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48 Cards in this Set
- Front
- Back
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what does median nerve innervate
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all flexors of the wrist and fingers
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what are the exceptions to the innervation of median nerve
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FCU and FDP
digits 4 and 5 |
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where should you have numbness with median nerve compression
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in the fingers but not in base of thumb
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most common nerve entrapment
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carpal tunnel syndrome
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where is the usual site of entrapment in CTS
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at the wrist under the transverse carpal ligament
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what is etiology of most cases of carpal tunnel syndrome
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idiopathic
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what are predisposing factors for CTS
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congenital, occupations, pregnancy, wrist edema, medical conditions
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most common presenting symptom of CTS
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nocturnal hand paresthesias with or without pain often awakening the patient from sleep
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some other common syptoms of CTS
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paresthesias with driving or holding a phone
relief by shaking hands atrophy of thenar eminence |
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what is effected first in CTS
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two point discrimination and tips of fingers
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phalens maneuver
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reproduction of paresthesias in 1-2 min of wrist flexion
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phalens maneuver is exteremly what
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sensitive
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tinels sign
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paresthesias elicited by tapping over the median nerve at the wrist
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which carpal tunnel test is more sensitive
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phalens maneuver
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what are the consistent symptoms of carpal tunnel
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pain in hand, wrist, forearm and even shoulder
perception of numbness in all digits absent sensory loss on examination |
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differential with CTS
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cervical radiculopathy
median neuropathy brachial plexopathy |
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radiculopathy assoc with sensory symptoms to the thumb
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C6
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radiculopathy assoc with sensory symptoms to the index finger
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C6 and C7
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radiculopathy assoc with sensory symptoms to the middle finger
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C7
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key differentiators between CTS and radiculopathy
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depressed biceps/brachioradialis or triceps with radiculopathy
weakness of elbow with radiculopathy sensory abnormalities in arm and forearm with radiculopathy |
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what are some sensitive electrodiagnositc test in CTS
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internal comparison studies
inching technique |
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what does internal comparison study do
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compares 2 nerves and their conduction speeds
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step 1 treatment of CTS
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withdraw provoking factors
neutral wrist splint while sleeping NSAIDs |
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step 2 treatment of CTS
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Local corticosteroids
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where are the local corticosteroids injected in CTS treatment
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outside the tunnel
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step 3 treatment for CTS
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surgical decompression
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when is surgical decompression of CTS indicated
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severe CTS assoc with axonal loss
failed conservative measures mass lesion acute CTS |
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meralgia paresthetica
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entrapment of the lateral femoral cutaneous nerve under or through the inguinal ligament
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main causes of meralgia paresthetica
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pregnancy, obesity, diabetes
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what are symptoms of meralgia paresthetica
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numbness and pain
burning, stinging, unpleasant and annoying |
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what is distribution of meralgia paresthetica
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trouser pocket area
-does not cross midline nor extend beyond knee |
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what are the common findings on lateral femoral cutaneous SNAP
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absent in healthy particularly obese
asymmetrically low amplitude or absent are most common |
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most common neuropathy in leg
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peroneal mononeuropathy
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where is the most common place for peroneal neuropathy
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around the fibular neck
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when is peroneal neuropathy acute in onset
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perioperatively
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when is peroneal neuropathy subacute in onset
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weight loss
grave illness |
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which peroneal is more commonly affected by lesions
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deep
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fxn of electrodiagnostic studies in peroneal nerve palsy
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confirm site of lesion
estimate extent of lesion establish pathophysiologic nature predict course of recovery |
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most common pathophysiology of peroneal nerve lesions
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axonal loss
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peroneal neuropathy at the hip is technically what
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neuropathy of the sciatic nerve
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what is predominantly with peroneal neuropathy at the hip
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there is asociated mild involvment of the tibial component
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tarsal tunnel syndrome
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compression of the tibial nerve or any of its three terminal branches under the flexor retinaculum
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most common presenting symptom of tarsal tunnel syndrome
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burning pain of the foot and heel which worsens after prolonged standing or walking
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terminal tibial nerve branches
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medial plantar
lateral plantar calcaneal |
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what does neurological exam of tarsal tunnel reveal
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sensory impairment in the sole in the distribution of one or all of the terminal tibial branches
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which muscle assesses the lateral plantar motor fibers
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abductor hallucis
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what muscle evaluates medial plantar motor fibers
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abductor digiti quinti pedis
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what is diagnostic for tarsal tunnel syndrome
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asymmetrical slowing or absence of one or both plantar responses
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