neurovascular entrapments of shoulder, elbow, wrist

Question 1

arm vasculature

Answer 1

subclavian a – axillary – brachial – radial & ulnar – palmar

Question 2

lymphatics of UE

Answer 2

RUE = R lymphatic duct
LUE = L lymphatic duct

Question 3

neurapraxia

Answer 3

• least severe
• focal myelin injury, mild stretching injury
• intact axon & CT

Question 4

axonotmesis

Answer 4

• medium severe
• axon injury, severe stretching injury
• incomplete recovery common

Question 5

neurotmesis

Answer 5

• most severe
• complete axon disruption, rupture, avulsion of nerve
• little or no recovery

Question 6

compression / direct pressure / entrapment

Answer 6

• nerves & vessels become trapped by tight muscles
• might involve compression b/n bones
• could squeeze BVs preventing normal flow of nutrients & O2

Question 7

common nerve entrapment sites

Answer 7

• C spine
• brachial plexus
• thoracic outlet
• elbow
• wrist

Question 8

shoulder nerve injuries to consider

Answer 8

• axillary
• long thoracic
• spinal accessory
• suprascapular

Question 9

elbow/forearm nerve injuries to consider

Answer 9

• median
• radial
• ulnar
• posterior interosseous

Question 10

hand nerve injuries to consider

Answer 10

• radial @ wrist
• ulnar @ wrist/elbow
• median @ wrist

Question 11

cervical radiculopathy

Answer 11

compression of nerve root by spondylosis or herniated disc
* tests to do:
- vertebral point tenderness
- distraction
- compression
* avoid HVLA at level of herniation

Question 12

Erb’s palsy

Answer 12

C5-6 nerve root injury falls on side of head & shoulder

Question 13

Klumpke’s palsy

Answer 13

C8-T1 stretching injury from traction on arm during birth or compression from tumor

Question 14

thoracic outlet syndrome

Answer 14

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 +)

Question 15

pronator syndrome

Answer 15

median nerve compressed b/n humeral & ulnar heads of pronator teres muscle
- forearm aches
- decreased sensation at thenar eminence
- Tinel & Phalen negative

Question 16

cubital tunnel syndrome

Answer 16

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

Question 17

radial tunnel syndrome

Answer 17

pain in lateral aspect of forearm w/ ttp over radial tunnel
* pain only, NO motor or sensory loss

Question 18

posterior interosseous nerve entrapment

Answer 18

*always associated with motor weakness, NO pain
- episodic forearm pain with progressive weakness of extensors

Question 19

radial nerve neuropathy

Answer 19

1. radial nerve compression injury = honeymoon palsy
2. saturday night palsy = fall asleep with arm over chair

Question 20

carpal tunnel syndrome

Answer 20

median nerve compressed at flexor retinaculum
- repetitive stress injury
- Tinel’s sign, Phalen’s maneuver

Question 21

ulnar tunnel syndrome of the wrist

Answer 21

compression of ulnar nerve at wrist in Guyon’s tunnel
-numb in 4-5th digits, muscle atrophy with weakness of grip

Question 22

FOOSH

Answer 22

1. scaphoid fx = avascular osteonecrosis
2. fx hook of hamate = ulnar tunnel syndrome
3. SD of radial head

Question 23

peripheral artery disease

Answer 23

decreased peripheral artery flow
- pain with arm exertion, +- dizziness
-asymmetric arm BPs

Question 24

subclavian steal syndrome

Answer 24

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