MSK Diag Mgt 7220 Final I

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created 3 years ago by Kelsey_Parker
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1

What is this nerve entrapment?

  • Motor deficits: All muscles of the posterior forearm.
  • Sensory deficits: First three digits on the dorsal surface of the hand, middle posterior forearm, and middle and lateral distal arm.

spiral groove syndrome

2

What is this nerve entrapment?

  • Motor deficit: Inability to extend digits. Extensor digitorum, extensor carpi ulnaris, extensor digiti minimi, abductor pollicis longus and brevis, extensor pollicis longus, and extensor indices may be effected.
  • Sensory deficits: None identified.

what are the sites of entrapment?

posterior interosseous nerve syndrome

AKA supinator syndrome (when at arcade of frohese)

AKA radial tunnel syndrome (when trapped at radial tunnel)

3

common differential diagnoses for something that looks like cubital tunnel syndrome? (3)

diagnosis: C8-T1 nerve root, thoracic outlet syndrome, compression of n. at Guyan’s canal

4

What is this nerve entrapment?

  • Site of entrapment: anteromedial humeral diaphysis in patients with a rare bony formation called the supracondylar process. The nerve becomes entrapped between the process and the ligament of Struthers, which extends from the supracondylar process to the humeral medial epicondyle.
  • Motor deficits: Weakness along the median nerve distribution. May be unable to perform pinch grip test.
  • Sensory loss: numbness and tingling of the hand along the median nerve distribution.

humerus supracondylar process syndrome

5

What is this nerve entrapment?

  • Motor deficits: None identified.
  • Sensory deficits: Pain and paresthesia at anterior elbow, forearm and wrist along median nerve distribution which may become more pronounced with repetitive supination and pronation.

Where is the entrapment?

Pronator syndrome

The entrapment is between the ulnar and humeral head of pronator teres.

6

What is this nerve entrapment?

  • Site of entrapment: In the deep flexor muscles
  • Motor deficits: weakness of deep flexors muscles; patient may be unable to make pinch grip.
  • Sensory deficits: Deep forearm pain may be present but is less likely than in pronator teres syndrome. Typically no loss of sensory function.

anterior interosseous syndrome

7

What is this nerve entrapment?

  • Motor deficits: Weakness in flexor muscles of the first 3 ½ digits.
  • Sensory deficits: Numbness, tingling and painin the lateral 3 ½ digits

carpal tunnel syndrome

8

What is this nerve entrapment?

  • Motor deficits: Weakness at the fourth and fifth digits. Possible claw hand deformity.
  • Sensory deficits: Numbness or pain along the ulnar nerve distribution especially at elbow and fourth and fifth digits.

Where is the entrapment?

card image

cubital tunnel syndrome

In the cubital tunnel formed by the medial epicondyle, olecranon, MCL, and FCU tendon.

9

What is this nerve entrapment?

  • Motor deficits: Possible loss of the ulnar intrinsic muscles of the hand (adductor pollicis, median lumbricals, and interossei muscles).
  • Sensory deficits: Possible pain and paresthesia in the two ulnar digits

where is the site of entrapment?

card image

Guyon's canal syndrome

Guyon's canal is above the transverse carpal ligament, under palmar carpal ligament, and between pisiform and hamate

10

What is this nerve entrapment?

  • Motor deficit: Inability to extend digits. Extensor digitorum, extensor carpi ulnaris, extensor digiti minimi, abductor pollicis longus and brevis, extensor pollicis longus, and extensor indices may be effected.
  • Sensory deficits: None identified.

what are the sites of entrapment?

posterior interosseous nerve syndrome AKA supinator syndrome

arcade of frohese or radial tunnel

11

nerve most likely to be compromised in a flexion type supracondylar fracture?

radial nerve

12

nerve most likely to be compromised in an extension type supracondylar fracture?

median and anterior interosseous nn.

13

if client says they heard a pop at the elbow followed by acute pain, reduced wrist strength, and pain with active wrist flexxion and passive wrist extension, what might you think is going on?

avulsion fracture

14

course of tx for avulsion fracture?

if displaced they will need surgery.

if non-displaced then splinting for six weeks and gentle ROM for two weeks.

