1. CHAPTER 21 COMPRESSION NEUROPATHIES
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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)
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2. ANATOMY OF PERIPHERAL NERVE
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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.
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3. CARPAL TUNNEL SYNDROME
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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.
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4. EPIDEMIOLOGY More common in females. Prevalence 2% of population.
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EPIDEMIOLOGY
More common in females.
Prevalence 2% of population.
Risk factors: Occupational, diabetes, hypothyroidism, pregnancy, masses.
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5. CLINICAL PRESENTATION
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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.
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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).
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7. DIAGNOSTIC X-rays of wrist (if fracture). Neck (HNP).
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DIAGNOSTIC
X-rays of wrist (if fracture).
Neck (HNP).
MRI of wrist to check for masses.
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8. LABS Rheumatoid arthritis, diabetes, hypothyroidism.
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LABS
Rheumatoid arthritis, diabetes, hypothyroidism.
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9. NERVE CONDUCTION TESTING
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NERVE CONDUCTION TESTING
Nerve conduction velocity and latency across motor and sensory components (EMG/NCV).
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10. DIFFERENTIAL DIAGNOSIS
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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).
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11. TREATMENT Night splints. Corticosteroid injection to carpal tunnel.
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TREATMENT
Night splints.
Corticosteroid injection to carpal tunnel.
Surgery.
TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY