1.  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

2.  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. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

3.  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

4.  More common in females.  Prevalence 2% of population.  Risk factors: Occupational, diabetes, hypothyroidism, pregnancy, masses. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

5.  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.  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

7.  X-rays of wrist (if fracture).  Neck (HNP).  MRI of wrist to check for masses. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

8.  Rheumatoid arthritis, diabetes, hypothyroidism. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

9.  Nerve conduction velocity and latency across motor and sensory components (EMG/NCV). TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY

10.  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

11.  Night splints.  Corticosteroid injection to carpal tunnel.  Surgery. TONY JABBOUR, MD KNEE & SHOULDER SUBSPECIALTY