NPTE MSK Review (● Radial Nerve Injuries ● Ulnar Nerve Injuries ● Adhesive Capsulitis ● Shoulder Special tests ● Patellofemoral Pain Syndrome ● Ankle sprains ● Compartment Syndrome - Acute vs Chronic ● Ottawa Ankle and Knee rules)

what are the nerve roots for radial nerve

C5-T1

BEAST think for which muscles

lateral 3 digits on back of the arm and hand

Crutch Palsy

Very high nerve palsy, Axilla injury

Radial nerve injury in axilla causing loss of elbow, wrist, and digit extension. weakness in supination

Sensory: Paresthesia posterior lateral arm, forearm, wrist, lateral 3.5 digits

High Radial Nerve Injury

Humerus spiral groove fracture causing wrist drop and thumb extension weakness; triceps spared.

Sensory: Paresthesia posterior forearm, wrist, posterior aspect of lateral 3.5

digits

Radial Tunnel Syndrome

PIN compression mimicking lateral epicondylitis; pain 5 cm distal to lateral epicondyle without motor/sensory loss.

Pain over the radial tunnel, 5 cm distal to the lateral epicondyle

• Mimics Lateral Epicondylitis. How to DD? DO MAUDLEYS TEST: resistive middle finger extension

• Pain on radial aspect of proximal forearm - most common presenting symptom

• No sensory symptoms and no motor weakness to little muscle weakness due to

pain

• Symptoms aggravates by resisted supination, finger extension positioning of the arm in elbow extension, forearm pronation and wrist flexion

Posterior Interosseous Nerve (PIN) Syndrome

MOTOR-only compression between supinator heads causing dropped fingers/thumb; ECRL function preserved and so the wrist can extend and radially deviate even in

cases of severe neuropathy

Wartenberg's Syndrome

SENSORY ONLY: Superficial radial nerve compression causing sensory disturbances on dorsum of hand; positive Tinel sign.

Mechanism: Trauma, tight watch, handcuffs.

• Pain/sensory disturbances on radial side of the dorsum of the hand;

Pain reproduced with flexion and ulnar deviation

• No motor loss

ulnar nerve roots and motor and sensory innervation

C8,T1

motor: MAFIA

Sensory: pinky and half of ring finger

Cubital Tunnel Syndrome

MOI: Prolonged elbow flexion, fractures, spurs, arthritis

Sensory (First) : Pain/sensory symptoms at 4th/5th digits (dorsal and palmar);

hypothenar

Motor symptoms (later): weakness in FDP 3/4, hypothenar muscles, ulnar

interossei, adductor pollicis

Tests:

I. Symptoms worse with elbow flexion test

II. Positive Froment's (FPL substitutes for weak Adduct. pollicis),

III. Wartenberg sign (inability to adduct the little finger.)

IV. Tinel's sign positive at elbow

Guyon's Canal Syndrome

MOI: history of heavy gripping, twisting, activities involving pressure (Bicycling)

Motor: weakness in hypothenar muscles, ulnar interossei, adductor pollicis. NO

FDP

Sensory: Pain/sensory symptoms at 4th/5th digits (ONLY palmar); hypothenar

Tests:

Froment's, Wartenberg sign and Tinel's sign positive at wrist

Froment's Sign

FPL substitution (thumb IP flexion) for weak adductor pollicis in ulnar nerve neuropathy.

Wartenberg's Sign (Ulnar Nerve) vs wartenberg syndrome

Inability to adduct the little finger due to weak intrinsic muscles.-MOTOR ONLY

Wartenberg syndrome: SENSORY ONLY:his causes pain, tingling, and numbness on the back of the thumb and hand,

Adhesive Capsulitis Stage 1

0-3 months; sharp pain at ROM extremes, capsular pattern loss of ER and abduction.

Adhesive Capsulitis Stage 2

3-9 months (freezing); progressive ROM loss in all planes with persistent pain.

Adhesive Capsulitis Stage 3

9-15 months (frozen); painful stiffening, significant ROM loss, pain only with movement, muscle atrophy, scapular hike.

Adhesive Capsulitis Stage 4

15-24 months (thawing); pain lessens with slow, steady recovery of ROM.

what is the treatment for adhesive capsulitis

Treatment:

● Corticosteroids injection

● Stretching determined by irritability

● Joint mobilizations - posterior glide

● Manipulation under anesthesia

● Modalities - ultrasound, e-stim, etc.

● Patient education

Patellofemoral Pain Syndrome (PFPS) (runners knee)

Age = 20-50 years old

○ Higher incidence in females due to their

higher Q-angle

● MOI: trauma, tightness in IT band, glute max, and TFL

● Tenderness on anterior knee - increased with patella compression

● Possible edema to anterior knee

● Pain with end-range knee flexion

● Symptoms worsen with prolonged sitting

(Moviegoer's sign), stairs, kneeling, incline

walking, and squatting

● (+) Clarke's test, Zohler's test (index and thumb push pressure down on patella)

Lateral Ankle Sprain

Forced plantarflexion/inversion injuring ATFL; tenderness distal to lateral malleolus.

most common in active individuals

+talar test, anterior drawer, calcaneal tilt test

High Ankle Sprain

Forced dorsiflexion/external rotation injuring tibiofibular ligaments; positive Kleiger (DF, ER) and Squeeze tests (compress proximal tibia side).

Medial Ankle Sprain

Forced eversion injuring deltoid ligament; risk of medial malleolus avulsion fracture.

very rare cuz deltoid is a strong ligament.

+talar tilt

Acute anterior Compartment Syndrome is? where would pain be? what muscles are weak? intervention?

Surgical emergency caused by trauma; features 5 P's (pain, pallor, paresthesia, paralysis, pulselessness).

Medical emergency

• Pain or tightness over anterior lower leg

• Weakness in DFs and toe extensors

• Edema

• Intervention - Fasciotomy (relieve pressure of the compartment to help with blood flow)

Chronic Exertional Compartment Syndrome is? pain will be where? what muscles will be weak? interventions?

Exercise-induced anterior leg pain/tightness resolving with rest; managed with activity modification.

No pain at rest

• Pain or tightness over anterior lower leg

• Weakness in DFs and toe extensors

• Edema

• Possible numbness/tingling

• Interventions - activity modifications, stretching, strengthening, NSAIDs

Ottawa Knee Rules Criteria

Age ≥55, isolated patella tenderness, fibular head tenderness, flexion

Ottawa Ankle Rules (Ankle Fluid/X-ray)

Bone tenderness at the posterior edge of

the distal 6 cm or the tip of the lateral

malleolus

• Bone tenderness at the posterior edge of

the distal 6 cm or the tip of the medial

malleolus

• Inability with weight-bearing for at least 4

steps both immediately after injury and at

the time of eval

Ottawa Ankle Rules (Foot X-ray)

Pain in midfoot zone plus navicular tenderness, 5th metatarsal base tenderness, or inability to bear weight 4 steps.