1- Lower extremity Entrapment Neuropathies (and brachial plexus injuries) - YQ

Question 1

What is the physical compression or irritation of peripheral nerves called (Ex. ulnar nerve) ?

Answer 1

entrapment

Question 2

Does entrapment only effect sensation of one dermatome?

Answer 2

No; it is not only ONE dermatome since a peripheral nerve often has multiple spinal root sources (ex. ulnar nerve = c7,c8, t1)

Question 3

What are areas of anatomical vulnerability?

Answer 3

Ulnar nerve (funny bone)

Head of fibula

Question 4

What are the three classification of nerve injuries? Where does entrapment fall under?

Answer 4

Neuropraxia (entrapment)
Axontemesis (entrapment)
Neurotemesis (NOT entrapment) only one that is NOT a true entrapment)

Question 5

What is a reversible compression of a nerve called?

Answer 5

Neuropraxia

ex. lunate bone moving and causing carpal tunnel in the wrist

Question 6

A nerve injury with the preservation of the nerve sheath with afferent fiber degeneration distally causing complete denervation is called what?

Answer 6

axonotemesis

Question 7

What is a nerve injury called when the nerve is completely severed?

Answer 7

Neurotemesis

Question 8

Between neuropraxia, axotemesis, and neurotemesis, which is not a true entrapment?

Answer 8

neurotemesis

Question 9

How do you diagnose an entrapment neuropathy and distinguish it from systemic disease?

Answer 9

MRI (first)

EMG/Nerve conduction studies

Question 10

When determining a treatment, what do you aim to do?

Answer 10

correct the underlying pathology when possible

Question 11

A 35 yo runner comes in complaining of sensation changes/paraesthesia in peripheral nerve distribution, pain when he walks, and occasional lower motor neuron signs and symptoms secondary to peripheral nerve compression, what do you suspect he has?

Answer 11

a nerve entrapment.

Question 12

What is the most common site of compression/entrapment for brachial plexus entrapment?

Answer 12

thoracic outlet

Question 13

What is the #1 cause of Erb’s palsy? what about in adults?

Answer 13

Difficult childbirth = #1 reason

Gunshot wounds = #1 in adults

Question 14

A 30 yo male patient walks in holding their arm in internal rotation, with their forearm extended and pronated. They complain t hat they cannot lift their arm above their head. What condition do you think they could have? What root levels does it effect?

Answer 14

Erb’s Palsy; C5/C6

Question 15

A 42 yo f patient visits your clinic. They complain of weakness of the wrists and finger flexors. Their forearm is supinated with their wrists and fingers hyperextended. When you see their hand, it looks like it is in a claw shape. What condition do you think they have? What root levels does it affect?

Answer 15

Klumpke’s Palsy; C8/T1

Question 16

Klumpke’s Palsy affects primarily what nerve?

Answer 16

Ulnar nerve.

Question 17

What are the three most common causes of Thoracic outlet syndrome, from most to least?

Answer 17

1. Brachial plexus compression (most)
2. subclavian vein compression
3. subclavian artery compression (least)

Question 18

What are the causes of thoracic outlet syndrome?

Answer 18

Hypertonic scaleneus anterior **`
hypertonic pectoralis minor
somatic dysfunction of 1st rib
cervical rib
decreased costoclavicular space

Question 19

A 14 yo f patient comes in complaining of tingling numbness (paresthesia) in the C8 and T1 dermatomes, what could be the cause?

Answer 19

Thoracic outlet syndrome (via compression of the brachial plexus/ulnar n)

Question 20

A 25 yo m patient comes into your clinic complaining of tingling in entire wrist/hand region, what could be wrong?

Answer 20

Thoracic outlet syndrome via subclavaian artery compression

Question 21

If a patient experiences only generalized unilateral UE edema and coolness of the extremity, with pain and darkness of the extremity, what could they have?

