Nerve Injuries & Syndromes Flashcards
1
Q
Radial Nerve Injury: Symptoms
A
- posture of hand is wrist drop
- possible lack of finger and thumb extension
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
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
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
5
Q
Radial Tunnel Syndrome: Symptoms
A
-burning pain in lateral forearm
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
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
8
Q
Anterior Interosseous Syndrome: Anatomical Cause
A
-compression to the anterior interosseous nerve
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
10
Q
Pronator Syndrome: Anatomical Cause
A
-entrapment of the proximal median nerve between the heads of the pronator muscles
11
Q
Pronator Syndrome: Symptoms
A
-deep pain in the proximal forearm with activity
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
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
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
15
Q
Median Nerve Injury: Non-Operative Treatment
A
- static thenar web spacer splint
* add picture
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
17
Q
Double Crush Syndrome: Anatomical Cause
A
-occurs when a peripheral nerve is entrapped in more than one location
18
Q
Double Crush Syndrome: Symptoms
A
-intermittent diffuse arm pain and paresthesias with specific postures
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
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
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
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
23
Q
Carpal Tunnel Syndrome: Motor Symptoms
A
- diminished fine motor coordination
- in advanced cases, the adductor pollicis may be atrophied
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
25
Phalen's test is one form of evaluation specific to carpal tunnel syndrome. What does this test consist of?
-holding the wrist in full flexion for 1 minute to elicit changes in sensation
26
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 timed test involving picking up, holding, manipulating, and identifying small objects
- used with children and cognitively impaired adults to test median nerve function
27
Semmes-Weinstein monofilament testing is one form of evaluation specific to carpal tunnel syndrome. What does this test assess?
-loss of sensation
28
Carpal Tunnel Syndrome: Non-Operative Treatment (Splint)
-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)
29
Carpal Tunnel Syndrome: Non-Operative Treatment (Exercises)
-nerve and tendon gliding exercises
30
Carpal Tunnel Syndrome: Non-Operative Treatment (Activity Modification)
- ergonomic handles
- gel pads
- padding on handles
31
Carpal Tunnel Syndrome: Non-Operative Treatment (Client Education)
- 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
Carpal Tunnel Syndrome: Operative Treatment (Surgery)
- 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
Carpal Tunnel Syndrome: Operative Treatment (Post-Op Pain Management)
- use of gel pads on the scar
| * pain on either side of the surgical release is called pillar pain
34
Carpal Tunnel Syndrome: Operative Treatment (Post-Op Splinting)
-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
Carpal Tunnel Syndrome: Operative Treatment (Post-Op Exercise & ROM)
- 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
Cubital Tunnel Syndrome: Anatomical Cause
- 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
Cubital Tunnel Syndrome: Can be caused be...?
- fracture or dislocation of the elbow
- OA
- RA
- diabetes
- alcohol abuse
- tourniquets
- assembly line work
38
Cubital Tunnel Syndrome: Sensory Symptoms
-sensation is decreased in the little finger and ulnar half of the ring finger (digit 5 and the ulnar half of digit 4)
39
Cubital Tunnel Syndrome: Motor Symptoms
-decreased grip and pinch strength because of weak interossei, adductor pollicis, and flexor carpi ulnaris muscles
40
Tinel's sign is one form of evaluation specific to cubital tunnel syndrome. What does this test consist of?
-a tap over the cubital tunnel to elicit symptoms
41
Froment's sign is one form of evaluation specific to cubital tunnel syndrome. What does this test consist of?
-flexion of the IP of the thumb when a lateral pinch is attempted
42
Wartenberg's sign is one form of evaluation specific to cubital tunnel syndrome. What does this test consist of?
-the fifth finger held abducted from the fourth finger
43
The elbow flexion test is one form of evaluation specific to cubital tunnel syndrome. What does this test consist of?
-holding the elbow in flexion for 5 minutes with the wrist in neutral to elicit symptoms
44
Cubital Tunnel Syndrome: Non-Operative Treatment (Splint, Exercise, Education)
- 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
Cubital Tunnel Syndrome: Post-Operative Treatment (Protection Phase)
- 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
Cubital Tunnel Syndrome: Post-Operative Treatment (Active Phase)
- 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
de Quervain Syndrome: Anatomical Cause
-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
de Quervain Syndrome: Can be caused by...?
