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Entrapment Neuropathies
Carpal tunnel syndrome (CTS)
Ulnar neropathy at the elbow
Thoracic outlet syndrome (TOS)
Radial neuropathy.
Peroneal nerve lesions
Meralgia paresthetica
Tarsal tunnel syndrome (TTS)
Carpal tunnel syndrome
The median nerve can be compressed as it passes through the carpal tunnel. The tunnel is at the base of the hand.
The carpal, or wrist bones, form the floor of the tunnel and the flexor retinaculum forms the roof. Nine flexor tendons also pass through the tunnel.
Numbness on the palmar surface of the thumb and index, middle, and half of the ring finger
Patients are often not aware of the true distribution of numbness and may report that all five fingers are involved.
The pain can be both distal and proximal to the site of compression. Patients can report pain in the hand, wrist, elbow, and shoulder. Carpal tunnel syndrome should be considered in any obscure complaint of pain in the arm.
symptoms at night/Driving
Patients usually do not complain of weakness. They may report dropping things or having difficulty with certain motor activities like doing up buttons or opening a jar.
Phalen’s maneuver
Tinel’s sign
*Diagnosis:: EMG/NCV
*Treatment:
splinting to maintain the wrist in a neutral position
Anti-inflammatory
Surgical decompression
ULNAR NEUROPATHY
AT THE ELBOW
Ulnar nerve entrapment at the elbow is the second most common neuropathy in the upper extremity.
Entrapment can occur either at the ulnar groove or at the cubital tunnel.
The ulnar nerve is particularly vulnerable to compression or stretch as it crosses the elbow and passes through the cubital tunnel.
The ulnar groove is formed by the medial epicondyle and the olecranon process.
The nerve is also vulnerable to impingement if there is a bony deformity or scar formation. Patients with a remote history of supracondylar fracture can develop such a bony deformity and nerve impringement in what has been called “tardy ulnar palsy.”
Intermittent numbness and tingling in the distribution of the ulnar nerve is usually the first symptom of ulnar palsy.
Patients can wake up with elbow pain radiating into the fifth digit.
There can be cramping and aching in the hypothenar eminence.
Symptoms can be exacerbated by flexion of the elbow.
Diagnosis: EMG/NCV
Treatment:
Mild cases of ulnar palsy at the elbow can be successfully treated with an elbow
pad to reduce trauma to the nerve or by avoiding prolonged flexion at the elbow.
More severe cases may require surgery
Radial neuropathy
Saturday night palsy
Compression site: axilla
Hand drop+ sensory problem in back of the hand
Treatment:
physical therapy+ wrist splint
T.O.S
There are many structures that can compress or impinge the brachial plexus as it enters the arm.
Vascular structures can also be compressed in the same way.
A cervical rib is the most discussed source of compromise in TOS, but easily identified by x-ray
An anomalous fibrous band from the transverse process of the last cervical vertebra to the first rib is a common cause of impingement.
Most commonly in neurogenic TOS the lower trunk of the brachial plexus is most involved.
Vascular syndromes usually involve compromise of the axillary and subclavian vessels.
Neurogenic symptom -numbness of the medial forearm and ulnar side of the hand.
clumsiness or weakness in the hand and fingers. Atrophy of both the thenar and hypothenar eminences can be seen.
Adson’s maneuver involves extending the arm at shoulder height to the side and supinating the hand .loss of radial pulse, and an increase in sensory symptoms.
Treatment: Surgery
Peroneal nerve lesions
Trauma or pressure at the head of fibula
Foot drop and eversion problem+ paresthesia in dorsum of foot.
Plantar flexion and in version and ankle reflex are intact
Treatment: ankle brace+ physiotherapy
Meralgia paresthetica
The lateral femoral cutaneous nerve of the thigh (L2&L3)arises from upper lumbar roots, travels through the pelvis, and exits into the leg at the upper lateral end of the inguinal ligament.
The nerve is usually trapped as it passes under or through the inguinal ligament.
Pressure from neighbor anatomic structures specially in pregnancy and obesity
Pain and paresthesia in lateral of thigh