Nerve Entrapment Syndromes

Question 1

Median nerve - c5-8, T1

Answer 1

Pronator Teres

Question 2

Nerve:
Median

Hx and Sx:
insidious onset of pain to radial side of palm
heaviness to forearm
sxs increase with activity
min nocturnal sx

Pain reproduction:
resisted forearm pronation and elbow flexion
active compression
palpation

Muscle weakness:
weakness along median nerve distribution

Special Test:
Resisted pronation
Tinels sign
ULTT w median nerve bias

Sensory:
parasthesia in thumb and index finger

Answer 2

Pronator Teres Syndrome

Question 3

Nerve:
AIN - median

Entrapment Site:
Between two heads of pronator teres
just below PT near flexor muscle groups

Hx and Sx:
Sometimes sudden and severe forearm pain
trauma or external compression
dull ache in forearm

Pain reproduction:
resisted IP thumb flexion
resisted distal IP flexion of index finger

muscle weakness:
flexor pollicis longus
pronator quadratus
lateral 1/2 of FDP

Special Test:
Pinch Grip

no sensory loss

Answer 3

AIN Syndrome

Question 4

Nerve:
Radial

Entrapment Site:
entrance to radial tunnel anterior to the radial head
ARCADE OF FROSHE

Hx & Sx:
pain over lateral epicondyle / lateral aspect of forearm
decreased grip strength

Pain reproduction:
passive elbow ext, forearm pron and wrist flex (ECRB)
Resisted supination in elbow extension
dynamic compression syndrome

no muscle weakness, pain is reproduced with dynamic compression syndrome

Special Test:
middle finger extension compression over radial tunnel
wrist extension

Answer 4

Radial Tunnel Syndrome

Question 5

entrapment site:
aracde of froshe
supinator

Hx & Sx:
increased use of the supinator muscle
difficulty extending thumb or fingers at MCP joints
forearm tenderness distal to arcade of froshe
functional wrist drop

pain reproduction:
active supination from a pronated position
passive forearm pronation

special test:
index finger extension

no objective muscle weakness unless chronic
no sensory losee

Answer 5

Posterior Interosseous Nerve Syndrome

Question 6

Entrapment site:
cubital tunnel
between two heads of flexor carpi ulnaris

Hx and Sx:
pain in 4th/5th digits
paraesthia at night
loss of grip power or dexterity
difficulty with adls requiring elboe flexion
sensory issues often initial sx

Pain reproduction:
positions that stretch and/or compress the ulnar nerve - primarily flexed elbow positions

muscle weakness:
atrophy of ulnar intrinsics
clawiing contracture of 4th 5th

Special Tests:
Wartenberg’s sign
elbow flexion test
tinel’s

sensory:
ulnar numbness

Answer 6

Cubital Tunnel Syndrome

Question 7

How would you differentiate between AIN and Pronator Teres syndrome?

Answer 7

with Pronator Teres syndrome there is motor and sensory loss while AIN is purely motor

PT Syndrome -sensory loss in thumb index and long finger (median nerve distribution - 1/2 LOAF)
AIN you will use the pinch grip test - will be unable to make an “ok” sign

Question 8

How would you differentiate between Radial Tunnel and PIN?

Answer 8

Radial Tunnel - mainly pain and radial distribution numbness

PIN - motor loss only

Question 9

Ligament of struthers

Answer 9

Median

Question 10

Arcade of froshe

Answer 10

radial