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05. OS Midterm/CPA 2 > Compression Neuropathies > Flashcards

Compression Neuropathies Flashcards

1
Q

Sites of Radial Nerve Entrapment

A

High on the humerus

Radial Tunnel

At the wrist

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2
Q

Radial Nerve Entrapment - High on the humerus

A

Usually secondary to a humerus fracture or compression of nerve near spiral groove

Symptoms: Wrist drop, weakness in elbow flexion (brachioradialis), +/- tricep involvement, pain/numbness

Treatment: Function usually returns in 4-5 months

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3
Q

Radial Nerve Entrapment - Radial Tunnel

A

Repetitive rotatory movement - rowing, discus, racquet sports

Heavy manual labor

Symptoms: Pain and tenderness 5 cm distal to lateral epicondyle, wrist drop or pain w/ resisted pronation

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4
Q

Radial Nerve Entrapment - At the wrist

A

Superficial branch (sensory) pinched between brachialialis and extensor carpi radialis longus during forearm pronation

Sensation change over posterolateral hand

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5
Q

Pronator Syndrome

A

Median nerve

Travels between the humeral (superficial) and ulnar (deep) head of the pronator teres

Worsens when pronating against force and flexing elbow against force

Positive Provocation maneuver

Pain over proximal middle forearm and numbness over palmar surface of thumb and thirst 3 digits

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6
Q

Pronator Syndrome Symptoms

A

Worsens when pronating against force and flexing elbow against force

Positive Provocation maneuver

Pain over proximal middle forearm and numbness over palmar surface of thumb and thirst 3 digits

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7
Q

Provocation maneuvers

A

Tests for pronator syndrome and compression of median nerve by pronator teres

Flexion of middle finger against resistance

Causes compression by the flexor digitorum superficialis

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8
Q

Anterior Interosseus Syndrome

A

Compression of median nerve

No sensory loss

Inability to make “OK” sign

Due to weak flexion ability of the index finger’s DIP and thumb’s IP

Treatment: General treatment and splinted elbow flexion at 90 for ~12 weeks

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9
Q

Cubital Tunnel Syndrome

A

Ulnar Nerve Entrapment

Compressed at cubital tunnel by medial epicondyle, medial trochlea, olecranon, ulnar collateral liagment

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10
Q

Positive Tests for Ulnar Nerve Entrapment/Cubital Tunnel

A

+ Tinel Sign at Elbow

Froment sign - pinch paper between 1st and 2nd digit if thumb flexes (+)

Due to weak 1st dorsal interosseus and ADP muscle

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11
Q

Carpel Tunnel Syndrome

A

Most common compression syndrome - compression of median nerve

Compression as passes under flexor retinaculum

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12
Q

Thoracic Outlet Syndrome and Symptoms

A

Compresion of the brachial plexus and/or subclavian vessels

Symptoms: Weakness, paresthesia of medial arm, forearm, and hand exacerbation by overhead activities

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13
Q

Testing for Thoracic Outlet Syndrome

A
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14
Q

Points of Compression that cause Thoracic Outlet Syndrome

A

Sclene Triangle

Costclavicular passage

Attachment of the pectoralis minor attachment at the coracoid process

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15
Q

Mergalgia Paresthetica and Causes

A

Compression of the lateral femoral cutaneous nerve under the inguinal ligament as it travels through the inguinal canal

Causes: very intense athletics, obseity, tight belts/gun holsters, seat belt misplaced or post-MVA

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16
Q

Symptoms f Meralgia Paresthetica

A

Numbness or buring pain on anterolateral thigh

Hyperesthesia over anterolateral leg (can’t put items in pockets)

Trophic skin changes (later)

+ Tinnel’s sign 1 cm medial and inferior to ASIS

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17
Q

Common Fibular Nerve Compression

A

3rd most common compression neuropathy

Common peroneal nerve is compressed as it wraps around the fibular neck and enters the fibular tunnel

Common peroneal nerve = L4-S2

18
Q

Causes of Common Fibular Nerve Compression

A

Leg hooked over a rail (bedridden, post-op)

“Strawberry Pickers Palsy” - spends a long time squatting

Ankle sprain (commonly posterior fibular head SD)

New meditators (sitting criss cross)

Lithotomy position during childbirth

Idiopathic

19
Q

Symptoms of Common Fibular Nerve Compression

A

Decreased sensation, numbness, tingling on outer part of lower leg and foot

Foot drop

Slapping gait (where foot is slapping with each step)

20
Q

Tarsal Tunnel Syndrome

A

Compression of posterior tibial nerve in the tarsal tunnel behind the medial malleolus w/ the overlying flexor retinaculum

21
Q

Causes of Tarsal Tunnel Syndrome

A

Idiopathic 50% of the time

Space-occupying lesion

Trauma to medial malleolus, distal tibia, or calcaneus

Autoimmune (RA, ankylosing spondylitis)

Diabetes

Lifestyle (standing for long periods)

