Disorders of the Peripheral Nervous System Presented By: Joseph S. Ferezy, D.C.

Disease of Peripheral Nerves Neuropathy – Functional Or Pathological Change In The PNS

Classification Mononeuropathy – One Peripheral Nerve – Usually Identifiable Trauma Wrist Drop Foot Drop CTS Ulnar Nerve Palsy

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.

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

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

Neuralgia Nerve Pain

The Cervical Plexus See Other Lecture

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

Bikele's Sign Pain on Elbow Extension With the Arm in Hyperabduction May Be Present With Injury or Meningitis.

Brachial Plexus Injuries The Most Common Form of Injury Is From Birth Trauma. Two Types Are Described: – Upper Plexus(Erb-Duchenne) – Lower Plexus (Klumpke)

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)

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)

The Thoracic Nerves Horner's Syndrome Beevor’s Sign

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

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)