Class 3 - Nerve Compression/Entrapment & Compartment Syndrome Flashcards
Compression or entrapment nerve injuries are known as _____ which see segmental demyelination with rapid and complete recovery of function!
neuropraxia
With neuropraxia there is no structural damage to the axon or to the tissue ____ to the lesion.
distal
What can cause neuropraxia?
external forces (pressure)
internal forces (structural abnormalities)
overuse
systemic conditions: pregnancy, D.M., R.A., neuromuscular disorders
What nerve roots contribute to the median nerve?
C5-T1
What is the hallmark symptom of CTS?
nocturnal wrist pain - painful numbness
With CTS, ___ symptoms precede ____ symptoms
sensory precede motor
CTS pain is BL in __% of cases!
50%
Thenar weakness (advanced cases), loss of grip strength, inability to pinch + sensory loss leading to clumsiness in the hands are all symptoms of…
CTS
What are the 2 special tests used by neurologists to tests for CTS?
Phalen’s test (wrist is flexed to 90* for 1 minute)
Tinel’s sign (percussion or compression over the flexor retinaculum)
When is surgery indicated for CTS?
if conservative tx fails after 2-3 months OR untreated symptoms for longer than 1 year
What is conservative tx for CTS?
ergonomic measures wrist splints steroid injections (50% experience relief for at least 1 year)
TOS compression usually occurs where?
between the interscalene triangle and inferior border of the axilla
Vascular TOS involves compression of the…
subclavian artery and/or vein
Disputed or non-specific TOS is differentiated by:
chronic pain with symptoms of brachial plexus entrapment without any specific evidence of such!
Chronic compression on nerve roots leads to edema and ischemia in the nerves, which leads to what type of nerve injury?
neuropraxia
If compression on nerves is not relieved, neuropraxia will progress to…
axonotmesis
Provocative tests to elicit symptoms for TOS have a high rate of _____
false positives
TOS must be ddx’d from:
cervical radiculopathy
cervical spondylosis
reflex sympathetic dystrophy
Raynaud’s disease
What is morton’s neuroma?
a benign growth of nerve tissue that develops in the foot, usually the common digital nerve
NOT a true tumor, it’s a PERINEURAL FIBROMA –> fibrous tissue formation around a nerve
Chronic (exertional) compartment syndrome is most often caused by…
athletic exertion
Interdigital perineural fibroma is also called..
Morton’s neuroma
MORTON’S NEUROMA:
Women are affected __ than men
Average age is __ to __ years
more
45-60
What is “hyalization”?
the process whereby tissue degenerates into a translucent glass-like substance, or the state of being hyaline
With morton’s neuroma, pain is most commonly felt where?
between the 3rd & 4th toes
