Neurological Conditions Flashcards by Rebecca Smart

What spinal nerves if impinged may produce hand symptoms?

C6, C7, C8

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What peripheral nerve goes with the C6 spinal nerve?

Musculoskeletal Nerve

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What peripheral nerve goes with the C7 spinal nerve?

Radial Nerve

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What peripheral nerve goes with the C8 spinal nerve?

Ulnar Nerve

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What functional questionnaires go with Carpal Tunnel Syndrome?

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

2.7%

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Carpal Tunnel Syndrome is the most common what?

Entrapment Mononeuropathy

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

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

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

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

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

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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What is the etiology of carpal tunnel syndrome?

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

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What can local inflammation at the wrist be due to?

Repetitive/ Forceful use
Age related joint changes
Trauma: Lunate subluxation/ dislocation

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What can systemic inflammation at the wrist be due to?

Auto-immune conditions
Circulatory conditions
Pregnancy

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What structures are involved in the carpal tunnel?

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

Over

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

Proximal palm, particularly the thenar surface

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The superficial branch of the median nerve travels where?

Through the carpal tunnel

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

Volar surface of the first 3.5 digits and their dorsal tips
NOT the palm

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

1st and 2nd Lumbricals
Opponens Pollicis
Abductor Pollicis Brevis
Flexor Pollicis Brevis

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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?

Gradual

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

Night due to prolonged/ repetitive wrist positions, especially flexion

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

Shaking hands

What actions are typically weak with carpal tunnel?

Grip
Pinch
Tip Strength

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

Purdue Pegboard
Dellon- Modified Moberg pick up test

What are observation signs of carpal tunnel?

Possible thenar atrophy

What are ROM signs of carpal tunnel?

Symptoms with prolonged wrist flexion or extension

What are resisted/MMT signs of carpal tunnel?

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

What are neuro signs of carpal tunnel?

- 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

What are accessory motion testing signs of carpal tunnel?

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

What special tests are done for carpal tunnel syndrome?

- 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

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

higher specificity

What is the best carpal tunnel syndrome special test?

Wainner's CPR

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

- with thermal sensation - Monofilament testing (light touch detection)

What is the PT Rx for carpal tunnel syndrome?

- 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

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

- 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

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

Tendon Glides

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

Joint mobilizations to the neck, forearm and wrist

Do neural glides help carpal tunnel syndrome?

Conflicting evidence

What is your MET for carpal tunnel syndrome?

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

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

3 times a week and they should also have an HEP

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

Combination of: - STM - Neural and tendon glides

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

- Better pain relief and functional reporting at 1 and 3 months - Equal to surgery with pain and function at 6 and 12 months

What is the MD Rx for carpal tunnel syndrome?

- Cortisone injections (helpful in 1/3 of patients) - CTS surgery

What is a CTS surgery?

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

What kind of effect does CTS surgery have for patients?

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

What is denervation of the median nerve called?

Ape hand - damage to the median nerve

What dose ape hand cause?

- 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

What is denervation of the ulnar nerve called?

Claw hand - damage to the ulnar nerve

What does claw hand cause?

- Atrophy of the hypothenar eminence - Deficient interossei muscles - Claw like deformity