Peripheral N Injuries & ULTTs Flashcards
Radiculopathy vs Mononeuropathy: what structure is involved?
Radiculopathy: N root compressed.
Mononeuropathy: single nerve disrupted.
Radiculopathy vs Mononeuropathy: common symptoms
Radiculopathy: follows dermatomes & myotomes.
Mononeuropathy: does NOT follow dermatomes & myotomes.
Median N entrapment sites/syndromes
- Ligament of Struthers (prox to elbow).
- Pronator Syndrome (pronator teres).
- AIN Syndrome (pronator teres).
- Carpal Tunnel Syndrome (transverse carpal ligament).
Ligament of Struthers compression: key sxs
-Pronator Teres mm affected.
-Motor + sensory loss.
Pronator Syndrome: motor loss (list the muscles)
-FPL
-APB
-FDP
-Opponens Pollicis
-Pronator Quadratus
*Pronator Teres spared.
Pronator Syndrome: P! reproduced with…
Resisted flex + pronation
Pronator Syndrome: sensory loss
-Digits 1-3
-Thenar
-Fingertips
AIN Syndrome: key sxs
-Pure motor.
-No sensory loss, but P! in forearm.
AIN Syndrome: motor loss (list the muscles)
-FPL
-FDP
-Pronator Quadratus
Kiloh-Nevin Sign
Unable to make OK sign.
Indicates AIN Syndrome.
Carpal Tunnel Syndrome: motor loss (list the muscles)
-APB
-Opponens Pollicis
-FPB
*Thenar atrophy
Carpal Tunnel Syndrome: P! reproduced with…
Prolonged wrist flexion
Carpal Tunnel Syndrome: sensory loss
-Digits 1-3
*Thenar spared.
Radial N entrapment sites/syndromes
- Crutch Palsy (axilla injury).
- High Radial N Injury (humerus fx).
- Radial Tunnel Syndrome (PIN in radial tunnel).
- PIN Syndrome (PIN compressed by supinator).
- Wartenberg’s Syndrome (superficial branch by ECRL + brachialis)
Crutch Palsy: motor loss
Weak:
-Elbow extension
-Wrist extension
-Digit extension
-Supination
Crutch Palsy: sensory loss
-Posterior/lateral arm, forearm, & wrist.
-Posterior thumb.
-Radial 2.5 digits (index, middle, half of ring).
High Radial N Injury: motor loss
-Wrist drop
-Weak thumb extension
*Triceps spared.
High Radial N Injury: sensory loss
-Posterior/lateral forearm & wrist.
-Posterior thumb.
-Radial 2.5 digits (index, middle, half of ring).
Radial Tunnel Syndrome: pain locations & key sxs
-No sensory loss.
-No motor loss (but may have weakness d/t pain-limited).
Pain:
-Radial tunnel (5cm distal to lateral epi).
-Radial aspect of proximal forearm.
Radial Tunnel Syndrome: P! aggravated by…
-Resisted supination.
-Resisted finger extension.
-Positioning in elbow extension, pronation, wrist flexion.
PIN Syndrome: key sxs
-Pure motor.
-P! in lateral elbow & forearm.
-Wrist extensor weakness.
-Dropped fingers & thumb.
Wartenberg’s Syndrome: MOI
Tight watch, handcuffs
Wartenberg’s Syndrome: key sxs & pain locations
-No motor loss.
-Pain/Sensory loss: dorsal hand, radial side.
Wartenberg’s Syndrome: P! aggravated by…
Flexion + UD
Ulnar N entrapment sites/syndromes
- Cubital Tunnel Syndrome (FCU).
- Guyon’s Canal (hook of hamate + transverse carpal ligament).
Cubital Tunnel Syndrome: MOI
-Prolonged elbow flexion.
-Fractures, bone spurs, arthritis.
Cubital Tunnel Syndrome: sensory loss
*Occurs early, before motor symptoms.
-Digits 4+5 (dorsal & palmar).
-Hypothenar.
Cubital Tunnel Syndrome: motor loss
*Occurs later.
-FDP
-Hypothenar
-Ulnar interossei
-Adductor Pollicis
Guyon’s Canal Syndrome: MOI
Heavy gripping
Guyon’s Canal Syndrome: sensory loss
-Digits 4+5 (palmar only).
-Hypothenar.
Guyon’s Canal Syndrome: motor loss
-Hypothenar
-Ulnar interossei
-Adductor Pollicis
ULTT: what indicates positive?
Reproduction of sxs.
>10deg difference in ROM btwn affected vs unaffected sides.
ULTT: how does cervical side bending affect symptoms?
Normal with nerve tension:
-SB toward = relief.
-SB away = worsens.
Impaired neurodynamics:
-Either direction may increase, decrease, or no change in symptoms.
ULTT A: nerve & steps
Median.
1. Shoulder abducted 90.
2. Supinate.
3. Shoulder ER.
4. Elbow ext.
*Maintain wrist ext throughout.
ULTT B: nerve & steps
Radial.
1. Elbow extended.
2. Pronate forearm & IR shoulder.
3. Flex wrist & fingers.
4. Abduct shoulder.
ULTT C: nerve & steps
Ulnar.
1. Shoulder abducted 90.
2. Pronate forearm & ER shoulder.
3. Ext wrist & fingers.
4. Flex elbow.
