©EVERLY 2024/2025 ALL RIGHTS RESERVED.
PCE Studying Guide.
Neurapraxia - Answer✔Injury to nerve that causes a transient loss of function (conduction block
ischemia); nerve dysfunction may be rapidly reversed or persist a few weeks, e.g., compression.
Axonotmesis - Answer✔Injury to nerve interrupting the axon and causing loss of function and
Wallerian degeneration distal to the lesion; with no disruption of the endoneurium, regeneration
is possible, e.g., crush injury.
Neurotmesis - Answer✔Cutting of the nerve with severance of all structures and complete loss
of function; reinnervation typically fails without surgical
intervention because of aberrant regeneration (failure of regenerating axon to find its terminal
end).
Wallerian degeneration - Answer✔Transection (neurotmesis) results in degeneration of the axon
and myelin sheath distal to the site of
axonal interruption to allow for regeneration.
Clinical symptoms LMN syndrome - Answer✔(1) Weakness/paresis of denervated muscle,
hyporeflexia and hypotonia, (rapid) atrophy,
fatigue. (2) Sensory loss; proprioceptive losses may yield sensory ataxia; insensitivity may yield
limb trauma. (3) Autonomic dysfunction: vasodilation and loss of vasomotor tone (dryness,
warm skin, edema, orthostatic hypotension).
(4) Hyperexcitability of remaining nerve
fibers. (a) Sensory dysesthesias: ie. hyperalgesia. (b) Motor: fasciculations, spasms.
(5) Muscle pain (myalgia) with inflammatory
myopathies (e.g., post polio syndrome).
Trigeminal neuralgia - Answer✔Degeneration/compression of trigeminal nerve (CNV), most
commonly mandibular or maxillary branches. Abrupt onset, mean age of 50. Causes sharp,
shooting pain, worse with stress, heat, cold, touch (brushing teeth), movement (chewing/talking),
eased with relaxation. Motor fxn remains normal.
Bell's Palsy - Answer✔Unilateral facial paralysis dt virus causing inflammatory response in
facial nerve (CN VII). Can't close eyelid on affected side. Decreased taste, tears, and saliva.
Recover in weeks to months.
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Charcot Marie Tooth Disease - Answer✔Hereditary Motor and Sensory Neuropathy (HMSN).
Symptoms begin in adolescence or early adulthood. Extensive demyelination of m&s nerves.
Begins in foot/lower leg and progresses to hand and forearm. Pes cavus or extremely flat footed,
with hammer toes.
Segmental Demyelination - Answer✔Myelin breakdown for a few segments but axons
preserved. Mostly reversible because Schwann cells make new myelin, but some axons may be
permanently lost. Example: GBS
Axonal degeneration (distal) - Answer✔Degeneration of axon cylinder and myelin. Possibly d/t
inability of neuronal body to keep up with metabolic demands. Distal to proximal. Example:
peripheral neuropathy.
Tendons consist of - Answer✔tenocytes (tendon-specific fibroblast cells that produce collage
molecules, crave mechanical load)
ECM (collagen, glycosaminoglycan)
Why load tendons? - Answer✔increased collagen synthesis, cellular proliferation, alignment
Tendonopathy/tendonosis - Answer✔chronic microtrauma = loss of collagen organization, no
inflammation
- collagen disorganisation, glycosaminoglycan, variable tenocyte density, increased vessel/nerve
Tendonitis - Answer✔inflammation, dt overloading --> pain, swelling, from tears
Achilles Tendonopathy - Answer✔Chronic/insidious onset of pain over Achilles tendon d/t
microtrauma. No inflammation. Rx: Eccentric loading necessary, heel lifts to offload,
stretching/man ther (DTF)
DDx - partial tear (doesn't respond well to loading program)
De Quervain's Tenosynovitis - Answer✔Microtrauma of APL and EPB btn radius and extensor
retinaculum in anatomical snuffbox. Degeneration (+/- inflammation) of tendons. Ax: Finkelstein
Test. Rx: offload, PRICE, edu, --> man ther, strengthen
Sever's Disease - Answer✔Calcaneal apophysitis. Inflammation of calcaneal growth plate.
Common in active kids (9-14, 7-15) boys > girls. Spontaneous recovery with maturation. Rx:
offload tissues, education, stretch calf muscles and plantar fascia
Tennis Elbow - Answer✔Lateral epicondylalgia - 90% of cases involve ECRB. Worse with
gripping, repetitive reach tasks.
Tests: Mills, Resisted extension of D3, Cozen's.
