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CHAPTER 21 COMPRESSION NEUROPATHIES

CHAPTER 21 COMPRESSION NEUROPATHIES. Clinical condition where pressure on peripheral nerve produces dysfunction in the nerve. Carpal Tunnel Syndrome (wrist – median nerve) Cubital Tunnel Syndrome (elbow – ulnar nerve). ANATOMY OF PERIPHERAL NERVE. Epineurium – outer covering cushions nerve.

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CHAPTER 21 COMPRESSION NEUROPATHIES

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  1. CHAPTER 21COMPRESSION NEUROPATHIES • Clinical condition where pressure on peripheral nerve produces dysfunction in the nerve. • Carpal Tunnel Syndrome (wrist – median nerve) • Cubital Tunnel Syndrome (elbow – ulnar nerve) TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

  2. ANATOMY OF PERIPHERAL NERVE • Epineurium – outer covering cushions nerve. • Perineurium – surrounds fascicle (group of axons) • Endoneurium – each axon surrounded by collagen shell. Compression causes damage by direct pressure on neural vasculature and tethering nerves to surrounding tissue. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

  3. CARPAL TUNNEL SYNDROME • Pain, numbness, weakness in median nerve distribution at wrist. • Median nerve enters wrist volar via carpal tunnel. • Transverse carpal ligament volar, carpal bones dorsally, 9 flexor tendons. • Under transverse carpal ligament. • As it exits carpal tunnel, the median nerve divides into branches to thumb, index and long fingers and the radial aspect of the ring finger. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

  4. EPIDEMIOLOGY • More common in females. • Prevalence 2% of population. • Risk factors: Occupational, diabetes, hypothyroidism, pregnancy, masses. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

  5. CLINICAL PRESENTATION • Vague wrist pain. • Numb thumb all the way to the radial aspect of the ring finger. • Pain with flexed wrist position (typing, bicycling). • Loss of fine motor control (chronic). • Nocturnal symptoms. • Decreased 2-point discrimination. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

  6. CLINICAL TEST • TINEL’S TEST: Percussing median nerve at volar wrist. • COMPRESSION TEST. • PHALEN’S TEST: Reproduced symptoms with sustained symmetric wrist flexion. • Decreased thenar muscle strength and atrophy (late findings). TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

  7. DIAGNOSTIC • X-rays of wrist (if fracture). • Neck (HNP). • MRI of wrist to check for masses. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

  8. LABS • Rheumatoid arthritis, diabetes, hypothyroidism. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

  9. NERVE CONDUCTION TESTING • Nerve conduction velocity and latency across motor and sensory components (EMG/NCV). TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

  10. DIFFERENTIAL DIAGNOSIS • Pronator Teres Syndrome – compression of median nerve at proximal forearm (FDS to all fingers). • Cervical myelopathy (C6-C7). • Ulnar nerve compression at Guyon’s canal (numbness little finger and ulnar aspect of ring finger). • Cubital tunnel syndrome (Tinel’s at medial aspect of elbow). • Thoracic outlet syndrome (vascular or neural compression of brachial plexus). TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

  11. TREATMENT • Night splints. • Corticosteroid injection to carpal tunnel. • Surgery. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

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