Peripheral Nerve Injuries Flashcards
What are the Median Nerve Entrapment Syndromes?
Pronator Syndrome
Anterior Interosseous Syndrome
Carpal Tunnel
What are the Radial Nerve Entrapment Syndromes?
Posterior Interosseous Syndrome
Radial Tunnel Syndrome
Wartenburg’s Syndrome
What are the Ulnar Nerve Entrapment Syndromes?
Cubital Tunnel
Guyon’s Canal
With Pronator Syndrome:
Where is the Site of Compression?
What Symptoms are Expected?
What Exam Findings Are Expected?
Compression Site: Between the Two heads of the Pronator Teres or between the FDS and FDP
Symptoms: anterior elbow pain over pronator and forearm that get worse with activity, no night pain
Exam Findings: Pain with pronator compression
With Pronator Syndrome:
What Sensory Loss is Expected?
What Motor Loss is Expected?
Sensory: digits 1-3 and thenar eminence
Motor: thumb, index, and middle finger
With Anterior Interosseous Syndrome:
Where is the Site of Compression?
What Symptoms are Expected?
What Exam Findings Are Expected?
Compression Site: As the nerve exits the pronator teres
Symptoms: 8-12 hours of forearm pain that resolves, inability to make the OK sign
Exam Findings: No pain with compressions but pain with thumb or index IP resisted flexion
With Anterior Interosseous Syndrome:
What Sensory Loss is Expected?
What Motor Loss is Expected?
Sensory: NO SENSORY LOSS
Motor: FPL, FDL, and pronator quadratus
With Carpal Tunnel:
Where is the Site of Compression?
What Symptoms are Expected?
What Exam Findings Are Expected?
Compression Site: between the carpal ligament and ulnar bursa
Symptoms: night symptoms, shaking hand for relief
Exam Findings: Phalen’s (+), compression, Tinel’s (+)
With Carpal Tunnel:
What Sensory Loss is Expected?
What Motor Loss is Expected?
Sensory: Digits 1-3, radial half of 4th digit
Motor: weak FPB, abductor pollicis, OP, and lumbricals 1-2
With Cubital Tunnel:
What Nerve is compressed?
Where is the Site of Compression?
What Symptoms are Expected?
What Exam Findings Are Expected?
Nerve: Ulnar
Compression Site: Can be in Cubital Tunnel. in Arcade of Struthers, in Fascia of the FCU, or between the heads of the FCU
Symptoms: clumsiness of the hand, loss of coordination, snapping/popping with flexion/extension, and pain is worse at night
Exam: Wartenberg Sign (abduction of the 5th digit), Tinel (+) @ cubital tunnel, tingling with elbow flexion, Froment’s sign (inability to hold tip to tip due to adductor pollicis and FPB weakness)
With Cubital Tunnel:
What Sensory Loss is Expected?
What Motor Loss is Expected?
Sensory: Digits 4-5
Motor: Weakness of FCU, FDP, adductor policis, interossei, hypothenar muscles, and lumbricals 3-4
With Guyon’s Canal:
What Nerve is Being Compressed?
What is the Site of Compression?
What Symptoms are expected?
What exam findings are expected?
Nerve: Ulnar
Sit of Compression: Between hook of Hamate and pisiform
Symptoms: hand clumsiness and weakness as well as numbness and tingling in digits 4-5
Exam: Froment’s and Wartenburg Signs (+)
With Guyon’s Canal:
What Sensory Loss is expected?
What Motor loss is expected?
Sensory: Digits 4-5
Motor: Weak adductor policis, interossei, hypothenar, and lumbricals 3-4
With Posterior Interosseous Syndrome:
What Nerve is Being Compressed?
What is the Site of Compression?
What Symptoms are expected?
What exam findings are expected?
Nerve: Radial
Sit of Compression: Arcade of Froshe and supinator
Symptoms: lateral forearm and elbow pain as well as functional wrist drop
Exam: Pain with extension and radial deviation and pain with thumb extension
With Posterior Interosseous Syndrome:
What Sensory Loss is expected?
What Motor loss is expected?
Sensory: NO SENSORY LOSS
Motor: weakness in ECU, some extension weakness and finger extensor weakness
With Radial Tunnel Syndrome:
What Nerve is Being Compressed?
What is the Site of Compression?
What Symptoms are expected?
What exam findings are expected?
Nerve: Radial
Sit of Compression: Arcade of Froshe and Supinator
Symptoms: symptoms more distal than with epicondylalgia that are a deep ache and pain at the brachioradialis
Exam: pain with resisted supination and pain with wrist flexion and pronation
With Radial Tunnel Syndrome:
What Sensory Loss is expected?
What Motor loss is expected?
Sensory: NO SENSORY LOSS
Motor: Lack of Motor Loss
With Wartenberg’s Syndrome:
What Symptoms are expected?
What Sensory Loss is expected?
What motor loss is expected?
