympathetic dystrophy;treatment should be initiated to reduce swelling,maintain range,and increase usage of the hand.
C) These signs are a normal reaction to trauma;it is important to tell the patient he is engaging in too much activity.
D) These are signs of a possible clot;immediately send him to the emergency room.