|Carpal Tunnel Syndrome (CTS) ||Median nerve compression - most common compression injury -- numbness/tingling thumb, index, middle, and radial half of the ring fingers -- PT will complain of dropping things -- parasthesias usually occur at night|
|Pronator Teres Syndrome (proximal volar forearm) ||Median nerve compression between 2 heads of pronator teres -- symptoms same as CTS + aching in proximal forearm |
|Carpal Tunnel Syndrome treatment ||Conservative: wrist splint in neutral, median nerve gliding and tendon gliding exercises, activity modification, ergonomics
|Pronator Teres Syndrome treatment ||Conservative: elbow splint at 90 w/ forearm in neutral, activity modification,
Surgical: decompression of nerve|
|Guyon's canal ||Ulnar nerve compression at wrist -- numbness/tingling ulnar nerve distraction, motor weakness, postive tinel's at wrist|
|Guyon's canal treatment ||Conservative: splint wrist in neutral, act. mod.
|Cubital tunnel syndrome ||Ulner nerve compression at the elbow -- 2nd most common compression injury -- numbness/tingling along ulnar aspect of forearm and hand, pain @ elbow with extreme position of flexion, weakness of power grip|
|Cubital tunnel syndrome treatment ||Conservative: Elbow splint to prevent extreme flexion, act. mod.
Surgical: decompression or transposition|
|Radial Nerve Palsy ||Radial nerve compression (Saturday Night Palsy) -- can occur with fx's to humeral shaft -- weakness/paralysis of extensors to wrist, MCP's & thumb|
|Radial nerve laceration classic sign ||Wrist drop -- loss of extensors at wrist, MCP's & thumb|
|Radial Nerve Palsy / laceration treatment ||Conservative: dynamic extension splint, act. mod.
|Median nerve laceration ||Sensory loss to central palm - thumb to radial 1/2 ring finger|
|Median nerve laceration classic sign - low lesion ||Ape hand -- low lesion -- loss of lumbricals I & II (MCP flexion of digits I & II), Opponens pollicis, Abductor pollicis brevis --(flexion of thumb MCP) -- flattening of thenar eminence|
|Median nerve laceration classic sign - high lesion ||Benediction sign - inability to flex index and middle finger, voluntary flexion of ring and small finger|
|Ulnar nerve laceration ||Ulnar aspect of palmar and dorsal surface -- loss of power grip, decreased pinch strength|
|Ulnar nerve laceration classic sign ||Claw hand -- loss of lumbricals III, IV (causes MCP flexion of ring and small fingers), loss of ADM, ODM, FDM (causes ABd, opposition and flexion of small finger)|
|Compare/Contrast Benediction Sign with Claw Hand ||Both look similar:
BS: affects index & middle fingers, unable to flex
CH: affects ring & small fingers, can flex index & middle fingers|
|Radial nerve laceration - low ||forearm level - loss of wrist ext due to impaired/absent ECU, loss of MCP extension, & thumb extension|
|Radial nerve laceration - high ||Above the elbow -- all of low level + loss of ECRB, ECRL & brachioradialis|