class 8: MSK bonus Flashcards by VB VB

what is Radiculopathy

Compression of a “nerve root”

Usually a combination of pain, motor, sensory, reflex deficits

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how does Radiculopathy present

Pain usually follows dermatomes and myotomes; sensory symptoms are more reliable

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what is a Mononeuropathies:

Disturbance of a “single nerve”

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what are some examples of Mononeuropathies:

Carpal tunnel syndrome, Guyon’s canal entrapment

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does Mononeuropathies follow a specific dermatomal pattern

Does not follow dermatomal or myotomal pattern

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what is the nerve root of the median nerve

(C5-T1)

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median nerve entrapment - Proximal to elbow where it it trapped

Compression under
Ligament of Struthers

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median nerve entrapment - Proximal to elbow what is lost

Motor and sensory loss in the entire distribution

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median nerve entrapment - Proximal to elbow radiograph what is seen

bone spur

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median nerve entrapment - Proximal to elbow what is lost what muscle is involved

pronator teres affected by this entrapment

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median nerve entrapment - Distal to elbow is also known as

pronator teres entrapment

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median nerve entrapment - Distal to elbow MOI:

Overuse, repetitive activities involving pronation like hammering,
tennis.

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median nerve entrapment - Distal to elbow signs an symptoms

heaviness and pain in forearm, minimal night pain

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median nerve entrapment - Distal to elbow Motor:

Flexor pollicis longus, Abductor pollicis brevis, Flexor digitorum
profundus (digits 2-3), Opponens pollicis, Pronator quadratus, Pronator
teres spared. Pain reproduced with resisted flexion and pronation

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median nerve entrapment - Distal to elbow sensory

Digits 1-3.5 and thenar eminence on palmar side and dorsal
fingertips

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median nerve entrapment - Distal to elbow sensory

Digits 1-3.5 and thenar eminence on palmar side and dorsal fingertips

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what is the branch of the median nerve

AIN

palamr cutaneous nerve - passes over the carpal tunnel suplies the thenar aspect

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median nerve entrapment - pronator treses special test

(+) Pronator teres syndrome test, (+) Tinel’s sign in the
forearm, (-) Phalen’s test

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what part of the brachial plexus does the median nerve come from

medial and lateral cord

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AIN syndrome - where is the entrapment

nerve compressed below
the pronator teres, near
flexor group

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AIN syndrome - motor or sensory

Pure Motor

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AIN syndrome - weakness of what

Flexor pollicis longus, Flexor digitorum profundus
(digits 2-3), Pronator quadratus

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AIN syndrome - pain

Forearm pain +++ but NO sensory symptoms

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AIN syndrome - testing

the Okay sign

collapse 2/2 lack of FPL and FDP

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what is the okay sign also known as

(Kiloh-Nevin sign)

Carpal Tunnel Syndrome: where is the compression

the carpal tunnel

Carpal Tunnel Syndrome: motor

Abductor pollicis brevis, Opponens pollicis, Flexor pollicis brevis (superficial head), Thenar muscle atrophy

Carpal Tunnel Syndrome: Sensory

Sensory deficits median distribution sparing thenar eminence (palmar cutaneous branch)

Carpal Tunnel Syndrome: special test

(+) Tinel’s at wrist ,(+) Phalen’s test, and reverse Phalen’s test

what is neumonic to remember median nerve issues

CAPS carpal tunnel AIN Pronator teres ligamanet of struthers

where does the ligament of struther run

medial lateral aspect of the humerus to the medial femoral condyle

what are the roots of the radial nerve

(C5-T1)

Crutch Palsy: what is it and where is it

Very high nerve palsy, Axilla injury

Crutch Palsy: motor

Loss of elbow extension, wrist and digit extensor weakness, weak supination

Crutch Palsy: sensory

Paresthesia posterior lateral arm, forearm, wrist, posterior aspect of thumb and radial 2.5 digits

