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MSK Final (Fall) > Neurological Conditions > Flashcards

Neurological Conditions Flashcards

1
Q

What spinal nerves if impinged may produce hand symptoms?

A

C6, C7, C8

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2
Q

What peripheral nerve goes with the C6 spinal nerve?

A

Musculoskeletal Nerve

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3
Q

What peripheral nerve goes with the C7 spinal nerve?

A

Radial Nerve

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4
Q

What peripheral nerve goes with the C8 spinal nerve?

A

Ulnar Nerve

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5
Q

What functional questionnaires go with Carpal Tunnel Syndrome?

A
  • Katz hand diagram (higher specificity than sensitivity; LR+ = 2.1 - 38, LR- = .1 - .5)
  • Boston Carpal Tunnel Questionnaire Symptom Severity Scale > 19 and Functional Scale
  • Hems Questionnaire (> 6 pts; LR- = .13)
  • Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire
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6
Q

What percentage of patients present with both a clinical and electrophysiological confirmation of carpal tunnel syndrome?

A

2.7%

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7
Q

Carpal Tunnel Syndrome is the most common what?

A

Entrapment Mononeuropathy

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8
Q

What is the gold standard for diagnostic testing of carpal tunnel syndrome?

A

Nerve Conduction Study
- Sensitivity - 85%
- Specificity - >95%

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9
Q

What are the strongest link risk factors for carpal tunnel syndrome?

A
  • Obesity
  • > 45 years of age
  • Biological Female (somewhat related to pregnancy and fluid build up)
  • Forceful hand activity with work
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10
Q

What are the lesser link risk factors for carpal tunnel syndrome?

A
  • Circulatory conditions (ex: cardiopulmonary such as CHF or HTN, Diabetes)
  • Age related joint changes
  • Hypothyroidism
  • Family history of CTS
  • Sedentary lifestyle
  • Wide hand
  • Short stature
  • Work involving repetitive work and vibration
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11
Q

What is the etiology of carpal tunnel syndrome?

A

Decreased axonal transport by:
- Local inflammation at the wrist
- Systemic inflammation
- Benign ganglion cyst

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12
Q

What can local inflammation at the wrist be due to?

A
  • Repetitive/ Forceful use
  • Age related joint changes
  • Trauma: Lunate subluxation/ dislocation
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13
Q

What can systemic inflammation at the wrist be due to?

A
  • Auto-immune conditions
  • Circulatory conditions
  • Pregnancy
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14
Q

What structures are involved in the carpal tunnel?

A
  • 10 tendons: FCR, FPL, FDS, FDP
  • Nerve under the transverse carpal ligament
  • Palmar branch of the median nerve
  • Superficial branch of the median nerve
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15
Q

Does the palmar branch of the median nerve travel over or under the carpal tunnel?

A

Over

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16
Q

What does the palmar branch of the median nerve provide sensory input to?

A

Proximal palm, particularly the thenar surface

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17
Q

The superficial branch of the median nerve travels where?

A

Through the carpal tunnel

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18
Q

What does the superficial branch of the median nerve provide sensory input to?

A
  • Volar surface of the first 3.5 digits and their dorsal tips
  • NOT the palm
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19
Q

What does the superficial branch of the median nerve provide motor input to?

A
  • 1st and 2nd Lumbricals
  • Opponens Pollicis
  • Abductor Pollicis Brevis
  • Flexor Pollicis Brevis
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20
Q

Carpal Tunnel Syndrome has a gradual or sudden onset of tingling that can become numb in the volar surface of the 1st 3.5 digits and dorsal tips?

A

Gradual

21
Q

Is carpal tunnel syndrome worse during the night or during the day? Why?

A

Night due to prolonged/ repetitive wrist positions, especially flexion

22
Q

What kind of day to day action might someone with carpal tunnel say relieves their symptoms?

A

Shaking hands

23
Q

What actions are typically weak with carpal tunnel?

A
  • Grip
  • Pinch
  • Tip Strength
24
Q

What kind of tests can be done for function, specifically limited dexterity for carpal tunnel?