Rule out: nerve root (C5-7), shoulder referral, bursitis, LCL sprain, prox RU jt
Rotator cuff tendinopathy - Answer✔Commonly long head of biceps + supraspinatus
impingement. Primary: older, degen, posture, etc. Secondary: younger (<35) microtrauma -->
instability --> subluxation --> impingement. Ant capsule lax, post capsule tight
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Patellar tendinopathy - Answer✔Repetitive loading of extensor mechanism of knee (quad,
patella, patellar tendon, tibial tuberosity). VS Osgood-Schlatter (tibial tuberosity of
children/adolescents) VS Sinding Larsen Johansson Syndrome (apex of patella in adolescents)
Gluteal tendinopathy - Answer✔AKA greater trochanteric pain syndrome. Mix of bursitis and
tendinopathy of abductors. Caused by trauma, repetitive movements, increased loading, previous
injury, hip instability/biomechanics.
2 Ant horns of SC - Answer✔contains cell bodies giving rise to efferent motor neurons: alpha
motor neurons (to muscle) and gamma motor neurons (to muscle spindles)
2 Post horns of SC - Answer✔contains afferent sensory neurons with cell bodies located in the
dorsal root ganglia (fine touch, proprio, vibration)
Lateral horn of SC - Answer✔Only in T and upper L-spine: pre-ganglionic fibers of the
autonomic nervous system
Dorsal columns of SC: info it carries - Answer✔- fine touch/2 point discrimination
- vibration
- conscious proprioception
Fasciculus gracilis: L/E, medial
Fasciculus cuneatus: U/E, lateral
Dorsal columns of SC: path + lesion - Answer✔Decussates at medulla, finishes in parietal lobe
Lesion above medulla: contralat loss of fine touch, proprio, vibration
Lesion below medulla: ipsilat loss of fine touch, proprio, vibration
Lateral spinothalamic tract of SC: fxn, path - Answer✔pain, hot/cold
decussates within 1-2 segments at anterior commissure, goes to thalamus and parietal lobe
1/2 cord lesion: ipsilat loss at level of injury, contralat loss below level of injury
Anterior spinothalamic tract of SC: fxn, path - Answer✔crude touch and pressure (lateral
spinothalamic is pain and temperature)
decussates within 1-2 segments in ant commissure of SC, goes to thalamus then parietal lobe
1/2 cord lesion: ipsilat loss at level of injury, contralat loss below level of injury
Lateral corticospinal tract - Answer✔Or pyramidal tract. Main voluntary motor pathway.
90% cross in pyramids in medulla, pyramidal decussation.
Start in frontal lobe, synapse in ant horn of SC
Anterior corticospinal tract - Answer✔10% that crosses at level of innervation, travels in ventral
white column. Innervates trunk muscles.
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Lesion cannot be clinically detected
Myofascial pain syndrome - Answer✔Trigger points caused by sudden
overload/stretching/repetitive strain/sustained activities. Can = referred pain, motor dysfunction,
autonomic phenomena. Rx: dry needling, stretching, soft tissue massage, modalities, manual
therapy if joints affected
TUBS (shoulder dislocation) - Answer✔Traumatic onset, Unidirectional, Bankart lesion,
Surgery
- MOI: abd/er
AMBRI (shoulder dislocation) - Answer✔Atraumatic, Multidirectional, Bilateral shoulder
findings, Rehab appropriate, Inferior capsule shift (if surgery performed)
Bankart Lesion - Answer✔Avulsion of ant/inf capsule and ligaments.
S/S:clicking, apprehension, deep vague pain
Hill-Sachs Fracture - Answer✔Compression fracture posterior/lateral humeral head, associated
w anterior shoulder dislocation (post/lat HOH impacts c ant glenoid)
Stabilization of the acromion (ligaments) - Answer✔Coracoclavicular ligament (conoid and
trapezoid ligaments)
Coracoacromial ligament - controls vertical stability
Acromioclavicular ligament - controls horizontal stability
SLAP lesion - Answer✔Superior Labrum Anterior-Posterior
- elevated position with sudden (concentric or eccentric) biceps contraction
- throwers
Colles Fracture - Answer✔MOI: FOOSH into extension, distal radius + ulna subluxation.
Extra-articular dorsal angulation + radial deviation/shortening
Dinner fork deformity
Smith's Fracture - Answer✔MOI: FOOSH with wrist flexed
Extra-articular + palmar angulation/ulnar deviation
Reverse Colles
Barton's Fracture - Answer✔Intra-articular distal radius fracture
Which areas are at a high risk of avascular necrosis with fracture? - Answer✔Proximal femur,
5th metatarsal, scaphoid, talus neck, proximal humerus
How long does it take an adult to heal from a fracture? - Answer✔10-12 weeks
4|Page
PCE Studying Guide.
