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 







Comments

Post a Comment

Popular posts from this blog

Outline of Treatment of Spinal Tuberculosis

Image
 Tuberculosis     In general , Rest and Nutrition                                 Chemotherapy                                Surgery if needed .                                    Dorsal Spine - Approach to surgery     A bit ambiguous      Many prefer to do Anterior Transpleural. Some choose Anterolateral/posterolateral extrapleural                and posterolateral approaches      Posterolateral Approach(Martin 1970)      Dura exposed by Hemilaminectomy first and then operation extended laterally to remove posterior         ends of 2 to 4 ribs, corresponding transverse process and pedicles.      He thinks  Anterolateral approach a very risky one.     Approach to Atlanto-occipital and Atlanto-axial joint         Numerous structures on the way anteriorly     Supine position, Neck on 5-10 degrees hyperextension ,Trachesostomy done     Transoral Anterior Approach           Uvula, Soft palate bissected , Hypopharynx packed, 5 cm long incision given, Flaps                                 
Read more

COXA VARA

Image
Coxa Vara Painless limp, LLD gradually worsening ,  Unilateral or bilateral in 30-50 % cases Prominent trochanters Pelvic Tilt- LLD  Trendelenburg test or delaye trendelenburg test + ve B/L waddling  High Greater trochnater - supratrochanteric shortening,  Decreased abduction, (decrease in articular trochanteric distance ) and internal rotation (due to decreased anteversion) may have out toeing r/o cervical instability causing limping  Types of Coxa Vara  https://quizlet.com/au/304405013/coxa-vara-flash-cards/ Mangement      Depends on Hilgenreiner Angle (HEA ) https://www.orthobullets.com/pediatrics/4041/developmental-coxa-vara  > 60 degrees - wait and watch    45-60 degrees - wait and watch  Goals of surgery      Neck shaft angle  (more or equal ) to 140.              degrees     Correct version      Ossification and healing of inferomedial.               fragment      Restore ATD (Articulo-trochanteric            distance    AND abductor mechanism                 (length -tension
Read more

Paediatric Supracondylar Humerus Fracture

Image
Supracondylar Fracture  Patient Presentation         Age 6-10 years         MOI - Fall on outstretched hand with elbow on extension, breaks.   Olecranon serves as the fulcrum      and the stress concentrates in distal humerus. Anteriorly the perisoteum hinges.     Pain , swelling, deformity, bruising      Deformity (usually S shaped ) , skin puckering      Compartment syndrome         Blood vessels spasm/ contusion/ tear/ thrombosis     If capillary refill present , hand arm Dunlop traction done.      No role of Angiography , further delays the treatment.      Nerve Injuries, proximal fragment spike hits nerve.             3a Posteromedial displacement - Radial Nerve involvement             3b Posterolateral displacement - Median Nerve involvement     Gartland and Wilkins Classification      Extension type fracture      1. Undisplaced Fracture      2. Displaced Fracture , posterior cortex is.                intact     3. Displaced fracture, posterior cortex breaks      Flexion type occ
Read more

Timing and Outcome of Surgery in Hip Fractures

Hip Joint Ball and Socket joint. Hip fracture is any fracture involving Interochanteric region head, neck or acetabulum. 310,000 Hip fractures in the United State in 2003     1/3 rd - receive a hip replacement.     10.3 - 15.2 billion dollars / year Elderly – Vast Majority  Co-morbidities Femoral Neck Fracture Fracture Healing is delayed due to          - I ntracapusular neck- No Cambium layer          - Synovial fluid clears out haematoma and inhibits fracture union          - Haematoma causes pressure on head Mechanism of injury  • Directly on lateral hip • Twisting mechanism • Fatigue or insufficiency fracture, then fall • In younger - RTA /  fall from a height Risk Factors of Hip Fractures   • Osteoporosis and Falls   Lifetime risk -17.5 percent for women : 6 percent for men  • Average -   women 77 years old  :  men 72 years old • Low socioeconomic status • Cardiovascular diseas
Read more

Hind Foot amputation

Image
Boyd Amputation -Tibiocalcaneal arthodesis, heel pad preserved. ( https://www.semanticscholar.org/ ) ( Modifizierte Pirogoff-Amputation | SpringerLink ) Pirgoff Amputation  Amputation at ankle. part of calcanuem left in the stump , Calcaneum cut vertically.  Advantages  long lever arm , self suspension , good proprioception , end wt bearing.  Disadvantages  poor cosmesis , too long to use standard foot , no possibility of prosthetic foot fitting 
Read more