Pain Syndromes Flashcards
Cubital Bursitis
Pain the front of the elbow (antecubital area)
Cubital Bursitis (bicipitalradial bursa)
NSAIDs
Bursae injection
Cubital Tunnel Syndrome
Ulnar nerve entrapment at the elbow
Confirmation of Cubital Tunnel Syndrome
EMG
Untreated Cubital tunnel Syndrome
May develop weakness in the hand
Atrophy of the hand muscles
Permanent flexion contractures of the fingers
Cubital tunnel Syndrome Treatment
NSAIDS
Steroid injections
Surgery
Cubital Tunnel Presentation
Produces pain and numbness from the inside back of the elbow down to the wrist and into the inside fourth and fifth finger
May lead to small muscle wasting of the hand and the ulnar side of the forearm
Pronator Teres Syndrome
Compression of the median nerve proximal to the carpal tunnel by the pronator teres muscle resulting in pain in the forearm
Pronator Teres Syndrome Presentation
- “tiredness” in the foream
- Clumsiness and weakness of the hand muscles (index/middle finger)
- Pain and numbness in the hand in the same pattern as carpal tunnel syndrome.
- Symptoms worsened by repetitive pronation and supination
Pronator Teres Syndrome
Negative Tinel’s Sign
Cause of Pronator Teres Syndrome
The syndrome is caused by inflammation of the muscle of the forearm responsible for rotating the hand from palm up to palm down position.
Cause of Pronator teres Syndrome
Activities such as repetitive elbow movements in chopping wood, rowing a boat, etc
Test for pronator teres syndrome
The pronator test is placing the elbow on a table and turning the palm down. The patient is instructed to resist the examiner rotating the palm upwards. If pain is produced in the forearm during this process, there is a positive pronator sign.
Treatment of pronator teres syndrome
NSAIDS Rest of the arm and elbow Avoidance of the repetitive triggering activity Steroid injections Surgery is rarely required.
Lateral epicondylitis presentation
Provoked pain of the lateral proximal forearm and lateral elbow with resisted wrist extension
Anterior interosseous nerve
Motor nerve only
Branch of median nerve
Anterior interosseous nerve
Innervates deep muscles of he forearm:
FPL (thumb), FDP to the( index and middle fingers), pronator quadratus
Anterior interosseous nerve Presentation
No motor function of the three muscles
Unable to make the “O” sign
Posterior Interosseous nerve
Purely motor nerve that branches from the radial nerve
Posterior Interosseous nerve
Consider in patients with weakness of the finger extensors
Severe cases may show radial deviation of the wrist with wrist extension
Posterior Interosseous Nerve presentation
Inability to extend thumb and other fingers
Lack of sensory disturbance
What are early signs of Posterior Interosseous nerve
Provocative pain of the lateral proximal forearm with resisted extension of the middle finger
Consider in patients with weakness of the finger extensors
What does it innervate Posterior Interosseous nerve
Innervates the finger Ulnar wrist extensors Thumb extensor Abductor muscles Extensor muscles of the forearm and hand Spares the radial wrist extensor
Where can it get entrapped and was is it described as( Posterior Interosseous Nerve)
Arcade of Frohse (part of the supinator muscle)
Described as a finger drop
Carpal tunnel syndrome
Sensory deficits 1st-4th finger
Decrease in muscle strength
Worsened by repetitive wrist flexion
Thoracic outlet syndrome
- Shoulder pain
- Pallor or coldness of the hand
- Negative Adsons test
Radial Nerve palsy (Wrist drop)
Weakness: 1. Wrist 2. Finger extensors 3. Brachioradialis muscle Preserved Triceps strength
Diff dx for Inability to extend the fingers in the setting of RA
- Extensor tendon rupture
- MCP joint dislocation
- Posterior interosseous Nerve compression
Presentation of extensor tendon rupture due to poorly controlled RA
Weakness of the middle through small finger extensors
Intact thumb abductors and wrist extensors
Extensor tendon rupture presentation
Inability to extend fingers in the order of 5th, 4th and 3rd
Lack of sensory disturbance
Piriformis Muscle
Muscle externally rotate the extended thigh and assists in abduction of flexed thigh
What is piriformis syndrome
Compression or irritation of the sciatic nerve by the piriformis muscle
Symptoms of Piriformis Syndrome
Sciatica- radiating pain down the leg Deep, boring pain in the buttock Tight and painful hamstrings Radiating pain in the calf Tightness and decreased mobility in the hip Pain in the hip Low back pain Generally one sided pain
Maneuver for piriformis syndrome
FADIR test: illicits buttock pain
- Passive flexion
- Adduction
- Internal rotation of the right hip with the patient in the supine position
Activities that exacerbate piriformis syndrome
Sitting
Activities that adduct and internally rotate the hip
Meralgia Paresthetica
Compression of lateral femoral cutaneous nerve (L2-L3)
Purely sensory defect
Burning pain with hyperesthesia and numbness of anterolateral thigh
Obese, pregnant, diabetics, trauma, tight clothes
Ischial Bursitis:
“Weaver’s bottom”
Trauma or prolonged sitting
Pain when sitting or lying down
Pain may radiate down back of thigh
Ischial Bursitis:
Bursa is superficial to the ischial tuberosity and separtates the gluteus maximus from the tuberosity
Tarsal Tunnel Syndrome
Posterior tibial nerve is compressed at or near the flexor retinaculum
Flexor retinaculum is located posterior and inferior to the medial malleolus
Tarsal Tunnel Syndrome Presentation
Medial ankle pain
Numbness, burning pain, and paresthesias of the toes and sole extend proximally to the area over the medial malleolus
Pain with eversion and dorsiflexion
Tarsal Tunnel Syndrome sign
+Tinel’s sign-percussion posterior to the medial malleolus
Peroneal Tendon Injury
Cause of lateral ankle pain
Fx rule out in Peroneal Tendon Injury
Fibular Fx
Peroneal Tendon Maneuvers
Active dorsiflexion and eversion of the foot against resistance
Peroneal Tendon Injury treatment
Protection Rest Ice Compression Medication Physical therapy Ankle taping Lateral Heel wedges
Common peroneal nerve compression
Difficulty with foot dorsiflexion or foot drop
Tibialis posterior tendon (TPT)
Medial ankle pain
Maneuvers Tibialis posterior tendon (TPT)
Plantar flexion
Inversion of the foot
Stabilization of the medial longitudinal arch
Maneuvers that exacerbate tibialis posterior tendon (TPT) pain
Standing on tiptoe
Inability to repeat raises on tiptoe
Varus deviation of the heel
Sign tibialis posterior tendon (TPT) pain
Too many toes signs
Anterior Tibialis tendon rupture
Swelling of the anterior ankle
Mild foot drop
Straight leg raising maneuver
+pain radiating below the knee with leg elevation 10-60 degrees
SI or hip joint pathology maneuver
FABER test:
- Flexion
- Abduction
- External rotation
