OT 644 nerve compression about the elbow

PIN palsy

- glaucoma or myxoma= constant compression

problems with guyon canal

numb on palm; good on back of hand

nerve entrapment

- compressed

- stretched

- friction

2 types of unstable ulnar nerve (friction)

- Subluxing: displacement

- Dislocating: complete rolling

- Dislocation is present in 14-16% ofa normal population

predisposing factors

- Bony abnormalities

- Trauma

- Soft tissue lesions

- Habitual dislocation/subluxation

- Diabetic, alcoholic

- Repetitive work

clinical presentation (radial tunnel syndrome)

- PAIN in dorsal forearm.

- Weakness of finger extension with normal radial wrist extension

- DSRN is proximal to ligament of Frohse

- Vague dorsal pain due to terminal branch of PIN

differential diagnosis (radial tunnel)

- C6, C7, and C8 nerve root irritation

- Brachial neuritis

- TOS

- Double crush

- Lateral epicondylitis

- De Quervains

- Extensor Tenosynovitis

- Wartenburg's syndrome

clinical presentation (pronator syndrome)

- 9 mos to 2 year Hx of non-localized forearm pain

- Reproduction of pain on resistance to pronation and flexion of FDS of long finger

- Fibrous bands of the pronator

- Difficult to diagnose

differential diagnosis (pronator syndrome)

- C5, C6 Lesion

- Thoracic outlet syndrome

- Carpal Tunnel Syndrome

- Medial Epicondylitis

- Brachial plexus neuritis

clinical presentation (cubital tunnel syndrome)

- Numbness in ulnar nerve distribution (dorsal and volar ulnar hand)

- Weakness of ulnar intrinsics

- Atrophy of ulnar intrinsics with severe cases

- Weak hand strength (intrinsics)

- Weak key pinch (thumb adductor)

differential diagnosis (cubital tunnel syndrome)

- C8 root lesion

- Thoracic outlet

- Carpal Tunnel Syndrome

- Ulnar nerve lesion at a different site (Guyon's canal; Dorsal ulnar sensory neuropathy)

- Medial epicondylitis

- UCL chronic laxity (throwing athletes)

pronator pain syndrome (test)

- resist pronator with elbow extended

-stretch pronator with elbow extended

-Percuss median nerve at pronator level

-Sensory test median distribution-Resist FDS of middle finger (Superficialis Arch)

pronator pain syndrome (results)

- pain/paresthesias proximal forearm

- + Tinel sign

-Sensory loss thenar emmin. (+ digits)

-Aching in forearm

proximal median (ligament of struthers) (test)

- sensory test median distribution

-MMT median extrinsic and intrinsic muscles

proximal median (ligament of struthers) (results)

- Sensory loss median distribution

- Weakness pron,wrist and finger flex

anterior interosseous syndrome (AIN) (test)

- MMT FPL and FDP of Index

- Repetitive wrist flex/ext (distal wrist innervation)

anterior interosseous syndrome (AIN) (results)

- No active contraction

- Weakness pron, wrist and finger flex

radial tunnel (PIN) (test)

- Palpate proximal supinator

- Stretch supinator with pronation and elbow ext.

- Resist supination with elbow extension

- resist M digit ext. with elbow extension

-Sensory test dorsal/radial hand

-(rule out DSRN)

radial tunnel (PIN) (result)

- Pain/point tenderness to palpation

- Pain, parasthesia

-Pain, parasthesia- Pain proximal-dorsal forearm (ECRB)

-Sensory loss dorsum of hand

posterior interosseous - PIN syndrom/palsy motor (test)

- Resist supination with elbow extension

- resist digit extensors

posterior interosseous - PIN syndrom/palsy motor (result)

- Localized pain in forearm

- Weakness/palsy digit and thumb extensors

ulnar cubital tunnel (test)

- Elbow Flexion Test

- Percuss nerve above/below tunnel

- Test lateral pinch

- Test abd/add of small digit

- Sensory tests volar/dorsal ulnar hand

highly recommended test for the elbow

- Tinels for cubital tunnel

- Elbow flexion test for cubital tunnel

recommended test for the elbow

- Moving valgus stress (MCL instability)

- Cross finger for cubital tunnel

- Shoulder internal rotation for cubital tunnel

- Scratch collapse test for cubital tunnel

- Ulnar nerve thickening sign for cubital tunnel

cubital tunnel treatment

- Splint elbow < 30° flexion at night

- Patient Education and Activity Modification

- Nerve glides

RT and PS treatment

- No splint or simple wrist in RT

- Stretching and soft tissue techniques forearm

splints

prevent static posture or m. contract