Lower Extremity Entrapment Flashcards
What is the physical compression or irritation of peripheral nerves called (Ex. ulnar nerve) ?
entrapment
Does entrapment only effect sensation of one dermatome?
No; it is not only ONE dermatome since a peripheral nerve often has multiple spinal root sources (ex. ulnar nerve = c7,c8, t1)
What are areas of anatomical vulnerability?
Ulnar nerve (funny bone)Head of fibula
What are the three classification of nerve injuries? Where does entrapment fall under?
Neuropraxia (entrapment)Axontemesis (entrapment)Neurotemesis (NOT entrapment) only one that is NOT a true entrapment)
What is a reversible compression of a nerve called?
Neuropraxiaex. lunate bone moving and causing carpal tunnel in the wrist
A nerve injury with the preservation of the nerve sheath with afferent fiber degeneration distally causing complete denervation is called what?
axonotemesis
What is a nerve injury called when the nerve is completely severed?
Neurotemesis
Between neuropraxia, axotemesis, and neurotemesis, which is not a true entrapment?
neurotemesis
How do you diagnose an entrapment neuropathy and distinguish it from systemic disease?
MRI (first)EMG/Nerve conduction studies
When determining a treatment, what do you aim to do?
correct the underlying pathology when possible
A 35 yo runner comes in complaining of sensation changes/paraesthesia in peripheral nerve distribution, pain when he walks, and occasional lower motor neuron signs and symptoms secondary to peripheral nerve compression, what do you suspect he has?
a nerve entrapment.
What is the most common site of compression/entrapment for brachial plexus entrapment?
thoracic outlet
What is the #1 cause of Erb’s palsy? what about in adults?
Difficult childbirth = #1 reasonGunshot wounds = #1 in adults
A 30 yo male patient walks in holding their arm in internal rotation, with their forearm extended and pronated. They complain t hat they cannot lift their arm above their head. What condition do you think they could have? What root levels does it effect?
Erb’s Palsy; C5/C6
A 42 yo f patient visits your clinic. They complain of weakness of the wrists and finger flexors. Their forearm is supinated with their wrists and fingers hyperextended. When you see their hand, it looks like it is in a claw shape. What condition do you think they have? What root levels does it affect?
Klumpke’s Palsy; C8/T1
Klumpke’s Palsy affects primarily what nerve?
Ulnar nerve.
What are the three most common causes of Thoracic outlet syndrome, from most to least?
- Brachial plexus compression (most)2. subclavian vein compression3. subclavian artery compression (least)
What are the causes of thoracic outlet syndrome?
Hypertonic scaleneus anterior **`hypertonic pectoralis minorsomatic dysfunction of 1st ribcervical ribdecreased costoclavicular space
A 14 yo f patient comes in complaining of tingling numbness (paresthesia) in the C8 and T1 dermatomes, what could be the cause?
Thoracic outlet syndrome (via compression of the brachial plexus/ulnar n)
A 25 yo m patient comes into your clinic complaining of tingling in entire wrist/hand region, what could be wrong?
Thoracic outlet syndrome via subclavaian artery compression
If a patient experiences only generalized unilateral UE edema and coolness of the extremity, with pain and darkness of the extremity, what could they have?
Thoracic outlet syndrome via subclavian vein compression
Match the thoracic outlet special test with their area.a) Roo’sb) Adson’s testc) Reverse Adson’s test1) tight scalenes on ipsilateral rotation2) generalized3) Cx rib/1st rib dysfunction (contralateral rotation)
a - 2b- 1c - 3
Which of the following is a thoracic out let special test of a hypertonic pec minor?a) Roo’sb) Costoclavicular spacec) Adson’sd) reverse Adson’se) hyperabduction test
e) hyperabduction test
Is piriformis syndrome an entrapment neuropathy of the lower extremity?
YES! Don’t forget this!!
What is the most common site of entrapment for tibial nerve entrapment?
Tarsal tunnel
A 42 yo m athlete, who also works at a standing desk during his day job, comes in complaining of burning pain that worsens with prolonged standing and walking, numbness on the sole of his foot and ankle, paresthesia at the medial 3.5 digits of the foot, plantar slide. What problem do you suspect they have?
Tarsal Tunnel Syndrome
What is the most common cause of tarsal tunnel syndrome?
Pronated feet
What are the most common sites of peroneal nerve entrapment?
Fibular head and neck
A 22 yo f comes in complaining on paresthesia to the anterior and lateral leg and dorsum of the foot. As she walked in you noticed a foot drop/slapping gait. What do you suspect the patient has?
Acute peroneal nerve entrapment
How do you treat a peroneal nerve entrapment?
- OMT to fibula head, tibia, talus.- Medications for pain- Corticosteroid injections- If chronic, may need AFO.
A 33 yo m comes in to your office complaining of unable to extend his right quadriceps, weakness, and numbness in his right anterior thigh and medial calf. You notice that his right thigh looks smaller than his left thigh. As you are thinking, the patient mentions that he sometimes feels pain in the inguinal region, anterior thigh or medial calf. What do you think he has?
Femoral nerve entrapment
What are the most common causes for femoral nerve entrapment?
- Pelvic somatic dysfunction- Scarred/tight inguinal ligament
True or False: OMT and proper footwear, orthotics, and assessment and correction of gait will reduce symptoms.
True
Ely’s Test is used to test what?
Anterior Femoral nerve entrapment
A 24 yo m comes into your office saying, “Doc Doc, there is a deep ache right by the pubic bone. It hurts so much when I work out. It gets better when I’m not doing anything, but it keeps hurting if I try to work out some more.” After a bit more of inquiry, you discover that the pain radiates down the medial thigh toward the knee. What do you suspect this guy has?
Obturator nerve entrapment
A 37 yo f comes into your office. You notice she is wearing tight spandex even though she is overweight. As she walks to a chair, she cringes in pain. However, when she sits down, she smiles in relief. When you ask her what is going on, she says that she has numbness and tingling on her left side, in the superior and lateral portion of her thigh. What do you think she has? What would you recommend for her?
Meralgia ParestheticaRecommend to WEAR LOOSER CLOTHING (most successful treatment), OMT, and medications
Meralgia Paresthetica is due to entrapment of what by what?
Entrapment of the lateral femoral cutaneous nerve under the inguinal ligament, lateral to the femoral nerve.
When thinking of entrapment, what other things are important to think of?
more proximal causes (ex. disc herniation, masses, etc.)
How important is footwear? Why?
VERY important!Pronators tend to provide tensile forces through post tibial n, and supinators place compressive forces through the tarsal tunnel.
