Peripheral N Entrapments: Upper Extremity

Question 1

what 3 symptoms do peripheral n entrapments cause

Answer 1

1. Pain
2. Sensory changes
3. Motor loss/dysfunction

Question 2

3 classifications of nerve injuries (Why does each happen) + what two are the cause of entrapments

Answer 2

1. Neurapraxia- loss of nerve conduction due to focal demylenation
2. Axonotmesis- more severe crushing of neve, proximities nerve has to regrow (6 m recovery)
   (1+2 usually entrapments)
3. Neurotmesis- complete laceration

Question 3

What is the progression of degeneration of compressive n injuries

Answer 3

Myelin sheath of large fibres undergoes mechanical distortion -> focal demyelination -> axonal damage -> Wallerian degeneration.

Question 4

what are 4 risk factors of pts with peripheral n entrapment

Answer 4

1. Pain in upper arm
2. Previous neck injury
3. Physical exam evidence of neuropathy proximal to suspected site of compression
4. Radiological deign of c spine

Question 5

what are the 5 entrapment sites of the median n

Answer 5

1. lig of struthers
2. Pronator syndrome
3. Bicipital aponeurosis
4. Ant interosseous n syndrome
5. carpal tunnel

Question 6

Pronator syndrome symptoms

Answer 6

Pain on ant surface of forearm causing decreased sensitivity of radial digits/weakness

Question 7

What are 4 tests to determine site of median n entrapment

Answer 7

1. resisted forarm pro (pronator teres)
2. Resisted flexion of PIP (flexor dig superficial)
3. elbow flex (bicipital aponeurosis)
4. Direct compression of pro tires

Question 8

tx of median n compression

Answer 8

• avoid activity which contribute to compression
• NSAIDS
• splinting at 90 in neutral w dorsiflex

Question 9

What are symptoms of ant interossueoses nerve entrapment

Answer 9

-poorly localized pain in pro forearm w insidious onset

Question 10

Diagnosis of ant interosseous nerve entrapment (tests)

Answer 10

• Inability to form ok sign

- weakness in pronator quadrates

Question 11

Symptoms of carpal tunnel syndrome

Answer 11

numbness, tingling in radial 3/1/2 digits

pain exacerbated by prolonged use of hand

Question 12

How do you sensory test carpal tunnel syndrome (2)

Answer 12

1. 2 point discrimination

2. Vibration sense (more sensitive)

Question 13

How do u motor test for carpal tunnel syndrome

Answer 13

1. Test abductor pollicis brevis

2. Test 1/2 lumbrical

Question 14

What are provacative tests of carpal tunnel syndrome

Answer 14

Phalens test
Tinels sign (tapping)

Question 15

Tx of carpal tunnel syndrome

Answer 15

discontinue offending activity
Splinting wrist in 20-25 degrees extension
NSAIDS
corticosteroids

Question 16

What are the 2 sites of entrapment of radial n

Answer 16

1. Post innteroseus n as it enters fibrous arch of supinator

2. Tendinous margin of the extensor carpi radials brevis

Question 17

Signs/symptoms of radial n comression

Answer 17

• Pain often @ site of compression
• Resisted sup produces pain (along w stretching it)
• middle finger resistance pot.

Question 18

tx of radial nerve compression (and if not successful)

Answer 18

• elimination of offending mech 4-6 weeks

- if not successful investigate neurolysis of nerve

Question 19

What are 5 causes of compression of the ulnar n

Answer 19

1. Thickened aponeurosis
2. hypertrophy of med head of Triceps
3. Osteophytes
4. increased cubital valgus
5. trauma or repetative elbow flex

Question 20

Signs/symptoms of ulnar nerve compression

Answer 20

• pain, aching, sharp pain at elbow/forearm
• paresthesia of ulnar 1 1/2 fingers
• atrophy of hypothenar mm

Question 21

Tests for ulnar n compression

Answer 21

• percussion on cubital tunnel
• Elbow flex test
• formets test- paper bw thumb and index

Question 22

tx of ulnar n compression

Answer 22

Avoid offending movements

• reduce elbow flex
• NSAIDS
• Elbow mobs/manip