Upper Limb Compressive Neuropathies

Question 1

carpal tunnel syndrome

Answer 1

medial nerve compression caused by swelling in the confines of the carpal tunnel

Question 2

contents of the carpal tunnel

Answer 2

Question 3

causes of carpal tunnel syndrome

Answer 3

idiopathic

RA - less space due to synovitis

fluid retention - pregnancy (symptoms subside at birth), diabetes, chronic renal failure, hypothyroidism

fracture around wrist

Question 4

which type of fracture can cause carpal tunnel syndrome

Answer 4

colles fracture

Question 5

are women or men more affected by carpal tunnel syndrome

Answer 5

women (8x)

Question 6

carpal tunnel syndrome clinical presentation

Answer 6

paraesthesia in the median nerve around innervated digits (thumb and 2.5 digits), usually worse at night

loss of sensation and weakness/clumsiness in area supplied by median nerve

demonstratable loss of sensation/muscle wasting of thenar eminence

Question 7

what 2 test can be used to demonstrate carpal tunnel syndrome symptoms

Answer 7

tinel’s and phalen’s test

Question 8

tinel’s test - median nerve

Answer 8

percussing over median nerve

Question 9

phalen’s test

Answer 9

decreases space in carpal tunnel

Question 10

in carpal tunnel syndrome what happens to the nerve conduction in the wrist

Answer 10

slowing

Question 11

treatment of carpal tunnel syndrome

Answer 11

non operative: splints at night to prevent flexion and injection of corticosteroid

surgical: carpal tunnel decompression

Question 12

cubital tunnel syndrome

Answer 12

compression of the ulnar nerve at the elbow behind the medial epicondyle - funny bone area

Question 13

clinical features of cubital tunnel syndrome

Answer 13

paraesthesia in the ulnar 1.5 fingers

positive tinel’s test over cubital fossa

Question 14

how can weakness of ulnar innervated nerves be demonstrated in cubital tunnel syndrome

Answer 14

1st dorsal interosseous - abduction of index finger

adductor pollicus - froment’s test

Question 15

what is the adductor pollicus innervated by

Answer 15

ulnar nerve

Question 16

what can cause cubital tunnel syndrome

Answer 16

tight band of fascia forming the roof of the tunnel - Osborne’s fascia

or due to tightness at the intermuscular septum as the nerve passes through

or between the 2 heads at the origin of flexor carpi ulnaris.

Question 17

positive froment’s test

Answer 17

due to weakness of adductor pollicus the patient will compensate action by flexing flexor pollicus longus of thumb to maintain grip strength

ulnar nerve