Term
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Definition
Carpal tunnel
-transverse carpal ligament (relatively inelastic)
-tenosynovitis of the flexor tendons within the carpal tunnel
-via swelling (pregnancy) or space occupying lesion within the carpal tunnel
-Colles Fracture, Smith’s Fracture, Scaphoid Fracture (fracture fragments or
effects of immobilization)
-dislocation of the lunate
-repetitive finger flexion activities in a forced flexed position with pressure on
tunnel (ex. Computer typing, improper guitar technique, heavy tool use)
-sleeping posture full flexion (Phalen’s position) |
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Term
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Definition
abductor pollicis brevis flexor pollicis brevis
opponens pollicis Lumbricals 1 and 2 |
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Term
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Definition
Median nerve distribution to the digits and palm. The sensory branch to the thenar
eminence branches off prior to the median nerve entering the carpal tunnel. Therefore, in true carpal tunnel entrapment, sensation to the base of the thenar eminence is spared. |
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Term
|
Definition
Patient will complain of intermittent pain and paresthesia in the median nerve
distribution of the hand. Symptoms may radiate upward into the forearm and are typically worse
at night. Observation of thenar (opponens) atrophy, sensation impaired to first 3 digits palmarly,
tips of digits 1 to 3 ½ dorsally. Watch for adduction substitution for a weak opponens pollicis,
PFT over transverse carpal ligament reproduces radiating pain and paresthesia in the involved
fingers, + Tinel’s, Phalen’s and Reverse Phalen’s test. |
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Term
| Median N. @ hand treatment |
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Definition
Night splints to reduce wrist flexion and carpal tunnel compression, transverse carpal ligament
stretching through the pisiform mobs, myofascial considerations, techniques to reduce edema,
ergonomic modification. Activity modification based upon individual factors to decrease nerve
compression with functional activities. |
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Term
| Median Nerve at elbow MOI |
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Definition
Space occupying lesions, direct blow, trauma or prolonged pressure. Volkman’s ischemic
contracture results when a fracture and increased fluid creates an increased pressure in fascial
planes, tenosynovitis.
-Pronator teres (action or hypertrophy)
-Ligament of Struthers
-Bicipital aponeurosis |
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Term
| Median Nerve at elbow Motor |
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Definition
pronator teres flexor carpi radialis
palmaris longus flexor digitorum superficialis
Anterior interosseous nerve is given off by the median trunk distal to the pronator.
Motor to:
flexor digitorum profundus (radial half),
flexor pollicis longus
pronator quadratus |
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Term
| Median Nerve at elbow Sensory |
|
Definition
all of median nerve distribution to the wrist/hand including the base of the thenar
eminence. |
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Term
| Median Nerve at elbow Exam |
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Definition
Median neuropathy at elbow vs pronator teres neuropathy- In pronator syndrome
the innervation of the pronator teres is spared. In neuropathy above the elbow, pronator teres will be spared |
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Term
| Median Nerve at elbow Treatment |
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Definition
find cause and decrease loading of nerve. myofascial manipulation, techniques to
reduce edema, ergonomic modification. Activity modification. |
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Term
| Median Nerve at elbow differential Dx |
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Definition
Cervical radiculopathy, shoulder girdle dysfunction, thoracic outlet syndrome, pronator teres
syndrome, wrist joint arthritis. |
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Term
| Ulnar nerve at the wrist MOI |
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Definition
Sensory disturbance of the palmar surface the fourth and fifth digits distal to the mid
palmar crease. Hypothenar eminence has normal cutaneous sensation. Often burning pain and paresthesia noted into this distribution. Branches of the ulnar nerve that supply the proximal
palm and dorsal surfaces of the 4th and 5th digits arise proximal to the wrist. |
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Term
| Ulnar nerve at the wrist motor |
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Definition
Palmaris brevis abductor digiti minimi Flexor digiti minimi,
Opponens digiti minimi lumbricals 3 and 4 interossei (all)
Flexor pollicis brevis (deep) adductor pollicis |
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Term
| Ulnar nerve at the wrist exam |
|
Definition
Pressure over the pisiform hamate tunnel will cause pain distal to the point of
entrapment. Claw hand deformity, guttering, bishops deformity can all be noted depending on
severity and duration of compression. Sensory-testing of the palmar surfaces of 4th and 5th digits
and the distal portion of the ulnar side of the palm.
