Neurovascular Entrapment Syndromes

Question 1

brachial plexus structure

Answer 1

5 ventral rami - C5-T1
3 trunks
6 divisions (3 ant, 3 post)
3 cords
5 peripheral nerves

Question 2

digits 4 and 5 innervation

Answer 2

ulnar nerve

Question 3

digits 1 to 3 palm

Answer 3

median nerve

Question 4

digits 1 to 3 back of hand

Answer 4

radial nerve

-also back of arm to above elvow

Question 5

axillary nerve

Answer 5

side of shoulder

Question 6

sympathetics to upper extremity

Answer 6

T2-6

Question 7

major joints

Answer 7

start proximal, move distal

Question 8

bounds of thoracic outlet

Answer 8

spinal column
first ribs
sternum
clavicle

Question 9

structures in thoracic outlet

Answer 9

brachial plexus
subclavian artery
subclavian vein

Question 10

causes of thoracic outlet syndrome

Answer 10

scalene tension
cervical rib
SD
pec minor
tumor
whiplash
fractured clavicle

Question 11

compression locations for TOS

Answer 11

scalenes - anterior and middle
pec minor - rib and pec minor
costoclavicular articulation - clavicle and first rib

Question 12

Sx of TOS

Answer 12

neurologic and vascular

Question 13

brachial plexus compression

Answer 13

numbness
parasthesias
muscle weakness

Question 14

subclavian artery compression

Answer 14

distal thromboembolism
arm pain with exertion - claudication
acute arterial thrombosis

Question 15

subclavian vein compression

Answer 15

DVT

extremity swelling

Question 16

claudication

Answer 16

pain with exertion

Question 17

adsons test

Answer 17

arm extended, abducted, ext rotated

-feel pulse

Question 18

roos test

Answer 18

arms up, open/close hands

Question 19

spurlings maneuver

Answer 19

cervical compression test

Question 20

hyperabduction test

Answer 20

abduct, extend arm

• deep breath
• feel pulse

Question 21

Tx for TOS

Answer 21

PT
NSAIDs
steroids
muscle block
surgical decompression

Question 22

OMT for TOS

Answer 22

SD of ribs, clavicle, sibsons fascia, C-spine, T-spine, etc.

Question 23

ulnar nerve entrapment

Answer 23

compression of ulnar nerve (C7,8 T1)

Question 24

areas of compression with UNE

Answer 24

epicondylar groove
cubital tunnel
guyons canal

Question 25

tardy ulnar palsy

Answer 25

entrapment in epicondylar groove ``` aching pain medial elbow, migrates distal numb 4/5 digits produced with elbow flexion motor symptoms less common -possible claw hand, loss of dexterity ```

Question 26

cubital tunnel syndrome

Answer 26

compression of ulnar nerve between 2 heads of flexor carpi ulnaris - hypertonicity of muscles - numb 4/5 digits - produced with elbow flexion - motor symptoms less comon Sx same as tardy ulnar palsy -difference is where impingement is

Question 27

guyons canal neuropathy

Answer 27

damage to ulnar nerve between pisohamate ligament anteriorly and flexor retinaculum posteriorly hand weakness, atrophy intrinsic hand muscles - loss dexterity - variable sensory loss - clawing of digits 4/5

Question 28

tests for ulnar nerve entrapment

Answer 28

``` tinels - tap on elbow and wrist elbow flexion - max for 1 minute pressure test - through all 3 flexion and pressure (combo) palpation for local nerve tenderness and thickening ```

Question 29

Tx for ulnar nerve entrapment

Answer 29

``` OMT don't lean on elbows limit flexion at night NSAIDs PT steroid injection medial epicondylectomy cubital tunnel release surgery ulnar nerve transposition surgery ```

Question 30

carpal tunnel syndrome

Answer 30

THE most common mononeuropathy | compression of median nerve

Question 31

median nerve

Answer 31

C6-8 T1

Question 32

carpal tunnel

Answer 32

transverse carpal ligament carpal bones median nerve and flexor tendons

Question 33

Sx of carpal tunnel

Answer 33

pain, paresthsia, numbness in 1st three digits - weak grip strength - hand pain at night - thenar atrophy and sensory loss

Question 34

aromatase inhibitor use

Answer 34

risk factor for carpal tunnel

Question 35

carpal tunnel syndrome tests

Answer 35

tinels** phalens (reverse prayer)** correlates with severty prayer sign carpal compression

Question 36

confirmation of carpal tunnel

Answer 36

EMG

Question 37

Tx for carpal tunnel

Answer 37

``` cock up splint NSAIDs steroid yoga/stretch PT nerve/tendon gliding exercise ultra sound therapy ergonomic key board surgical decompression ```

Question 38

double crush syndrome

Answer 38

compression at one point not significant to cause Sx - multiple compression sites have cumulative effect leading to impaired neuronal signaling - when in doubt, check entire length of nerve and its nerve roots