22
Q

Symptoms of Tarsal Tunnel Syndrome

A

Pain on plantar surface of foot

Nonspecific burning, tingling, or numbness over plantar part of foot

Gait is usually not effected

23
Q

Treatments of Tarsal Tunnel Syndrome

A

Rest

NSAIDS

Ultrasound

PT and Acupunture

OM - Myofascial release and HVLA

24
Q

Anterior Tarsal Tunnel Syndrome

A

Compression of deep fibular nerve at the inferior extensor retinaculum

Deep fibular nerve = L4-S2

25
Q

Symptoms of Anterior Tarsal Tunnel Syndrome

A

Pain over dorsomedial aspect of foot that worsen at rest

Weakness of extensor digitorum brevis = flexing the proximal and medial phalanges of the 2nd-5th toes

26
Q

Causes of Anterior Tarsal Tunnel Syndrome

A

Trauma (recurrent ankle sprain, soccer players)

Talonavicular dysfunction

Prolonged plantar flexion (high heels)

Compression from shoes

27
Q

Froment’s Sign

A

Tests for Ulnar Nerve Palsy or Compression

Tests strength of adductor pollicus of the thumb

Compressing paper between thumb and hand with thumb straight - Paper shouldn’t slip

Abnormal - Patient flexes thumb to prevent paper from slipping

28
Q

Plexopathy Tests

A

EAST (elevated arm stress test)

Adson - Scalene hypertonicity & first rib/extra rib

Military Brace/Eden’s Test - Clavicle

Wright Test - Pect minor hypertonicity

29
Q

EAST Test

A

Elevated arm stress test - Aka Roo’s test

Tests for Thoracic Outlet Syndrome

Abduct 90º and externally rotate arm

Flex elbows 45º

Hold for 90 seconds

Have patient slowly open and close hands

Forearm and hand paresthesia

30
Q

Adson’s Test

A

Test for Thoracic Outley Syndrome caused by hypertonic scalene muscle or extra rib which compress the subclavian A.

Arm abducted 30º and shoulder maximally extended

Patient extends neck and turns head towards symptomatic shoulder and asked to take a deep breath and hold

Radial pulse is monitored throughout

(+) = drastic decrease in radial pulse

31
Q

Military Brace

A

Eden’s test - tests for Thoracic Outlet Syndrome cause by a depressed clavical

Monitor radial pulse

Shoulder is depressed and retracted

Arm is abducted 30º

Hyperextend neck and head

(+) = increased neurological symptoms on UE

32
Q

Wright Test

A

Tests for Thoracic Outet Syndrome cause by a hypertonic pec minor m.

Head flexed while the arm is passively brought into abduction and external rotation to 90º

Elbow is flexed to 45º

Arm is held for 1 min

Monitor radial pulse and monitor patient symptoms onset

Continue to increase abduction until end of ROM

(+) = decreased pulse or worsened neurological symptoms

33
Q

Pronator Teres Mononeuropathy Tests

A

Phalen test

Resistance Pronation test

OK test

+/- Tinel test over proximal 1/3 of lower arm

Decreased sensation

Reflexes normal

34
Q

Meralgia Paresthetica Treatment

A

Behavior changes: Wear looser clothes, lose weight, tell patient its not serious

Biomechanical: Treat SD of Psoas, sacrum, innominant, anterior thigh musculature

Local MFR to abdomen

L2-L3

35
Q

Hoffmann sign

A

Firmly grasping the middle finger and quickly snapping or flipping the dorsal surface

(+) quick flexion of both thumb and index finger

Indicates: Cervical myelopathy (cervical spinal stenosis)

36
Q

5-Model Treatment for Radial Nerve Compression

A

Rest

Avoid aggravating behavior

Stretching

NSAIDs

Counterstrain/Muscle Energy

37
Q

Carpel Tunnel Syndrome Symptoms

A

Symptoms: Nighttime numbness of lateral 3.5 digits, tingling, wrist pain, grip weakness, thenar atrophy

Caused by repetitive wrist flexion and pregnancy

38
Q

Treatment for Carpel Tunnel Syndrome

A

Treatment: Gold Standard EMG

NSAIDs

OMT - Lymphatics (if pregnant), ST, MFR

Testing: XRay is maybe fracture or MRI is soft tissue damage

Rest from repetitive motion and stretching

Wear wrist splint that extends wrist at 30º

Steroid injections if more converative treatments don’t work

Surgical release if other treatments fail

39
Q

Tests for Carpel Tunnel Syndrome

A

Phalen’s - flex hands to 90º, reproduce sxs within 60 sec

Tinel’s - tapping over flexor retinaculum and reproduce sx

Two point discrimination - unable to distinguish 2 point touch with calipers less than 5 mm

40
Q

Causes of Cubital Tunnel Syndrome

A

Baseball pitcher

Prolonged elbow flexion (during sleep)

External compression against a hard surface (Student’s elbow)

Thickened cubital tunnel retinaculum

41
Q

Symptoms of Cubital Tunnel Syndrome

A

Parasthesia of 4th and 5th digit

Medial elbow pain radiating down the hand

Weak intrinsic muscle strength - can’t turn key

42
Q

Treatment for Cubital Tunnel Syndrome

A

General treatment (rest, NSAIDs etc)

Paddle elbow sleeve to limit terminal elbow flexion and provide cushioning

05. OS Midterm/CPA 2 (12 decks)

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