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OS3 Exam II > Compression Neuropathy > Flashcards

Compression Neuropathy Flashcards

1
Q

Neuropathy

A

functional or pathologic changes in the peripheral nervous system

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2
Q

Compression neuropathy

A

-process whereby a nerve becomes entrapped as it passes through a narrow tunnel or passage

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3
Q

Pathological changes that occur with neuropathy include

A
  • microvascular compression–>ischemia
  • thickened epineurium
  • myelin thinning distortion
  • microtubule closure
  • axonal degeneration
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4
Q

Etiology of Nerve Entrapment

A
  • increased muscle mass by repetitive activity
  • space occupying lesions (cysts or tumors)
  • inflammation of surrounding tissues leads to venous congestion in epineurial and perineurial vascular plexuses–>endoneurial edema–>nerve anoxia
  • Post traumatic conditions (hematoma, fracture, or compression by equipment)
  • systemic causes–pregnancy, hypothyroidism or diabetes, etc.
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5
Q

Neurapraxia

A
  • least severe nerve injury
  • involves focal damage of myelin fibers around axon, but the connective tissue sheath remains intact
  • limited course (days to weeks0
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6
Q

Axonotmesis

A
  • injury to the axon itself

- regneration is possible, but prolonged (months) without full recovery

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7
Q

Neurotmesis

A

-complete disruption of the axon with little likelihood of recovery

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8
Q

Conservative measures for compression neuropathy include

A
  • modification of activity, use of antiinflammatories, splinting, and/or injections
  • PT, OMM, pain management
  • should be pursued for 3-6 months (except with cubital tunnel syndrome)
  • surgical release is considered when nonoperative management fails
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9
Q

Cervical Nerve Root Compression

A
  • usually caused secondary to cervical disc disease (i.e. disc bulging or herniation)
  • most commonly the disc ruptures posterior-laterally using compression of the nerve root as it exits the intervertebral foramen
  • causes radiculopathy–pain caused by compression of the spinal nerve that radiates in the distribution of the defined nerve root
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10
Q

C5

A
  • deltoid, biceps motor
  • sensation to lateral arm
  • biceps reflex
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11
Q

C6

A
  • wrist extension, elbow flexion
  • sensation to radial forearm, thumb and index finger
  • brachioradialis reflex
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12
Q

C7

A
  • wrist flexion, elbow extension, finger extension
  • sensation to middle finger
  • triceps reflex
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13
Q

C8

A

finger flexion

-sensation to ulnar forearm, small finger

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14
Q

T1

A
  • Finger abduction

- sensation to medial arm

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15
Q

Peripheral Nerves at Risk in the upper extremity

A
  • radial nerve
  • median nerve
  • ulnar nerve
  • musculocutaneous and axillary
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16
Q

Radial Nerve Entrapment Sites

A
  • High on the humerus
  • radial tunnel
  • at the wrist
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17
Q

Radial Nerve Function

A
  • motor to triceps brachii, anconeus, wrist extensors

- sensation to majority of the dorsum of the hand (via posterior interosseous nerve)

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18
Q

Radial Nerve Entrapment High on the humerus

A
  • usually secondary to a humorous fracture or compression of nerve near spinal groove
  • symptoms: wrist drop, weakness of elbow flexion (brachioradialis), possible triceps involvement, +/- triceps reflex diminished, pain and numbness
  • Treatment: function usually returns in 4-5 month
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19
Q

Radial Nerve Entrapment: Radial Tunnel Syndrom

A
  • compression of posterior interosseous branch of the radial nerve as it passes under the supinator muscle at the Arcade of Frohse (purely motor branch)
  • Supinator syndrome
  • repetitive rotatory movements–>rowing, discus, racquet sports
  • heavy manual labor
  • symptoms: pain and tenderness 5 cm distal to lateral epicondyle
  • wrist drop or pain with resisted supination
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20
Q

Median nerve Entrapment sites of entrapment

A
  • ligament of Strutters
  • Pronator Syndrome
  • Anterior Osseous Syndrome
  • Carpal Tunnel Syndrome
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21
Q

Median Nerve functions

A
  • forearm flexion and pronation
  • wrist flexion and radial deviation
  • thumb abduction and opposition
  • index and middle finger abduction and flexion
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22
Q

