Compression Neuropathy Lecture

Question 1

What is compression neuropathy?

Answer 1

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

Question 2

Sunderland classification of nerve injury

Answer 2

Question 3

Answer 3

Question 4

What usually is the cause of cervical nerve root compression?

Answer 4

2° to cervical disc disease (i.e. disc bulging or herniation)

Question 5

What is a bulging disc? herniated disc?

Answer 5

a. compressed evenly without significant damage to cartilage rings
b. Some tearing of the cartilage rings
i. Protrusion: only a few cartilage rings are torn; no leakage of central material
ii. Extrusion: cartilage rings have torn in a small area, nucleus pulposus is able to flow out of the disc space

Question 6

How does the disc most commonly herniate?

Answer 6

posterior laterally –> causes radiculopathy

Question 7

Answer 7

Question 8

What is justified in most cases of cubital tunnel syndrome? what is the exception?

Answer 8

operative decompression –> prevent nerve damage

not needed in very mild cases

Question 9

What nerves are at risk in peripheral UE?

Answer 9

Radial nerve

Median nerve

Ulnar nerve

Musculocutaneous

Axillary

Question 10

What sensation does the radial nerve supply?

Answer 10

majority of dorsum of hand (via posterior interossesous

motor to triceps, anconeus, wrist extensors

Question 11

What are names for paresthetica in superficial radial nerve?

Answer 11

Wartenber’s syndrome or Handcuff Neuropathy

caused by compression, edema, surgical injury

Question 12

What four sites can trap the median nerve?

Answer 12

Ligament of Struthers

Pronator Syndrome

Anterior Osseous Syndrome

Carpal Tunnel Syndrome

Question 13

What is pronator syndrome?

Answer 13

Question 14

What tests are done to test for carpal tunnel syndrome?

Answer 14

Question 15

How do we treat carpal tunnel?

Answer 15

Question 16

Where can the ulnar nerve have entrapment?

Answer 16

Cubital Tunnel

Guyon’s Canal

Question 17

What are the two parts of the ulnar nerve, and what are their functions?

Answer 17

Question 18

Thoracic Outlet Syndrome Flow Chart

Answer 18

Question 19

What nerves are at risk to become entrapped in the LE?

Answer 19

Common Fibular n. (L4-S2)

Deep Fibular n. (L4-S2)

Posterior Tibial n. (L4-S2)

Lateral Femoral Cutaneous n. (L2-3)

Question 20

What are sx of common fibular n. compression? tx?

Answer 20

Sx: pain along proximal third of lateral leg, foot drop with a slapping gait, sx exacerbated during plantarflexion & inversion of the foot

Tx: posterior fibular head HVLA or ME, ME on gastroc/soleus, biceps femoris

Question 21

How do we treat anterior tarsal tunnel syndrome?

Answer 21

• Remove compressive forces
• Myofascial release of extensor retinaculum
• Traction tug of talonavicular joint
• Hiss whip for navicular, cuneiforms, 1st and 2nd metatarsal

Question 22

What is a unique sx of lateral femoral cutaneous n compression?

Answer 22

trophic skin changes (later on)

(+) Tinel’s sign 1cm medial and inferior to the ASIS

Question 23

What is the etiology of tarsal tunnel syndrome?

Answer 23

Question 24

What is spinal disc disease?

Answer 24

can develop chronic back pain

weak back ligaments (predispose to further injury; accelerated OA)

Question 25

What mainly causes sciatica?

Answer 25

sacroiliac ligament weakness