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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
Symptoms of Anterior Tarsal Tunnel Syndrome
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
Causes of Anterior Tarsal Tunnel Syndrome
Trauma (recurrent ankle sprain, soccer players) Talonavicular dysfunction Prolonged plantar flexion (high heels) Compression from shoes
27
Froment's Sign
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
Plexopathy Tests
**EAST** (elevated arm stress test) **Adson** - Scalene hypertonicity & first rib/extra rib **Military Brace/Eden's Test** - Clavicle **Wright Test** - Pect minor hypertonicity
29
EAST Test
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
Adson's Test
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
Military Brace
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
Wright Test
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
Pronator Teres Mononeuropathy Tests
Phalen test Resistance Pronation test OK test +/- Tinel test over proximal 1/3 of lower arm Decreased sensation Reflexes normal
34
Meralgia Paresthetica Treatment
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
Hoffmann sign
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
5-Model Treatment for Radial Nerve Compression
Rest Avoid aggravating behavior Stretching NSAIDs Counterstrain/Muscle Energy
37
Carpel Tunnel Syndrome Symptoms
Symptoms: Nighttime numbness of lateral 3.5 digits, tingling, wrist pain, grip weakness, thenar atrophy Caused by repetitive wrist flexion and pregnancy
38
Treatment for Carpel Tunnel Syndrome
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
Tests for Carpel Tunnel Syndrome
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
Causes of Cubital Tunnel Syndrome
Baseball pitcher Prolonged elbow flexion (during sleep) External compression against a hard surface (Student's elbow) Thickened cubital tunnel retinaculum
41
Symptoms of Cubital Tunnel Syndrome
Parasthesia of 4th and 5th digit Medial elbow pain radiating down the hand Weak intrinsic muscle strength - can't turn key
42
Treatment for Cubital Tunnel Syndrome
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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