Pinch weakness of the thumb, positive Wartenberg’s and Froment’s. |
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Term
| Ulnar nerve at the wrist diff Dx |
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Definition
Cubital tunnel syndrome, Carpal tunnel syndrome, TFCC pathology
Entrapment of the ulnar nerve in Guyon’s canal will affect sensation only on the palmar side of
the hand, distal to the mid palmar crease in the ulnar distribution (in the area of the superficial
terminal branch in this illustration). |
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Term
| Ulnar nerve at the elbow (“cubital tunnel syndrome MOI |
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Definition
-Increased carrying angle/valgus tensioning nerve,
- hypomobility of fascial structures (medial intermuscular septum, between 2 heads of the
FCU and the flexor pronator aponeurosis)
-mechanical pressure, as the nerve is only covered by fascia and skin,
-laxity causing dislocation of nerve (flexion) with reduction (on extension) |
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Term
| Ulnar nerve at the elbow (“cubital tunnel syndrome motor |
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Definition
| Motor to Flexor carpi ulnaris, ulnar half of the Flexor digitorum profundus |
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Term
| Ulnar nerve at the elbow (“cubital tunnel syndrome sensory |
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Definition
Ulnar entrapment at the elbow will cause sensation changes in the ulnar distribution on
the dorsal and palmar side of the hand in the ulnar distribution |
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Term
| Ulnar nerve at the elbow (“cubital tunnel syndrome exam |
|
Definition
medial elbow and hand pain,
-exacerbated by elbow flexion
-Palmar trunk motor loss, fine motor difficulties (pinch weakness of thumb)
-+ Tinel’s and cubital tunnel compression test |
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Term
| Ulnar nerve at the elbow (“cubital tunnel syndrome treatment |
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Definition
-removal of irritating force,
- addressing fascial elements which may give rise to problem (intramuscular septum), ----
-stabilization of the elbow while sleeping
-neurodynamic stretching |
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Term
| Radial nerve-at the elbow moi |
|
Definition
-lateral head of triceps muscle
-Fibrous edge of the ECRB origin (Radial Tunnel Syndrome) and entrance into the
supinator
-Radiocapitular dysfunction (dislocations, fracture radial head, RA synovitis)
-Arcade of Frohse- fibrous band at the edge of the supinator
-Single or repeated forceful supination, extension or radial deviation against resistance
(hammer, racket, etc)
-Direct trauma, humeral fracture, Bennett’s fracture (CMC base), space occ. lesion, etc.
-“Saturday night palsy”- sleeping with arm draped over a chair or axillary crutch misuse |
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Term
| Radial nerve-at the elbow sensory |
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Definition
superficial radial nerve- skin sensory to the skin over the radial side of the dorsum of
the wrist/hand and radial 3 ½ digits to the ~DIP. |
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Term
| Radial nerve-at the elbow motor |
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Definition
extensor carpi radialis longus extensor carpi radialis brevis
extensor digitorum extensor digiti minimi
extensor digiti ulnaris abductor pollicis longus
extensor pollicis longus extensor pollicis brevis
extensor indicis supinator |
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Term
| Radial nerve-at the elbow exam |
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Definition
1st MCP joint and anatomical snuffbox pain location or diminished sensation (may be
referral from the superficial radial nerve)
-provocative wrist extension, supination of the forearm, MSTT of the ECRB (3rd digit)
-PFT should cause pain and radiation in neuropathy. |
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Term
| Radial nerve-at the elbow treatment |
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Definition
myofascial manipulation to ECRB and supinator
-stretching of ECRB or supinator
- neurodynamic stretching
-ergonomics eval/activity modification |
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