Entrapment Neuropathy

Question 1

Pick the false statement about entrapment neuropathy.
● A. It can be either an external force or a force by nearby structure
● B. One or repetitive insult
● C. Most common symptom is pain which frequently occurs at rest and is more severe at night
● D. Never consider the possibility of systemic disease
● E. None of the above

Answer 1

D. Never consider the possibility of systemic disease

Question 2

A young female presented with pain in occiput with trigger point at the back of head. Any pressure on that reproduces the pain which radiates up along the vertex. She was diagnosed with occipital nerve entrapment. Treatment options for this patient are the following except?
● A. Idiopathic cases are self-limiting
● B. Temporary relief with occipital nerve block
● C. TENS provide no relief
● D. Collar for 2 weeks may help
● E. C and D

Answer 2

E. C and D

Question 3

A coal mine worker presented with weak grip in his dominant hand. His hands get fatigued easily now with poorly localized paresthesia in index finger and thumb. What are the salient features to differentiate pronator teres syndrome from carpal tunnel syndrome (CTS)?
● A. Pain in palm rule out CTS
● B. Nocturnal exacerbation
● C. More common than CTS
● D. Involvement of ulnar nerve

Answer 3

A. Pain in palm rule out CTS

Question 4

A young female with moderate obesity often visits OPD with tingling in the hand, on palmar side of thumb, index finger, middle finger, and radial half of ring finger. Now all of sudden it has become severe. Acute carpel tunnel syndrome is uncommon and is associated with which of the following?
● A. Exertion or trauma
● B. Median artery thrombosis
● C. Hematoma in transverse carpal ligament (TCL)
● D. All of the above

Answer 4

D. All of the above

Question 5

A young female complains about tingling on palmer side of hand involving the thumb, index, middle, and half of ring finger, which wakes her up at night with painful numbness. Her grip gradually became weak. How much increase in carpel tunnel pressure produces sensory and motor dysfunction?
● A. 40 mmHg
● B. Less than 20
● C. 30
● D. 20–30

Answer 5

A. 40 mmHg

Question 6

Regarding carpel tunnel syndrome, which statement is false?
● A. Most common entrapment neuropathy
● B. Females are 4 times more affected
● C. Pain at palmar area is characteristic of pronator teres syndrome
● D. Neutral position splint relieves only 20% of patients
● E. Steroid injection may improve symptoms in 75% of patients

Answer 6

D. Neutral position splint relieves only 20% of patients

Question 7

In carpel tunnel syndrome, surgical intervention is recommended for which of the following?
● A. Constant numbness
● B. Symptoms lasting > 1 year
● C. Sensory loss
● D. Thenar atrophy
● E. All of the above

Answer 7

E. All of the above

Question 8

A 32-year-old male presented to the OPD with discomfort in little finger and medial half of ring finger, with slight hand weakness of 4 + power and mild muscle atrophy. What is the grade of ulnar nerve injury classification of this patient?
● A. Grade 1
● B. Grade 2
● C. Grade 3
● D. Grade 4

Answer 8

B. Grade 2

Question 9

Which one is a wrong statement about ulnar nerve?
● A. Elbow is most vulnerable for entrapment
● B. Tardy ulnar palsy is due to delayed onset following bony injury at the elbow
● C. NCS shows 4 m/sec faster than median nerve
● D. Early symptoms of ulnar nerve entrapment may be purely motor

Answer 9

D. Early symptoms of ulnar nerve entrapment may be purely motor

Question 10

A manual labor worker with frequent use of pneumatic drill presented to the OPD with Froment’s sign and claw hand deformity with no sensory loss at dorsum of hand. Most probably
injury to which of the following has caused the lesion?
● A. Cubital tunnel
● B. Osborne ligament
● C. Guyon’s canal
● D. Struther’s arcade

Answer 10

C. Guyon’s canal

Question 11

How can radial nerve injury be distinguished from posterior cord injury?
● A. Involvement of all forearm extensor
● B. Patchy sensory loss in the distribution of radial nerve
● C. Sparing of deltoid and latissimus dorsi muscles
● D. Purely motor involvement

Question 12

Injury to radial nerve proximal to radial groove of humerus will involve which of the following?
● A. Wrist extensors only
● B. Finger extensors only
● C. Triceps only
● D. Triceps, wrist, and finger extensors

Question 13

A young male was hit by a car while he was riding a bike. He is unable to dorsiflex his ankle and shows weakness of lateral hamstring. Which nerve will be involved in this case?
● A. Common peroneal nerve
● B. Posterior tibial nerve
● C. Deep peroneal nerve
● D. Superficial peroneal nerve

Answer 13

A. Common peroneal nerve

Question 14

A male presented to the OPD with complains of spontaneous rubbing or massaging of upper lateral aspect of thigh, along with burning dysesthesia and hyperpathia. How can meralgia paresthetica be differentiated from femoral neuropathy?
● A. Sensory changes on upper lateral aspect
● B. Purely sensory involvement
● C. No motor weakness
● D. None of the above

Answer 14

A. Sensory changes on upper lateral aspect

Question 15

A patient presented with complaint of pain that is more severe at night, frequently at rest, often with retrograde radiation, causing more proximal lesion to be suspected. The patient also has tenderness at the site of pain. He is suspected to have entrapment neuropathy. What are most common associations
with entrapment neuropathy?
● A. Diabetes mellitus and hypothyroidism
● B. Acromegaly and amyloidosis
● C. Carcinomatosis and polymyalgia rheumatica
● D. Rheumatoid arthritis
● E. All of the above

