Clinical Notes
A YOUNG MAN HAD BEEN IN A SNOWBOARDING ACCIDENT AND REQUIRED A CAST FOR HIS UPPER ARM. AFTER THE CAST WAS REMOVED, HE STARTED TO EXPERIENCE WRIST DROP. WHAT IS THIS INDICATIVE OF?
Radial Groove Compression
Common neuropathies associated with the median nerve
1. Pronator Syndrome
2. Anterior Interosseous Nerve Syndrome
3. Carpal Tunnel Syndrome
What neuropathies are associated with the ulnar nerve?
1. Cubital tunnel syndrome
2.Guyon’s canal syndrome
What are the two types of compression of the radial nerve at the axilla?
1.Axilla-crutch palsy
2.Saturday night palsy
A CLASSMATE ASKS TO BORROW YOUR NOTES BECAUSE HE HAS BEEN HAVING DIFFICULTY WRITING. HE SAYS AFTER FALLING ONTO HIS FOREARM HIS INDEX FINGER HAS BEEN GIVING HIM TROUBLE AND HIS MIDDLE FINGER IS STARTING TO ACT UP TOO, HOWEVER HIS THUMB IS FINE. WHAT MIGHT HE HAVE?
AIN; Anterior Interosseous Nerve Syndrome
Name the potential sites of compression of the median nerve.
1. Ligament of Struthers
2.Bicipital aponeurosis
3.Pronator teres
4.Arch of the flexor digitorum superficialis
How many different types of Guyon’s canal syndrome are classified and what are they involved in?
1.Type I - involved in hypothenar muscles and deep branches of the ulnar nerve.
2. Type II - involved in deep branches of the ulnar nerve.
3. Type III - involved in superficial sensory branch of ulnar n.
Posterior Interosseous Nerve Syndrome is also known as?
Radial Tunnel Syndrome
Damage to the MAC, MBC and axillary nerve will result in?
MAC: lack in sensation to the medial forearm
MBC: Lack of sensation to the lower medial arm
Axillary: Shoulder weakness and sensory loss below the lateral part of the shoulder
What is the difference between the lateral and medial attachment of the transverse carpal ligament?
Lateral consist of the scaphoid and trapezium
Medial consist of the pisiform, triquetrum and hook of hamate
How can a physician diagnose Guyon’s canal syndrome?
Physician can look for:
1.Possible + Tinel’s test.
2. Claw hand deformity
3. Look for motor and sensory deficits distal to Guyon’s canal
4. Check if the pt. Has difficulty making a fist.
At which border of the supinator muscle does the radial nerve change its name to the posterior interosseous nerve?
At the superior border.
A patient who works as an oyster shucker comes in complaining of recent fatigue and pain near her elbow. What symptoms does she present?
Pronator syndrome and carpal tunnel syndrome
What are the main differences between carpal tunnel syndrome and pronator syndrome?
Carpal tunnel occurs distal, not medial.
Women are 4x more likely to get pronators while only 1-3% of the general pop. and 5-15% of indiv. in industrial setting
What branches are given off by the ulnar nerve in the distal forearm and proximal to flexor retinaculum?
In distal forearm, dorsal branch that innervates the dorsum of medial 1.5 digits of the hand and proximal to flexor retinaculum, palmar branch that innervates the skin of the medial palm.
In addition to a broken humerus, what can also result in radial groove compression?
Vascular constriction of the radial nerve due to pressure from adjacent arteries.
A patient complains of pain at the medial elbow and explains to the doctor that he feels weakness in his hand when he tries to grip anything. Doctor asks him to cross his fingers and then spread them but the pt is unable to do that. Pt also shows signs of weak flexion and adduction of the wrist. What might the pt be experiencing?
These are all symptoms of cubital tunnel syndrome.
What test would be recommended for each neuropathies of the median nerve?
Pronator: tinel’s
AIN: “ok” sign
Carpal: tinel’s or phalen’s, unless it is grade 3
How can you distinguish between cubital tunnel syndrome and Guyon’s canal syndrome?
They both are due to the compression of the ulnar nerve. Difference is that cubital tunnel syndrome occurs proximally at the elbow region and Guyon’s canal syndrome occurs at the region of distal wrist.
What is the primary branch of the radial nerve?
The posterior interosseous nerve