Nerve Compression Syndrome of the Upper Extremity

Question 1

Many different nerves may be compressed causing symptoms.
(1) More common:
–(a) _______ syndrome
–(b) ________ compression

Answer 1

a) Cubital tunnel
b) Median nerve

Question 2

Many different nerves may be compressed causing symptoms
Less common:
(a) Posterior _______ nerve compression
(b) ______ syndrome
(c) _______ tunnel syndrome

Answer 2

a) interosseous
b) Pronator
c) Radial

Question 3

Compression of the Ulnar Nerve
(a) Compression of ulnar nerve is second only to _________ syndrome as a source of nerve entrapment in the upper extremity
(b) Most common site is where ulnar nerve passes in groove on posterior aspect of ________ (cubital tunnel)

Answer 3

a) carpal tunnel
b) medial epicondyle

Question 4

Cubital Tunnel Syndrome
Etiology:
(a) Direct blow to _______
(b) Nerve stretched from _______ for prolonged periods on time
(c) Cubitus valgus (carrying angle greater than ___ degree)
(d) Osteophytes or scar tissue

Answer 4

a) cubital tunnel
b) flexed elbow
c) 10

Question 5

Tx/ Dx
Clinical Symptoms:
(a) Ulnar Nerve Compression
–1) Numbness and tingling in the 4th and 5th digits
–2) Elbow pain/ache
–3) May radiate proximally to shoulder and neck
–4) Inability to do activities of daily living (ADL) such as opening jars or turning key in door are late signs
–5) Intrinsic muscle atrophy implies nerve compression of several months
Physical Exam:
1) Visual = Usually unremarkable
–a) Carrying angle greater than 10 degrees may be aggravating findings for ulnar nerve neuritis
–b) Visible muscle wasting implies ulnar nerve compression of several months
to years duration
2) Neurovascular
a) Vibration and light touch will be affected in the 5th digit and ulnar half of the 4th digit
b) Two point discrimination will be affected with progressive nerve degeneration
3) Special tests
–a) Tinel Sign: Firm percussion over the ulnar nerve in the ulnar groove and over cubital tunnel
—-(1 Positive if it reproduces symptoms

Answer 5

Cubital Tunnel Syndrome

Treatment
1) Modify activities to limit elbow flexion and direct pressure on the ulnar nerve is the most important step in treatment
2) Splint elbow or wrap towel around elbow to avoid greater than 90 degree flexion at night
3) NSAIDS
4) Surgical decompression and transposition of ulnar nerve if 3-4 months of conservative management failed

Question 6

Diagnostic Tests
(a) Electromyographic/nerve conduction velocity(EMG/NCV) study with velocity reduction of ____% or more suggests significant ulnar nerve compression
(b) Radiographs of elbow are indicated when previous elbow _____ has occurred

Answer 6

a) 30%
b) trauma