clinical condition where pressure on peripheral nerve produces dysfunction in the nerve. carpal...

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

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 tosurrounding tissue.

TONY JABBOUR, MD

KNEE & SHOULDER SUBSPECIALTY

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

More common in females.

Prevalence 2% of population.

Risk factors: Occupational, diabetes, hypothyroidism, pregnancy, masses.

TONY JABBOUR, MD

KNEE & SHOULDER SUBSPECIALTY

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

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

X-rays of wrist (if fracture).

Neck (HNP).

MRI of wrist to check for masses.

TONY JABBOUR, MD

KNEE & SHOULDER SUBSPECIALTY

Rheumatoid arthritis, diabetes, hypothyroidism.

TONY JABBOUR, MD

KNEE & SHOULDER SUBSPECIALTY

Nerve conduction velocity and latency across motor and sensory components (EMG/NCV).

TONY JABBOUR, MD

KNEE & SHOULDER SUBSPECIALTY

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

Night splints.

Corticosteroid injection to carpal tunnel.

Surgery.

TONY JABBOUR, MD

KNEE & SHOULDER SUBSPECIALTY