Neurapraxia - Answer✔Injury to nerve that causes a transient loss of function (conduction block
ischemia); nerve dysfunction may be rapidly reversed or persist a few weeks, e.g., compression.
Axonotmesis - Answer✔Injury to nerve interrupting the axon and causing loss of function and
Wallerian degeneration distal to the lesion; with no disruption of the endoneurium, regeneration
is possible, e.g., crush injury.
Neurotmesis - Answer✔Cutting of the nerve with severance of all structures and complete loss
of function; reinnervation typically fails without surgical
intervention because of aberrant regeneration (failure of regenerating axon to find its terminal
end).
Wallerian degeneration - Answer✔Transection (neurotmesis) results in degeneration of the axon
and myelin sheath distal to the site of
axonal interruption to allow for regeneration.
Clinical symptoms LMN syndrome - Answer✔(1) Weakness/paresis of denervated muscle,
hyporeflexia and hypotonia, (rapid) atrophy,
fatigue. (2) Sensory loss; proprioceptive losses may yield sensory ataxia; insensitivity may yield
limb trauma. (3) Autonomic dysfunction: vasodilation and loss of vasomotor tone (dryness,
warm skin, edema, orthostatic hypotension).
(4) Hyperexcitability of remaining nerve
fibers. (a) Sensory dysesthesias: ie. hyperalgesia. (b) Motor: fasciculations, spasms.
(5) Muscle pain (myalgia) with inflammatory
myopathies (e.g., post polio syndrome).
Trigeminal neuralgia - Answer✔Degeneration/compression of trigeminal nerve (CNV), most
commonly mandibular or maxillary branches. Abrupt onset, mean age of 50. Causes sharp,
shooting pain, worse with stress, heat, cold, touch (brushing teeth), movement (chewing/talking),
eased with relaxation. Motor fxn remains normal.
Bell's Palsy - Answer✔Unilateral facial paralysis dt virus causing inflammatory response in
facial nerve (CN VII). Can't close eyelid on affected side. Decreased taste, tears, and saliva.
Recover in weeks to months.
1|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
Charcot Marie Tooth Disease - Answer✔Hereditary Motor and Sensory Neuropathy (HMSN).
Symptoms begin in adolescence or early adulthood. Extensive demyelination of m&s nerves.
Begins in foot/lower leg and progresses to hand and forearm. Pes cavus or extremely flat footed,
with hammer toes.
Segmental Demyelination - Answer✔Myelin breakdown for a few segments but axons
preserved. Mostly reversible because Schwann cells make new myelin, but some axons may be
permanently lost. Example: GBS
Axonal degeneration (distal) - Answer✔Degeneration of axon cylinder and myelin. Possibly d/t
inability of neuronal body to keep up with metabolic demands. Distal to proximal. Example:
peripheral neuropathy.
Tendons consist of - Answer✔tenocytes (tendon-specific fibroblast cells that produce collage
molecules, crave mechanical load)
ECM (collagen, glycosaminoglycan)
Why load tendons? - Answer✔increased collagen synthesis, cellular proliferation, alignment
Tendonopathy/tendonosis - Answer✔chronic microtrauma = loss of collagen organization, no
inflammation
- collagen disorganisation, glycosaminoglycan, variable tenocyte density, increased vessel/nerve
Tendonitis - Answer✔inflammation, dt overloading --> pain, swelling, from tears
Achilles Tendonopathy - Answer✔Chronic/insidious onset of pain over Achilles tendon d/t
microtrauma. No inflammation. Rx: Eccentric loading necessary, heel lifts to offload,
stretching/man ther (DTF)
DDx - partial tear (doesn't respond well to loading program)
De Quervain's Tenosynovitis - Answer✔Microtrauma of APL and EPB btn radius and extensor
retinaculum in anatomical snuffbox. Degeneration (+/- inflammation) of tendons. Ax: Finkelstein
Test. Rx: offload, PRICE, edu, --> man ther, strengthen
Sever's Disease - Answer✔Calcaneal apophysitis. Inflammation of calcaneal growth plate.
Common in active kids (9-14, 7-15) boys > girls. Spontaneous recovery with maturation. Rx:
offload tissues, education, stretch calf muscles and plantar fascia
Tennis Elbow - Answer✔Lateral epicondylalgia - 90% of cases involve ECRB. Worse with
gripping, repetitive reach tasks.
Tests: Mills, Resisted extension of D3, Cozen's.