- forceful, repetitive thumb abduction with wrist ulnar deviation
- carpometacarpal (CMC) OA
- scaphoid fracture
- intersection syndrome
- radial nerve neuritis
49
de Quervain Syndrome: Who is at greatest risk of developing it?
- 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
de Quervain Syndrome: Non-Operative Treatment (Medical)
-includes corticosteroid injections
51
de Quervain Syndrome: Non-Operative Treatment (OT - splint, ROM, exercises, etc.)
- 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
de Quervain Syndrome: Operative Treatment (Medical)
-surgical release of the first dorsal compartment
53
de Quervain Syndrome: Post-Operative Treatment (OT - splint, ROM, exercises, etc.)
- 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
Claw Deformity: Anatomical Cause
-distal ulnar nerve compression or lesion at the wrist
55
Claw Deformity: Can be caused by...?
- ganglion
- neuritis
- arthritis
- carpal fractures at Guyon's canal
56
Claw Deformity: Sensory Symptoms
- 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
Claw Deformity: Motor Symptoms
- 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
Froment's sign is one form of evaluation specific to claw deformity. What does this test consist of?
-flexion of the IP of the thumb when a lateral pinch is attempted
59
Wartenberg's sign is one form of evaluation specific to claw deformity. What does this test consist of?
-the fifth finger held abducted from the fourth finger
60
Jeanne's sign is one form of evaluation specific to claw deformity. What does this test consist of?
-hyperextension of the thumb MCP
61
Semmes-Weinstein monofilament testing is one form of evaluation specific to claw deformity. What does this test assess?
-loss of sensation
62
Claw Deformity: Non-Operative Treatment (Splint)
-an ulnar nerve palsy or anticlaw splint is used, and dynamic PIP extension assist may be added if PIP flexion contractures are present
63
Claw Deformity: Non-Operative Treatment (Activity Modification)
- 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
Claw Deformity: Non-Operative Treatment (Client Education)
-avoidance of postures and activities that aggravate the condition, such as ulnar deviation combined with wrist flexion
65
Claw Deformity: Post-Operative Treatment (Wound Care)
- bulky dressing is applied for 3-10 days
- wound care
- scar mobilization
66
Claw Deformity: Post-Operative Treatment (Splint)
- 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
Claw Deformity: Post-Operative Treatment (Sensory)
- 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
Claw Deformity: Post-Operative Treatment (ROM & Strengthening)
- AROM of the wrist and hand begins at 6 weeks
| - clients may resume ADLs and begin muscle strengthening and work conditioning, if needed
69
Claw Deformity: Post-Operative Treatment (Complications with Nerve Regeneration)
- 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
Digital Stenosing Tenosynovitis / Trigger Finger: Anatomical Cause
-sheath inflammation or nodules near the A1 pulley
71
Digital Stenosing Tenosynovitis / Trigger Finger: Treatment (Splint)
-splinting the MCP at 0 degrees for 3-6 weeks
72
Digital Stenosing Tenosynovitis / Trigger Finger: Treatment (Medical)
-surgically releasing the A1 pulley
73
Digital Stenosing Tenosynovitis / Trigger Finger: Sensory Reeducation after Nerve Injury (Protective Reeducation)
-protective reeducation educates clients to visually compensate for sensory loss and to avoid working with machinery and temperatures below 60 degrees
74
Digital Stenosing Tenosynovitis / Trigger Finger: Sensory Reeducation after Nerve Injury (Discriminative Reeducation)
-discriminative reeducation uses motivation and repetition in a vision-tactile matching process in which clients identify objects with and without vision
75
Digital Stenosing Tenosynovitis / Trigger Finger: Sensory Reeducation after Nerve Injury (Sensory Recovery)
-sensory recovery begins with pain perception and progresses to vibration of 30 cycles per second, moving touch, and constant touch
76
Digital Stenosing Tenosynovitis / Trigger Finger: Sensory Reeducation after Nerve Injury (Desensitization)
-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
