Mononeuropathies

Question 1

Carpal Tunnel Syndrome

pathophys

Answer 1

compression of the median nerve at the wrist within the carpal tunnel

Question 2

Carpal Tunnel Syndrome

which fingers does the median nerve innervate?

2

Answer 2

• pointer
• middle

Question 3

Carpal Tunnel Syndrome

Risk Factors

7

Answer 3

1. RA
2. myxedema
3. amyloidosis
4. sarcoidosis
5. leukemia
6. acromegaly
7. hyperparathyroidism

Question 4

Carpal Tunnel Syndrome

Signs/Sx

4

Answer 4

1. pain, burning, tingling, or numbness in the fingers
2. weakness in fingers
3. sensations increase w/ activity
4. to alleviate sx, they try to “shake out” their fingers

Question 5

Carpal Tunnel Syndrome

PE findings

Answer 5

• diminished sensation to the 1st to 3rd fingers and half the 4th
• poor grip strength, thenar atrophy
• pos tinel sign
• pos phalen sign

Question 6

Carpal Tunnel Syndrome

what is tinel sign

Answer 6

reproduction of sx w/ nerve percussion

Question 7

Carpal Tunnel Syndrome

what is phalen sign

Answer 7

reproudction of sx w/ flexing wrist to 90deg for 60s

Question 8

Carpal Tunnel Syndrome

dx

Answer 8

1. US can show flattening of nerve
2. EMG/NCV (gold standard)

Question 9

Carpal Tunnel Syndrome

what can EMG/NCV show that US can’t

Answer 9

severity of disease

Question 10

Carpal Tunnel Syndrome

tx

6

Answer 10

1. splint in neutral position
2. reduce repetitive activities
3. NSAIDs/oral steroids
4. physical therapy
5. steroid injection
6. surgical release

Question 11

Ulnar Neuropathy

pathophys

Answer 11

• compression of the ulnar nerve in either the elbow (cubital) or the wrist (Guyon’s)

Question 12

Ulnar Neuropathy

which fingers are innervated by ulnar neuropathy

Answer 12

1/2 4th finger and all of the 5th finger

Question 13

Ulnar Neuropathy

signs/sx

Answer 13

• pain, tingling, or numbness in the ulnar nerve distribution
• +/- weakness
• sensations worsen w/ elbow flexion

Question 14

Ulnar Neuropathy

PE Findings

3

Answer 14

• diminished sensation in fingers
• pos tinel sign
• +/- reduced grip strength

Question 15

Ulnar Neuropathy

dx

Answer 15

1. US (flattening of nerve)
2. EMG/NCV (gold standard)

Question 16

Ulnar Neuropathy

what does EMG/NCV show that US doesn’t

Answer 16

• severity of disease
• where compression is occuring (elbow vs wrist)

Question 17

Ulnar Neuropathy

tx

Answer 17

1. bracing elbow/wrist
2. NSAIDs/oral steroids
3. avoid pressure on the nerve
4. surgical release w/ relocation of nerve @ elbow

Question 18

Ulnar Neuropathy

what is this typically due to if it occurs at the wrist/hand?

Answer 18

mass/tumor related

Question 19

Radial Neuropathy

pathophys

Answer 19

• damage to radial nerve w/ humerus fracture
• compression of radial nerve (@ axilla or wrist)

Question 20

Radial Neuropathy

signs/sx

3 components

Answer 20

• numbness to back of hand
• weakness w/ wrist extension & at triceps
• all sx & PE findings are location dependent

Question 21

Radial Neuropathy

dx

Answer 21

• EMG/NCV

Question 22

Radial Neuropathy

tx

Answer 22

• remove compression/stop activity causing compression

Question 23

Radial Neuropathy

what should you always check if there is a humerus shaft fracture

Answer 23

check the integrity of the radial nerve status

Question 24

Tarsal Tunnel Syndrome

pathophys

Answer 24

compression of the posterior tibial nerve at the foot/ankel, could be due to nerve stretching

Question 25

# Tarsal Tunnel Syndrome signs/sx | 4

Answer 25

* pain & numbness to medial ankel & arch of foot * spares heel * occasional weakness (not often) * worsens after exercise/at night

Question 26

# Tarsal Tunnel Syndrome PE Findings

Answer 26

* abnormal sensation in foot/ankle * +/- tenderness over posterior tibial tendons and nerve in tarsal tunnel * weakness (if present) is only in the foot)

Question 27

# Tarsal Tunnel Syndrome dx

Answer 27

EMG/NCV gold standard, but less accurate

Question 28

# Tarsal Tunnel Syndrome tx | 2

Answer 28

* arch supports/orthotics * surgical release

Question 29

# Tarsal Tunnel Syndrome often accompanied by:

Answer 29

flat feet

Question 30

# Meralgia Paresthetica pathophys

Answer 30

compression of lateral femoral cutaneous nerve

Question 31

# Meralgia Paresthetica pts at largest risk | 3

Answer 31

1. pregnant 2. obese 3. diabetic

Question 32

# Meralgia Paresthetica signs/sx | 2

Answer 32

* numbness to lateral thigh that does not pass the knee joint * unilateral

Question 33

# Meralgia Paresthetica PE Findings

Answer 33

* no loss of motor function in areas of sensory loss

Question 34

# Meralgia Paresthetica dx

Answer 34

clinical

Question 35

# Meralgia Paresthetica tx | 3

Answer 35

1. nothing: often spontaneously resolves 2. steroid injections 3. surgical decompression