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MSK- Spine and Upper Limb > Compressive Neuropathies > Flashcards

Compressive Neuropathies Flashcards

1
Q

Where will the symptoms and signs of compressive neuropathies affect?

A

The peripheral nerve’s sensory and motor territories

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2
Q

What is the most common upper limb compressive neuropathy?

A

Carpal tunnel

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3
Q

What forms the carpal tunnel of the wrist?

A

Carpal bones and flexor retinaculum

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4
Q

What structures pass through the carpal tunnel?

A

The medial nerve, and 9 flexor tendons

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5
Q

What are the flexor tendons which pass through the carpal tunnel covered with?

A

Synovium

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6
Q

Any swelling within the confines of the carpal tunnel may result in what?

A

Median nerve compression

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7
Q

Most cases of carpal tunnel are what?

A

Idiopathic

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8
Q

What conditions can cause carpal tunnel?

A

Rheumatoid arthritis, and any condition which results in fluid retention

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9
Q

Why does rheumatoid arthritis cause carpal tunnel?

A

Synovitis of the flexor tendons means there is less space in the tunnel

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10
Q

What conditions can increase fluid retention to cause carpal tunnel?

A

Pregnancy, diabetes, chronic renal failure, hypothyroidism

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11
Q

What traumatic injury is most likely to cause carpal tunnel?

A

Wrist fractures, especially a Colles fracture

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12
Q

If you get carpal tunnel when you are pregnant, do the symptoms go away?

A

Yes, usually after childbirth

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13
Q

Which sex is more likely to be affected by carpal tunnel? By how much?

A

Females, 8 times

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14
Q

How will patients with carpal tunnel present?

A

Paraesthesia in the median nerve innervated digits. There may be weakness of the thumb or clumsiness in the area of the hand supplied by the median nerve.

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15
Q

What are the median nerve innervated digits?

A

The thumb, and the radial 2 and a half fingers (half of ring finger nearest to middle finger)

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16
Q

When is the parasthesia of carpal tunnel often worse?

A

At night

17
Q

What may be seen on examination of carpal tunnel?

A

Loss of sensation and/or muscle wasting of the thenar eminence

18
Q

What is Tinel’s test?

A

Percussing over the median nerve to test for carpal tunnel

19
Q

What is Phalen’s test?

A

Holding the wrist hyper flexed to decrease the space in the carpal tunnel to test for carpal tunnel syndrome

20
Q

What investigation can be used to confirm a diagnosis of carpal tunnel? What will it show?

A

Nerve conduction studies- show slowing of conduction across the wrist

21
Q

What are some non-surgical treatment options for carpal tunnel?

A

Wrist splints at night to prevent flexion, corticosteroid injections

22
Q

What surgical treatment can be used for carpal tunnel?

A

Carpal tunnel decompression: division of the transverse carpal ligaments under local anaesthetic

23
Q

What are the outcomes of surgery for carpal tunnel? What is the risk?

A

Highly successful surgery. Risk of damage to the median nerve or one of its smaller branches.

24
Q

Cubital tunnel syndrome involves compression of which nerve?

A

Ulnar nerve

25
Q

Where does the nerve get compressed in cubital tunnel?

A

At the elbow, behind the medial epicondyle

26
Q

What is the main complaint of patients with cubital tunnel?

A

Paraesthesia in the ulnar 1 1/2 fingers

27
Q

Is there any overlap of the fingers affected by cubital/carpal tunnel?

A

No

28
Q

Weakness of the ulnar nerve innervated muscles may be present in cubital tunnel- what are these?

A

First dorsal interosseous and adductor pollicis

29
Q

What movement does the first dorsal interosseous muscle allow?

A

Abduction of index finger

30
Q

Weakness of which muscle is assessed with Froment’s test?

A

Adductor pollicis

31
Q

What can compression in cubital tunnel be due to?

A

A tight band of fascia forming the roof of the tunnel OR tightness at the inter muscular septum that the nerve passes through

32
Q

What inter muscular septum must the ulnar nerve pass through which can be a cause of cubital tunnel?

A

Between the two heads at the origin of flexor carpi ulnaris

33
Q

What test can be used to confirm cubital tunnel syndrome?

A

Nerve conduction studies

34
Q

How can cubital tunnel be treated?

A

Surgical release of any tight structures

MSK- Spine and Upper Limb (13 decks)

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