Term
| Peripheral Nerve Injuries (three major nerves, types of nerve injuries, diagnoses) |
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Definition
three major nerves: median, ulnar and radial
types of nerve injuries: compression, laceration
diagnoses:
Carpal tunnel syndrome
Pronator teres syndrome
Guyon's canal
Cubital tunnel syndrome
Radial nerve palsy
Median nerve laceration
Ulnar nerve laceration
Radial nerve laceration |
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Term
| Carpal Tunnel Syndrome (description, etiology, symptoms, conservative treatment, surgical treatment, post-op treatment) |
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Definition
| [image]
description: median nerve compression
etiology: repetition, awkward postures, vibration, anatomical anomalies, pregnancy
symptoms: numbness and tingling of thumb, index, middle and radial half of ring fingers
conservative treatment:
night neutral wrist splint
activity mod
surgical treatment: carpal tunnel release (CTR)
post-op treatment: edema control, AROM, nerve gliding exercises, sensory reeducation, strengthening of thenar muscles, work/activity modification |
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Term
| Pronator teres syndrome (description, etiology, symptoms, conservative treatment, surgical intervention, post-op treatment) |
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Definition
| [image]
description: (proximal volar forearm) a medial nerve compression between two heads of pronator teres
etiology: repetitive pronation and supination and excessive pressure on volar forearm
symtpoms: numbness and tingling of thumb, index, middle and radial half of ring fingers, aching pain of proximal forearm, positive Tinel's sign at the forearm, ** NO night symptoms **
conservative treatment: elbow splint at 90degrees with forearm in neutral, avoid activities that include repetition
surgical intervention: decompression
post-op treatment: AROM, nerve gliding, strengthen (2 weeks post-op), sensory reeducation, work/activity mod |
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Term
| Guyon's canal (description, etiology, symptoms, conservative treatment, surgical intervention, post-op intervention) |
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Definition
| [image]
description: ulnar nerve compression @ wrist
etiology: repetition, ganglion, pressure, and fascia thickening
symptoms: numbness and tingling in ulnar nerve distribution of hand, motor weakness, Positive Tinel's sign, advanced stages can lead to atrophy of ulnar nerve-innervated musculature in hand
surgical intervention: decompression
post-op intervention: edema control, AROM, nerve gliding, strengthening (2 to 4 weeks -- focus on power grip), sensory reeducation |
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Term
| Cubital Tunnel Syndrome (description, etiology, symptoms, conservative treatment, surgical intervention, post-op treatment) |
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Definition
| [image]
description: ulnar nerve compression @ elbow
etiology: 2nd most common compression; pressure at elbow (often from leaning on elbow) and extreme elbow flexion
symptoms: numbness and tingling along ulnar aspect of forearm and hand, pain at elbow with extreme flexion, weakness of power grip, positive Tinel's sign @ elbow, advanced stages can lead to atrophy of FCU, FDP to digits IV and V and ulnar nerve-innervated intrinsic muscles of hand
conservative treatment: elbow splint to prevent extreme flexion (especially at night), elbow pad to decrease compression of nerve when leaning on elbows, activity/work mod
surgical intervention: decompression or transposition
post-op treatment: edema control, scar management, AROM and nerve gliding (2 weeks post-op), strengthening (4 weeks post-op), MCP flexion splint if clawing noted |
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Term
| Radial Nerve Palsy (aka, description, etiology, symptoms, conservative treatment, surgical intervention, post-op treatment) |
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Definition
| [image]
aka: Saturday night palsy
description: radial nerve compression
etiology: sleeping in a position that places stress on the radial nerve, compression as a result of a humeral shaft fracture
symptoms: weakness or paralysis of extensors to wrist, MCPs, and thumb; wrist drop
