Cortex - adult orthopaedics spine and upper limb (upper limb) 3 Flashcards
What is the difference between cervical nerve root compressions and peripheral nerve root compressions ?
Peripheral nerve compression neuropathies will cause symptoms and signs affecting peripheral nerve sensory and motor territories rather than dermatomal and myotomal distributions
What is the carpal tunnel formed from ?
Formed by the carpal bones and the flexor retinaculum
What structures pass through the carpal tunnel ?
The median nerve passes through the carpal tunnel along with 9 flexor tendons with their synovial covering.
What is carpal tunnel syndrome ?
It is where swelling in the carpal tunnel causes median nerve compression
Carpal tunnel syndrome is mainly idiopathic but can be secondary to some conditions - what are they?
RA (synovitis > less space)
Conditions resulting in fluid retention – pregnancy, diabetes, chronic renal failure, hypothyroidism (myxoedema)
Fractures - esp colles fractures
Describe the typical presentation of carpal tunnel syndrome
Affects the median nerve innervated digits (thumb and radial 2½ fingers):
- Parathesiae (burning/prickling sensation) - Worse at night
- Loss of sensation and muscle wasting/weakness
Name and describe the two clinical tests for carpal tunnel syndrome
- Tinels test - percussing over median nerve produces symptoms
- Phalens test - holding wrist hyper-flexed (think when someone pretends to be gay they flick the wrist this test is just holding it there)
How is carpal tunnel syndrome diagnosed ?
EMG - nerve conduction studies show reduced conduction across the wrist
What is the treatment of carpal tunnel syndrome ?
- Mild or moderate - 1st line - wrist splint and corticosteroid injection
- Severe - 1st line - surgery (carpal tunnel decompression)
What is cubital tunnel syndrome ?
Compression of the ulnar nerve at the elbow behind the medial epicondyle (”funny bone” area).
Compression can be due to a tight band of fascia forming the roof of the tunnel (known as Osborne’s fascia) or due to tightness at the intermuscular septum as the nerve passes through or between the two heads at the origin of flexor carpi ulnaris.
What area of the hand does the ulnar nerve supply ?
What are the signs/symptoms of cubital tunnel syndrome ?
- Paraesthesiae in the ulnar 1½ fingers
- Weakness of ulnar innervated muscles
What clinical tests suggest cubital tunnel syndrome ?
- Tinels test - over the cubital tunnel though
- Froments test - patient is asked to hold an object, usually a flat object such as a piece of paper, between their thumb and index finger (pinch grip). The examiner then attempts to pull the object out of the subject’s hands.
How is cubital tunnel syndrome diagnosed and treated ?
Diagnosis - EMG
Treatment - may need surgical release of any tight structures
