5- Upper Extremity - Entrapment Neuropathy - YQ

Question 1

What are the most common sites of entrapment for a median nerve entrapment?

Answer 1

• Pronator Teres : Muscular branch of median nerve
• Anterior Interosseous Nerve
• Carpal Tunnel Syndrome

Question 2

Carpal tunnel vs. Pronator Teres Syndrome

Answer 2

Carpal tunnel:
NO numbness or tingling in lateral forearm (only numbness and tingling in fingers)
- Weakness with pronation

Question 3

A 35 yo male computer programmer/handyman comes with with pain/heaviness in the forearm, paresthesias, and motor weakness along the distribution of the median nerve. They have an decreased ability to oppose and flex the thumb, index and middle fingers. He tells you that sometimes there is pain.

What syndrome do you think they have? What test would you perform?

Answer 3

Pronator Teres - Median Nerve Entrapment

Perform Tinel’s test.

Question 4

What is a treatment for Pronator Teres?

Answer 4

Counterstrain for forearm flexors

Question 5

How do you diagnose Pronator Teres Syndrome clinically?

Answer 5

• Pain with resisted pronation
• hypertonic pronator teres
• (+) Tinel’s test

Question 6

A 60 yo male OPP professor (like Dr. Sandhouse) comes with complaining of pain in the forearm. Upon physical exam, you notice that there is weakness and paralysis in the flexor pollicus longus, lateral flexor digitorum profundus, and pronator quadratus muscle w/ no sensory loss.

What syndrome do you think they have? What test would you perform?

Answer 6

Anterior Interosseous Nerve - Median Nerve entrapment.

Perform Froment’s sign test

Question 7

What is the major difference between Pronator Teres Syndrom and AIN (Anterior Interosseus Nerve) Syndrome?

Answer 7

PTS = pain with resisted pronation
AIN = No Pain w/ resisted pronation.

Question 8

Any process that encroaches on the median nerve within the carpal tunnel, either extrinsically or intrinsically can lead to the clinical entity of ….?

Answer 8

Carpal tunnel syndrome!

Question 9

A 40 yo f pregnant OPP professor comes in complaining of numbness, intermittent tingling on the THUMB, index, and long fingers and half of the ring finger. She says that at night, she feels more pain (nocturnal pain) and increased pain with activity. However, sensation to the palm region is OK, but she might have some thenar atrophy. What do you think she has? What do you recommend for her?

Answer 9

Carpal Tunnel Syndrome

SURGERY!! ASAP! Because she has Thenar Atrophy.
Thenar Atrophy is the #1 indicator for surgery.

Question 10

What is the major MAJOR etiology for Carpal Tunnel Syndrome?

Answer 10

Repetitive Motion = activities that include flexing and extending the wrist, especially with additional weigh ton the hands.

Question 11

Somatic dysfunction of lunate and capitate can result to what?

Answer 11

Carpal Tunnel syndrome

Question 12

A patient comes into your clinic with numbness and tingling of the distal middle three fingers. What three special tests could you use to diagnose/exclude CTS?

Answer 12

Tinel’s sign
Phalen’s test
Reverse Phalen’s test (Prayer’s Test)

Question 13

What is the basic treatment of CTS based on?

Answer 13

Prevention

Question 14

With CTS treatment, place the following in the correct order of treatment.

a) OMT
b) occupational therapy
c) NSAID
d) Injection
e) Brace/Splint

Answer 14

Least invasive to most invasive!

So…
e –> a –> b –> c –> d

Question 15

If you have tried everything for CTS besides surgery, what type of surgery is most recommended?

Answer 15

One-Portal Endoscopic Surgery

Question 16

What OMT techniques can you use to treat CTS?

Answer 16

Carpal bone articulation,
HVLA of carpal bones
Flexor retinaculum release

Question 17

What are the three most common sites of ulnar nerve entrapment?

Answer 17

• Ulnar groove
• Cubital Tunnel
• Guyon’s canal

Question 18

If Homer Simpson had a normal human hand, what nerve supplies the flexor digitorum superficialis, flexor capri ulnatris, interossei, and ADDUCTOR POLLICIS (AP)?

Answer 18

Ulnar Nerve

She seems to really like the Adductor Pollicis

Question 19

A 14 yo f comes into your clinic complaining of decreased sensation in the fifth and medial fourth fingers. Upon looking at her hand, you notice that her muscles she has a CLAW hand. What problem do you think she has?

Answer 19

Ulnar nerve entrapment

Question 20

What is extension of MCP and flexed PIP and DIPs result in?

Answer 20

Claw hand

Question 21

The more distal an ulnar nerve entrapment the more _______ the claw hand.

Answer 21

PARTIAL

Question 22

Entrapment between two heads of CFU in the Cubital tunnel results in a __________ Tinel sign at the elbow

Answer 22

Negative Tinel sign

Question 23

If there is ulnar nerve entrapment in the guyon’s canal, you will have ____________ loss if it is proximal to canal and _______ if loss distal.

Answer 23

Muscle and sensory loss = proximal

Sensory loss = distal compression

Question 24

A 50 yo f homeless person and a 24 yo m college student come in with wrist weakness, and wrist drop (unopposed flexion) with theirs hand stuck in the waiter’s tip position. They have numbness and tingling and the lateral and back side of their hand. What do you think they have?

Answer 24

Radial nerve entrapment - Spiral Groove (aka. Saturday Night Palsy)

Question 25

A 24 yo f comes in with chronic aching pain/tenderness over the lateral elbow, usually 6-7 cm distal to the lateral epicondyle. She has partial wrist extension and no sensory loss with poor gripping strength. What problem do you think she has and where does it occur?

Answer 25

Radial nerve entrapment - Radial Tunnel Syndrome

Question 26

Miss you

Answer 26

already. <3