Entrapment Syndromes

Median Nerve Entrapment (Pronator Syndrome )

Injury proximal to Elbow - Involvement of  Wrist , Fingers and Thumb 

Injury on proximal forearm -- Wrists spared 

Injury on Wrist - thenar group of muscles involved 


Benediction sigh - High median nerve injuries . 

D/D 
1. Bicipital Tendinitis 

     resisted elbow flexion illicits pain 

2. Resisted Pronation 

  with a finger 3 finger breadth below elbow crease illicits pain 



Radial Tunnel Syndrome 

PIN compression at Arcade of Forhse 

4 fingers below lateral epicondyle illicits tenderness. 

Resisted long finger  extension test  - finger and wrist at 30 degrees extension - give pressure to flex MCP passively. 

a severe PIN compression , ECU doesnot function and wrist goes into radial  deviation.  

Note 

Brachioradialis , ,ECRB , ECRL lie proximal to radial tunnel . 

ECU , EDC , EPL and EPB lie distal to Radial tunnel . 




Anterior Interosseous Nerve (AIN ) - 

Aching pain  simiilar to that of pronator syndrome . aching pain in proximal forearm. 

Weakness - FPL , FDP to IF and Pronator quadratus  - Ok sign +ve 
 

Cubital  Tunnel Syndrome 

Repititive movement,  RA , OA , Fracture , Dislocation , Cubitus Valgus , Instability , Anconeus Epitrochlearis crossing nerve in region of medial epidondyle 


Inspection - Clawing of fingers,  atrohpy of hypothenar muscles 

Palpation - Ulnar Nerve 
  
                   Tinel's sign - tip of long finger suggestive of irritation of nerve 

                                (radiating pain distally ) 

                    Instability - palpae elbow - flexion / extension 

                    Compression test 

                         holding more or  upto 1 min with elbow in maximum flexion leads to paresthesiae of                          
                           LF and RF 

                    
                     Finger abductioon / adduction (intrinsic weakness )

                      FDP - RF / LF weakness 

                      FDP - LF , RF and Wrist flexion in radial deviation 

                                   weakness suggestive of compression proximal to wrist. 

                      High lesion - ulnar clawing 

      

claw hand - weakend lumlbricals allow MCP hyperextension and it inhibits full extension of PIP     
                       
   joint . 


Bovier's test for claw hand - examiner passively prevents MCP hyperextension allowing PIP to fully extend. 




Investigation 

X-ray 

RBS 

TFT 

NCS , EMG 

USG / MRI 







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