Upper Extremity Entrapment Flashcards
What are the most common sites of entrapment for a median nerve entrapment?
- Pronator Teres : Muscular branch of median nerve- Anterior Interosseous Nerve- Carpal Tunnel Syndrome
Carpal tunnel vs. Pronator Teres Syndrome
Carpal tunnel: NO numbness or tingling in lateral forearm (only numbness and tingling in fingers)- Weakness with pronation
A 35 yo male computer programmer/handyman comes with with pain/heaviness in the forearm, paresthesias, and motor weakness along the distribution of the median nerve. They have an decreased ability to oppose and flex the thumb, index and middle fingers. He tells you that sometimes there is pain.What syndrome do you think they have? What test would you perform?
Pronator Teres - Median Nerve EntrapmentPerform Tinel’s test.
What is a treatment for Pronator Teres?
Counterstrain for forearm flexors
How do you diagnose Pronator Teres Syndrome clinically?
-Pain with resisted pronation- hypertonic pronator teres- (+) Tinel’s test
A 60 yo male OPP professor (like Dr. Sandhouse) comes with complaining of pain in the forearm. Upon physical exam, you notice that there is weakness and paralysis in the flexor pollicus longus, lateral flexor digitorum profundus, and pronator quadratus muscle w/ no sensory loss. What syndrome do you think they have? What test would you perform?
Anterior Interosseous Nerve - Median Nerve entrapment.Perform Froment’s sign test
What is the major difference between Pronator Teres Syndrom and AIN (Anterior Interosseus Nerve) Syndrome?
PTS = pain with resisted pronationAIN = No Pain w/ resisted pronation.
Any process that encroaches on the median nerve within the carpal tunnel, either extrinsically or intrinsically can lead to the clinical entity of ….?
Carpal tunnel syndrome!
A 40 yo f pregnant OPP professor comes in complaining of numbness, intermittent tingling on the THUMB, index, and long fingers and half of the ring finger. She says that at night, she feels more pain (nocturnal pain) and increased pain with activity. However, sensation to the palm region is OK, but she might have some thenar atrophy. What do you think she has? What do you recommend for her?
Carpal Tunnel SyndromeSURGERY!! ASAP! Because she has Thenar Atrophy. Thenar Atrophy is the #1 indicator for surgery.
What is the major MAJOR etiology for Carpal Tunnel Syndrome?
Repetitive Motion = activities that include flexing and extending the wrist, especially with additional weigh ton the hands.
Somatic dysfunction of lunate and capitate can result to what?
Carpal Tunnel syndrome
A patient comes into your clinic with numbness and tingling of the distal middle three fingers. What three special tests could you use to diagnose/exclude CTS?
Tinel’s signPhalen’s test Reverse Phalen’s test (Prayer’s Test)
What is the basic treatment of CTS based on?
Prevention
With CTS treatment, place the following in the correct order of treatment.a) OMTb) occupational therapyc) NSAIDd) Injectione) Brace/Splint
Least invasive to most invasive!So…e –> a –> b –> c –> d
If you have tried everything for CTS besides surgery, what type of surgery is most recommended?
One-Portal Endoscopic Surgery
What OMT techniques can you use to treat CTS?
Carpal bone articulation,HVLA of carpal bonesFlexor retinaculum release
What are the three most common sites of ulnar nerve entrapment?
- Ulnar groove- Cubital Tunnel- Guyon’s canal
If Homer Simpson had a normal human hand, what nerve supplies the flexor digitorum superficialis, flexor capri ulnatris, interossei, and ADDUCTOR POLLICIS (AP)?
Ulnar NerveShe seems to really like the Adductor Pollicis
A 14 yo f comes into your clinic complaining of decreased sensation in the fifth and medial fourth fingers. Upon looking at her hand, you notice that her muscles she has a CLAW hand. What problem do you think she has?
Ulnar nerve entrapment
What is extension of MCP and flexed PIP and DIPs result in?
Claw hand
The more distal an ulnar nerve entrapment the more _______ the claw hand.
PARTIAL
Entrapment between two heads of CFU in the Cubital tunnel results in a __________ Tinel sign at the elbow
Negative Tinel sign
If there is ulnar nerve entrapment in the guyon’s canal, you will have ____________ loss if it is proximal to canal and _______ if loss distal.
Muscle and sensory loss = proximalSensory loss = distal compression
A 50 yo f homeless person and a 24 yo m college student come in with wrist weakness, and wrist drop (unopposed flexion) with theirs hand stuck in the waiter’s tip position. They have numbness and tingling and the lateral and back side of their hand. What do you think they have?
Radial nerve entrapment - Spiral Groove (aka. Saturday Night Palsy)
A 24 yo f comes in with chronic aching pain/tenderness over the lateral elbow, usually 6-7 cm distal to the lateral epicondyle. She has partial wrist extension and no sensory loss with poor gripping strength. What problem do you think she has and where does it occur?
Radial nerve entrapment - Radial Tunnel Syndrome
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