conservative treatment: dynamic extension splint, work/activity mod, strengthening wrist and finger extensors when motor function returns
surgical intervention: decompression
post-op treatment: ROM, nerve gliding, strengthening (6 to 8 weeks post-op), ADLs and meaningful role activities |
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Term
| Median Nerve Laceration (sensory loss, motor loss for low vs. high lesion, deformity, functional loss, interventions, splinting considerations, sensory reeducation) |
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Definition
| [image]
sensory loss: thumb to radial 1/2 of ring finger; palmar surface of thumb, index, middle and radial 1/2 of ring finger; dorsal surface of index, middle, and radial 1/2 of ring fingers
motor loss for low lesion: lumbricals I and II (MCP flexion of digits II and III); opponens pollicis (opposition); ABductor pollicis brevis (ABduction); flexor pollicis brevis (flexion of thumb MCP)
motor loss for high lesion: lumbricals I and II (MCP flexion of digits II and III); opponens pollicis (opposition); ABductor pollicis brevis (ABduction); flexor pollicis brevis (flexion of thumb MCP); FDP to index and middle fingers, and FPL (flexion of tip of index, middle fingers, and thumb)
deformity: flattening of thenar eminence ("ape hand"), clawing of index and middle fingers for a low lesion, benediction sign for a high lesion
functional loss: loss of thumb opposition, weakness of pinch
interventions: dorsal protection splint with 30degree flexion @ wrist if a low lesion, include 90degree @ elbow if high lesion; begin A/PROM of digits with wrist in flexed position (2 weeks post-op), strengthening (9 weeks post-op), scar management
splinting considerations: C-bar to prevent thumb ADduction contracture
sensory reeducation: begin when level of diminished sensation is demonstrated at 4.31 on Semmes-Weinstein |
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Term
| Ulnar Nerve Laceration (sensory loss, motor loss for low vs. high lesion, motor loss, deformity, functional loss, interventions, splinting considerations, sensory reeducation) |
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Definition
| [image]
sensory loss: ulnar aspects of palmar and dorsal surfaces, ulnar 1/2 of ring and little fingers on palmar and dorsal surfaces
motor loss for low lesion: palmar and dorsal interossei (ADuction and ABduction of MCP), lumbricals III and IV (MCP flexion of digits 4 and 5), FPB and ADductor pollicis (flexion and ADduction of thumb), ADM, ODM, FDM (Abduction, opposition, and flexion of 5th digit)
motor loss of high lesion: palmar and dorsal interossei (ADuction and ABduction of MCP), lumbricals III and IV (MCP flexion of digits 4 and 5), FPB and ADductor pollicis (flexion and ADduction of thumb), ADM, ODM, FDM (Abduction, opposition, and flexion of 5th digit), FCU (flexion towards ulnar wrist), FDP IV and V (flexion of DIPs of ring and little fingers)
deformity: claw hand, flattened MCP arch, Positive Froment's sign
functional loss: loss of power grip, decreased pinch strength
interventions: dorsal protection splint with 30degree flexion @ wrist if a low lesion, include 90degree @ elbow if high lesion; begin A/PROM of digits with wrist in flexed position (2 weeks post-op), strengthening (9 weeks post-op), scar management
splinting considerations: MCP flexion block splint
sensory reeducation: begin when level of diminished sensation is demonstrated at 4.31 on Semmes-Weinstein |
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Term
| Radial nerve laceration (sensory loss, motor loss at low vs. high lesion, functional loss, deformity, interventions) |
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Definition
| [image]
sensory loss: (high lesions at the level of the humerus) medial aspect of dorsal forearm, radial aspect of dorsal palm, thumb, and index, middle and radial 1/2 of ring phalanges
motor loss at low level: loss of wrist extension due to absent or impaired innervation to ECU, EDC, EI, EDM (MCP extension), EPB, EPL, APL (thumb extension)
motor loss high lesion: loss of wrist extension due to absent or impaired innervation to ECU, EDC, EI, EDM (MCP extension), EPB, EPL, APL (thumb extension), ECRB, ECRL, brachioradialis (extension), if level of acilla, loss of triceps (elbow extension)
deformity: wrist drop
interventions: dynamic extension splint, ROM, sensory reeducation if needed, instruct in home program, activity mod |
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