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Peripheral Nerve inj

per NBCOT Study Guide, 6th ed. pgs 145-147

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 Surgical: CTR
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. Surgical: decompression
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. Surgical: decompression
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
Created by: msmaus on 2013-02-07

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