1 / 23

Median Nerve Compression syndromes

Median Nerve Compression syndromes. Jeff Auyeung SpR Freeman. Content. Anatomy Median Nerve Pronator Syndrome Anterior Interosseous Nerve Syndrome Carpal Tunnel Syndrome. Anatomy. Formed by 2 cords anterior to 3 rd part of axillary artery Crosses Brachial artery from lateral to medial

ishi
Download Presentation

Median Nerve Compression syndromes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Median Nerve Compression syndromes Jeff Auyeung SpR Freeman 23 April 2007 RVI

  2. Content • Anatomy Median Nerve • Pronator Syndrome • Anterior Interosseous Nerve Syndrome • Carpal Tunnel Syndrome 23 April 2007 RVI

  3. Anatomy • Formed by 2 cords anterior to 3rd part of axillary artery • Crosses Brachial artery from lateral to medial • Lies medial to brachial artery in cubital fossa • Passes between 2 heads of PT • Lies between FDS and FDP then deep to flexor retinaculum 23 April 2007 RVI

  4. XXXX Pronator Syndrome XXXX Anterior Interosseous Syndrome 23 April 2007 RVI

  5. Pronator Syndrome Sites of Compression • Supracondylar process • Ligament of Struthers • Bicipital aponeurosis • Between two heads of pronator teres • Under origin of FDS 23 April 2007 RVI

  6. Symptoms: Forearm pain Hand numbness No night pain Signs: Resisted elbow flexion with supinated forearm (bicipital aponeurosis) Resisted forearm pronation with elbow extended (PT heads) Isolated long finger PIPJ Flexion (FDS) Pronator Syndrome 23 April 2007 RVI

  7. Investigation Xray Elbow EMG/NCT Treatment Splint/NSAIDs Release all potential sites of compression Pronator Syndrome 23 April 2007 RVI

  8. Anterior Interosseous Nerve Syndrome • Characterised by motor loss without sensory involvement • Muscles affected: FDP(radial half), FPL and Pronator Quadratus • Beware bilateral cases - ?Parsonage-Turner syndrome 23 April 2007 RVI

  9. Anterior Interosseous Nerve Syndrome Sites of compresion • Fibrous bands in PT • FDS origin • Enlarged bicipital bursa • Gantzer’s muscle 23 April 2007 RVI

  10. Anterior Interosseous Nerve Syndrome • OK sign to test FPL and FDP • Beware Isolated FPL rupture (Mannerfelt-Norman Syndrome) • Pronation in max elbow flexion for PQ 23 April 2007 RVI

  11. Anterior Interosseous Nerve Syndrome 23 April 2007 RVI

  12. Investigation EMG/NCT Treatment Splint elbow at 90°/NSAIDs Release all potential sites of compression Anterior Interosseous Nerve Syndrome 23 April 2007 RVI

  13. 23 April 2007 RVI

  14. Carpal Tunnel Syndrome- Epidemiology • Most common peripheral nerve compression syndrome • F>M • 43 to 74/100’000 decompression in UK • Plus countless conservatively treated 23 April 2007 RVI

  15. Carpal Tunnel Syndrome – Aetiology/Pathophysiology • Increase pressure in Carpal tunnel ( 8mm vs 90mm Hg) • Ischaemia • Focal demyelination • Risk factors: DM, RA, OA, Hypothyroidism wrist trauma, obesity, pregnancy 23 April 2007 RVI

  16. Prescribed disease if related to use of vibrating tools Vibrating tool = more than 2 fold increase in risk Keyboard and computer work not risk for CTS Palmer KT, Harris EC, Coggon D.Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occup Med (Lond). 2007 Jan;57(1):57-66. Epub 2006 Nov 2 No relationship between work and CTS Except “work that involves very cold temperatures (possibly in conjunction with load and repetition) such as butchery “ Falkiner S, Myers S When exactly can carpal tunnel syndrome be considered work-related? ANZ J Surg. 2002 Mar;72(3):204-9. Carpal Tunnel Syndrome –Work 23 April 2007 RVI

  17. Carpal Tunnel SyndromeDiagnosis • History and Exam (structured? – 85-100%) • Tinel’s ( 38-62%/57%), Phalen’s (77-86%/ 48%) • Neurophysiology (?worse in men) • Kamath V, Stothard J. A clinical questionnaire for the diagnosis of carpal tunnel syndrome. J Hand Surg [Br]. 2003 Oct;28(5):455-9. Erratum in: J Hand Surg [Br]. 2004 Feb;29(1):95.. • Gunnarsson LG, Amilon A, Hellstrand P, Leissner P, Philipson L. The diagnosis of carpal tunnel syndrome. Sensitivity and specificity of some clinical and electrophysiological tests. J Hand Surg [Br]. 1997 Feb;22(1):34-7. • Padua L, Padua R, Aprile, Tonali P. Italian multicentre study of carpal tunnel syndrome. Differences in the clinical and neurophysiological features between male and female patients J Hand Surg [Br]. 1999 Oct;24(5):579-82. 23 April 2007 RVI

  18. Oral Meds Vit B6 Steroid injection(? Most useful in reversible causes/holding measure) Splint - ? Positions ? Rigidity Likely to fail: 50+years > 10/12 symtoms Constant paraesthesia Atrophy of APB +ve Phalen’s Carpal Tunnel SyndromeManagement - Conservative Giele H. Evidence-based treatment of carpal tunnel syndrome. Current Orthopaedics 15, 249-255 23 April 2007 RVI

  19. Carpal Tunnel Syndrome Management - Surgical • Open CTR • Endoscopic CTR • Limited CTR • Lengthening of Flexor Retinaculum 23 April 2007 RVI

  20. Carpal Tunnel SyndromeOpen Release • Beware motor branch • Reconstruction vs. Lengthening • 24% increase in volume(AP) • 96% Satisfaction • Pinch and grip strength return 6-12 weeks 23 April 2007 RVI

  21. Carpal Tunnel SyndromeEndoscopic • Uniportal vs Two portal technique • Leave palmar skin and fat alone, not disturbed thenar and hypothenar muscles • Faster recovery • No Difference by 12 weeks 23 April 2007 RVI

  22. Carpal Tunnel SyndromeOutcome • >80% satisfied (?meaning) • Boston Carpal Tunnel Questionnaire • Scar tenderness • Pillar pain • Weakness • Slower return to work in manual worker 23 April 2007 RVI

  23. Thank you! 23 April 2007 RVI

More Related