Mononeuropathies Flashcards
Carpal Tunnel Syndrome
pathophys
compression of the median nerve at the wrist within the carpal tunnel
Carpal Tunnel Syndrome
which fingers does the median nerve innervate?
2
- pointer
- middle
Carpal Tunnel Syndrome
Risk Factors
7
- RA
- myxedema
- amyloidosis
- sarcoidosis
- leukemia
- acromegaly
- hyperparathyroidism
Carpal Tunnel Syndrome
Signs/Sx
4
- pain, burning, tingling, or numbness in the fingers
- weakness in fingers
- sensations increase w/ activity
- to alleviate sx, they try to “shake out” their fingers
Carpal Tunnel Syndrome
PE findings
- diminished sensation to the 1st to 3rd fingers and half the 4th
- poor grip strength, thenar atrophy
- pos tinel sign
- pos phalen sign
Carpal Tunnel Syndrome
what is tinel sign
reproduction of sx w/ nerve percussion
Carpal Tunnel Syndrome
what is phalen sign
reproudction of sx w/ flexing wrist to 90deg for 60s
Carpal Tunnel Syndrome
dx
- US can show flattening of nerve
- EMG/NCV (gold standard)
Carpal Tunnel Syndrome
what can EMG/NCV show that US can’t
severity of disease
Carpal Tunnel Syndrome
tx
6
- splint in neutral position
- reduce repetitive activities
- NSAIDs/oral steroids
- physical therapy
- steroid injection
- surgical release
Ulnar Neuropathy
pathophys
- compression of the ulnar nerve in either the elbow (cubital) or the wrist (Guyon’s)
Ulnar Neuropathy
which fingers are innervated by ulnar neuropathy
1/2 4th finger and all of the 5th finger
Ulnar Neuropathy
signs/sx
- pain, tingling, or numbness in the ulnar nerve distribution
- +/- weakness
- sensations worsen w/ elbow flexion
Ulnar Neuropathy
PE Findings
3
- diminished sensation in fingers
- pos tinel sign
- +/- reduced grip strength
Ulnar Neuropathy
dx
- US (flattening of nerve)
- EMG/NCV (gold standard)
Ulnar Neuropathy
what does EMG/NCV show that US doesn’t
- severity of disease
- where compression is occuring (elbow vs wrist)
Ulnar Neuropathy
tx
- bracing elbow/wrist
- NSAIDs/oral steroids
- avoid pressure on the nerve
- surgical release w/ relocation of nerve @ elbow
Ulnar Neuropathy
what is this typically due to if it occurs at the wrist/hand?
mass/tumor related
Radial Neuropathy
pathophys
- damage to radial nerve w/ humerus fracture
- compression of radial nerve (@ axilla or wrist)
Radial Neuropathy
signs/sx
3 components
- numbness to back of hand
- weakness w/ wrist extension & at triceps
- all sx & PE findings are location dependent
Radial Neuropathy
dx
- EMG/NCV
Radial Neuropathy
tx
- remove compression/stop activity causing compression
Radial Neuropathy
what should you always check if there is a humerus shaft fracture
check the integrity of the radial nerve status
Tarsal Tunnel Syndrome
pathophys
compression of the posterior tibial nerve at the foot/ankel, could be due to nerve stretching
Tarsal Tunnel Syndrome
signs/sx
4
- pain & numbness to medial ankel & arch of foot
- spares heel
- occasional weakness (not often)
- worsens after exercise/at night
Tarsal Tunnel Syndrome
PE Findings
- abnormal sensation in foot/ankle
- +/- tenderness over posterior tibial tendons and nerve in tarsal tunnel
- weakness (if present) is only in the foot)
Tarsal Tunnel Syndrome
dx
EMG/NCV gold standard, but less accurate
Tarsal Tunnel Syndrome
tx
2
- arch supports/orthotics
- surgical release
Tarsal Tunnel Syndrome
often accompanied by:
flat feet
Meralgia Paresthetica
pathophys
compression of lateral femoral cutaneous nerve
Meralgia Paresthetica
pts at largest risk
3
- pregnant
- obese
- diabetic
Meralgia Paresthetica
signs/sx
2
- numbness to lateral thigh that does not pass the knee joint
- unilateral
Meralgia Paresthetica
PE Findings
- no loss of motor function in areas of sensory loss
Meralgia Paresthetica
dx
clinical
Meralgia Paresthetica
tx
3
- nothing: often spontaneously resolves
- steroid injections
- surgical decompression
