Entrapment Neuropathies I

Medical Sciences Medical School 5121 with Boesler at Nova Southeastern University

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By: Danielle Beharie
Created: 2012-02-28
Size: 41 flashcards
Views: 11

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Entrapment Neuropathy

Distinctive clinical neuropathic sensory and motor syndrome caused by physical compression or irritation

Classification

Neuropraxia
Axonotrmesis
Neurotrnesis

Neuropraxia

Reversible compression of nerve

Axonotemesis

Preservation of the nerve sheath with AFFERENT fiber degeneration distally causing complete denervation

Neurotemesis

Nerve is completely severed

Which category of entrapment is not a true entrapment?

Neurotemesis

Diagnosis

Nerve conduction-emg, MRI
Differentiate between true entrapment and systemic disease

Causes

Compression from neighboring structures
Somatic dysfunction
Repetitive stress
Compromise of local circulation
Direct trauma
Metabolic causes

Describe EMG of neuropathy

Decreased responses in muses supplied by same nerve or nerve root

Treatment of entrapment

Aimed for correction of underlying pathology
OMT
Splinting-CTS
pain meds
PT,OT
Education
Surgery

What are the four branches of the Median nerve?

Articular-elbow joint
Muscular- pronator teres
AIN- no sensory loss
Palmer cutaneous branch- does not go through carpal tunnel. So sensation remains over lateral palm and thumb

Most common sites of median nerve entrapment

Pronator teres
Anterior interosseus nerve
Carpal tunnel

Symptoms of Pronator Teres syndrome

Pain/ heaviness in forearm
Paresthesias
Motor weakness among distribution of the median nerve

Hallmark changes of CTS

Numbness, intermittent tingling of the thumb, index finger, long fingers and half ring finger
Association with nocturnal pain and after activity
Thenar atrophy
Sensation remains on palm region

Other symptoms of CTS

Muscle weakness of index and middle and thumb
Lack of feeling that may cause a person to drop objects
Difficulty in fine hand motor activities
Fatigue
Stiffness or cramping

Risk factors for CTS

Diabetes, gout
Pregnant, oral contraceptions
High levels of job stress
Alcoholics
Women between 40-60years

Special tests to diagnose carpal tunnel syndrome

Tinnels sign
Phaelens test
Reverse phaelens test/ prayer test

True/false : surgery to relieve CTS only requires special tests for diagnosis

False
Require EMG to determine nerve conduction

Treatment of CTS

Brace
OMT
OT
NSAIDS
CORTICOSTEROIDS
SURGERY

Symptoms of ulnar groove entrapment

Parenthesis in the fifth and medial fourth fingers

Claw hand

Extended MCPs with flexed PIPs and DIPs
Caused because interossei lose innervation.
**ULNAR GROOVE ENTRAPMENT

Cubital tunnel syndrome

Entrapment of ulnar nerve between two heads of FCU
Negative tinnels sign at elbow

Radial tunnel syndrome

Chronic achy and tenderness distal to lateral epicondyle
No sensory loss
Partial wrist extension
Poor grip extension

Open Release Surgery

2 in incision in wrist to cut carpal ligament to increase carpal tunnel space
**not as common

OMT for Radial nerve entrapment

Counterstrain
Nerve stretches ( also uses for other nerve entrapments)

Most common CTS decompression surgery

One-Portal endoscopic surgery
Cut transverse carpal ligament

Pronator teres syndrome

Occurs in those with repetitive pronation
Diagnosed by EMG/NCS
Pain with resisted pronation
Weakness in pronation
? treat with Counterstrain

Signs and Symptoms of AIN entrapment

Motor weakness and paralysis of fpl
No Sensory loss

Pain in forearm

Cause of AIN entrapment

Entrapment due to anatomical variations of musculature of forearm

Define carpal tunnel syndrome

CTS
Any process that encroaches on the Media nerve within the carpal tunnel

Differences between ulnar grooves entrapment and Cubital tunnel entrapment

UG- positive tinnels sign at elbow
CTE- negative tinnels sign at elbow, less clawing of hand

Radial nerve entrapment- most common sites

Spiral groove
Supinator muscle/ radial tunnel syndrome

Saturday night palsy

Spiral groove radial nerve entrapment
Caused by arm slung over hard surface or fall asleep with arm over head
Symptoms- wrist weakness, wrist drop, hand held in flexion, elbow in extension.

Other things to look for when suspecting entrapment

Posture
Carrying angle
Somatic dysfunction- cervicals/ upper thoracics

OMT treatments for CTS

Carpal bond articulation
HVLA
Flexor retinaculum release

Ulnar nerve entrapment is most commonly found

Ulnar groove
Cubital tunnel flexor ulnar is
Guyons canal

What is the difference between a I N entrapment and pronator teres entrapment?

Ain- no pain with resisted pronation

What region of the hand maintains sensation during carpal Tunnel syndrome?

Palm due to Palmer cutaneous nerve

Somatic dysfunction of what carpal bones can cause the CTS?

Lunate or scaphoid

Does radial nerve Entrapment lead to sensory loss?

About this deck

By: Danielle Beharie
Created: 2012-02-28
Size: 41 flashcards
Views: 11

About StudyBlue

“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
Dennis