Ulnar / Radial Neuropathies
Anatomy
- Ulnar Nerve
- C8 and T1
- Medial Cord
- Sensory & Motor Branches
Ulnar Neuropathy at the Elbow
- Anatomy
- Pathogenesis
- Clinical Manifestations
- Electrodiagnosis
- Treatment
Ulnar Neuropathy at the Elbow
- Clinical Manifestations
- Symtoms
- Pain
- Tingling / Numbness
- Weak or clumsy hands
Ulnar Neuropathy at the Elbow
SIGNS- Sensory loss
- Muscle weakness / atrophy Wartenbergís sign Fromentís sign
- Tinelís sign
- The elbow flexion test combined with pressure
Ulnar Neuropathy at the Elbow
Differential Diagnosis- Cervical disc disease
- TOS
- Pancoast tumor
- Lesion at the Guyonís canal
- Polyneuropathy
- Motor neuron disease
ELECTRODIAGNOSIS
- Sensory conduction studies
- Motor conduction studies
- Mixed nerve conduction studies
- EMG
ELECTRODIAGNOSIS
- Recording from ADM / FDI
- Dorsal ulnar cutaneous nerve
- Elbow position (Cadaver studies)
- Segment length
- Comparison (elbow - forearm, elbow - arm)
- Proximal segment motor latencies
- Amplitude change - Inching technique
ELECTRODIAGNOSIS
- EMG
- Fibrillations / positive sharp waves / CRD
- MUAP abnormalities
- EMG Motor Tinelís sign
ULNAR TUNNEL SYNDROME
ETIOLOGY- Ganglion
- Trauma
- Anomalous muscle bellies (FDM, ADM, PL)
- Lipoma
- Giant cell tumor
- Schwannoma
- Bipartite hamulus
- Pisiform-hamate coalition
TREATMEMT - CONSERVATIVE
- Avoid aggravating factors
- Avoid full flexion
- Elbow pad
- Splint
- Ergonomic workplace modification
- NSAID
- Local steroid injection
- Vitamin B6
TREATMENT - SURGICAL
- SURGICAL
- Local procedures
- Simple decompression
- Medial epicondylectomy
- Transposition procedures
- Subcutaneous
- Submuscular
- Intramuscular
Radial Neuropathy
- Anatomy
- Sites of entrapment
- Clinical manifestations
- Electrodiagnosis
- Treatment
Radial Neuropathy
UPPER ARM- Saturday night palsy (Bridegroomís palsy)
- Trauma
- Excessive muscular effort
- Crutches
- Alcohol / lead / arsennic
- Compression (fibrous myopathy)
Radial Neuropathy
CLINICAL MANIFESTATIONS- Weakness below the triceps --- wrist drop
- Sensory impairment
- Inferior lateral brachial cutaneous nerve
- Posterior lateral brachial cutaneous nerve
- Superficial radial nerve
Radial Neuropathy
- SLEEP PARALYSIS
- The fundamental damage is neuropraxic, but often associated with additional axonal involvement
- Signs of denervation persist in the most distal muscle even after 2-4 years
Radial Neuropathy
ELECTRODIAGNOSIS NCS (Trojaborg, 1970)- MCV & SCV: 50% if normal during the first 2 weeks and return to normal at 6 -8 weeks
Radial Tunnel Syndrome
PATHOGENESIS- Fibroma
- Neuroma
- Ganglion
- Synovial chondromatosis
- Rheumatoid synovitis
- Bursitis
- Venipuncture
- Monteggia fracture
- Excessive pronation and supination
Radial Tunnel Syndrome
- Michele and Krueger (1956 ): radial pronator syndrome
- Roles and Maudsley (1972): RTS
- Werner and Lister (1979): establish RTS
Radial Tunnel Syndrome
- Symptoms
- Pain: dull, aggravated by use, nocturnal, awaken the patient
- Paresthesia
- Mild weakness
Radial Tunnel Syndrome
- Signs
- Tenderness at 4-5 cm distal to the lateral epicondyle
- Pain induced by supination against resistance
- The middle finger extension test
Radial Tunnel Syndrome
ELECTRODIAGNOSIS- Not sensitive
- Most likely due to intermittent, rather than continuous compression
Cheiralgia Paresthetica
- Wartenbergís disease (1932)
- Etiologies
- Tight wrist-watch strap
- Handcuff
- Surgery around the wrist
- Trauma
- Repeated pronation / supination activities
Cheiralgia Paresthetica
- Symptoms
- Burning or shooting pain
- Radiation pain
- Numbness or tingling
- Aggravation by ulnar flexion of the wrist or with grasping and pinching
Cheiralgia Paresthetica
- Signs
- No muscle weakness
- Hypoesthesia
- Tinelís sign
- Finkelstein sign
- Provocative test
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