15

movement to reduce subluxed radial head (nursemaids elbow)

full supination and flexion

16

Special tests for ulnar nerve entrapment

Tinels

Wartenberg's sign

elbow flexion test

(The patient is asked to fully flex the elbow with extension of the wrist and abduction and depression of the shoulder girdle. Hold position for 3-5 minutes.)

ULTT

17

if client says they heard a pop at the elbow followed by acute pain, reduced wrist strength, and pain with active wrist flexxion and passive wrist extension, what might you think is going on?

avulsion fracture (usually at medial epicondyle)

18

special tests for median nerve involvement

sensory and motor

ULTT

pronator test

pinch grip

19

Describe the ULTT for each nerve

card image
20

What is this nerve entrapment?

  • Site of entrapment: In the deep flexor muscles
  • Motor deficits: weakness of deep flexors muscles; patient may be unable to make pinch grip.
  • Sensory deficits: Deep forearm pain may be present but is less likely than in pronator teres syndrome. Typically no loss of sensory function.

anterior interosseous syndrome

(anterior interosseous is branch of median nerve)

21

which nerve entrapment mimics lateral epicondylalgia - most symptoms are of pain and inflammation at the lateral elbow and distal?

radial tunnel syndrome - a compression of the anterior interosseous nerve near the radial head

22

common differential diagnoses for something that looks like cubital tunnel syndrome?

diagnosis: C8-T1 nerve root, thoracic outlet syndrome, compression of n. at Guyan’s canal

23

management for cubital tunnel syndrome in each phase when no surgery is done

acute - active rest, neural glides, protection

repair - stretch and strength

remodel - advance stretch and strength and improve stability of elbow and shoulder complex

return to sport - functional strengthening. possible preventative taping.

24

management for cubital tunnel syndrome post surgery

phase I (0-2 weeks) - inflammation pain control, limit flexion with bracing

phase II (2-4 weeks) - progress PROM 15-120 degrees. d/c or open brace

Phase III (4-8 weeks) progress strength ad normalize motion

phase IV (8-12 weeks)- correct throwing mechanics. interval throwing program.

25

What is this nerve entrapment?

  • Motor deficits: None identified.
  • Sensory deficits: Pain and paresthesia at anterior elbow, forearm and wrist along first 3.5 digits which may become more pronounced with repetitive supination and pronation.

Where is the entrapment?

Pronator syndrome

The entrapment is between the ulnar and humeral head of pronator teres.

median nerve

26

which nerve entrapment mimics lateral epicondylalgia - most symptoms are of pain and inflammation at the lateral elbow and distal?

radial tunnel syndrome - a compression of the posterior interosseous nerve near the radial head

27

Special tests for ulnar nerve entrapment

Tinels

Wartenberg's sign

elbow flexion test

(The patient is asked to fully flex the elbow with extension of the wrist and abduction and depression of the shoulder girdle. Hold position for 3-5 minutes.)

ULTT

28

use, patient position, and technique for Cozen's test

card image

pt should be sitting. elbow placed on table and stabilized by examiners thumb which is on lateral epicondyle. patient actively makes a fist, pronate, and extend wrist against therapist resistance.

positive test means pain in the lateral epicondyle.

is test for lateral epicondylalgia

29

purpose and technique of Maudsley's 3rd finger extension test

positive test = pain at lateral epicondyle = lateral epicondylalgia

therapist resists active extension of third digit. therapist places resistance distal to DIP to stress extensor digitorum.

30

interventions for lateral epicondylalgia

bracing - short term gains no long term improvement

medical - corticosteroid injections and surgery - not great evidence

PT - CFM, mills manipulation, exercise, phonophoresis

- adding cervical mobes to local mobes results in fewer visits

31

pt experiences pain with resisted flexion and passive wrist extension, weakness in hand esp fourth and fifth digits, numbness and tingling, and sensitivity at medial elbow, what are you thinking?

pt. is a pitcher.

card image

medial epicondylalgia

differentials:

C6 and C7 radiculopathy (neurological examination of muscle strength, sensory loss and reflexes, compression and distraction)

UCL/MCL instability - valgus stress test

cubital tunnel syndrome - Tinel's sign or elbow flexion test

32

tx for medial epicondylalgia

acute - rest, medication, ice, ther ex

chronic - relative rest, manual therapy, ther ex with emphasis on eccentrics, postural shoulder complex strengthening

33

capsular patterns cyriax

card image

at elbow - flexion, extension (supination = pronation?)