neurovascular entrapments of shoulder, elbow, wrist Flashcards
arm vasculature
subclavian a – axillary – brachial – radial & ulnar – palmar
lymphatics of UE
RUE = R lymphatic duct
LUE = L lymphatic duct
neurapraxia
- least severe
- focal myelin injury, mild stretching injury
- intact axon & CT
axonotmesis
- medium severe
- axon injury, severe stretching injury
- incomplete recovery common
neurotmesis
- most severe
- complete axon disruption, rupture, avulsion of nerve
- little or no recovery
compression / direct pressure / entrapment
- nerves & vessels become trapped by tight muscles
- might involve compression b/n bones
- could squeeze BVs preventing normal flow of nutrients & O2
common nerve entrapment sites
- C spine
- brachial plexus
- thoracic outlet
- elbow
- wrist
shoulder nerve injuries to consider
- axillary
- long thoracic
- spinal accessory
- suprascapular
elbow/forearm nerve injuries to consider
- median
- radial
- ulnar
- posterior interosseous
hand nerve injuries to consider
- radial @ wrist
- ulnar @ wrist/elbow
- median @ wrist
cervical radiculopathy
compression of nerve root by spondylosis or herniated disc
* tests to do:
- vertebral point tenderness
- distraction
- compression
* avoid HVLA at level of herniation
Erb’s palsy
C5-6 nerve root injury falls on side of head & shoulder
Klumpke’s palsy
C8-T1 stretching injury from traction on arm during birth or compression from tumor
thoracic outlet syndrome
compression of brachial plexus / subclavian or axillary a
-d/t cervical 1st rib, tumor, hypertonicity of muscles or
-Adson’s test (abduct, ext R and feel for a radial pulse)
- Roo’s test (goal posts, hold for 2 mins, lose feeling is +)
pronator syndrome
median nerve compressed b/n humeral & ulnar heads of pronator teres muscle
- forearm aches
- decreased sensation at thenar eminence
- Tinel & Phalen negative
cubital tunnel syndrome
compression of ulnar nerve in cubital tunnel at the medial elbow
- 2nd most common compression neuropathy to UEs
- numb in 4-5th digits, ulnar side dorsum of hand
- Tinels at elbow, Phalen test
radial tunnel syndrome
pain in lateral aspect of forearm w/ ttp over radial tunnel
* pain only, NO motor or sensory loss
posterior interosseous nerve entrapment
*always associated with motor weakness, NO pain
- episodic forearm pain with progressive weakness of extensors
radial nerve neuropathy
- radial nerve compression injury = honeymoon palsy
- saturday night palsy = fall asleep with arm over chair
carpal tunnel syndrome
median nerve compressed at flexor retinaculum
- repetitive stress injury
- Tinel’s sign, Phalen’s maneuver
ulnar tunnel syndrome of the wrist
compression of ulnar nerve at wrist in Guyon’s tunnel
-numb in 4-5th digits, muscle atrophy with weakness of grip
FOOSH
- scaphoid fx = avascular osteonecrosis
- fx hook of hamate = ulnar tunnel syndrome
- SD of radial head
peripheral artery disease
decreased peripheral artery flow
- pain with arm exertion, +- dizziness
-asymmetric arm BPs
subclavian steal syndrome
stenosis or occlusion of subclavian artery proximal to origin of vertebral a.
-flow to ipsilateral UE is blocked
- retrograde flow from contralateral vertebral a
* No HVLA to area of stenosis
