Upper Limb Compressive Neuropathies Flashcards
What is the carpal tunnel of the wrist formed by?
Carpal bones and flexor retinaculum
Which nerve passes through the carpal tunnel?
Median nerve
As well as the median nerve, what else passes through the carpal tunnel?
9 flexor tendons
(Flexor digitorum superficialis - 4 tendons, Flexor digitorum profundus - 4 tendons and Flexor pollicis longus tendon)
What is the principle behind carpal tunnel syndrome?
Compression of the carpal tunnel causes median nerve compression
Most cases of carpal tunnel syndrome are __________
Idiopathic
Carpal tunnel syndrome can occur secondary to which pathologies?
- RA
- Conditions resulting in fluid retention e.g. pregancy, diabetes, chronic renal failure, hypothyroidism
- Fractures around the wrist
A Colles’ fracture is a fracture associated with carpal tunnel syndrome, what is it?
A fracture of the distal radius in which the fractured radius bend backwards
Which sex is affected more by carpal tunnel syndrome?
Females
How will patients with carpal tunnel present?
- Parasthesia/clumsines in median nerve affected digits - thumb and radial 2 1/2 fingers
- Pain is usually worse at night
- Loss of sensation
- Weakness of thumb
What may be found on examination for carpal tunnel syndrome?
- Loss of sensation
- Muscle wasting at thenar eminence
Which tests can reproduce symptoms of carpal tunnel syndrome?
- Tinel’s test - pecussion over medial nerve
- Phalen’s test - holds wrists hyper-flexed
How can carpal tunnel syndrome be diagnosed?
Nerve conduction studies
What are the treatment options for carpal tunnel syndrome?
- Non surgical - wrist splints, injection of corticosteroid
- Surgical - carpal tunnel decompression (division of transverse carpal ligament)
Cubital tunnel syndrome involves compression of which nerve?
Ulnar nerve
Where does compression of the ulnar nerve take place in cubital tunnel sydrome?
Elbow behind the medial epicondyle
How do patients present with cubital tunnel syndrome?
Parasthesia of ulnar 1 1/2 fingers
Which clinical tests can aid in the diagnosis if cubital tunnel syndrome
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
What may cause compression of the ulnar nerve in cubital tunnel syndrome?
Osbourne’s fascia - ight band of fascia forming around the roof of the tunnel
What can confirm the diagnosis of cubital tunnel syndrome?
Nerve conduction studies
(surgical release of any tight structures may then be required)