Median Nerve Entrapment: Pronator Syndrome

A
  • occurs as the median nerve passes between the superficial and deep heads of the pronator teres muscle
  • seen with repetitive pronating motions: pianists, fiddlers, baseball players, dentists, weight trainers, etc.
  • symptoms: achy pain in the mid/proximal forearm, aggravated by repeated lifting
  • may have sensory abnormality in the radial three and a half digits
  • pain with resisted forearm pronation
23
Q

Median nerve entrapment: Anterior Interosseous syndrome

A
  • deep motor branch of the median nerve
  • just distal to the pronator teres
  • innervates flexors
  • no sensory symptoms
  • trauma, cast pressure
  • bulky tendinous origin of ulnar head of pronator teres
  • soft tissue masses
  • fibrous band
  • treatment: general, and elbow can be splinted in 90 degrees of flexion for up to 12 weeks
  • If patient unable to hold and rest OK sign
  • due to weak flexion ability of the index finger’s DIP and the thumb’s IP
24
Q

Median Nerve Entrapment: Carpal tunnel syndrome

A
  • most common compression syndrome
  • compression as nerve passes with flexor tendons under the flexor retinaculum
  • nighttime numbness of lateral 3 1/2 digits, tingling, wrist pain, dropping things, thenar atrophy
  • common in repetitive motion jobs (wrist flexion) and in pregnancy
  • diagnosis gold standard is EMG
25
Q

Carpal tunnel Diagnosis

A
  • Phalen’s–flex hands to 90 degrees, reproduction of symptoms within 60 seconds is positive sign
  • tinel’s–tapping over the flex retinaculum reproduces symptoms in the first 3.5 digits
  • two point discrimination–unable to distinguish 2 points on a caliper if closer than 5 mm
26
Q

Carpal Tunnel Syndrome Treatment

A
  • rest from repetitive motions if possible and self-stretching
  • wrist splinting with 30 degrees of hand extension, usually at night
  • NSAIDs
  • steroids injections if failure of conservative measures
  • surgical release if failure of other treatments
27
Q

Ulnar Nerve Sites of Entrapment

A
  • cubital tunnel

- Guyon’s canal

28
Q

Ulnar nerve function

A
  • innervates skin and muscles of the ulnar side of the forearm and hand (flexors)
  • deep branch in hand–>motor innervation for interosseous muscles and adductor pollicis
  • superficial branch in hand–>sensory innervation to ring and pinky fingers
29
Q

Ulnar Nerve Entrapment: Cubital Tunnel Syndrome

A
  • most common compression seen in elbow
  • compression at the cubital tunnel from by medial epicondyle, medial trochlea, olecranon, and ulnar collateral ligament
  • baseball pitchers, prolonged elbow flexion (during sleep), external compression against a hard surface, thickened cubital tunnel retinaculum
30
Q

Cubital Tunnel Syndrome Symptoms and Diagnosis

A
  • parasthesia to the 4th and 5th digits
  • medial elbow pain radiating to the hand with decreased intrinsic muscle strength
  • can’t turn a key in a door
  • positive tinel’s sign at elbow
  • symptom reproduction with elbow flexion and wrist extension
31
Q

Cubital Tunnel Syndrome Treatment

A

-general treatment, and a padded elbow sleeve to limit terminal elbow flexion and provide cushioning

32
Q

Cubital Tunnel Syndrome Tests

A
  • Froment’s sign–patient must flex thumb in order to pinch paper between 1st and 2nd digits
  • must contract FPL (supplied by median n) due to weak 1st dorsal interosseous and ADP muscles (positive sign)
33
Q

Thoracic Outlet Syndrome

A
  • compression of the brachial plexus and/or subclavian vessels
  • sites of compression include scalene triangle, costoclavicular passage, at the pectoralis minor attachment at the coracoid process
  • weakness, paresthesia of medial arm, forearm, and hand exacerbated by overhead activities
  • provocative tests: EAST, Adson’s, Wright’s hyperabduction test, Military/costoclavicular maneuver
34
Q

L1-L2

A
  • Hip flexion

- sensation to inguinal crease (L1), anterior thigh (L2)

