UE Diagnostic Packet - Neurologic Conditions Flashcards by Owen Honroth

cause of thoracic outlet syndrome

compression of brachial plexus and/or associated vasculature
- subclavian art/vein

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locations for thoracic outlet syndrome inducing entrapment

interscalene triangle
costoclavicular space
thoraco-coraco-pectoral space

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TOS due to interscalene triangle entrapment causes

vascular and neurogenic issues only

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risk factors for developing thoracic outlet syndrome

posture, tight anterior chest muscles

respiratory diseases

cervical rib

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typical sensory presentation of TOS

pain
paresthesia
numbness
–> all nondermatomal

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typical motor presentation of TOS

non-specific weakness in affected UE

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what could aggravate symptoms of TOS

overhead use of UE

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Cause of Erb-Duchenne Palsy

lesion to upper part of brachial plexus precipitated by traction-type injury

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nerve root palsy specific to Erb-Duchenne palsy

C5 / C6 and sometimes C7

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typical sensory presentation of Erb-Duchenne palsy

parestheisa
pain
numbness
–> all in C5,6 dermatome pattern

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typical motor presentation associated with Erb-Duchenne palsy

significant decrease in shoulder/elbow flexion

atrophy of deltoid, supraspinatus, and infraspinatus muscles

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Erb-Duchenne palsy affects which muscles and nerve roots

Biceps Brachii (C5-7)
Deltoid (C5,6)
Supraspinatus (C5,6)
Infraspinatus (C5,6)

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cause of klumpke’s palsy

lesion to lower part of brachial plexus

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nerve roots involved with klumpke’s palsy

C8,T1

– can involve C7

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typical sensory presentation of klumpke’s palsy

paresthesia
pain
numbness
–> C7,8,T1 dermatomes
(medial arm, ulnar aspect of FA / hand)

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typical motor presentation of klumpke’s palsy

inability to use the hand

palsy in muscles supplied by C8,T1
- ulnar and median nerve muscles
- finger extensors
- extensor carpi ulnaris

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compare motions lost in upper and lower plexus injuries

upper = shoulder elvation, external rotation, elbow flexion

lower = hand intrinsics

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how is ROM and muscle performance affected by nerve palsys

weakness seen and AROM significantly reduced

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explain palpation findings associated with nerve palsys

symptom reproduction with localized palpation of entrapment site

hypersensitivity

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explain joint mobility associated with nerve palsy

likely to remain unaffected
- deficits may been seen with severe weakness due to immobilization

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special tests associated with TOS

roos test
costoclavicular test
adson’s test
hyperabduction
cervical rotation/lateral flexion test

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intervention focus for TOS

education on positioning, repetitive tasks

restoration of upper quadrant muscle strength/mobility

manual therapy to reduce pain / improve postural mobility

nerve glides

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intervention focus of plexus injuries

development of strength, flexibility, stamina and coordination

maintaining ROM via PROM, positioning/splinting

functional training/adaptive devices if needed

pain control via TENS / NMES

edema management

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Outcome measures associated with carpal tunnel syndrome

DASH
Boston Carpal Tunnel Questionnaire

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Pronator Syndrome cause

high median nerve entrapment precipitated by compression of median nerve before it branches --> can be associated with repetitive overuse activities (pro/supination)

typical sensory presentation for pronator syndrome

paresthesia pain numbness --> in median nerve distribution --> palmar sensation affected

median nerve distribution

palmar aspect of digits 1-3 radial half of digit 4 dorsal aspect of fingertips and nailbeds

typical motor presentation for pronator syndrome

weakness in thumb, index, and middle finger weakness in pronation

typical motor presentation for anterior interosseous nerve lesion

weakness of FDP / flexor pollicis longus inability to make OK sign

cause of CTS

compression of median nerve at the carpal tunnel

strong risk factors for CTS

obesity, female, older age

typical onset of symptoms related to CTS

at night may involve digits 1-3

typical sensory presentation for carpal tunnel syndrome

paresthesia pain numbness --> all in or part of median nerve distribution thenar eminence will be spared

sensory impairments specifically seen in CTS

object recognition manipulation coordination grading movement

typical motor presentation for carpal tunnel syndrome

1,2 LOAF muscle weakness --> FDP / FPL sparring

clinical prediction rule for CTS

shaking hands relieving symptoms wrist ratio >0.67 (measures in cm) symptom severity scale >1.9 diminished sensation in median sensory field of thumb >45 years old

how to differentiate Pronator and Carpal Tunnel Syndrome

sensory loss in palm (pronator) inability to make OK sign (pronator) weak thumb abduction (carpal tunnel)

what should not be used for diagnosis of CTS? why?

