Upper Limb Compressive Neuropathies

Question 1

What is the carpal tunnel of the wrist formed by?

Answer 1

Carpal bones and flexor retinaculum

Question 2

Which nerve passes through the carpal tunnel?

Answer 2

Median nerve

Question 3

As well as the median nerve, what else passes through the carpal tunnel?

Answer 3

9 flexor tendons

(Flexor digitorum superficialis - 4 tendons, Flexor digitorum profundus - 4 tendons and Flexor pollicis longus tendon)

Question 4

What is the principle behind carpal tunnel syndrome?

Answer 4

Compression of the carpal tunnel causes median nerve compression

Question 5

Most cases of carpal tunnel syndrome are __________

Answer 5

Idiopathic

Question 6

Carpal tunnel syndrome can occur secondary to which pathologies?

Answer 6

1. RA
2. Conditions resulting in fluid retention e.g. pregancy, diabetes, chronic renal failure, hypothyroidism
3. Fractures around the wrist

Question 7

A Colles’ fracture is a fracture associated with carpal tunnel syndrome, what is it?

Answer 7

A fracture of the distal radius in which the fractured radius bend backwards

Question 8

Which sex is affected more by carpal tunnel syndrome?

Answer 8

Females

Question 9

How will patients with carpal tunnel present?

Answer 9

1. Parasthesia/clumsines in median nerve affected digits - thumb and radial 2 1/2 fingers
2. Pain is usually worse at night
3. Loss of sensation
4. Weakness of thumb

Question 10

What may be found on examination for carpal tunnel syndrome?

Answer 10

1. Loss of sensation
2. Muscle wasting at thenar eminence

Question 11

Which tests can reproduce symptoms of carpal tunnel syndrome?

Answer 11

1. Tinel’s test - pecussion over medial nerve
2. Phalen’s test - holds wrists hyper-flexed

Question 12

How can carpal tunnel syndrome be diagnosed?

Answer 12

Nerve conduction studies

Question 13

What are the treatment options for carpal tunnel syndrome?

Answer 13

1. Non surgical - wrist splints, injection of corticosteroid
2. Surgical - carpal tunnel decompression (division of transverse carpal ligament)

Question 14

Cubital tunnel syndrome involves compression of which nerve?

Answer 14

Ulnar nerve

Question 15

Where does compression of the ulnar nerve take place in cubital tunnel sydrome?

Answer 15

Elbow behind the medial epicondyle

Question 16

How do patients present with cubital tunnel syndrome?

Answer 16

Parasthesia of ulnar 1 1/2 fingers

Question 17

Which clinical tests can aid in the diagnosis if cubital tunnel syndrome

Answer 17

Tinel’s test (over cubital fossa)

Froment’s test - weakness of ulnar innervated muscles may be present e.g. adductor pollicis - the patient is asked to hold an object between their thumb and index finger and the examiner tried to pull it out

Question 18

What may cause compression of the ulnar nerve in cubital tunnel syndrome?

Answer 18

Osbourne’s fascia - ight band of fascia forming around the roof of the tunnel

Question 19

What can confirm the diagnosis of cubital tunnel syndrome?

Answer 19

Nerve conduction studies

(surgical release of any tight structures may then be required)