2/14/16 Hand Nerves

Question 1

Factors associated with nerve repair outcomes

Answer 1

Age

Question 2

Complex Regional Pain Syndrome (CRPS)

• pathophysiology
• symptoms
• treatments

Answer 2

diffuse swelling, stiffness, shiny skin, changes in patterns of hair and perspiration

• can contribute to osteopenia, delayed bony healing or nonunion, joint stiffness, tendon adhesions, arthrofibrosis, palmar fibrosis, swelling, atrophy
• prophylaxis: vitamin C?
• treatment: amitriptyline, gabapentin, lyrica, prednisone

Question 3

High ulnar nerve injuries

Answer 3

• ulnar nerve have poor recovery
• since nerves grow 1mm/day, will need a babysitter transfer to keep the motor endplates intact
• AIN to Ulnar nerve

Question 4

Ways to correct ulnar clawing

Answer 4

• wrist extensor to lumbricals

- FDS to A2 pulley

Question 5

lateral epicondylitis

Answer 5

Responsible muscle is the ECRB

Question 6

Medial epicondylitis

Answer 6

interface between the pronator teres and the FCR origin

- medial epicondyle is origin of the forearm flexor and pronator muscles

Question 7

At what point do you do surgery for nerve pain if there is indications of a neuroma?

Answer 7

6 months.
Neuroma - tinel’s sign and numbness distal to scar.
Treatment of neuroma: release of scar, repair of nerve, transposition of nerve into bone/vein, coverage of nerve

Question 8

suprascapular nerve injury

Answer 8

• first branch off of upper trunk of brachial plexus
• atrophy of posterior scapular muscles (supraspinatus and infraspinaturs)
• weakness of shoulder external rotation

Question 9

axillary nerve injury

Answer 9

comes off the posterior cord

• deltoid and teres minor
• impaired shoulder abduction

Question 10

Long thoracic nerve injury

Answer 10

C5-C7

• serratus anterior muscle
• scapular winging

Question 11

Thoracodorsal nerve injury

Answer 11

C6-C8

• latissimus dorsi
• impaired shoulder extension, adduction, and internal rotation

Question 12

Spinal accessory nerve injury

Answer 12

• trapezius and SCM muscles

Question 13

Thoracic Outlet Syndrome surgical treatments

Answer 13

1. transax resection of first rib
2. transcervical anterior and medial scalenectomies (most common)
3. combo of the above two

Question 14

Conservative treatment of Thoracic Outlet syndrome

Answer 14

scalene stretching, first rib intercostal relaxation, nerve gliding, muscle relaxants, pain patches.

Question 15

First step in working up Thoracic Outlet Syndrome

Answer 15

noninvasive vascular studies and electrodiagnostics

Question 16

Wartenberg sign

Answer 16

involuntary abduction of the small finger due to denervation of the ulnar nerve

Question 17

Wartenberg syndrome

Answer 17

compression at the wrist of the superficial sensory branch of the radial nerve

Question 18

Median nerve neuropathies

Answer 18

Carpal tunnel syndrome
AIN compressive neuropathy
Pronator syndrome

Question 19

Ulnar nerve neuropathies

Answer 19

Cubital Tunnel syndrome

Ulnar tunnel syndrome

Question 20

Radial nerve neuropathies

Answer 20

PIN compression syndrome
Radial tunnel syndrome
Wartenberg’s syndrome

Question 21

Sites of ulnar nerve entrapment in cubital tunnel syndrome

Answer 21

FCU heads, osborne’s ligament, arcade of struthers

Question 22

Sites of median nerve entrapment

Answer 22

??