UE Diagnostic Packet - Neurologic Conditions Flashcards
cause of thoracic outlet syndrome
compression of brachial plexus and/or associated vasculature
- subclavian art/vein
locations for thoracic outlet syndrome inducing entrapment
interscalene triangle
costoclavicular space
thoraco-coraco-pectoral space
TOS due to interscalene triangle entrapment causes
vascular and neurogenic issues only
risk factors for developing thoracic outlet syndrome
posture, tight anterior chest muscles
respiratory diseases
cervical rib
typical sensory presentation of TOS
pain
paresthesia
numbness
–> all nondermatomal
typical motor presentation of TOS
non-specific weakness in affected UE
what could aggravate symptoms of TOS
overhead use of UE
Cause of Erb-Duchenne Palsy
lesion to upper part of brachial plexus precipitated by traction-type injury
nerve root palsy specific to Erb-Duchenne palsy
C5 / C6 and sometimes C7
typical sensory presentation of Erb-Duchenne palsy
parestheisa
pain
numbness
–> all in C5,6 dermatome pattern
typical motor presentation associated with Erb-Duchenne palsy
significant decrease in shoulder/elbow flexion
atrophy of deltoid, supraspinatus, and infraspinatus muscles
Erb-Duchenne palsy affects which muscles and nerve roots
- Biceps Brachii (C5-7)
- Deltoid (C5,6)
- Supraspinatus (C5,6)
- Infraspinatus (C5,6)
cause of klumpke’s palsy
lesion to lower part of brachial plexus
nerve roots involved with klumpke’s palsy
C8,T1
– can involve C7
typical sensory presentation of klumpke’s palsy
paresthesia
pain
numbness
–> C7,8,T1 dermatomes
(medial arm, ulnar aspect of FA / hand)
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
compare motions lost in upper and lower plexus injuries
upper = shoulder elvation, external rotation, elbow flexion
lower = hand intrinsics
how is ROM and muscle performance affected by nerve palsys
weakness seen and AROM significantly reduced
explain palpation findings associated with nerve palsys
symptom reproduction with localized palpation of entrapment site
hypersensitivity
explain joint mobility associated with nerve palsy
likely to remain unaffected
- deficits may been seen with severe weakness due to immobilization
special tests associated with TOS
roos test
costoclavicular test
adson’s test
hyperabduction
cervical rotation/lateral flexion test
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
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
Outcome measures associated with carpal tunnel syndrome
DASH
Boston Carpal Tunnel Questionnaire
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
