Wrist & Hand Common Presentations: Nerve Entrapment Flashcards
peripheral nerve entrapment
- typically report vague pain or sensory disturbances
what must you rule in/out even if you have ruled in a peripheral nerve entrapment
cervical spine involvement and thoracic outlet syndrome
double crush syndrome
compression of a nerve at two or more locations
thoracic outlet syndrome
group of disorders that occur when blood vessels or nerves in the space btw the collarbone and first rib are compressed
common symptoms of thoracic outlet syndrome
numbness
pain
weakness
median nerve sensory loss
- 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
median nerve functional loss
- pronation, wrist flexion, radial deviation weak
- inability to oppose thumb or flex
- thumb abd weak
- gripping weak
- pinching weak/loss
- ape hand deformity
pronator syndrome
entrapment of median nerve as passes btw two parts of pronator teres
pt history with pronator syndrome
- 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
ape hand deformity
- thenar wasting
- first digit moving dorsally until it is in line with second
- median n. dysfunction
treatment for ape hand
- pain meds
- edema management
- flexibility exercise
- splinting
- functional strengthening/endurance/coordination
palpation with pronator teres syndrome
- pressure applied over pronator teres with resisted pronation, elbow and wrist flexion
special tests for pronator teres syndrome
- none
- carpal tunnel tests should be negative
- ULTT median n.
treatment for pronator teres syndrome
- RICE
- pain meds
- flexibility/strength of wrist flexors and pronators
- STM
- nerve glides/tensioners
median nerve - anterior interosseous sensory loss
none
median nerve - anterior interosseous functional loss
- pronation weak
- finger flexion weak
- pinching weak
anterior interosseous syndrome
entrapment of AIN
possible compression sites for median nerve - anterior interosseous
- tendinous origin of FDS
- accessory head of FPL
- tendinous origin of pronator teres
median nerve - anterior interosseous strength loss
triad of weakness:
flexor pollicis longus
flexor digitorum profundus of 2nd & 3rd digit
pronator quadratus
median nerve - anterior interosseous pain symptoms
resisted flexion of IP of thumb and DIP of index finger
carpal tunnel syndrome
median nerve compression at the wrist as it passes through the carpal tunnel
demographics of carpal tunnel
- any age, most common 40-60
- female > male
- half of cases related to repetitive and cumulative trauma at work
what should you limit with pt’s who have carpal tunnel
- vibration
- prolonged positioning at end range flexion and end range extension
initial characteristics of carpal tunnel
- intermittent pain & parathesisas in median n. distribution of hand
- becomes persistant
carpal tunnel weakness
- weakness and paralysis may occur if left untreated
- abductor pollicis brevis, opponens pollicis, lateral 2 lumbricals, flexor pollicis brevis
when are symptoms worse for pt’s who have carpal tunnel
at night due to position of wrist flexion
radial n. sensory loss
- C5 - T1
- posterior side of lateral 2/3s hand
- posterior and lateral thumb
- proximal posterior 2/3s index, middle and half of ring finger
radial n. functional loss
- supination, wrist extension, grasping weak
- inability to stabilize wrist
- loss of finger extension
- extreme difficulty to abduct thumb
high radial n. compression pt history
- insidious compression may occur at level of triceps due to strenuous muscle exercise
- traumatic: mid shaft humeral fracture
high radial n. compression strength loss/sensory loss/palpation site
- loss of wrist extension
- inability to extend fingers and thumb
- decreased first digit posterior web space
- site of entrapment should reproduce symptoms
radial n. - posterior interosseous nerve syndrome (PIN) sensory loss
none
radial n. - posterior interosseous nerve syndrome (PIN) functional loss
- wrist extension weak
- finger extension weak
- hard to stabilize wrist
- difficulty grasping and abducting thumb
radial n. - posterior interosseous nerve syndrome (PIN) common compression sites
- 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
radial n. - posterior interosseous nerve syndrome (PIN) where would you feel pain
- lateral elbow pain that radiates into distal forearm
- repeated pronation/supination
- resisted supination
treatment for radial n. - posterior interosseous nerve syndrome (PIN)
- nerve glides
- STM
- rest
- activity mod
- splinting
- gentle stretching
ulnar nerve sensory loss sites
- C8 - T1
- posterior and palmar aspect of little and medial half of ring finger
ulnar nerve functional loss
- 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
cubital tunnel syndrome
- entrapment of ulnar n. as runs through cubital tunnel
pt history with cubital tunnel syndrome
- insidious, can be trauma
- repetitive motion
- prolonged elbow flexion recreates symptoms
- overhead throwing athlete
- pain or paresthesia worst at night
- loss of grip strength
observation seen in cubital tunnel syndrome
- 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)
sensation/palpation/pain felt with cubital tunnel syndrome
- sensation: decreased in ulnar hand distribution
- palpation: tender at cubital tunnel
- pain: at 4th and 5th digits and elbow
guyon canal
entrapment of ulnar n. as passes btw pisiform and hook of hamate
pt history with guyon canal
- blunt trauma
- hook of hamate fx
- use of crutches
- repeated vibration
strength/sensation loss with guyon canal
- strength: weak hypothenar, adductor pollicis, interossei, medial 1/2 lumbricals
- sensation: decreased or absent of 5th and medial half of 4th digit
