Carpal tunnel and ulnar tunnel nerve entrapments

what nerve roots make up the median nerve?

C5-T1

what nerve roots makes up the radial nerve?

C5-T1

what nerve roots make up the ulnar nerve?

C7-T1

what are the UE dermatomes?

C2: subocciptal

C3: subclavicular

C4: upper trap

C5: lateral elbow

C6: thumb

C7: third digit

C8: 5th digit

T1: medial elbow

what are the UE myotomes?

C2: cervical extension

C3: cervical lateral flexion

C4: scapular elevation

C5: shoulder abduction

C6: elbow flexion, wrist extension

C7: elbow extension, wrist flexion

C8: thumb extension

T1: finger abduction

what do we do if sensation is lost in the hand?

to determine if its a peripheral nerve or a nerve root, we need to map it out via circumfirential mapping of the wrist or dermatome/myotomes and peripheral nerve patterns. then we can looka tcervical ROM to see if symptoms improve or not and also reflexes which would only be effected if it’s a nerve root problem

what are the carpal tunnel otucome measures?

boston carpal tunnel questionarre

BCTQ clinimetrics

what treatments have the best pieces of evidence for treating carpal tunnel?

orthosis and education

what findings would be more consistent with a nerve root?

• neck or scapular symptoms may be present

• dermatomal sensory changes

• myotomal weakness across more than one peripheral nerve

• relfex changes present

• cervical testing may reproduce or alter symptoms

what findings would be more consistent with a peripheral nerve?

• symptoms may be reproduced at a known entrapment site

• sensory loss follows the named nerve distribution

• weakness limited to muscles supplied by the involved nerve distal to the lesion

• reflexes are typically preserved unless the lesion is proximal

• local provocation tests or palpation may reproduce symptoms

what are the recommended tests and measures by the CPG for examination of carpal tunnel?

A: monofilament threshold test, static 2PD test

B: phalen test, carpal compression test, tinel sign

what are the muscles of the hand that the median nerve innervates?

thenar muscles except for adductor pollicis

what are the muscles of the hand that the ulnar nerve innervates?

hypothenar muscles— abductor digiti minimi, flexor digiti minimi, opponens digiti minimi, adductor pollicis

what athletic context do we most often see ulnar tunnel syndrome in?

cyclists

what are the entrapment sites of the median nerve?

pronator teres, bicipital aponeurosis, ligament of struthers

where does the median nerve run between in the carpal tunnel?

flexor carpi radialis and palmaris longus

what are the contributing factors for these?

forward shoulder and neck posture due to stiffness of pecs, lats, SCM, scalenes, and UT or weakness of extensors

what forms the roof of the carpal tunnel and the floor?

roof: transvese ligament

floor: carpal arch

what is the clinical manifestations of carpal tunnel syndrome?

1. dull ache

2. pins and needles pain

3. muscle weakness

4. thenar muscle wasting

what are risk factors for carpal tunnel?

obesity, pregnancy, repetitive stress, diabetes, RA

what form the borders of the tunnel of guyon?

pisiform and hook of hamate

what are the branches of the ulnar nerve?

superficial branch: hypothenar emminence

deep branch: interossei and adductor pollicis

sensory branches

what are the zones of entrapment for ulnar tunnel syndrome?

1. all branches in guyons canal

2. most common, outside of canal at the hook of hamate affecting the motor branch

3. rarest with just sensory branch affected