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MSK > Wrist & Hand Common Presentations: Nerve Entrapment > Flashcards

Wrist & Hand Common Presentations: Nerve Entrapment Flashcards

1
Q

peripheral nerve entrapment

A
  • typically report vague pain or sensory disturbances
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2
Q

what must you rule in/out even if you have ruled in a peripheral nerve entrapment

A

cervical spine involvement and thoracic outlet syndrome

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3
Q

double crush syndrome

A

compression of a nerve at two or more locations

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4
Q

thoracic outlet syndrome

A

group of disorders that occur when blood vessels or nerves in the space btw the collarbone and first rib are compressed

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5
Q

common symptoms of thoracic outlet syndrome

A

numbness
pain
weakness

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6
Q

median nerve sensory loss

A
  • C5 - T1
  • palmar aspect of hand: thumb, index, middle and lateral half of ring finger
  • posterior: distal third of index, middle and lateral half of ring finger
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7
Q

median nerve functional loss

A
  • pronation, wrist flexion, radial deviation weak
  • inability to oppose thumb or flex
  • thumb abd weak
  • gripping weak
  • pinching weak/loss
  • ape hand deformity
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8
Q

pronator syndrome

A

entrapment of median nerve as passes btw two parts of pronator teres

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9
Q

pt history with pronator syndrome

A
  • insidious
  • pain at anterior aspect of elbow, radial side of palm, palmar side of first, second, third and fourth digit
  • heaviness & weak in forearm & hand
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10
Q

ape hand deformity

A
  • thenar wasting
  • first digit moving dorsally until it is in line with second
  • median n. dysfunction
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11
Q

treatment for ape hand

A
  • pain meds
  • edema management
  • flexibility exercise
  • splinting
  • functional strengthening/endurance/coordination
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12
Q

palpation with pronator teres syndrome

A
  • pressure applied over pronator teres with resisted pronation, elbow and wrist flexion
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13
Q

special tests for pronator teres syndrome

A
  • none
  • carpal tunnel tests should be negative
    • ULTT median n.
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14
Q

treatment for pronator teres syndrome

A
  • RICE
  • pain meds
  • flexibility/strength of wrist flexors and pronators
  • STM
  • nerve glides/tensioners
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15
Q

median nerve - anterior interosseous sensory loss

A

none

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16
Q

median nerve - anterior interosseous functional loss

A
  • pronation weak
  • finger flexion weak
  • pinching weak
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17
Q

anterior interosseous syndrome

A

entrapment of AIN

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18
Q

possible compression sites for median nerve - anterior interosseous

A
  • tendinous origin of FDS
  • accessory head of FPL
  • tendinous origin of pronator teres
19
Q

median nerve - anterior interosseous strength loss

A

triad of weakness:
flexor pollicis longus
flexor digitorum profundus of 2nd & 3rd digit
pronator quadratus

20
Q

median nerve - anterior interosseous pain symptoms

A

resisted flexion of IP of thumb and DIP of index finger

21
Q

carpal tunnel syndrome

A

median nerve compression at the wrist as it passes through the carpal tunnel

22
Q

demographics of carpal tunnel

A
  • any age, most common 40-60
  • female > male
  • half of cases related to repetitive and cumulative trauma at work
23
Q

what should you limit with pt’s who have carpal tunnel

A
  • vibration

- prolonged positioning at end range flexion and end range extension

24
Q

initial characteristics of carpal tunnel

A
  • intermittent pain & parathesisas in median n. distribution of hand
  • becomes persistant
25
Q

carpal tunnel weakness

A
  • weakness and paralysis may occur if left untreated

- abductor pollicis brevis, opponens pollicis, lateral 2 lumbricals, flexor pollicis brevis

26
Q

when are symptoms worse for pt’s who have carpal tunnel

A

at night due to position of wrist flexion

27
Q

radial n. sensory loss

A
  • C5 - T1
  • posterior side of lateral 2/3s hand
  • posterior and lateral thumb
  • proximal posterior 2/3s index, middle and half of ring finger
28
Q

radial n. functional loss

A
  • supination, wrist extension, grasping weak
  • inability to stabilize wrist
  • loss of finger extension
  • extreme difficulty to abduct thumb
29
Q

high radial n. compression pt history

A
  • insidious compression may occur at level of triceps due to strenuous muscle exercise
  • traumatic: mid shaft humeral fracture
30
Q

high radial n. compression strength loss/sensory loss/palpation site

A
  • loss of wrist extension
  • inability to extend fingers and thumb
  • decreased first digit posterior web space
  • site of entrapment should reproduce symptoms
31
Q

radial n. - posterior interosseous nerve syndrome (PIN) sensory loss

A

none

32
Q

radial n. - posterior interosseous nerve syndrome (PIN) functional loss

A
  • wrist extension weak
  • finger extension weak
  • hard to stabilize wrist
  • difficulty grasping and abducting thumb
33
Q

radial n. - posterior interosseous nerve syndrome (PIN) common compression sites

A
  • fibrous bands that connect brachialis and brachioradialis
  • under blood vessels that cross the nerve at the radial neck
  • medial proximal portion of ECRB
  • fibrous bands at proximal and distal edge of supinator
34
Q

radial n. - posterior interosseous nerve syndrome (PIN) where would you feel pain

A
  • lateral elbow pain that radiates into distal forearm
  • repeated pronation/supination
  • resisted supination
35
Q

treatment for radial n. - posterior interosseous nerve syndrome (PIN)

A
  • nerve glides
  • STM
  • rest
  • activity mod
  • splinting
  • gentle stretching
36
Q

ulnar nerve sensory loss sites

A
  • C8 - T1

- posterior and palmar aspect of little and medial half of ring finger

37
Q

ulnar nerve functional loss

A
  • wrist flexion weak
  • loss of ulnar deviation, DIP flexion of pinky, abduction and adduction of fingers
  • inability to extend 2nd and 3rd phalanges of pinky and ring finger
38
Q

cubital tunnel syndrome

A
  • entrapment of ulnar n. as runs through cubital tunnel
39
Q

pt history with cubital tunnel syndrome

A
  • insidious, can be trauma
  • repetitive motion
  • prolonged elbow flexion recreates symptoms
  • overhead throwing athlete
  • pain or paresthesia worst at night
  • loss of grip strength
40
Q

observation seen in cubital tunnel syndrome

A
  • excessive elbow varus or valgus
  • claw contracture of the 4th & 5th fingers (late) –> loss of lumbricals
  • atrophy or weakness of ulnar intrinsic muscles of hand (late)
41
Q

sensation/palpation/pain felt with cubital tunnel syndrome

A
  • sensation: decreased in ulnar hand distribution
  • palpation: tender at cubital tunnel
  • pain: at 4th and 5th digits and elbow
42
Q

guyon canal

A

entrapment of ulnar n. as passes btw pisiform and hook of hamate

43
Q

pt history with guyon canal

A
  • blunt trauma
  • hook of hamate fx
  • use of crutches
  • repeated vibration
44
Q

strength/sensation loss with guyon canal

A
  • strength: weak hypothenar, adductor pollicis, interossei, medial 1/2 lumbricals
  • sensation: decreased or absent of 5th and medial half of 4th digit

MSK (13 decks)

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