A
  • Purdue Pegboard
  • Dellon- Modified Moberg pick up test
25
Q

What are observation signs of carpal tunnel?

A

Possible thenar atrophy

26
Q

What are ROM signs of carpal tunnel?

A

Symptoms with prolonged wrist flexion or extension

27
Q

What are resisted/MMT signs of carpal tunnel?

A

Weakening grip, pinch, and tip strength, primarily 1st/ 2nd digits

28
Q

What are neuro signs of carpal tunnel?

A
  • Diminished sensation with fast progression to numbness over volar surface of the 1st 3.5 digits and dorsal tips
  • DTRs and Myotomes are WNL
  • ULTT for median nerve: conflicting support
29
Q

What are accessory motion testing signs of carpal tunnel?

A

Possible hypo- or hypermobility with carpal, RC or distal RU joints

30
Q

What special tests are done for carpal tunnel syndrome?

A
  • Carpal tunnel compression
  • Wainner’s CPR
  • Two-Point discrimination
  • Tinel’s
  • Wrist ratio index > .67
  • Decreased sensation on involved fingers
  • Phalen’s
  • Reverse Phalen’s
31
Q

With two point discrimination if > 6 mm on the index finger this is indication of …

A

higher specificity

32
Q

What is the best carpal tunnel syndrome special test?

A

Wainner’s CPR

33
Q

Decreased sensation on the involved fingers for carpal tunnel syndrome is done how?

A
  • with thermal sensation
  • Monofilament testing (light touch detection)
34
Q

What is the PT Rx for carpal tunnel syndrome?

A
  • POLI (No C) ED - bc compression is MOST often the cause
  • Pt education: pathology and risk factors, aggravating factors
  • Modalities: conflicting evidence or recommended not to use with some, short term pain control with others
35
Q

What are recommendations (still PT Rx) that you can make for a pt with carpal tunnel syndrome?

A
  • Use the computer mouse less (alternate hands, use arrow keys or touch screens)
  • Keyboards with lower strike force
  • Orthoses (neutral wrist splints: especially at night but also during the day when night only use if ineffective)
  • Possible immobilization of the MTP joints prn
36
Q

What is an abnormal PT Rx recommendation for carpal tunnel syndrome?

A

Tendon Glides

37
Q

What will help with short term progress of carpal tunnel syndrome?

A

Joint mobilizations to the neck, forearm and wrist

38
Q

Do neural glides help carpal tunnel syndrome?

A

Conflicting evidence

39
Q

What is your MET for carpal tunnel syndrome?

A

Lack of research for CTS (combination of orthoses and stretching)

40
Q

How often should your carpal tunnel syndrome patients be seeing you?

A

3 times a week and they should also have an HEP

41
Q

What should your carpal tunnel syndrome patients be receiving when they see you?

A

Combination of:
- STM
- Neural and tendon glides

42
Q

What are the results of 3 times weekly and HEP PT with STM and neural/ tendon glides for carpal tunnel syndrome?

A
  • Better pain relief and functional reporting at 1 and 3 months
  • Equal to surgery with pain and function at 6 and 12 months
43
Q

What is the MD Rx for carpal tunnel syndrome?

A
  • Cortisone injections (helpful in 1/3 of patients)
  • CTS surgery
44
Q

What is a CTS surgery?

A

A carpal tunnel surgery that can be preformed operatively where they cut through the transverse ligament

45
Q

What kind of effect does CTS surgery have for patients?

A
  • Effect is similar to 3 manual therapy treatments following 12 months of symptoms (Improved symptoms and pinch tip grip force)
46
Q

What is denervation of the median nerve called?

A

Ape hand - damage to the median nerve

47
Q

What dose ape hand cause?

A
  • Weakness in the thenar muscles
  • Thenar atrophy with the thumb held more in the plane of the hand
  • Inability to flex, oppose, or abduct the thumb
48
Q

What is denervation of the ulnar nerve called?

A

Claw hand - damage to the ulnar nerve

49
Q

What does claw hand cause?

A
  • Atrophy of the hypothenar eminence
  • Deficient interossei muscles
  • Claw like deformity

MSK Final (Fall) (15 decks)

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