Peripheral compression nerve syndromes.

Question 1

what are the peripheral nerve compression syndromes ?

Answer 1

upper body
carpal tunnel syndrome - median nerve

cubital tunnel syndrome- ulnar nerve

GUYAN canal syndrome - ulna nerve

posterior interosseous nerve entrapment

lower limb
tarsal tunnel syndrome

Question 2

what is carpal tunnel syndrome ?

Answer 2

compression of the median nerve as as it passes under the flexor retinaculum which is a traverse carpal ligament on the palmar side forming the roof of the carpal tunnel

Question 3

what are the signs and symptoms of carpal tunnel syndrome ?

Answer 3

it causes pain , numbness and tingling to the the thumb , index finger , middle finger and radial side of the ring finger

muscle weakness - clumsiness when holding objects

thenar muscles warts away because the median never innervates the flexor pollicus longs

the symptoms are worst at night after a day of use of the wrist

pregnancy

Question 4

what causes carpal tunnel syndrome ?

Answer 4

inflammation of the nearby tendons and tissue leading to edema in the carpal tunnel

pregnancy

repetitive stress like typing

obesity

ra

Question 5

how can you diagnose carpal tunnel syndrome

Answer 5

electrophysiological testing

phalanx manuever - flex the wrist as far as possible for one minute
results in numbness of the area innervated by the median nerve

tinel sign
tapping the transverse carpal ligaments causing the symtoms to appear

Question 6

treatment of carpal tunnel syndrome ?

Answer 6

behaviour modification when typing

physical therapy

inflammation - injection of corticosteroid

surgery which is cut the transverse carpal ligamanent

Question 7

the ulnar nerve passes behind and under which epicondyle in the humerus ?

Answer 7

the medial epicondyle

Question 8

causes of cubital tunnel syndrome ?

Answer 8

cubital valgus
elbow dislocation 
arthritis  
repeatedly leaning on you elbow 
keep the elbow flexed for a very long time 

most frequent site of compression is between the two heads of the flexor carpi ulnaris muscle

Question 9

what are the symptoms of cubital tunnel syndrome ?

Answer 9

can be motor or sensory

motor - flexion of the wrist
innervates the medial half of flexor digitoum profundus
and flexor carpi ulnaris
clumsiness and muscle wasting

deep branch - dosrsal and palmar interosseous muscle
abduction and flexion of hypothenar
adductor pollicus
and

palmar and dorsal part of ulnar half of the hand

pain tingling and numbness in the ulnar half of the hand

Question 10

how can we diagnose cubital tunnel syndrome ?

Answer 10

Tinel sign - tapping on the cubital tunnel and checking for sensations

Froment sign - weakness of adductor pollicus innervated by the ulnar nerve
when pinching a poevce of paper between the thumb and index finger the thumb interphalangeal joint will flex , the flexor pollicus longus which is innervated by the median nerve willl substitute the function of adductor pollicus

electrophysiological testing

Question 11

where is the guyans canal located

Answer 11

space medially bounded by the pisiform and lateral bounded by the hook of the hamate more distally
floor - flexor retinaculum which is a traverse carpal ligament

the guys canal contains the ulnar nerve with its deep motor division an superficial sensory division
and the ulnar artery

Question 12

causes of guyan canal syndrome ?

Answer 12

volar ganglion cyst
hook of hamate fracture
repetitive compression and trauma
pisiform fracture or dislocation

Question 13

what are the signs and symptoms of guyan canal syndrome ?

Answer 13

deep branch of the ulnar nerve innervates the palmar and the dorsal interosseus muscle helping the adduction and flexion and extension

innervates the hypothenar muscles
adductor pollicus
and palmar and dorsal sensory innervation of the ulnar half

pain and parenthesis in the ulnar half of the hand
clawing of the 4/5 the fingers - th flexor digitorium profundus is working causing the clawing
interosseous muscle atrophy and wasting (high ulnar nerve palsy less clawing of the hand)

weak grasp due to intrinsic muscle wasting

Question 14

how do we diagnose guyan canal syndrome ?

Answer 14

froment test

EMG study

Question 15

treatment of guyan canal syndrome ?

Answer 15

cute the transverse carpal ligament

splinting

Question 16

what causes posterioir interossues nerve entrapment ?

Answer 16

from monteggia or radial head
lipomas
repetitive pronation and supination movements

Question 17

where is the tarsal tunnel located ?

Answer 17

part of the inner leg
covered by the flexor retinaculum (from the medial malleolus of tibial to calcaneus )

posterioir tibial artery
tendons of tibias posterioir
flexor digitorium longus
flexor hallucis longus

Question 18

what nerve does the tarsal tunnel syndrome compress ?

Answer 18

posterioir tibial nerve

Question 19

what causes tarsal tunnel syndrome

Answer 19

space occupying lipoma or ganglion cyst
varicose viens
rheumatoid arthritis
broken or sprained ankle - fracture of talus
flat feet putting increase stress in the tarsal tunnel area

Question 20

what are the symptoms of tarsal tunnel syndrome ?

Answer 20

burning pain , numbness , tingling around ankle and plantar aspect of of feet

swelling of ankle

symptoms are exacerbated by walking or standing and at night
and received with rest and elevation

Question 21

what is the diagnosis ?

Answer 21

Tinel sign - tapping on the nerve posterioir to the medial malleolus cause radiating pain to the ankle and foot

dorsiflexion of the ankle and bring toe into extension hod this position and palpate for tenderness in the posterioir tibia nerve

EMG and nerve studies

Question 22

what is the treatment ?

Answer 22

nonoperative
corticosteroids
immobilisation

surgical release of the tarsal tunnel if non operative fails - release the flexor retinaculum