Median and Ulnar Nerve Entrapment Flashcards Preview

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Flashcards in Median and Ulnar Nerve Entrapment Deck (20):

Define carpal tunnel syndrome

1. Most common peripheral neuropathy
2. Compression of median nerve under transverse carpal ligament


what are the rf for carpal tunnel syndrome?

1. Female
2. Pregnancy
3. DM
4. RA
5. Hypothyroidism
6. Premenstrual fluid retention
7. Most commonly precipitated by:
Repetitive flexion/extension wrist


What are the sxs for carpal tunnel?

1. Night pain
2. Numbness
3. Paresthesias
A. “pins and needles”
4. Clumsiness
5. Dropping objects/weakness


What are the Physical exams and results for carpal tunnel?

1. Tinel’s sign
2. Phalen’s test
3. Thenar eminence atrophy
A. Late sign
4. Sensation
A. Median and ulnar nerve distribution
5. Strength
A. Grip
B. Finger abd/adduction
6. Examine elbow also
B. Tinel’s @ elbow
C. ck for co-existing ulnar nerve entrapment


What are the dx studies for carpal tunnel syndrome?

1. Labs
A. Glucose
2. usually a clinical dx


What is the confirmatory test for carpal tunnel?

1. Nerve conduction studies (NCS) & electromyography (EMG) studies
Confirms dx


What is the tx for carpal tunnel syndrome?

1. Initial treatment
A. Modify activity
B. Volar wrist splint (cock-up wrist splint) @ night
C. NSAIDs- short term
2. Persistent sxs
A. Refer to Orthopedics- Steroid injection
B. Surgical decompression of nerve- carpal tunnel release (endoscopic or open)


Define ulnar nerve entrapment

1. Aka Cubital tunnel syndrome – ulnar neuropathy @ medial elbow
A. Not as common as CTS


What are the sxs of ulnar nerve entrapment?

1. Paresthesias 4th and 5th digits
2. Medial elbow pain, worsens w/ repetitive elbow or wrist flexion
3. Nocturnal numbness/tingling


How is ulnar nerve entrapment diagnosed?

1. Dx usually clear from H&P
2. Confirm dx with NCS/EMG


How is ulnar nerve entrapment treated?

1. Conservative management
A. Avoidance of aggravating activities
B. Nerve gliding exercises (PT)
C. Night Splinting and/or pad medial elbow
D. Refer to Ortho for consultation- ulnar nerve decompression


Where else can the ulnar nerve become entrapped?

Can also have entrapment of ulnar
nerve in Guyon canal called Guyon’s
Canal syndrome or Handlebar palsy
At the wrist


What is thoracic outlet syndrome?

NV sxs in UE d/t pressure on nerves and vessels in thoracic outlet area
Brachial plexus, subclavian artery or vein


Who gets thoracic outlet syndrome?

1. Rare
2. Women btw 20-50 yo most commonly affected


What is the etiology of thoracic outlet syndrome?

1. Etiology
A. Congenital anomaly- Cervical rib (accessory rib from C7 vertebral body)
2. Congenital and acquired variants are common
A. Cervical rib articulates with 1st thoracic rib, supernumary scalene muscles, variations in scalene muscle attachments
3. Pts w/ a cervical rib:
A. Predisposed to develop TOS after whiplash injury
-Poor posture and rounded shoulders


What are the sxs of TOS?

1. Pain, dysesthesias, numbness, weakness of upper extremity that can affect neck, head, shoulders, arm, chest and hand (HA, weakness, loss of coordination)
2. Can mimic ulnar nerve entrapment or cervical radiculopathy


What can TOS be aggravated by?

1. Sxs reproducibly aggravated by activity that requires elevation or sustained use of arms or hands
A. Reaching overhead
B. Prolonged typing
C. Driving
D. Talking on phone
E. Brushing hair


What PE tests are used for TOS?

1. Provocative maneuvers*
A. EAST- elevated arm stress test: Nl up to 3 mins, TOS report pain and fatigue w/in 30 sec
B.. “At-attention” test
C. Adson test: dec in radial or ulnar pulse w/ abduction of the upper extremity overhead. Lean head back and turn toward tested arm

*above tests must reproduce pt’s sxs as well


What diagnostic tests are used for TOS? What are the results?

1. CXR- may see cervical rib
2. EMG- assesses all UE nerves/muscle function
3. Brachial plexus (interscalene) block


What treatment is used for TOS?

1. Only for symptomatic pts
2. Physical Therapy
A. Active release techniques of scalene muscles
B. Strengthening/stretching exercises
C. Chin/neck retraction, shoulder rolls, corner stretch, neck stretches
D. Posture exercises

3. Thoracic outlet decompressive surgery when nonoperative tx have failed (cervical rib present)