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Tunnel Syndromes 1

Dr. Homack's Tunnel Syndromes Midterm

What are other names that can be used to describe tunnel syndromes? (3) Canalicular, canal, channel
How does Webster's define canalicular and canal? An enclosed passage.
How does Webster's define channel? A "bed in which a material body may run."
How does Webster's define tunnel? A bodily channel.
What 5 things are tunnel type syndromes named for? 1. Compressed Nerve 2. Anatomical Area 3. Anatomical Tunnel 4. Action producing the syndrome 5. Author's names
What is neurapraxia? Temporary loss of function caused by minor trauma or pressure, like when an extremity falls asleep, recovery occurs w/in minutes.
What is Axonotemesis? Loss of function d/t severe ischemia, recovery can occur w/in weeks.
What is Neurotemesis? Loss of function d/t transection of nerve, no recovery unless nerve repaired.
What are some common causes of nerve injury? tumor, trauma, infection, toxic exposure, muscular compression, iatrogenic, vascular, anatomic variation, idiopathic
What does an EMG try to pick up and what can it confirm? Action potentials indicating muscle activity; axonal lesions in LMN lesions.
What does an NCV evaluate and what does it measure? Condition of peripheral nerves; the speed at which an applied signal travels along a nerve.
Why are EMG and NCV useful in tunnel syndromes? To localize the location of the lesion.
What does a DC's approach to tunnel management depend on? Region, tissue and concomitant symptoms of the entrapment.
What is the initial modality in treating a tunnel syndrome and how much is needed to relieve pain perception? cryotherapy, reduction of the skin temperature by around 5 degrees C reduces nerve transmission velocity which relieves pain perception (AP not coming from peripheral n.)
What is the 2nd modality that should be used to treat a tunnel syndrome? Phonophoresis, in pulsed form, of low intensity w/ ointment (corticosteroid and lidocaine). If congestion starts resolving but pain still present interferential current can be added.
What reasons are there for referring a tunnel patient out for an EMG/NCV? Previous 2 treatments failed to resolve, muscle atrophy or loss in muscle strength. If pathology is advanced refer to orthopedists for decompression.
What is ergonomics? Defined the scientific study of human work; study of problems of people in adjusting to their environment; science relating to man and his work, anatomic, physiologic and mechanical principles affecting the efficient use of human energy.
What is included in ergonomics? Office, industrial, injury prevention, treatment, work station design and layout including equipment design, personnel safety, manual material handling.
What is meant by human factors? The discovery of information regarding human behavior, abilities and limitations and applies these characteristics to the design of systems, tasks, machines, tools and environments to enhance efficiency, safety and productivity in their use.
What is human factors associated w/? Human psychology, human computer interface/usability, product design, person in the workplace, environmental considerations
What is true neurologic TOS? Rare, typically painless, and caused by congenital anomalies (cervical rib)
What are 3 categories of true TOS? Anterior scalene syndrome Costoclavicular syndrome Hyperabduction syndrome
What does thoracic outlet syndrome consist of? A group of distinct disorders that affect the nerves in the brachial plexus and various nerves and blood vessels b/w the base of the neck and axilla.
What is the operculum? The “thoracic outlet”; upper lid of the chest cage called outlet/operculum b/c it is the site from where the arterial flow of the thorax goes out.
What flows into the thorax at the operculum and does more flow in or out? Venous flow, ascending and descending terminal ducts of the lymph system, vagus n., phrenic n., and parts of brachial plexus, esophagus and trachea; more flows in than out.
Where does arterial TOS occur, who is affected and what is it often caused by? One side of the body; both genders and more often in young people; often caused by a congenital anomaly.
What are Sx of arterial TOS? Sensitivity to cold in the hands and fingers, numbness or pain in the fingers and finger ulcers or severe limb ischemia.
What causes venous TOS and how does it develop? Unknown cause; develops suddenly, usually following unusual, prolonged limb exertion.
What causes traumatic TOS, what is the most common symptom and what can exacerbate symptoms? Traumatic or repetitive activities; Pain that occurs w/ tenderness; body postures can exacerbate.
What 2 TOS exams for anterior scalene syndrome are in the notes? Adson’s test for anterior scalene; Reverse Bakody Maneuver.
What 3 TOS tests for costoclavicular syndrome are in the notes? Costoclavicular Maneuver (Eden’s), Hostage position, Soldier’s Position.
How is true neurologic TOS treated and how are other forms treated? True usually treated w/ surgery; other forms need symptomatic Tx requiring conservative care: analgesics, PT for neck and shoulders and strengthen mm. to improve posture.
What is used in chiropractic management of TOS? Educate patient, address subluxations, Address acute phase, Address fibrotic tissue, Address musculature.
What is accommodation? When the lens capsule in the eye changes shape to focus on a close object.
What is RPA and its measurement? Resting Point of Accommodation (RPA) is 30 inches for young people and farther as we age. It is the default distance eyes focus on when there is nothing to look at.
What is convergence? How your eyes work together to aim at an object as it gets closer to you.
What is RPV and its measurement? Resting point of vergence is 45 inches when looking straight ahead and averages 35 inches when looking downward at a 30 degree angle. Default distance when nothing to look at. AKA dark vergence.
How does lowering the monitor help a person working on a computer? It will reduce the RPV and improve overall posture, reducing craning of the neck.
Where should the top of the monitor sit to help the computer user? The top of the screen should be at or below eye level.
What is the most common neurological disorder of the shoulder? Winging of the scapula.
What 7 muscles attach the scapula to the chest wall and help control the scapula? trapezius, levator scapulae, rhomboids major and minor, pec minor, omohyoid and serratus anterior.
