Compression Neuropathy Flashcards
Three sites of radial nerve entrapment:
High on humerus, radial tunnel, at wrist
Radial nerve entrapment symptoms:
if high on humerus: wrist drop, weak elbow FLEXION, possible tricep involvement, diminished, pain/numbness
Radial tunnel: pain and tenderness 5 cm distal to lateral epicondyle (wrist drop or pain with resisted supination)
wrist drop, weak elbow flexion, wrist drop, pain/tenderness 5 cm to lateral epicondyle, and pain with resisted supination is seen in compression of which location?
Radial tunnel
A patient (work = athlete, lifter) complains of numbness + tingling in mid/proximal forearm which radiates to wrist + first 3 digits of hand. Gets worse by end of day. What issue do they have?
mononeuropathy- pronator teres
pronator teres mononeuropathy special test findings:
+phalen, resisted pronation test, OK test
+/- tinels
decreased sensation
normal reflexes
Pronator teres mononeuropathy is associated with the:
median nerve.
Treatments for mononeuropathy (pronator teres):
radial head pronated (posterior) SD or radial head head supinated (anterior) SD
Counterstrain (F Pronate, adduct)
A pt complains of waking up at night with wrist PAIN + numbness + tingling in 1st 3 digits of hand; pain is present intermittently throughout day and is dull+ achy. they have___.
Carpal tunnel syndrome
Carpal tunnel mononeuropathy is compression of the ___.
median n.
what issues affect the median n.
pronator teres + carpal tunnel mononeuropathy
carpal tunnel mononeuropathy special test findings:
+ phalen, prayer test (like phalens), OK test, tinel
decreased sensation, normal reflexes
Treatments for mononeuropathy (carpal tunnel):
Wrist E/F SD
Wrist add/abd SD
Wrist extension/ventral carpal SD HVLA (thrust into flexion
Wrist F/dorsal carpal SD HVLA (thrus into extension)
Figure 8 wrist articulation
Wrist isotonic MET
Wrist Flexor Retinaculum MFR
A pt px with numbness + tingling along medial forearm,ascending to 4th and 5th digits. THey cant turn a key in door. What area is being compressed and what nerve is most likely affected?
Cubital Tunnel- ULNAR N.
Cubital Tunnel mononeuropathy special test findings:
+ tinels (post/superior to elbow)
Froments (grasp paper test- > thumb flexes bc abductor pollicus is weak)
elbow flexion + wrist extension ==> PAIN
decreased sensation
normal reflexes
Anterior Interosseous Syndrome affects the ___. How is it different?
median n.
NO SENSORY SYMPTOMS THO
(can splint in 90 degree of flexion for up to 12 weeks to tx)
what is the “OK sign test”?
pt unable to hold + resist tip to tip of thumb to index pinch
due to weak flexion ability of index fingers DIP + thumbs IP
**LONG flexor muscle of thumb
What would you do to treat ulnar nerve entrapment (cubital tunnel)
general tx, padded elbow sleeves to limit terminal elbow flexion + provide cushioning
What is a “froment sign”
patient must flex thuumb in order to pinch paper bw 1st + 2nd digits
+ = must contract FPL (supplied by median n.) due to weak 1st dorsal interosseus and ADP** muscles
MC compression syndrome is
Median nerve entrapment (carpal tunnel syndrome)
Carpal tunnel syndrome common in
pregnancy + jobs where u flex ur wrist a lot
Gold standard for diagnosing Compression neuropathy of median nerve (Carpal tunnel)
EMG
Site of compression for thoracic outlet syndrome is:
1) scalene triangle
2) Costoclavicular passage
3) @ pectoralis minor attachment @ coracoid process
A patient has weakness, paresthesia (tingling) of medial arm, forearm, and hand
It is exacerbated by overhead activities. What do they have?
thoracic outlet syndrome
Specialty tests for thoracic outlet syndrome include:
EAST test/Roos Test - hand gripping over and over (pulse changes)
Adsons test:
+ (pulse goes away) when look away from side –> scalenes
+ (pulse goes away) when look toward side–> rib 1
Wrights hyperabduction test - hyperabduct arm and if decreased radial pulse (@pectoralis minor)
military/costoclavicular maneuver- testng infraclavicular (pull arms behind person and hold pulses)
Do adsons test and look toward tested arm. What is affected? Look away?