lateral pinch test thumb flexion uses median and ulnar nerve FPL via AIN would be sparred

efficacy of grip strength as an outcome measure for CTS? what about any other recommendations?

do not use within 3 months of surgery - MAYBE do grip/3 point pinch (C level evidence) - do not do sensory / vibratory testing

explain palpation associated with CTS and Pronator Syndrome

symptom reproduction is often present with Tinel's anterior elbow pain (PS)

explain joint mobility associated with CTS

may be unremarkable/normal

special test to determine level of median nerve entrapment

CTS cluster tinel's phalen's OK sign

when is surgery indicated in CTS

unresolved symptoms after >3 months of treatment thenar atrophy monofilament testing score exceeds 3.61

cause of Saturday Night palsy

compression of radial nerve in axilla

specific population that SNP can be seen in

those who use axillary crutches

typical sensory presentation of SNP

paresthesia, pain and numbness over 1st dorsal interosseous muscles dorsal hand muscles

typical motor presentation for Saturday night palsy

wrist, finger, thumb extension issue Triceps sparring (elbow extension)

what should be ruled out when determining SNP

brachial neuritis cervical radiculopathy

cause of Radial Tunnel Syndrome

impingement or compression of radial nerve at radial tunnel in lateral elbow

where does the radial nerve branch? what does it branch to?

radial tunnel - posterior interosseous nerve

differentiating factor between radial tunnel syndrome and PIN syndrome

RTS = no motor loss PIN = motor loss

differentiating sensory factor between RTS and PINS

trick question -- both have no sensory loss

typical sensory presentation associated with radial tunnel syndrome

pain with repetitive wrist flexion and/or pronation --> no true sensory loss

typical motor presentation associated with RTS

no true motor loss pain with resisted supination

location and type of pain associated with radial tunnel syndrome

distal to lateral epicondyle belly of brachioradialis deep aching

muscle performance associated with SNP

wrist, finger, thumb extension loss

interventions associated with RTS vs SNP

avoidance of repetitive aggravating movements modification of crutches (both)

interventions associated with radial nerve entrapments

stretching radial nerve glides soft tissue mobs progressive loading of radial muscles

cause of cubital tunnel syndrome

impingement of ulnar nerve at cubital tunnel that can be precipitated by - traction injury at elbow - valgus deformity at elbow - sustained elbow flexion

subjective reports specific to cubital tunnel syndrome

worse in morning clumsiness of hand / fingers

typical sensory presentation of cubital tunnel syndrome

paresthesia, pain and numbness --> ulnar digits (palmar and dorsal) and hypothenar eminence

typical motor presentation associated with cubital tunnel syndrome

weakness in 5th digit adduction thumb adduction opposition

cause of guyon's canal

compression of ulnar nerve at guyon's canal

common population for guyon's canal syndrome

cyclists -- will report shaking the hands makes pain go away

typical sensory presentation of guyon's canal syndrome

paresteshia, pain, numbness in: 4th/5th digit palmar and dorsal --> hypothenar eminence will be sparred

typical motor presentation associated with guyon's canal syndrome

intrinsic muscle weakness -- weak finger abduction / thumb adduction

those with more severe/prolonged guyon's canal syndrome will present with

clawing deformity of 4th/5th digit intrinsic hand muscle wasting atrophy of thumb web space

special tests associated with cubital tunnel syndrome

pressure provocation test elbow flexion tests

special tests associated with guyon's canal syndrome

froment's sign

interventions related to ulnar nerve entrapments

activity modification (splinting/padding) education - tendon gliding/nerve gliding manual - ulnar nerve entrapment reduction

key points post carpal tunnel release during protection phase

limit end range wrist motions lightweight removeable splint during day stiff night splint