class 8: MSK bonus Flashcards
what is Radiculopathy
Compression of a “nerve root”
Usually a combination of pain, motor, sensory, reflex deficits
how does Radiculopathy present
Pain usually follows dermatomes and myotomes; sensory symptoms are more reliable
what is a Mononeuropathies:
Disturbance of a “single nerve”
what are some examples of Mononeuropathies:
Carpal tunnel syndrome, Guyon’s canal entrapment
does Mononeuropathies follow a specific dermatomal pattern
Does not follow dermatomal or myotomal pattern
what is the nerve root of the median nerve
(C5-T1)
median nerve entrapment - Proximal to elbow where it it trapped
Compression under
Ligament of Struthers
median nerve entrapment - Proximal to elbow what is lost
Motor and sensory loss in the entire distribution
median nerve entrapment - Proximal to elbow radiograph what is seen
bone spur
median nerve entrapment - Proximal to elbow what is lost what muscle is involved
pronator teres affected by this entrapment
median nerve entrapment - Distal to elbow is also known as
pronator teres entrapment
median nerve entrapment - Distal to elbow MOI:
Overuse, repetitive activities involving pronation like hammering,
tennis.
median nerve entrapment - Distal to elbow signs an symptoms
heaviness and pain in forearm, minimal night pain
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
median nerve entrapment - Distal to elbow sensory
Digits 1-3.5 and thenar eminence on palmar side and dorsal
fingertips
median nerve entrapment - Distal to elbow sensory
Digits 1-3.5 and thenar eminence on palmar side and dorsal fingertips
what is the branch of the median nerve
AIN
palamr cutaneous nerve - passes over the carpal tunnel suplies the thenar aspect
median nerve entrapment - pronator treses special test
(+) Pronator teres syndrome test, (+) Tinel’s sign in the
forearm, (-) Phalen’s test
what part of the brachial plexus does the median nerve come from
medial and lateral cord
AIN syndrome - where is the entrapment
nerve compressed below
the pronator teres, near
flexor group
AIN syndrome - motor or sensory
Pure Motor
AIN syndrome - weakness of what
Flexor pollicis longus, Flexor digitorum profundus
(digits 2-3), Pronator quadratus
AIN syndrome - pain
Forearm pain +++ but NO sensory symptoms
AIN syndrome - testing
the Okay sign
collapse 2/2 lack of FPL and FDP
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