toward - rib 1
away- scalenes
Impingement of nerve at the level of the C-spine can be a result of:
radiculopathy (disc dz, herniation, degnerative arthritis)
To treat cervical radiculopathy you would:
prep muscles –> contralateral traction, suboccipital release, unilateral/bilateral forearm fwd bending
Diagnosis (OA, AA, C2-C7)
Muscle energy
A patient comes in with intermittent numbness + tingling, NOT consisting w/ one nerve root. They have pain in their neck/shoulder region(generalized); They also have intermittent weakness of extremities. What specialty tests can you try?
EAST
Adson
Military Brace- first rib/cervical
Wright- pectoralis minor muscle (hyperabduction)
A patient comes in with intermittent numbness + tingling, NOT consisting w/ one nerve root. They have pain in their neck/shoulder region(generalized); They also have intermittent weakness of extremities. What do they most likely have?
Plexopathy (rib, clavical, maybe pectoralis minor?)
How would you treat plexopathy at the first rib?
MET, HVLA
How would you treat plexopathy at the clavicle?
SC horizontal extension SD MET
SC elevated/adducted SD MET
AC IR/ER MET
How could you treat pectoralis minor (plexopathy)?
counterstrain- f-F ADD (pull shoulder/scapula anteriorly)
A pt comes in complaining of numbness in their gluteal region after a few days of lifting boxes. They are experiening tingling and some pain from their butt radiating to their foot (more of a Posterior-lateral fashion). They have intact sensations however but slightly reduced reflexes and muscle strength. What do they most likely have?
Lumbosacral radiculopathy (disc herniation maybe from picking up boxes)
Lumbosacral radiculopathy is found in which segments?
MC segment = L5-S1
PL pain down one leg
What are some red flag symptoms
weight loss, fever, chills, decreased/absent bladder + bowel sounds
What are treatments for lumbosacral radiculopathy?
Counterstrain–> UPL5 (E add ir/er), LPL5 (FIR add), and HISI (e-E Abd ER)
MET–> NUDR, SUUE, and FDDR
UPL5 tenderpoint:
superior medial surface of posteiror superior iliac spine (PSIS)
LPL5 tenderpoint:
on ilium just inferior to PSIS pressing superiorly
HISI tenderpoint
2-3 cm lateral to PSIS; pressing medially toward PSIS
A truck driver pt comes in with gluteal rgn pain (dysesthesia) that ravels down back of thigh to knee; they have intact sensations bilaterally; He has pain with sitting for longer than 20 mins of time (oh no his job tho!) and has difficulty walking.
No change in DTR and 5/5 muscle strength. What nerve could be impinged in this case and what is the syndrome called?
Sciatic N. - Piriformis Syndrome
Piriformis Syndrome symptoms present similarly to ___. What would you use to RULE it out?
similar to sciatica(due to lumbar disc herniation)– use imaging studies to rule it out!
What treatments can you do on piriformis syndrome/sciatic n compression?
Piriformis counterstrain - F abd ER
Supine piriformis self stretch
piriformis MET (F hip 90 and ER increased)
Pt comes in with paresthesia + numbness over anterolateral aspect of left thigh w/ no other radiation after using a utility belt for quite some time. they also have gained some weight over last few weeks. Skin examination slows slight trophic skin changes. What specialty test would most likely be +?
Tinels sign (1 cm medial and inferior to asis)
Pt (intense athlete) comes in with paresthesia + numbness over anterolateral aspect of left thigh w/ no other radiation after using a utility belt for quite some time. they also have gained some weight over last few weeks. Skin examination slows slight trophic skin changes. What issue is this? what nerve?
