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Hand & Upper Extremity > Nerve Injuries & Syndromes > Flashcards

Nerve Injuries & Syndromes Flashcards

1
Q

Radial Nerve Injury: Symptoms

A
  • posture of hand is wrist drop

- possible lack of finger and thumb extension

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2
Q

Radial Nerve Injury: Non-Operative Treatment (i.e. type of splint, type of ROM, and type of strengthening exercises)

A
  • wrist cock-up splint with or without dynamic finger and thumb extension assist
  • passive and active ROM
  • isotonic strengthening exercises upon muscle reinnervation
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3
Q

Radial Nerve Injury: Operative Treatment (i.e. splint)

A
  • static wrist extension splint, 30 degrees

- after 4 weeks, adjust splint to 10-20 degrees extension

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4
Q

Radial Tunnel Syndrome: Anatomical Cause

A

-entrapment of the radial nerve in an area extending from the radial head to the supinator muscle

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5
Q

Radial Tunnel Syndrome: Symptoms

A

-burning pain in lateral forearm

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6
Q

Radial Tunnel Syndrome: Non-Operative Treatment (i.e. type of splint, type of ROM, and type of strengthening exercises)

A
  • long arm splint with elbow flexed, forearm supinated, and wrist neutral
  • massage or TENS for pain management
  • pain-free ROM
  • nerve glides
  • activity modification to avoid forceful wrist extension and supination
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7
Q

Radial Tunnel Syndrome: Operative Treatment (i.e. type of splint, type of ROM, and type of strengthening exercises)

A
  • long arm splint with elbow flexed, forearm supinated, and wrist neutral for 2 weeks then wrist cock-up for 2 more weeks
  • passive and active pronation and supination
  • hand strengthening exercises at 3 weeks and resistive exercises at 6 weeks
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8
Q

Anterior Interosseous Syndrome: Anatomical Cause

A

-compression to the anterior interosseous nerve

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9
Q

Anterior Interosseous Syndrome: Symptoms

A

-motor loss involving the flexor digitorum longus, the flexor profundus to the index finger, and the pronator quadratus

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10
Q

Pronator Syndrome: Anatomical Cause

A

-entrapment of the proximal median nerve between the heads of the pronator muscles

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11
Q

Pronator Syndrome: Symptoms

A

-deep pain in the proximal forearm with activity

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12
Q

Pronator Syndrome: Non-Operative Treatment

A
  • splint elbow 90-100 degrees flexion with forearm neutral
  • TENS for pain
  • gentle prolonged stretching via supination as well as elbow, wrist, and finger extension
  • activity modification to avoid repetitive forearm rotation with resistance and prolonged elbow flexion
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13
Q

Pronator Syndrome: Operative Treatment

A
  • half cast
  • AROM all UE joints while wearing cast
  • muscle strengthening in 1 week
  • full AROM gained by 8 weeks
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14
Q

Median Nerve Injury: Symptoms

A
  • ape hand deformity
  • sensory loss in index, middle, and radial side of ring finger
  • loss of pinch, thumb opposition, index finger MCP and PIP flexion
  • decreased pronation
  • add picture
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15
Q

Median Nerve Injury: Non-Operative Treatment

A
  • static thenar web spacer splint

* add picture

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16
Q

Median Nerve Injury: Operative Treatment

A
  • dorsal wrist blocking splint worn for 4-6 weeks with AROM and PROM in splint for digits and thumb as well as tendon gliding exercises and scar massage
  • discontinue splint at 6 weeks and begin strengthening exercises
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17
Q

Double Crush Syndrome: Anatomical Cause

A

-occurs when a peripheral nerve is entrapped in more than one location

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18
Q

Double Crush Syndrome: Symptoms

A

-intermittent diffuse arm pain and paresthesias with specific postures

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19
Q

Double Crush Syndrome: Non-Operative Treatment

A
  • treat according to each nerve injury or syndrome
  • avoid movements or postures that aggravate the symptoms
  • nerve gliding exercises
  • exercises for scapular stability, posture, and core trunk strengthening
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20
Q

Carpal Tunnel Syndrome: Anatomical Cause

A
  • entrapment of the median nerve as it courses through the carpal tunnel
  • the most common nerve compression of the UE
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21
Q

Carpal Tunnel Syndrome: Can be caused by…?

