Sunday, March 3, 2013

Ulnar tunnel syndrome


Motion:

 >  Dorsiflexion- 0-50
Palmarflexion 0-60
Radial deviation 0-15
Ulnar deviation 0-50
Supination/Pronation 75-80 each
        

ULNAR TUNNEL SYNDROME

Compression of sensory, motor or both in Guyons canal at wrist

Guyons canal fibro-osseous triangular space ulnar aspect of volar wrist, roof volar carpal ligament and pisohamate ligament, lat. Wall TCL and hook of hamate, medial wall pisiform and fibrous structures
Ulnar nerve and artery



Causes- SOL like ganglions, aneurysms, lipoma
# hook of hamate, repeated trauma vibration tools, long distance cyclists

Symotoms – numbness and tingling ring and little finger, weakness of intrinsic muscles, pain at wrist
Sensory deficit – sparing of dorsal hand
Motor – weak intrinsics, clawing, Froments sign, confrontation test, Egawa test
Diagnosis – history, clinical tests, Tinels sign, Nerve Conduction study
Treatment – Cessation of provocative activities,  NSAID, Local steroid injection, Surgery

CARPAL TUNNEL SYNDROME

Compression of median nerve at wrist in carpal tunnel
Carpal tunnel three sides by carpal bones, roof by Transverse Carpal Ligament


Causes– Secondary, Idiopathic

Clinical features:

aching and burning pain along median nerve distribution, night symptoms, aggravated by elevation, repetitive activities and prolonged wrist flexion, clumsiness of hand, female predominance

Physical signs :

Sensory loss, Motor weakness and atrophy
   
PROVOCATIVE TESTS


Phalen's test
Carpal compression test
Tinel's test
Diagnosis

History, Physical findings, Provocative tests, NCV study

Treatment:

Avoiding aggravating activities and posture, Splinting, NSAIDS, Local steroid, Surgery



De QUERVAINS DISEASE
  • Tenosynovitis of 1st compartment – APL, EPB
  • Overuse, spontaneous
  • Woman, 40-50 yrs, pain radial side, swelling over radial styloid, tenderness

Finkelstein's test

Treatment
  • Crepe bandage and slab application
  • Analgesics
  • Local steroid injection
  • Chronic case  excision of part of tendon sheath



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