What 2 muscles are the most important in controlling the scapula? Serratus anterior and the trapezius; Scapular winging is almost always associated w/ partial or complete paralysis of either muscle.
When does the trapezius muscle stabilize the scapula and what causes dysfunction, weakness and pain of this muscle? Stabilizes the scapula during rotation, elevating upper limb and retracting the scapula; Accessory nerve palsy.
Where can the spinal accessory nerve become entrapped? Multiple points along its course behind the SCM, scalenes and upper trap; may be caused by muscle, vascular distention or lymph.
How can chiropractors treat spinal accessory nerve compression? Adjust cervical subluxations and work on muscles: stretch upper traps; graston to SCM, scalenes and proximal trap; strengthen lateral cervical flexors, shoulder elevators and GHJ abductors.
What does long thoracic nerve compression cause? Weakness or paralysis of the serratus anterior, secondary to palsy of the long thoracic nerve is most common cause of scapular winging.
How may a patient w/ injury to the long thoracic nerve present? Pain, weakness, limitation of shoulder elevation, scapular winging w/ medial transition of the scapula, rotation of the inferior angle toward the midline and prominence of the vertebral border.
What causes long thoracic nerve compression? Rapid head motion (esp. lateral), whiplash, poorly adjusted crutches, injury or tumor in the axilla.
What is the typical posture of a person w/ dorsal scapular nerve syndrome? Lateral tilt and rotation of the cervical spine. The head tilt and rotation take some tension of the scalenes giving some release of the nerve.
How does a patient w/ dorsal scapular nerve syndrome typically present? General aching; rhomboid and levator tenderness to deep palpation; tenderness of the middle scalene, palpation to the middle of the middle scalene may increase pain in the rhomboids and levator and in the arm.
What does unilateral entrapment of the dorsal scapular nerve cause? An imbalance b/w the bilateral rhomboid major and minor muscles and/or the bilateral levator scapulae muscles.
What can occur d/t the levator origin? Subluxations in the cervical and/or thoracic spine or at least chronic strain. After the dorsal scapular nerve entrapment is corrected and muscles return to normal, vertebral corrections will be maintained.
What is the Gower sign? Deltoid atrophy: upper traps attempt to raise arm w/ help from supraspinatus. Axillary nerve entrapment -> deltoid atrophy.
What can cause axillary nerve entrapment/quadrilateral space syndrome? SOL, humeral Fx, GHJ dislocation, sleeping w/ arm under head, organizing hematomas.
How can axillary nerve entrapment/quadrilateral space syndrome be managed? Verify lack of SOL, address adhesions surrounding muscle hypertrophy, reduce fascial scar tissue, address C/T subluxations, rehab deltoid w/ light weights first.
How does a patient feel w/ scapulocostal syndromel? Pain in medial scapular border, neck, shoulder, upper arm and later the thorax; can be mistaken for angina or heart attack; pain, numbness, tingling may be felt in medial forearm into hand.
What trigger point is usually found in someone suffering from scapulocostal syndrome? Myofascial periostitis: a trigger area at the site of the attachment of levator scap to the upper medical angle of the scapula.
What is the usual mechanism of forming a myofascial periostitis? Usually postural causing tension traction irritation of the attachment site; fascial in nature, may have cervical paraspinals involved, subluxation; posture and occupation related.
What muscles have a branch of the suprascapular nerve? Supraspinatus: branch after comes through suprascapular notch and Infraspinatus: an external rotator.
How do you test for suprascpular nerve syndrome? External shoulder rotators and abductors to find where trapped.
What causes intercostobrachial nerve syndrome? Intercostal neuritis, entrapment in the medial triceps fascia, axillary compression d/t tumor, infection or direct trauma.
What generates more power pushing or pulling and why? Generate more power pushing than pulling; large leg muscles activated in pushing and low back uses small stabilizers for pulling. Safer to push than pull objects especially for the shoulder, low back, knees and ankles.
What does the musculocutaneous nerve innervate? coracobrachialis, brachialis and biceps brachii and carries sensory to the lateral aspect of the forearm.
How would a patient w/ musculocutaneous nerves syndrome of the shoulder present? Sensory changes to lateral forearm, weakness across elbow, diminished or absent biceps reflex, wasting and atrophy of biceps brachii.
What sort of history would a patient w/ musculocutaneous nerve syndrome of the shoulder have and how should chiro treat? Hx of frequent and/or heavy workouts w/ a flexed arm; responds well to conservative Tx; R/O biceps tendon rupture, C5-6 radiculopathy, brachial plexus injury or compression.
Where can compression of musculocutaneous nerve occur for musculocutaneous nerve syndrome of the elbow? Where musculocutaneous nerve pierces the brachial fascia proximal to the elbow; this location makes nerve prone to impact injury like falling and landing on side, football, MVA.
Where is the pure patch for the musculocutaneous nerve so sensory testing can be done? Brachioradialis muscle body carried by the lateral antebrachial cutaneous nerve.
What can radial nerve compression in the axilla affect? Triceps, anconeus and majority of the extensors of the forearm (posterior interosseous branch of the radial nerve).
Where would radial nerve compression in the upper arm occur and what can be affected? Most vulnerable at the spiral groove (wraps around humeral shaft); sensory changes of the radial nerve can be evaluated at the pure patch; motor paralysis gives typical wrist drop.
What is involved in typical wrist drop and what is involved in sensory loss with radial nerve compression in the upper arm? Extension of elbow, wrist, knuckles and all joints of the thumb, supinator and brachioradialis; dorsum of 1st, 2nd and 3rd metacarpals (1/2 of 4th too).
What else can affect the radial nerve? Heavy metal toxicity.
Created by: kabrown