A
  • tenosynovitis
  • cumulative trauma disorder
  • fluid retention (i.e. from pregnancy, endocrine malfunctions)
  • ganglions
  • tumors
  • diabetes
  • rheumatoid arthritis
  • trauma such as wrist fracture or lunate dislocation
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22
Q

Carpal Tunnel Syndrome: Sensory Symptoms

A

-numbness and tingling in the thumb and index and middle fingers (digits 1-3), especially at night

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23
Q

Carpal Tunnel Syndrome: Motor Symptoms

A
  • diminished fine motor coordination

- in advanced cases, the adductor pollicis may be atrophied

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24
Q

Tinel’s sign is one form of evaluation specific to carpal tunnel syndrome. What does this test consist of?

A

-a tap on the median nerve at the wrist to elicit symptoms

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25
Q

Phalen’s test is one form of evaluation specific to carpal tunnel syndrome. What does this test consist of?

A

-holding the wrist in full flexion for 1 minute to elicit changes in sensation

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26
Q

The Moberg Pickup Test is one form of evaluation specific to carpal tunnel syndrome. What does this test consist of? With whom is it used?

A
  • a timed test involving picking up, holding, manipulating, and identifying small objects
  • used with children and cognitively impaired adults to test median nerve function
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27
Q

Semmes-Weinstein monofilament testing is one form of evaluation specific to carpal tunnel syndrome. What does this test assess?

A

-loss of sensation

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28
Q

Carpal Tunnel Syndrome: Non-Operative Treatment (Splint)

A

-a CTS splint or wrist cock-up splint at 0-10 degrees wrist extension is used to relieve pressure on the median nerve in the carpal tunnel and control edema (may use a prefab wrist cock-up splint if wrist position is adjustable)

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29
Q

Carpal Tunnel Syndrome: Non-Operative Treatment (Exercises)

A

-nerve and tendon gliding exercises

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30
Q

Carpal Tunnel Syndrome: Non-Operative Treatment (Activity Modification)

A
  • ergonomic handles
  • gel pads
  • padding on handles
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31
Q

Carpal Tunnel Syndrome: Non-Operative Treatment (Client Education)

A
  • avoidance of postures and activities that aggravate the condition (i.e. those involving wrist flexion)
  • training in the use of an ergonomic keyboard, if applicable
  • postural retraining and proximal conditioning exercise
32
Q

Carpal Tunnel Syndrome: Operative Treatment (Surgery)

A
  • traditional open carpal tunnel release surgery or endoscopic release
  • some clients may not need therapy after surgery
  • in more complicated cases, wound care and scar mobilization are provided
33
Q

Carpal Tunnel Syndrome: Operative Treatment (Post-Op Pain Management)

A
  • use of gel pads on the scar

* pain on either side of the surgical release is called pillar pain

34
Q

Carpal Tunnel Syndrome: Operative Treatment (Post-Op Splinting)

A

-provided only to clients who sleep with the wrist flexed or who will engage in too much activity too soon (i.e. immediate return to work)

35
Q

Carpal Tunnel Syndrome: Operative Treatment (Post-Op Exercise & ROM)

A
  • AROM of wrist, thumb, and fingers begins 1-2 days post-surgery
  • nerve and tendon gliding exercises are provided
  • strengthening activities begin in 3-6 weeks
36
Q

Cubital Tunnel Syndrome: Anatomical Cause

A
  • proximal ulnar nerve compression at the elbow between the medial epicondyle and the olecranon process
  • the second most common nerve compression of the UE after CTS
37
Q

Cubital Tunnel Syndrome: Can be caused be…?

A
  • fracture or dislocation of the elbow
  • OA
  • RA
  • diabetes
  • alcohol abuse
  • tourniquets
  • assembly line work
38
Q

Cubital Tunnel Syndrome: Sensory Symptoms

A

-sensation is decreased in the little finger and ulnar half of the ring finger (digit 5 and the ulnar half of digit 4)

39
Q

Cubital Tunnel Syndrome: Motor Symptoms

A

-decreased grip and pinch strength because of weak interossei, adductor pollicis, and flexor carpi ulnaris muscles

40
Q

Tinel’s sign is one form of evaluation specific to cubital tunnel syndrome. What does this test consist of?