Meralgia Paresthetica- Lateral Femoral Cutaneous N. entrapment
Meralgia Paresthetica- Lateral Femoral Cutaneous N. entrapment spinal levels:
L2-L3
Meralgia Paresthetica- Lateral Femoral Cutaneous N. entrapment is compression @
compression under inguinal ligament @inguinal canal
Treatment of Meralgia Paresthetica:
Behavioral model **- wear looser fitting clothes, lose weight reassure pt not serious
Biomechanical model- treat SD of Psoas, Sacrum, innominate, anterior thigh muscles; local MFR to abdomen, L2-L3
Pt comes in with pain (numbness + paresthesia) that occurs at lateral aspect of lower leg + dorsum of foot. They recently had sprained their ankle and havent been able to go to their job as a yoga instructor. What is the most worrisome symptom that you could see in this patient?
Foot drop–> altered ambulation 2ndary to weak dorsiflexed foot drop
Third MC compression neuropathy
Common fibular nerve compression
Common fibular nerve compression happens @:
L4-S2
compression as nerve winds around fibular neck + enters fibular tunnel
What can you do to treat Common fibular nerve compression?
Posterior fib head MET or HVLA (make sure to PRONATE ankle- abduct, evert, dorsiflex); then flex knee all way and anterior thrust for HVLA
Post fib head BLT (check inhal/exhal–> hold breath–> reassess)
“foot drop”
slapping noise in gait cycle with steps that get louder
Pt comes in with pain at plantar aspect of foot. Overpronated foot. Vague burning (nonspecific). What are your DDx?
Tarsal Tunnel syndrome
Plantar fasciitis (gets worse in morning/step on; tight fascia)
Tarsal tunnel nerve innervation:
Posterior tibial N. (L4-S2)
etiology of tarsal tunnel syndrome:
compression of posterior tibial nerve in tarsal tunnel behind medial malleolus w/ overlying flexor retinaculum
idiopathic in 50% cases
space occupying lesion
trauma to medial malleolus
congenital, autoimmune, DM, lifestyle (lots of standing)
Treatment for Tarsal Tunnel Syndrome
Calcaneal HVLA
Talar Tug HVLA
ankle figure 8
Gastrocnemius -CS plantarflex
Anterior Tarsal Tunnel Syndrome innervation + cause:
L4-S2
compression of DEEP FIBULAR N. @ inferior extensor retinaculum
Pt comes in with pain over dorsomedial aspect of foot, worse @ rest; they have had recurrent ankle sprains and their shoes have been compressing their feet (HIGH HEELS). Has weak extensor digitorum brevis. what dis.
anterior tarsal tunnel syndrome
Ant. tarsal tunnel syndrome is compression @which retinaculum?
inferior extensor retinaculum
Cervical Nerve root compression
usually secondary to cervical disc dz
bulging disc–> herniated disc = either protrusion: no leakage of central material or extrusion (worse): nucleus pulposus able to flow out of disc space
The cervical nerve root compression causes disc rupture in what direction?
posterior-lateral (causes compression of nerve root as exits intervertebral foramen)
Causes RADCULOPATHY
You can perform cervial nerve root testing by doing:
Compression test or Spurlings maneuver (rotate toward and extend neck)
Adsons (elevate chin and rotate head toward affected side while inspiring deeply)
Hoffmans sign (firmly grasp middle finger and quickly snap/flip dorsal surface looking for flexion of both thumb and index finger)
Lumbar spine and cervical spine disc rupture is differnet why?
C8 an above pedicle/nere root mismatch; has extra c8 nerve root without pedicle that allows Thoracic ones to match
T1 and below pedicle/nerve root match
Lumbar spine pedicle/nerve root match
Compression of superficial radial nerve is called:
cheiralgai paresthetica, Wartenbergs syndrome, “handcuff neuropathy”
burning, pain in SRN distribution (2.5 fingers from thumb); caused by compression, edema, and surgical injury
Does anterior interosseuous syndrome have symptoms?
no sensory symptoms; weak flexion ability tho (median n.)`
+ OK sign = what syndrome
Median nerve entrapment
+Froments sign = what syndrome
ulnar nerve entrapment
+ hoffmans sign = what sydnrome
CNS problem
Sciatica:
SYMPTOM not a cause; low back pain
Post-cast pressure pt case:
Ant. interosseous syndrome (median n.)
Weight lifter pt case:
pronator syndrome(median n.)
gymnast pt case:
carpal tunnel syndrome (median n.)