High radial nerve injury: location

Humerus spiral groove or shaft fracture

High radial nerve injury: motor

Triceps spared, wrist drop & thumb extension weakness wrist drop

High radial nerve injury: sensory

Paresthesia posterior forearm, wrist, posterior aspect of thumb and radial 2.5 digits

Radial tunnel syndrome vs Posterior interosseous nerve syndrome:

PIN: pure motor radial tunnel: pain

Radial tunnel syndrome: lesion location

Compression of posterior interosseous nerve in the radial tunnel

Radial tunnel syndrome: most prominent feature

pain

Radial tunnel syndrome: pain location

Pain over the radial tunnel, 5 cm distal to the lateral epicondyle Pain on radial aspect of proximal forearm – most common presenting symptom

Radial tunnel syndrome: what is it presentation similar to

Mimics Lateral Epicondylitis.

Radial tunnel syndrome: sensory

No sensory symptoms and no motor weakness to little muscle weakness due to pain

Radial tunnel syndrome: reproduction of pain

aggravates by resisted supination - forearm pronation finger extension positioning of the arm in elbow extension wrist flexion

Posterior interosseous nerve syndrome: compression location

posterior interosseous nerve between the two heads of supinator muscle

Posterior interosseous nerve syndrome: motor or sensory

prue motor

Posterior interosseous nerve syndrome: motor

Weakness of the wrist extensors Patients typically present with dropped fingers and thumb.

Posterior interosseous nerve syndrome: what muscle function is preserved

Extensor carpi radialis longus (above the elb)

Posterior interosseous nerve syndrome: what movements do we still have since the ECRL is persevered

extension and radial deviation

Wartenberg’s syndrome: location of impig

Compression of superficial sensory branch under extensor carpi radialis longus and brachialis tendons

Wartenberg’s syndrome: also known as

Cheiralgia paresthetica

Wartenberg’s syndrome: MOI

Trauma, tight watch, handcuffs.

Wartenberg’s syndrome: pain and sensation

Pain/sensory disturbances on radial side of the dorsum of the hand

Wartenberg’s syndrome: pain reproduction

Pain reproduced with flexion and ulnar deviation putting muscle on stretch

Wartenberg’s syndrome: motor

no motor loss

Wartenberg’s syndrome: special tests

(+) Tinel’s sign at site of compression

what are the type of radial never entrapment

crutch palsy high nerve lesion radial tunnel PIN wartenburgs syndrome

Ulnar Nerve Entrapments - types

Cubital Tunnel Syndrome Guyon’s Canal Syndrome:

Cubital Tunnel Syndrome: MOI

Prolonged elbow flexion, fractures, spurs, arthritis

Cubital Tunnel Syndrome: sensory

Pain/sensory symptoms at 4th/5th digits (dorsal and palmar); hypothenar

Cubital Tunnel Syndrome: what comes first sensory or motor symptoms

sensory first motor second

Cubital Tunnel Syndrome: motor muscle impacted

Flexor digitorum profundus 3/4, hypothenar muscles, ulnar interossei, adductor pollicis

Cubital Tunnel Syndrome: special tests

(+) elbow flexion test, (+) Froment paper sign, (+) Wartenberg sign (+) Tinel’s sign at the site of compression

Guyon’s Canal Syndrome: local

Ulnar nerve entrapment between hook of hamate and transverse carpal ligament

Guyon’s Canal Syndrome: MOI

heavy gripping, twisting, activities involving pressure

Guyon’s Canal Syndrome: Sensory

Pain/sensory symptoms at 4th/5th digits (ONLY palmar); hypothenar

Guyon’s Canal Syndrome: motor

hypothenar muscles, ulnar interossei, adductor pollicis. NO Flexor digitorum profundus

Guyon’s Canal Syndrome: Special Tests

(+) Froment paper sign, (+) Wartenberg sign and (+) Tinel’s sign at wrist

what does the palmar cutaneous nerve serve

the thenar aspect of the thumb

is AIN motor, sensory, or both

motor