Symptoms: handcuff palsy
Sensory: radial dorsum of hand and posterior thumb
Motor: no motor loss
What Nerve Pathologies typically involve night pain?
Cubital Tunnel and Carpal Tunnel
What nerve pathologies have activity based symptoms?
Pronator Teres Syndrome
What Nerve Pathologies have no Sensory Loss associated with them?
Anterior and Posterior Interosseous Nerve Syndromes
What Nerve Pathologies have no motor Loss associated with them?
Radial tunnel and Posterior Interosseous Nerve Syndromes
How can you differentiate between radial nerve syndrome and posterior interosseous syndrome?
Special Tests for:
PIN: Index Finger extension with palm rested on table
RTS: middle finger extension, compression over radial tunnel, wrist extension
What are the component of the Carpal Tunnel CPR?
-shaking hands improve symptoms
-wrist-ratio index greater than .67
-symptom severity score is over 1.9
-age over 45
-diminished sensation in median nerve distribution
Will Phalen’s test be positive for Pronator Teres syndrome?
No
How is the presentation of pronator teres syndrome different from carpal tunnel syndrome?
the thenar eminence has sensory loss as well, not just digits 1-3 with pronator teres syndrome
What are the 3 (5 levels) Sedon Classifications for nerve injury?
Neuropraxia-least severe-grade 1
-temporary palsy associated with prolonged ischemia with usually a full recovery
Axonotmesis-grades 2-4
-loss of axons or nerve fibers due to a crush or laceration usually, can have full or incomplete recovery
Neurotmesis-grade 5-most severe
-loss of axons and nerve fubers such as perineum and epineurium and high risk of no recovery of the nerve function
What is Saturday night palsy?
What symptoms are associated with this palsy?
Where is the typical location of the injury? What happens if the injury is proximal to this area?
an upper arm lesion of the radial nerve due to compression (also known as Crutch Palsy)
associated with weakness distal to triceps and sensory loss in dorsum of hand and first two digits
typically at spiral groove but if proximal to spiral groove then sensory loss happens in posterior arm and forearm as well as hand and triceps are also weak
What nerve is likely injured if a person present with a hand deformity where their hand has the thumb abducted and a flat thenar eminence that resembles an Ape’s hand?
Median Nerve
What nerve is likely injured if a person present with a hand deformity where their hand has the fingers flexed, mostly fingers 4 and 5 with 2-3 slightly extended and the MCP joints are extended (bishop’s sign)
Ulnar Nerve
What nerve may be injured in a claw hand deformity?
both Ulnar nerve and Median Nerve
What hand deformity would you expect wit a radial nerve injury?
wrist drop
How is the Axillary nerve usually injured?
Where are the sensory and motor deficits?
often result of dislocation
sensory deficits in axillary patch
motor deficits in teres minor and deltoid
How is the suprascapular nerve usually injured?
What SxS are usually associated with this nerve injury?
traction injury, direct trauma, or due to cysts
often mistaken as a RTC tear
-deep burning that is worse with horizontal adduction
-TTP over suprascapular or spinoglenoid notches
-no sensory deficits
-RTC weakness and atrophy of supra/infraspinatus muscles
How is the Long Thoracic Nerve usually injured?
What are common clinical findings associated with this nerve injury?
usually idiopathic but can occur when you fall and land on your side
clinical features
-scapular winging
-pain is possible (usually an ache)
-affects serratus anterior so weakness in this muscle is likely
For Non-Operative nerve injury rehabilitation, what should the focus be on?
What stretching regimen should be implemented?
What is likely timeframe?
How often should E-stim be performed?
-focus on education and pain control while maintaining strength and ROM and controlling inflammation
stretching should be avoided but mobility work is encouraged to prevent contractures
Timeframe depends but plan on a lengthy recovery
E-stim should not be used as it has not been found to be beneficial
How would you bias a straight leg raise to target the Sciatic Nerve?
Sural nerve?
Posterior Tibial Nerve?
Common Peroneal Nerve?
Sciatic-hip flexion, IR, and adduction + ankle dorsiflexion
Sural N.-Hip flexion plus ankle dorsiflexion and inversion (SID)
Posterior Tib-hip flexion, ankle dorsiflexion, and eversion + toe extension (TED)
Common Peroneal neve symptoms. ankle plantarflexion and inversion (PIP)
Where would the motor and sensory symptoms be if a patient had a Femoral Nerve Mononeuropathy?
Motor: Quad weakness and possible atrophy ad if entrapment is prior to inguinal line hip flexion would be weak as well
Sensory: Anterior leg and Saphenous nerve distribution
Where would the motor and sensory symptoms be if a patient had a Saphenous Nerve Mononeuropathy?
Motor: None
Sensory: medial knee, medial lower leg, medial foot, and 1st MTP
Where would the motor and sensory symptoms be if a patient had an Obturator Nerve Mononeuropathy?
Motor: adductors post-exercise weakness
Sensory: medial thigh