Answer 15

E. All of the above

Question 16

What is the mechanism of injury in case of entrapment neuropathy?
● A. Chronic compression can cause axonolysis and Wallerian degeneration
● B. Acute compression can compromise axoplasmic flow, which can reduce membrane excitability
● C. There can be ischemia due to vascular supply compromise
● D. Venous stasis can produce ischemia which can lead to edema outside the axonal sheath, which can further exacerbate ischemia
● E. All of the above

Answer 16

E. All of the above

Question 17

A patient after trauma to back of the head presents with headache mostly in back and myofascial spasm. Diagnosis of occipital nerve entrapment was made which occurs due to entrapment of the great occipital nerve, which is a sensory branch of C2. All of the following are surgical options for treatment of occipital neuralgia except?
● A. Decompression of C2 nerve root if compressed between c1 and c2
● B. Occipital neurectomy
● C. Occipital nerve block with local anesthetic and steroids
● D. Occipital nerve stimulators
● E. Ganglionectomy

Answer 17

C. Occipital nerve block with local anesthetic and steroids

Question 18

The median nerve is supplied by nerve roots C5 through T1 and it arises from medial and lateral cords of brachial plexus. In the cubital fossa, it passes just behind the lacertus fibrosus (bicipital aponeurosis) and enters the upper forearm between the two heads of pronator teres and supplies this muscle. Following statements regarding median nerve are correct except?
● A. Anterior interosseous nerve is purely motor branch of median nerve that supplies all but two muscles of finger and wrist flexion
● B. Near the wrist, it lies medial to the tendon of flexor carpi radialis and passes under transverse carpal ligament which also contains the tendons of FDP and FDS deep to the median nerve
● C. The second motor branch of the median nerve arises deep to the TCL and supplies LOAF muscles in the hand
● D. Palmaris cutaneous branch of the median nerve passes under the TCL and provides sensory innervation to the base of thenar eminence
● E. In the case of main trunk injury of the median nerve, a benediction hand is made when trying to make a fist (due to weakness of flexor digitorum 1 and 2)

Question 19

A patient presents in neurosurgical emergency with complaint of difficulty in grasping small objects between the thumb and the index finger with no sensory loss. Pinch sign is positive. EMG assesses pronator quadratus and flexor pollicis longus. What is the diagnosis in this patient?
● A. Anterior interosseus neuropathy
● B. Pronator teres syndrome
● C. Carpal tunnel syndrome
● D. Injury to the main trunk of median nerve
● E. None of the above

Question 20

A bulky female of 45 years of age presents in the OPD with complaints of pain in the palmer aspect of radial three and half fingers, dorsal side of these same fingers distal to PIP, and radial half of palm. The patient gets awakened at night by painful
numbness in the hands. There is also hand weakness especially grip. Phalen’s test (wrist flexion to 90 degrees angle reproduces the pain) is positive. What is the diagnosis in this patient?
● A. Cervical radiculopathy
● B. Pronator teres syndrome
● C. Carpal tunnel syndrome
● D. Reflex sympathetic atrophy
● E. De Quervain’s syndrome

Answer 20

E. De Quervain’s syndrome

Question 21

In case of carpal tunnel syndrome patient, EMG shows sensory latencies of 3.7 to 4 and 4.1 to 5 in mild and moderate CTS, respectively, while motor latencies are 4.4 to 6.9 and 7 to 9.9 in mild and moderate CTS. Laboratory workup for these pa-
tients include all of the following except?
● A. Thyroid hormone levels
● B. CBC
● C. There is no role of serum electrolytes in CTS patients
● D. HbA1c and glucose
● E. Vitamin B12, folate, and MMA

Question 22

Which statement is true regarding treatment of carpal tunnel syndrome?
● A. NSAIDs, pyridoxine, and diuretics have strong evidence of good efficacy with no obvious benefits of neutral position splint for 2 to 4 weeks or steroid injection of 10 to 25 mg hydrocortisone into carpal tunnel
● B. Surgery is recommended for symptoms less than 1 year duration with no sensory or motor symptoms
● C. Recurrent motor branch which innervates muscles of the thenar eminence is also called as million dollar nerve because its injury can lead to loss of thumb function and a possible malpractice lawsuit
● D. Kaplan’s cardinal line runs from the base of the thumb web space to the hook of hamate which has no link with anastomosis between superficial and deep palmer arches
● E. Incision extends from the proximal wrist flexion crease up to Kaplan’s cardinal line between digits 3 and 4

Question 23

Ulnar nerve has components of c7, c8, and T1. It is second most common entrapment neuropathy after CTS. Potential sites of its compression are above the elbow by arcade of Struthers, at the elbow in retroepicondylar groove (ulnar groove), cubital tunnel, at the point of exit from flexor carpi ulnaris, and in the wrist at Guyon’s canal. What are the motor findings in ulnar entrapment neuropathy?
● A. Wasting of interossei may occur
● B. Wartenberg’s sign: patients may complaint that the little finger does not make it in when they reach into their pocket due to abducted little finger because of the weakness of the third palmer interosseous muscle
● C. Froment’s prehensile thumb sign: grasping a piece of paper between the thumb and the extended index finger results in extension of the proximal phalanx of the thumb and flexion of the distal phalanx
● D. Claw deformity of hand: benediction sign when trying to open the fist from closed position, which is fingers 4 and 5 are hyperextended at MCP joints and flexed at the interphalangeal joint
● E. All of the above