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Unformatted text preview: Chapter 8: Spinal Nerve Roots • Spinal segments o Area of spinal cord that contributes to the nerve roots at that level o 8 cervicals, 12 thoracics, 5 lumbars, 2 sacral, 1 coccygeal o Spinal cord ends at L1-L2 then the nerve roots form the cauda equine o Cervical enlargement Cause of enlargement: anterior horn cells which are LMN o Lumbar enlargement: goes down to feet o Mixed spinal nerve • Dermatomes and Myotomes o Dermatome is the area of skin innervated by a single nerve root: more specific in lower extremity o Myotome is the muscle innervated by a single nerve root: more specific in upper extremity o Sclerotome: embryological association, non-specific pain that corresponds only to a general region • Neuropathy o Nerve disorder that may involve axons, myelin or both; large fibers, small fibers or both; sensory deficit, motor deficit or both o Reversible damage or it can be permanent o Mononeuropathy: affects one nerve o Polyneuropathy: multiple nerves o Causes: diabetes, trauma, infection, malnutrition, toxins, immune disorders • Diabetic Neuropathy o Caused by vascular compromise to peripheral nerves: capillaries swell up with glucose and water narrows lumen o Most common pattern is stocking glove sensory loss: starts in toes and progresses across foot, up the leg, then to fingertips, hand, arm o Insulin is the “permission slip” to take insulin out of blood o Nerves don’t need insulin, uses glucose directly via blood o Sensory loss usually start with vibration and proprioception (biggest nerve with highest metabolic need), numbness, pain and tingling (spinothalamic, occurs later) o Autonomic loss involves hypotension, arrhythmia, impaired thermoregulation, altered bowel and bladder function and sexual function o Motor loss tends to be more deep tendon reflexes: due to issue with motor nerves o Loss of trophic functions: growth and repair functions; example is diabetic ulcers o Effect on eye: back of eye abnormal optic nerve, presence of red dots in eye and yellow spots due to swelling Diabetic retinopathy: new capillaries are made too fast and they rupture because of poor quality • Mechanical injury o Extrinsic compression of disc or tumor o Laceration o Traction: whiplash injury, stretching leading to tearing of nerves if traction long/strong enough o Entrapment: carpal tunnel syndrome, subluxation o Neuropraxia: mild, temporary interruption/compression of nerve transmission without nerve damage o Wallerian degeneration, Axonotomesis: when there is nerve damage, distal to site of lesion the nerve will degenerate and proximal to site of lesion will start to repair • Causalgia o Complex regional pain syndrome due to a minor injury o A.k.a. reflex sympathetic dystrophy syndrome, Sudek’s atrophy o Long-term pain along a peripheral nerve following minor injury o May include a regional osteoporosis o The more epinephrine, the more pain you feel, the more sympathetic reaction, the more sensitive pain receptor becomes, get better at feeling pain...
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This note was uploaded on 11/23/2011 for the course DIAG 2740 taught by Professor Markamos during the Winter '11 term at Life Chiropractic College West.
- Winter '11