O: Nerve Entrapment

Question 1

what is soft tissue rheumatism?

Answer 1

general term to describe pain that is caused by inflammation/ damage to ligaments, tendons, muscles or nerves near a joint

Question 2

s/s of soft tissue rheumatism?

Answer 2

localised pain at specific site

Question 3

what’s the difference between soft tissue rheumatism and fibromyalgia in terms of presentation?

Answer 3

STR: specific localised pain
fibromyalgia: generalised soft tissue pain

Question 4

common sites for soft tissue rheumatism?

Answer 4

neck, shoulder, elbow, wrist, pelvis, foot

Question 5

ix for soft tissue rheumatism?

Answer 5

x-ray, mri

Question 6

tx for soft tissue rheumatism

Answer 6

conservative- analgesia, rest, ice compress, physio, steroid injections

Question 7

what is carpal tunnel syndrome?

Answer 7

relative ischaemia of medial nerve

Question 8

T/F: carpal tunnel is common in women >60

Answer 8

F: women >30

Question 9

aetiology of carpal tunnel?

Answer 9

pregnancy, hypothyroidism, diabetes, obesity, RA, acromegaly, fluid overload

Question 10

pathophysiology of carpal tunnel?

Answer 10

compression of median nerve at wrist due to hypertrophy or oedema of the flexor synovium

Question 11

which muscles does the median nerve supply?

Answer 11

LOAF 
Lumbricalis IF & MF
Opponens 
Abductor Pollicis Brevis 
Flexor Pollicis Brevis

Question 12

where would you assess medial nerve function in hand?

Answer 12

palmar aspect hand, thumb, index, middle and radial half of ring finger

Question 13

s/s of carpal tunnel?

Answer 13

pins & needles- esp in morning, pain, clumsiness, fingers feel swollen- relief of symptoms by shaking hand

Question 14

what are late signs of carpal tunnel?

Answer 14

weakness and numbness

Question 15

ix for carpal tunnel?

Answer 15

exam: thenar atrophy, altered sensation, weakness
ix: Kamath & Stothard questionnaire, EMG

Question 16

what are the 3 specialised tests for carpal tunnel?

Answer 16

Tinel’s test, Phalen’s test,Durkin’s Test

Question 17

mx for carpal tunnel?

Answer 17

mild- splint, physio, steroid injections

severe- carpal tunnel decompression surgery (divides transverse carpal ligament)

Question 18

what is cubital tunnel syndrome?

Answer 18

neuropathy and relative ischaemia of ulnar nerve usually as a result of compression of elbow region

Question 19

do males or females tend to get cubital tunnel syndrome?

Answer 19

males

Question 20

aetiology of cubital TS?

Answer 20

trauma to medial epicondyle, direct pressure, arthritis, medial epicondylitis

Question 21

which muscles does ulnar nerve supply sensation to?

Answer 21

all other nerves except LOAF

Question 22

s/s of cubital TS?

Answer 22

pins and needles, pain in ring and little finger, clumsiness

Question 23

ix for cubital TS?

Answer 23

exam: hypothenar and interosseous atrophy, clawing of ring and small finger, altered sensation, weakness- grasp/pinch
ix: nerve conduction studies

Question 24

what is the signs and specialist tests for cubital TS?

Answer 24

Wartenberg’s sign (abduction of small finger)

Tinel’s, Phalen’s, Froment’s sign

Question 25

mx for cubital TS?

Answer 25

mild- elbow splint, physio, NSAIDs

severe- ulnar nerve decompression, medial epicondylectomy