PNI continuation,, not all mononeuropathis are discussed

2. Entrapment Syndromes
Mononeuropathies : caused by Entrapment
Syndromes. Occurs in most nerves of the body.
Commonly Affected
Long Thoracic nn.
Spinal Accessory nn.
Common Peroneal nn.
Lateral femoral
cutaneous nn.
Tibial nn.
Brachial Plexus
Lumbrosacral Plexus

3. Median Nerve
 Nerve Root: C6 – T1
 Originates from the
Brachial Plexus.
 Enters the anterior
compartment of the
forearm via the cubital
fossa.
• The median nerve enters the
hand via the carpal
tunnel, where it terminates by
dividing into two branches
1. Recurrent branch: thenar
mm.
2. Palmar digital branch:
palmar surface and fingertips
of the lateral three and half
digits; lateral two lumbrical
muscles.

4. Median Nerve
Carpal Tunnel Syndrome (CTS)
Median nn. is entrapped at wrist, as it passes through
the Carpal tunnel.

5. Carpal Tunnel
 median nerve
 flexor pollicis longus
tendon
 four tendons each from
the flexor digitorum
superficialis
 profundus muscles

6.  Swelling or increased pressure inside the carpal
tunnel can lead to compression of the median nerve,
producing symptoms of CTS.

7. Clinical Presentation
 Paresthesia (numbing, tingling and burning)
involving the median nn. distribution
 deep aching pain in the hand and wrist.
 Pain may radiate to forearm and shoulder.
 Px may report subjective swelling of the hand
 Sx worsen at night.

8.  Carpal tunnel syndrome is more common in women
 50% of the cases occurs bilaterally.

9. Carpal Tunnel Syndrome
Special Tests
 Tinel's sign
 Phalen's sign,
 median nerve compression test.

10. Carpal Tunnel Syndrome
 EMG – NCV
Treatment
- Rest
- Remove aggravating factors
- Anti-inflammatory meds.
- Treat associated med. Conditions
- Vitamin B6 ( 50 – 300 mg)
- Nocturnal Wrist plints
- Surgery ( Carpal Tunnel Release ; Endoscopic Release)

11. Ulnar Nerve
Nerve root: C8 and T1
 At the medial epicondyle,
the nerve is easily
palpable and vulnerable
to injury.
 Ulnar nn. enters the
cubital tunnel between
the medial epicondyle
and the olecranon

12. Ulnar Neuropathy at the Elbow (UNE)
 Aka Cubital Tunnel Syndrome
 2nd most common entrapment neuropathy.

13. Symptoms of UNE
 paresthesias of the fourth and fifth digits and the
ulnar aspect of the dorsum of the hand.
 Weakness & atrophy occurs later ( intrinsic mm.)
 Loss of Elbow ROM
 Elbow valgus deformity.

14. Special Tests for UNE
 Side to side confrontational strength testing
: to detect weakness of the intrinsic hand mm.
 Tinel’s sign at elbow

15. Radial nerve
 Nerve roots: C5-T1.
 Sensory: Innervates most of the skin
of the posterior side of forearm, and
the dorsal surface of the lateral side of
the palm, and lateral three and a half
digits.
 Motor: Innervates the triceps brachii,
responsible for extension at the elbow.
Innervates the majority of the extensor
muscles in the forearm, responsible for
extension of wrist and fingers and
supination of the forearm



16. Radial neuropathy
 Lesions of the radial nerve can be broadly categorized into four
groups – depending on where the damage has occurred, and
what components of the nerve have been affected.
 In the Axilla
 How it commonly occurs: Dislocation of humerus at the
glenohumeral joint or fracturesof proximal humerus. Can also
happen via excessive pressure on the axilla, e.g. a badly fitting
crutch.
 Motor functions: Triceps brachii and muscles in posterior
compartment are paralysed. The patient is unable to extend the
forearm, wrist and fingers. Unopposed flexion of wrist occurs,
known as wrist drop.
 Sensory functions: All four cutaneous branches of the radial
nerve are affected. There will be a loss of sensation over the
lateral and posterior upper arm, posterior forearm, and dorsal
surface of the lateral three and a half digits.

17. In the Radial Groove:
 How it commonly occurs: Fracture of the shaft of the
humerus – damaging the radial nerve when it is bound in
the radial groove.
 Motor functions: The triceps brachii may be weakened,
but is not paralysed. The deep branch of the radial nerve
is affected, so the muscles in the posterior compartment
of the forearm are paralysed. The patient is unable to
extend the wrist and fingers. Unopposed flexion of wrist
occurs, known as wrist drop.
 Sensory functions: The cutaneous branches to the arm
and forearm have already arisen. The superficial branch
of the radial nerve will be damaged, resulting in sensory
loss on the dorsal surface of the lateral three and half
digits, and their associated palm area.

18. Deep Branch of Radial Nerve
 How it commonly occurs: Fractures of the radial
head, or a posterior dislocation of the radius at the
elbow joint.
 Motor functions: Muscles in posterior compartment
of the forearm are affected – except for the supinator
and extensor carpi radialis longus. The extensor
carpi radialis longus is a strong extensor at the wrist,
and so wristdrop does not occur.
 Sensory functions: None, as it is a motor nerve.

19. Superficial Branch of the Radial Nerve
 How it commonly occurs: Stabbing or laceration of
the forearm.
 Motor functions: None, as it is a sensory nerve.
 Sensory functions: There will be sensory loss
affecting the dorsal surface of the lateral three and
half digits and their associated palm area.