Compressive Neuropathies Flashcards
What forms the carpal tunnel of the wrist.
carpal bones and flexor retinaculum
what nerve is compressed in carpal tunnel syndrom
median
what conditions can carpal tunnel syndrome occur secondary to
RA- synovitis=less space Fluid retention: pregnancy diabetes renal failure hypothyroidism fractures - colles
how will patients presents with carpal tunnel
parathesiae in the median nerve innervated digits (thumb and radial 2 and a half fingers) worse at night loss of sensation weakness clumsiness
What are the signs of carpal tunnel
thenar eminence wasting
postive tinels or phalens
weakness of LOAF muscles
What examinations can reproduce the symptoms of carpal tunnerl
tinel’s- percussing over median nerve
phalens- holding the wrists hyper flexed
How can carpal tunnel be treated
Splint at night to prevent flexion of wrist
steroid injection
surgical decompression - division of the transverse carpal ligament
what is cubital tunnel syndrome
compression of the ulnar nerve at the elbow behind the medial epicondyle
Where do patients complain of parasthesiae in cubital tunnel syndrome?
the ulnar 1 and a half fingers
Is tinel’s test positive in cubital tunnel
yes - but tap over cubital tunnel
Which muscles may be weak due to compromise in ulnar nerve innervation
the first dorsal interosseous muscle
adductor pollicis
What can the compression in cubital tunnel be due to
a tight band of fascia forming the roof of the tunnel (Osborne’s fascia)
tightness of the intermuscular septum as the nerve passes through or between the two heads at the origin of flexor carpi ulnaris
how can carpal tunnel be diagnosed with investigations
EMG - nerve conduction studies
outline treatment options for carpel tunnel
wrist splint at night
steroid injection
surgical decompression
what clinical examination can be done in cubital tunnel
froments test - paper between thumbs