35
Q

L2-L3

A
  • knee extension

- sensation to anterior thigh (L2), anterior thigh just above knee (L3)

36
Q

L4

A
  • ankle dorsiflexion
  • sensation to medial leg and foot
  • knee jerk (patellar) reflex
37
Q

L5

A
  • extensor hallucis longus

- sensation to lateral leg, foot dorsum

38
Q

S1

A
  • ankle plantar flexion
  • sensation to lateral foot, plantar foot
  • Achilles reflex
39
Q

Lower Extremity Nerves at risk for compression neuropathy

A
  • common fibular nerve (L4-S2)
  • deep fibular nerve (L4-S2)
  • posterior tibial nerve (L4-S2)
  • lateral femoral cutaneous nerve (L2-L3)
40
Q

Common fibular nerve

A
  • divides into a deep and superficial branch
  • deep branch innervates the anterior compartment (tibialis anterior m, extensor digitorum longus/brevis mm., and extensor hallicus longus)
  • superficial branch innervates the lateral compartment (fibulas longus and brevis)
41
Q

Common Fibular Nerve compression

A
  • 3rd most common compression neuropathy
  • compression as nerve winds around the fibular neck and enters the fibular tunnel
  • leg hooked over rail (bedridden, comatose, post op)
  • Strawberry pickers palsy–time spent in squatting position
  • ankle sprains or trauma to fibular head
  • new meditators (lotus position)
  • lithotomy position during childbirth
  • idiopathic
42
Q

Common Fibular Nerve compression symptoms

A
  • pain along proximal third of lateral leg
  • foot drop with a slapping gait
  • exacerbated during plantar flexion and inversion of the foot
43
Q

Common Fibular Nerve Treatment

A
  • posterior fibular head HVLA or ME

- ME on gastrocnemius/soleus, biceps femoris

44
Q

Anterior Tarsal Tunnel Syndrome

A
  • deep fibular nerve compression at the inferior extensor retinaculum
  • trauma (recurrent ankle sprains, soccer players), talonavicular dysfunction, prolonged plantar flexion, compression from shoes
45
Q

Anterior Tarsal Tunnel Syndrome Symptoms

A
  • pain over dorsomedial aspect of foot and worse at rest

- weakness of extensor digitorum brevis

46
Q

Anterior Tarsal Tunnel Syndrome Treatment

A
  • remove compressive forces
  • myofascial release of extensor retinaculum
  • traction tug of talonavicular joint
  • hiss whip for navicular, cuneiforms, 1st and 2nd metatarsal
47
Q

Tarsal Tunnel Syndrome

A
  • compression of posterior tibial nerve in the tarsal tunnel behind medial malleolus with the overlying flexor retinaculum
  • motor to the plantar muscles of the foot and sensation to plantar aspect of foot and toes
48
Q

Tarsal Tunnel Syndrome Etiology

A
  • idiopathic in 50% of cases
  • space-occupying lesion: synovial cyst, ganglion from tendon sheath, lipoma, tenosynovitis
  • trauma to medial malleolus, distal tibia, or calcaneous (MVAs)
  • congenital, autoimmmune (RA, ankylosing spondylitis)
  • diabetes, lifestyle
49
Q

Tarsal Tunnel Syndrome Symptoms

A
  • pain on plantar surface of foot
  • not very specific–vague burning, tingling, or numbness on plantar aspect of foot
  • gait seldom affected
50
Q

Tarsal Tunnel Syndrome Treatment

A

-myofascial release and HVLA

51
Q

Lateral Femoral Cutaneous Nerve: Meralgia Paresthetica

A
  • compression under the inguinal ligament at the inguinal canal
  • very intense athletics, obesity, tight girdle/belt, tight clothing, seta belt misplacement or post-accident, anatomic anomaly
52
Q

Lateral femoral Cutaneous nerve function

A

-sensory only of anterolateral thigh down to the knee

53
Q

Lateral Femoral Cutaneous Nerve Compression neuropathy symptoms

A
  • numbness or burning pain on anterolateral thigh
  • hypersthesia to the point of not putting anything in pockets
  • trophic skin changes later on
  • positive Tinel’s sign 1 cm medial and inferior to the ASIS

OS3 Exam II (10 decks)

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