Peripheral Nerve Disorders

Details

Title

Peripheral Nerve Disorders

Type

Stage One

Module code

HPS221

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and apply knowledge with respect to peripheral nerve disorders in collaboration with more senior Clinical Scientists and the clinician(s) responsible for the overall care of the patient. They will be competent to identify the specialist assessments required to form a structured differential diagnosis. Operating in a range of settings they will consistently demonstrate the attitudes and behaviours necessary to undertake the role of a Consultant Clinical Scientist.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will analyse, synthesise, critically evaluate and apply their knowledge with respect to peripheral nerve disorders, including:

• the anatomy of peripheral nerves and muscles so that detailed anatomical considerations and anomalies can be taken into account with regard to electrode placement and needle insertion;
• physiology of nerve conduction, neuromuscular transmission and excitation– contraction mechanisms in muscle;
• epidemiology;
• hereditary and acquired chronic and acute causes of peripheral nerve disorder;
• the natural history of the three commonest causes of neuropathy in the developed world (diabetes, alcohol and vitamin deficiencies);
• conditions detected by blood tests included in neuropathy screens pathophysiology, to include:
  • mononeuropathy: compression; ischaemia; inflammation
  • mononeuritis multiplex
  • polyneuropathy
  • amyotrophic lateral sclerosis
  • Bell’s palsy
  • cervical spondylosis
  • muscular dystrophy
  • Charcot-Marie-Tooth disease
  • myasthenia gravis
  • trauma, brachial plexus injury.

Clinical presentation:

• clinical presentation and pathophysiology of diseases of the peripheral nerves, neuromuscular junction and muscles, including peripheral neuropathy (toxic +/- inflammatory), entrapment neuropathies;
• typical referrals, e.g. neurologists;
• history, focusing on type of symptoms, onset, progression and location, as well as information about potential causes (e.g. family history, toxic exposures, past medical disorders);
• physical and neurological examination to define type of deficit (e.g. motor deficit, type of sensory deficit, combination);
• evaluation of sensation (using temperature for small fibres; using vibration proprioception tests for large fibres), motor strength and deep tendon reflexes;
• cranial nerves as well as peripheral nerve function are evaluated;
• evaluation of autonomic function;
• signs and symptoms.

Diagnostic investigations and management, including:

• laboratory blood tests:
  • ferritin levels
  • full blood count
  • thyroid function test
  • HLA typing
  • urine drug screening
  • CSF hypocretin
  • OGTT, HbA1 and blood glucose results
• treatment options, including communication and liaison with other clinical teams;genomics.
• the role of lumbar puncture and CSF analysis;
• the role and scope of genetic testing, including issues of consent;
• neuroimaging, e.g. radiculopathy or to rule out cervical spinal cord compression;
• clinical neurophysiology investigations;
• nerve conduction studies and electromyography, including: techniques for study of peripheral nerves, e.g. sensory, motor and F wave studies; H reflex; repetitive nerve stimulation; and blink reflex;
• adaptations necessary in particular patient groups or difficult recording situations;
• normal values, including anatomical variants, effects of age, temperature, height and co-morbid conditions;
• use of internal controls, e.g. the opposite limb in contralateral conditions;
• other relevant investigations, including:
  • genetic testing if a hereditary neuropathy is suspected
  • nerve biopsy, e.g. to help differentiate demyelinating from vasculitic large- fibre neuropathies.

Medical management of peripheral nerve disorders:

• treatment of underlying disorder with particular reference to entrapment neuropathies such as carpal tunnel syndrome;
• role of the multidisciplinary team, including physiotherapists, occupational therapists, speech and language therapists.

Clinical scientific research topics:

• stem cell biology;
• vascular biology;
• genomics.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will be able to perform, and critically evaluate appropriate nerve conduction studies in complex patients, taking into account special circumstances, contraindications, confounding factors and risks. They will be expected to analyse the results of nerve conduction studies and present accurate, clear and concise documentation of patient data. They will also be expected to contribute to the supervision, teaching and assessment of colleagues.

By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice an appropriate range of clinical and communication skills to and will have experience of:

Clinical examination:

• obtaining informed consent;
• taking a relevant focused history (see Stage 1(ii), Advanced History Taking and Clinical Examination);
• selecting the neurophysiological investigations, taking into account special circumstances, contraindications, confounding factors and risks.

Diagnostic investigations and management and will:

• identify and evaluate appropriate clinical neurophysiological procedures needed to achieve a differential diagnosis, taking into account special circumstances, contraindications, confounding factors and risks.
• interpret the relevance of structural neuroimaging data;
• interpret the results of nerve conduction studies and produce a supervised clinical report;
• explain results and clinical implications simply and effectively to both clinicians and, where appropriate, patients;
• advise and communicate effectively with patients, relevant clinicians and the public, and other healthcare professionals working within the multidisciplinary team;
• reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence;
• recognise and respond to the evolving information needs of each patient;
• adopt a multidisciplinary approach to the diagnosis and management of peripheral nerve disorders.