Peripheral Nerve Entrapments & Conditions 39%

Question 1

Caused by trauma, obesity, and fluid retention due to pregnancy, hypothyroidism, RA.

• Site: under the flexor retinaculum
• Presents with numbness and tingling in the first three digits.
• Thenar atrophy, nocturnal pain, week opponens pollicis (ape hand appearance)

Answer 1

Carpal Tunnel Syndrome

Question 2

What nerve is affected with Carpal Tunnel Syndrome

Answer 2

Median Nerve

Question 3

What tests to dx Carpal Tunnel Syndrome?

Answer 3

Tinel’s, Phalen’s, Grip strength with dynamometer

Question 4

What treatment for Carpal Tunnel Syndrome?

Answer 4

Adjust, Cock up splint, natural diuretic Vit B6

Question 5

Caused by hypertonicity of the muscle by things such as occupation (carpenters, mechanics)

• Site: between heads at the elbow
• Anterior Interosseous Nerve
• Presents with pain and paresthesia on the volar aspect of the forearm, lateral palm and lateral digits
• Pain with pronation, wrist flexion, and has thenar atrophy

Answer 5

Pronator Teres Syndrome

associated with Median Nerve

Question 6

Tests for Pronator Teres Syndrome

Answer 6

Pinch Grip Test

Question 7

Treatment for Pronator Teres Syndrome

Answer 7

Trigger point therapy, Spray & Stretch

Question 8

Caused by direct trauma or repetitive microtrauma

• Site: at the tunnel of Guyon (under the hook of hamate), cubital tunnel (elbow).
• Presents with pain, tingling, and numbness in the last 2 digits and weakness of adductor pollicis (Claw Hand Deformity) and hypothenar atrophy.
• Will present with weak wrist flexion on the ulnar side ***

Answer 8

Ulnar Nerve - Cubital Tunnel entrapment

Question 9

Palsy of the lower brachial plexus (C8-T1) from childbirth

- Creates a claw hand deformity with flexion of wrist

Answer 9

Klumpke’s Paralysis

Question 10

Caused by trauma, lead poisoning or pressure from crutches

• Wrist Drop (unable to extend elbow and wrist)
• Erb’s Palsy (Waiter’s Tip Deformity: adduction, internal rotation and flexion of the wrist)
• Site: Spiral Groove
• Presents with loss of triceps reflex
• Decreased sensation to posterior arm, forearm, and posterolateral 3.5 fingers

Answer 10

Radial Nerve

Question 11

The result of numerous causes, including traumatic, iatrogenic, and idiopathic processes that most often result in nerve injury and paralysis of the serratus anterior
- Scapular (medial) winging

Answer 11

Long Thoracic Nerve

Question 12

Nerve injury and paralysis of the Rhomboid muscles

- Flaring of the scapula

Answer 12

Dorsal Scapular Nerve

Question 13

Caused by external pressure, obesity and tight jeans.

• Site: over the pelvic brim under the inguinal ligament
• Meralgia Paresthetica (L2, L3 nerve roots)
• Presents with burning dysesthesia on anterolateral thigh
• Tx: advise with weight loss and loose clothing

Answer 13

Lateral Femoral Cutaneous Nerve

Question 14

Caused by trauma, traction, wallet pressure, piriformis, and muscle spasm.

• Site: pelvis, hip, popliteal fossa
• Presents with sensory pain in the posterior buttocks, thigh, leg down to floor.
• Weak knee flexion and decreased achilles reflex.
• DDx with facet

Answer 14

Sciatic (Sciatica)

Question 15

Presents with burning paresthesia and decreased sensation on soles of feet and weak muscles of the foot aggravated by walking or standing.

• Medial Plantar Nerve and Tibial Nerve
• Tx: adjust, orthotic support to keep foot in inversion

Answer 15

Tarsal Tunnel Syndrome

Medial plantar nerve and Tibial Nerve

Question 16

Caused by repetitive microtrauma, narrow toed shoes, RA or foot deformities.

• Site: between 3rd and 4th metatarsals
• Presents with pain in the toes and dorsum of foot
• Surgery may be necessary

Answer 16

Morton’s Neuroma

Intermetatarsal neuroma

Question 17

Presents with pain in the lateral aspect of the leg, weak peroneal muscle, or foot drop.

• Caused by trauma
• Site: Fibular Head

Answer 17

Common Peroneal Nerve

Question 18

Anterior Compartment Syndrome

• Can affect any and all four muscles of that compartment: Tibialis Anterior, Extensor Hallucis Longus, Extensor Digitorum Longus, and Peroneus Tertius.
• s/s similar to Charcot Marie Tooth

Answer 18

Deep Peroneal Nerve

Question 19

A deformity in which the fingertip is curled in and cannot straighten itself. This deformity usually results from injury, which either damages the tendon or tears the tendon from the bone.

Answer 19

Mallet Finger

Question 20

Hyper-flexion of the DIP and hyper-extension of the PIP.

- Seen with RA

Answer 20

Swan Neck Deformity

Question 21

Hyper-extension of the DIP and hyper-flexion of the PIP.

- Seen with RA

Answer 21

Boutonniere Deformity

Question 22

An abnormal thickening underneath the skin of the palm and fingers. Causes the last two fingers to curl into the palm. Later on the middle finger may be involved.

Answer 22

Dupuytren’s Contracture

Question 23

A finger becomes locked in a flexed position. The finger locks when one of the tendons that flex the finger become inflamed and swollen. To straighten the finger, a person must force the swollen area into the sheath producing a popping or snapping.

Answer 23

Trigger Finger

Question 24

Inflammation of extensor pollicis brevis and the abductor pollicis longus tendons on the side of the wrist at the base of the thumb. Can be brought on by simple strain injury. Treated by bracing the thumb and wrist.

Answer 24

DeQuervain’s Tenosynovitis

Question 25

DeQuervain’s Tenosynovitis test

Answer 25

Finkelstein’s Test