A

-a tap over the cubital tunnel to elicit symptoms

41
Q

Froment’s sign is one form of evaluation specific to cubital tunnel syndrome. What does this test consist of?

A

-flexion of the IP of the thumb when a lateral pinch is attempted

42
Q

Wartenberg’s sign is one form of evaluation specific to cubital tunnel syndrome. What does this test consist of?

A

-the fifth finger held abducted from the fourth finger

43
Q

The elbow flexion test is one form of evaluation specific to cubital tunnel syndrome. What does this test consist of?

A

-holding the elbow in flexion for 5 minutes with the wrist in neutral to elicit symptoms

44
Q

Cubital Tunnel Syndrome: Non-Operative Treatment (Splint, Exercise, Education)

A
  • edema control
  • pain management
  • elbow splint or positioning at 30-60 degrees flexion for 3 weeks
  • ulnar nerve gliding
  • proximal conditioning activities
  • posture and ergonomic training
45
Q

Cubital Tunnel Syndrome: Post-Operative Treatment (Protection Phase)

A
  • protection phases = 1 day to 3 weeks
  • splint the elbow at 70-90 degrees flexion
  • provide wound care, edema control, pain management, and AROM of uninvolved joints
  • teach one-handed ADL techniques
46
Q

Cubital Tunnel Syndrome: Post-Operative Treatment (Active Phase)

A
  • active phase = begins at 3 weeks
  • discontinue the elbow splint and anticlaw splint if used before surgery, then add elbow AROM (in pronation first, then supination; add wrist motion with elbow flexed, then extended), ulnar nerve gliding, and desensitization techniques
47
Q

de Quervain Syndrome: Anatomical Cause

A

-cumulative microtrauma resulting in tenosynovitis of the thumb muscle tendon unit, the abductor pollicis longus and the extensor pollicis brevis, and the tendons in the first dorsal compartment of the wrist

48
Q

de Quervain Syndrome: Can be caused by…?

A
  • forceful, repetitive thumb abduction with wrist ulnar deviation
  • carpometacarpal (CMC) OA
  • scaphoid fracture
  • intersection syndrome
  • radial nerve neuritis
49
Q

de Quervain Syndrome: Who is at greatest risk of developing it?

A
  • women ages 33-55
  • women in late pregnancy
  • mothers of young children
  • people who engage extensively in keyboarding, piano playing, knitting, needlepoint, and racket sports
50
Q

de Quervain Syndrome: Non-Operative Treatment (Medical)

A

-includes corticosteroid injections

51
Q

de Quervain Syndrome: Non-Operative Treatment (OT - splint, ROM, exercises, etc.)

A
  • a forearm-based thumb spica splint with wrist in neutral and thumb radially abducted for 3 weeks
  • activity modification and avoidance of pinch
  • after 3 weeks, progress to a soft splint and isometric exercises
  • computer ergonomics education
  • strengthening activities
52
Q

de Quervain Syndrome: Operative Treatment (Medical)

A

-surgical release of the first dorsal compartment

53
Q

de Quervain Syndrome: Post-Operative Treatment (OT - splint, ROM, exercises, etc.)

A
  • a forearm-based thumb spica splint with wrist at 20 degrees extension and thumb radially abducted for 3 weeks
  • gentle ROM and tendon gliding exercises
  • grip and pinch strengthening begins at 2 weeks
  • scar management and desensitization techniques
54
Q

Claw Deformity: Anatomical Cause

A

-distal ulnar nerve compression or lesion at the wrist

55
Q

Claw Deformity: Can be caused by…?

A
  • ganglion
  • neuritis
  • arthritis
  • carpal fractures at Guyon’s canal
56
Q

Claw Deformity: Sensory Symptoms

A
  • sensory loss occurs in the little finger and ulnar side of the ring finger plus the palmar ulnar hand (digit 5 and ulnar side of digit 4)
  • if sensory loss is on the dorsal side of the hand, the injury is proximal to Guyon’s canal
57
Q

Claw Deformity: Motor Symptoms

A
  • loss of intrinsic ulnar innervated muscles (interossei and adductor pollicis, flexor and abductor digiti minimi)
  • motor loss results in deformity in which the MCPs hyperextend and the IPs flex, hand arches are flattened, and pinch strength is lost
58
Q

Froment’s sign is one form of evaluation specific to claw deformity. What does this test consist of?

