Upper Limb Compressive Neuropathies Flashcards
what is the carpal tunnel of the wrist formed by
carpal bones and the flexor retinaculum
what passes through carpal tunnel
median nerve flexor digitorum superficialis (x4) flexor digitorum profundus (x4) flexor policis longus (x1)
what may swelling within carpal tunnel result in
median nerve compression
what gender does carpal tunnel syndrome affect more
women affected 8x more
what causes carpal tunnel syndrome
idiopathic can be secondary to RA and conditions which result in fluid retention such as pregnancy, diabetes, chronic renal failure, hypothryoidism (myxoedema) and also may be due to fractures around wrist esp colles fracture
what are symptoms of carpal tunnel syndrome
parathesiae in thumb and radial 2 and half fingers loss of sensation weakness of thumb clumsiness in medial nerve areas may be loss of sensation and wasting of thenar eminence
how is carpal tunnel syndrome diagnosed
symptoms reproduced by performing - tinels test (percussing over median nerve) - phalens test (holding wrists hyper-flexed which decreases space in carpal tunnel) nerve conduction studies confirm diagnosis with slowing of conduction across wrist
what is the non-operative treatment of carpal tunnel syndrome
use of wrist splints at night to prevent flexion (4 weeks) injection of corticosteroids can also be used
what is surgical treatment of carpal tunnel syndrome
carpal tunnel decompression involves division of transverse carpal ligament under local anaesthetic highly successful but small risk of damage to median nerve or branches
what is cubital tunnel syndrome
compression of ulnae nerve at the elbow behind the medial epicondyle (funny bone)
what causes cubital tunnel syndrome
tight band of fascia forming the roof of tunnel (Osborne’s fascia) or due to tightness at the inter muscular septum as nerve passes through or between the two heads at the origin of flexor carpi ulnaris
what is symptoms of cubital tunnel syndrome
paraesthesia in ulnar 1 and a half fingers (pinky and half ring finger) weakness of ulnar nerve innervated muscles may be present including 1st dorsal interosseous (abduction index finger) and adductor pollicis
how is cubital tunnel syndrome diagnosed
Tinels test Froments test nerve conduction studies confirm diagnosis
what is tinels test
percussing over cubital tunnel positive (ie complains of pain / numbness when do this)
what is froments test
hold flat piece of paper due to weakness of adductor pollicis, patient will compensate by flexing flexor pollicis longus of thumb to maintain grip