Answer 21

Thoracic outlet syndrome via subclavian vein compression

Question 22

Match the thoracic outlet special test with their area.

a) Roo’s
b) Adson’s test
c) Reverse Adson’s test

1) tight scalenes on ipsilateral rotation
2) generalized
3) Cx rib/1st rib dysfunction (contralateral rotation)

Answer 22

a - 2
b- 1
c - 3

Question 23

Which of the following is a thoracic out let special test of a hypertonic pec minor?

a) Roo’s
b) Costoclavicular space
c) Adson’s
d) reverse Adson’s
e) hyperabduction test

Answer 23

e) hyperabduction test

Question 24

Is piriformis syndrome an entrapment neuropathy of the lower extremity?

Answer 24

YES! Don’t forget this!!

Question 25

What is the most common site of entrapment for tibial nerve entrapment?

Answer 25

Tarsal tunnel

Question 26

A 42 yo m athlete, who also works at a standing desk during his day job, comes in complaining of burning pain that worsens with prolonged standing and walking, numbness on the sole of his foot and ankle, paresthesia at the medial 3.5 digits of the foot, plantar slide. What problem do you suspect they have?

Answer 26

Tarsal Tunnel Syndrome

Question 27

What is the most common cause of tarsal tunnel syndrome?

Answer 27

Pronated feet

Question 28

What are the most common sites of peroneal nerve entrapment?

Answer 28

Fibular head and neck

Question 29

A 22 yo f comes in complaining on paresthesia to the anterior and lateral leg and dorsum of the foot. As she walked in you noticed a foot drop/slapping gait. What do you suspect the patient has?

Answer 29

Acute peroneal nerve entrapment

Question 30

How do you treat a peroneal nerve entrapment?

Answer 30

• OMT to fibula head, tibia, talus.
• Medications for pain
• Corticosteroid injections
• If chronic, may need AFO.

Question 31

A 33 yo m comes in to your office complaining of unable to extend his right quadriceps, weakness, and numbness in his right anterior thigh and medial calf. You notice that his right thigh looks smaller than his left thigh. As you are thinking, the patient mentions that he sometimes feels pain in the inguinal region, anterior thigh or medial calf. What do you think he has?

Answer 31

Femoral nerve entrapment

Question 32

What are the most common causes for femoral nerve entrapment?

Answer 32

• Pelvic somatic dysfunction

- Scarred/tight inguinal ligament

Question 33

True or False: OMT and proper footwear, orthotics, and assessment and correction of gait will reduce symptoms.

Answer 33

True

Question 34

Ely’s Test is used to test what?

Answer 34

Anterior Femoral nerve entrapment

Question 35

A 24 yo m comes into your office saying, “Doc Doc, there is a deep ache right by the pubic bone. It hurts so much when I work out. It gets better when I’m not doing anything, but it keeps hurting if I try to work out some more.” After a bit more of inquiry, you discover that the pain radiates down the medial thigh toward the knee. What do you suspect this guy has?

Answer 35

Obturator nerve entrapment

Question 36

A 37 yo f comes into your office. You notice she is wearing tight spandex even though she is overweight. As she walks to a chair, she cringes in pain. However, when she sits down, she smiles in relief. When you ask her what is going on, she says that she has numbness and tingling on her left side, in the superior and lateral portion of her thigh. What do you think she has? What would you recommend for her?

Answer 36

Meralgia Paresthetica

Recommend to WEAR LOOSER CLOTHING (most successful treatment), OMT, and medications

Question 37

Meralgia Paresthetica is due to entrapment of what by what?

Answer 37

Entrapment of the lateral femoral cutaneous nerve under the inguinal ligament, lateral to the femoral nerve.

Question 38

When thinking of entrapment, what other things are important to think of?

Answer 38

more proximal causes (ex. disc herniation, masses, etc.)

Question 39

How important is footwear? Why?

Answer 39

VERY important!

Pronators tend to provide tensile forces through post tibial n, and supinators place compressive forces through the tarsal tunnel.