Rule out: nerve root (C5-7), shoulder referral, bursitis, LCL sprain, prox RU jt
Rotator cuff tendinopathy - Answer✔Commonly long head of biceps + supraspinatus
impingement. Primary: older, degen, posture, etc. Secondary: younger (<35) microtrauma -->
instability --> subluxation --> impingement. Ant capsule lax, post capsule tight
2|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
Patellar tendinopathy - Answer✔Repetitive loading of extensor mechanism of knee (quad,
patella, patellar tendon, tibial tuberosity). VS Osgood-Schlatter (tibial tuberosity of
children/adolescents) VS Sinding Larsen Johansson Syndrome (apex of patella in adolescents)
Gluteal tendinopathy - Answer✔AKA greater trochanteric pain syndrome. Mix of bursitis and
tendinopathy of abductors. Caused by trauma, repetitive movements, increased loading, previous
injury, hip instability/biomechanics.
2 Ant horns of SC - Answer✔contains cell bodies giving rise to efferent motor neurons: alpha
motor neurons (to muscle) and gamma motor neurons (to muscle spindles)
2 Post horns of SC - Answer✔contains afferent sensory neurons with cell bodies located in the
dorsal root ganglia (fine touch, proprio, vibration)
Lateral horn of SC - Answer✔Only in T and upper L-spine: pre-ganglionic fibers of the
autonomic nervous system
Dorsal columns of SC: info it carries - Answer✔- fine touch/2 point discrimination
- vibration
- conscious proprioception
Fasciculus gracilis: L/E, medial
Fasciculus cuneatus: U/E, lateral
Dorsal columns of SC: path + lesion - Answer✔Decussates at medulla, finishes in parietal lobe
Lesion above medulla: contralat loss of fine touch, proprio, vibration
Lesion below medulla: ipsilat loss of fine touch, proprio, vibration
Lateral spinothalamic tract of SC: fxn, path - Answer✔pain, hot/cold
decussates within 1-2 segments at anterior commissure, goes to thalamus and parietal lobe
1/2 cord lesion: ipsilat loss at level of injury, contralat loss below level of injury
Anterior spinothalamic tract of SC: fxn, path - Answer✔crude touch and pressure (lateral
spinothalamic is pain and temperature)
decussates within 1-2 segments in ant commissure of SC, goes to thalamus then parietal lobe
1/2 cord lesion: ipsilat loss at level of injury, contralat loss below level of injury
Lateral corticospinal tract - Answer✔Or pyramidal tract. Main voluntary motor pathway.
90% cross in pyramids in medulla, pyramidal decussation.
Start in frontal lobe, synapse in ant horn of SC
Anterior corticospinal tract - Answer✔10% that crosses at level of innervation, travels in ventral
white column. Innervates trunk muscles.
3|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
Lesion cannot be clinically detected
Myofascial pain syndrome - Answer✔Trigger points caused by sudden
overload/stretching/repetitive strain/sustained activities. Can = referred pain, motor dysfunction,
autonomic phenomena. Rx: dry needling, stretching, soft tissue massage, modalities, manual
therapy if joints affected
TUBS (shoulder dislocation) - Answer✔Traumatic onset, Unidirectional, Bankart lesion,
Surgery
- MOI: abd/er
AMBRI (shoulder dislocation) - Answer✔Atraumatic, Multidirectional, Bilateral shoulder
findings, Rehab appropriate, Inferior capsule shift (if surgery performed)
Bankart Lesion - Answer✔Avulsion of ant/inf capsule and ligaments.
S/S:clicking, apprehension, deep vague pain
Hill-Sachs Fracture - Answer✔Compression fracture posterior/lateral humeral head, associated
w anterior shoulder dislocation (post/lat HOH impacts c ant glenoid)
Stabilization of the acromion (ligaments) - Answer✔Coracoclavicular ligament (conoid and
trapezoid ligaments)
Coracoacromial ligament - controls vertical stability
Acromioclavicular ligament - controls horizontal stability
SLAP lesion - Answer✔Superior Labrum Anterior-Posterior
- elevated position with sudden (concentric or eccentric) biceps contraction
- throwers
Colles Fracture - Answer✔MOI: FOOSH into extension, distal radius + ulna subluxation.
Extra-articular dorsal angulation + radial deviation/shortening
Dinner fork deformity
Smith's Fracture - Answer✔MOI: FOOSH with wrist flexed
Extra-articular + palmar angulation/ulnar deviation
Reverse Colles
Barton's Fracture - Answer✔Intra-articular distal radius fracture
Which areas are at a high risk of avascular necrosis with fracture? - Answer✔Proximal femur,
5th metatarsal, scaphoid, talus neck, proximal humerus
How long does it take an adult to heal from a fracture? - Answer✔10-12 weeks
4|Page