A

-flexion of the IP of the thumb when a lateral pinch is attempted

59
Q

Wartenberg’s sign is one form of evaluation specific to claw deformity. What does this test consist of?

A

-the fifth finger held abducted from the fourth finger

60
Q

Jeanne’s sign is one form of evaluation specific to claw deformity. What does this test consist of?

A

-hyperextension of the thumb MCP

61
Q

Semmes-Weinstein monofilament testing is one form of evaluation specific to claw deformity. What does this test assess?

A

-loss of sensation

62
Q

Claw Deformity: Non-Operative Treatment (Splint)

A

-an ulnar nerve palsy or anticlaw splint is used, and dynamic PIP extension assist may be added if PIP flexion contractures are present

63
Q

Claw Deformity: Non-Operative Treatment (Activity Modification)

A
  • a padded antivibration glove can be used during activity to protect from further nerve irritation
  • ergonomic handles, gel pads, or padding on handles of vibratory equipment (i.e. lawnmower)
64
Q

Claw Deformity: Non-Operative Treatment (Client Education)

A

-avoidance of postures and activities that aggravate the condition, such as ulnar deviation combined with wrist flexion

65
Q

Claw Deformity: Post-Operative Treatment (Wound Care)

A
  • bulky dressing is applied for 3-10 days
  • wound care
  • scar mobilization
66
Q

Claw Deformity: Post-Operative Treatment (Splint)

A
  • a dorsal blocking splint is used to maintain the wrist at 20-30 degrees flexion and an MCP block to 45 degrees extension to protect nerve repair
  • splint is adjusted at 3-6 weeks to increase wrist position to neutral
  • discontinue splint at 6 weeks
  • use of the pre-operative splint continues until muscle function returns
67
Q

Claw Deformity: Post-Operative Treatment (Sensory)

A
  • sensory desensitization begins when the wound has healed and stitches are removed
  • sensory reeducation begins at 10-12 weeks post-surgery, once protective sensation has returned
68
Q

Claw Deformity: Post-Operative Treatment (ROM & Strengthening)

A
  • AROM of the wrist and hand begins at 6 weeks

- clients may resume ADLs and begin muscle strengthening and work conditioning, if needed

69
Q

Claw Deformity: Post-Operative Treatment (Complications with Nerve Regeneration)

A
  • tendon transfer is done if the nerve has not regenerated within 1 year
  • after surgery, the practitioner may provide electromyography biofeedback, NMES, and instruction in avoiding substitution of movement patterns
70
Q

Digital Stenosing Tenosynovitis / Trigger Finger: Anatomical Cause

A

-sheath inflammation or nodules near the A1 pulley

71
Q

Digital Stenosing Tenosynovitis / Trigger Finger: Treatment (Splint)

A

-splinting the MCP at 0 degrees for 3-6 weeks

72
Q

Digital Stenosing Tenosynovitis / Trigger Finger: Treatment (Medical)

A

-surgically releasing the A1 pulley

73
Q

Digital Stenosing Tenosynovitis / Trigger Finger: Sensory Reeducation after Nerve Injury (Protective Reeducation)

A

-protective reeducation educates clients to visually compensate for sensory loss and to avoid working with machinery and temperatures below 60 degrees

74
Q

Digital Stenosing Tenosynovitis / Trigger Finger: Sensory Reeducation after Nerve Injury (Discriminative Reeducation)

A

-discriminative reeducation uses motivation and repetition in a vision-tactile matching process in which clients identify objects with and without vision

75
Q

Digital Stenosing Tenosynovitis / Trigger Finger: Sensory Reeducation after Nerve Injury (Sensory Recovery)

A

-sensory recovery begins with pain perception and progresses to vibration of 30 cycles per second, moving touch, and constant touch

76
Q

Digital Stenosing Tenosynovitis / Trigger Finger: Sensory Reeducation after Nerve Injury (Desensitization)

A

-desensitization is a process of applying different textures and tactile stimulation to reeducate the nervous system so clients can tolerate sensations during functional use of the upper extremity

Hand & Upper Extremity (11 decks)

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