Upper limb compressive neuropathies Flashcards
Carpal tunnel syndrome
Compression of the median nerve as it passes through the carpal tunnel causing loss of sensation in particular areas in the hand.
What forms the carpal tunnel?
The carpal bones and the flexor retinaculum.
Where is sensation lost?
The thumb, index finger, middle finger and half of the ring finger.
Symptoms of carpal tunnel syndrome
Parathesia (abnormal sensation)
Loss of sensation
On examination- muscle wasting in the thenar (in extreme cases)
What occurs to cause carpal tunnel syndrome?
Any swelling in the carpal tunnel will compress the median nerve.
What runs through the carpal tunnel?
The median nerve and 9 flexor tendons.
Tests for carpal tunnel syndrome
Tinels test- percussing over the median nerve
Phalens test- Holding wrists in flexion decreasing the space in the carpal tunnel
Treatment of carpal tunnel syndrome
Non-operative- steroid injections
Use of splints at night
Operative- carpal tunnel decompression
Why/who gets carpal tunnel syndrome?
Usually random
Can occur secondary to other conditions such as RA (synovitis- means less space), and fluid retaining- pregnancy, diabetes, chronic renal failure, hypothyroidism
Can also be a consequence of wrist fracture
Cubital tunnel syndrome
Compression of the ulnar nerve at the elbow behind the medial epichondyle.
Causes of cubital tunnel syndrome
Tightness of the Osborne fascia.
Tightness of the intermuscular septum between the two heads at the origin of flexor carpi ulnaris.
Patient presentation of cubital tunnel syndrome
Parathesia in the ulnar fingers (little finger and half of the ring finger).
Weakness of ulnar nerve innervated muscles.
Tinels test positive
Treatment of cubital tunnel syndrome
Surgical release.
