Neurovascular Entrapment Syndromes Flashcards
brachial plexus structure
5 ventral rami - C5-T1 3 trunks 6 divisions (3 ant, 3 post) 3 cords 5 peripheral nerves
digits 4 and 5 innervation
ulnar nerve
digits 1 to 3 palm
median nerve
digits 1 to 3 back of hand
radial nerve
-also back of arm to above elvow
axillary nerve
side of shoulder
sympathetics to upper extremity
T2-6
major joints
start proximal, move distal
bounds of thoracic outlet
spinal column
first ribs
sternum
clavicle
structures in thoracic outlet
brachial plexus
subclavian artery
subclavian vein
causes of thoracic outlet syndrome
scalene tension cervical rib SD pec minor tumor whiplash fractured clavicle
compression locations for TOS
scalenes - anterior and middle
pec minor - rib and pec minor
costoclavicular articulation - clavicle and first rib
Sx of TOS
neurologic and vascular
brachial plexus compression
numbness
parasthesias
muscle weakness
subclavian artery compression
distal thromboembolism
arm pain with exertion - claudication
acute arterial thrombosis
subclavian vein compression
DVT
extremity swelling
claudication
pain with exertion
adsons test
arm extended, abducted, ext rotated
-feel pulse
roos test
arms up, open/close hands
spurlings maneuver
cervical compression test
hyperabduction test
abduct, extend arm
- deep breath
- feel pulse
Tx for TOS
PT NSAIDs steroids muscle block surgical decompression
OMT for TOS
SD of ribs, clavicle, sibsons fascia, C-spine, T-spine, etc.
ulnar nerve entrapment
compression of ulnar nerve (C7,8 T1)
areas of compression with UNE
epicondylar groove
cubital tunnel
guyons canal
tardy ulnar palsy
entrapment in epicondylar groove
aching pain medial elbow, migrates distal numb 4/5 digits produced with elbow flexion motor symptoms less common -possible claw hand, loss of dexterity
cubital tunnel syndrome
compression of ulnar nerve between 2 heads of flexor carpi ulnaris
- hypertonicity of muscles
- numb 4/5 digits
- produced with elbow flexion
- motor symptoms less comon
Sx same as tardy ulnar palsy
-difference is where impingement is
guyons canal neuropathy
damage to ulnar nerve between pisohamate ligament anteriorly and flexor retinaculum posteriorly
hand weakness, atrophy intrinsic hand muscles
- loss dexterity
- variable sensory loss
- clawing of digits 4/5
tests for ulnar nerve entrapment
tinels - tap on elbow and wrist elbow flexion - max for 1 minute pressure test - through all 3 flexion and pressure (combo) palpation for local nerve tenderness and thickening
Tx for ulnar nerve entrapment
OMT don't lean on elbows limit flexion at night NSAIDs PT steroid injection medial epicondylectomy cubital tunnel release surgery ulnar nerve transposition surgery
carpal tunnel syndrome
THE most common mononeuropathy
compression of median nerve
median nerve
C6-8 T1
carpal tunnel
transverse carpal ligament
carpal bones
median nerve and flexor tendons
Sx of carpal tunnel
pain, paresthsia, numbness in 1st three digits
- weak grip strength
- hand pain at night
- thenar atrophy and sensory loss
aromatase inhibitor use
risk factor for carpal tunnel
carpal tunnel syndrome tests
tinels**
phalens (reverse prayer)** correlates with severty
prayer sign
carpal compression
confirmation of carpal tunnel
EMG
Tx for carpal tunnel
cock up splint NSAIDs steroid yoga/stretch PT nerve/tendon gliding exercise ultra sound therapy ergonomic key board surgical decompression
double crush syndrome
compression at one point not significant to cause Sx
- multiple compression sites have cumulative effect leading to impaired neuronal signaling
- when in doubt, check entire length of nerve and its nerve roots
