1 / 61

Tingling Fingers

Tingling Fingers. Doug Campbell Consultant Hand Surgeon, Leeds. www.handandwristclinic.com. Contents. C spine Dermatomes Peripheral nerves Examination Decisions Referrals Treatments. Functions. Execution Reception Social interaction Cosmetic Thermoregulation. Composition.

keene
Download Presentation

Tingling Fingers

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. Tingling Fingers Doug Campbell Consultant Hand Surgeon, Leeds www.handandwristclinic.com

  2. Contents • C spine • Dermatomes • Peripheral nerves • Examination • Decisions • Referrals • Treatments

  3. Functions • Execution • Reception • Social interaction • Cosmetic • Thermoregulation

  4. Composition • 19 bones • 17 joints • 19 muscles

  5. Composition • 19 bones • 17 joints • 19 muscles • 1 wrist • 1 elbow • 1 shoulder

  6. Composition • 19 bones • 17 joints • 19 muscles • 1 wrist • 1 elbow • 1 shoulder • 1 BRAIN !!!!

  7. The Homunculus

  8. Dermatomes C7 C6 C8 Same front & back

  9. Acute disc prolapse • Sudden onset severe pain • Lancinating • Brachalgia • Scoliosis • Torticollis • Uncontrollable NOT ‘tingly fingers’!

  10. Cervical spondylosis • Some neck pain • Trapezial spasm • Brachalgia • Posturally dependent • Altered motor power • ?altered reflexes ‘Tingly fingers’

  11. Thoracic Outlet Syndrome (TOS) • Posture or activity dependent • Intermittent • Significant brachalgia • Ache • Poorly localised Rarely ‘tingly fingers’

  12. Cervical spondylosis • Neurological examination • Neural tension tests • History based diagnosis

  13. Thoracic Outlet Syndrome (TOS) Adson’s Test

  14. Thoracic Outlet Syndrome (TOS) Roos’s Test

  15. Dermatomes C7 C6 C8 Same front & back

  16. Peripheral nerves Ulnar Median NOT Same front & back

  17. Dorsal sensation

  18. Dorsal sensation Radial Ulnar

  19. Peripheral Nerves • Radial • Median • Ulnar

  20. Wrist, finger and thumb extensors Dorsum 1st web space Radial Nerve MOTOR SENSORY Posterior Interosseous NerveRadial Sensory Nerve

  21. Thenar muscles Radial half of palm Median Nerve MOTOR SENSORY Recurrent Motor Branch Main Trunk Palmar cutaneous branch

  22. Median Nerve • Tinel’s test • Phalen’s Test

  23. Carpal tunnel syndrome • Spontaneous improvement in up to 34% • NSAIDs as effective as splints & PT • Unusual to find a cause • No workplace association

  24. Carpal tunnel syndrome Steroid injections • Benefits are early (1-3 months) • Effectiveness beyond 1 month uncertain • Multiple injections may be reqd • Similar results with simple splinting

  25. Carpal tunnel syndrome Do I need nerve conduction studies? • Only when diagnosis uncertain • Less useful in elderly • 15% false negative rate

  26. Intermittent paraesthesia Nocturnal wakening +/- pain BSSH guidelines MILD

  27. Exclude a cause Nocturnal splint Activity modification Consider steroid injection if trained Intermittent paraesthesia Nocturnal wakening +/- pain BSSH guidelines MILD

  28. Permanent paraesthesia ADL interference Reversible numbness or pain Weakness or clumsiness BSSH guidelines MODERATE

  29. Exclude a cause Nocturnal splint Activity modification Consider steroid injection if trained Permanent paraesthesia ADL interference Reversible numbness or pain Weakness or clumsiness BSSH guidelines MODERATE

  30. Diminished sensation Disabling pain Thenar wasting Weakness of APB/OP BSSH guidelines SEVERE

  31. Surgery Diminished sensation Disabling pain Thenar wasting Weakness of APB/OP BSSH guidelines SEVERE

  32. MILD MODERATE SEVERE

  33. MILD • Night splints • Steroid injctn • Hand therapy TFTs, BlGl MODERATE SEVERE

  34. MILD • Night splints • Steroid injctn • Hand therapy TFTs, BlGl Max 3 mths MODERATE SEVERE

  35. RESOLVED MILD Improvement • Night splints • Steroid injctn • Hand therapy TFTs, BlGl Max 3 mths MODERATE SEVERE

  36. RESOLVED MILD Improvement • Night splints • Steroid injctn • Hand therapy TFTs, BlGl Max 3 mths MODERATE Deterioration SEVERE SURGERY

  37. RESOLVED MILD Improvement • Night splints • Steroid injctn • Hand therapy TFTs, BlGl Max 3 mths MODERATE Deterioration SEVERE SURGERY

  38. RESOLVED MILD Improvement • Night splints • Steroid injctn • Hand therapy TFTs, BlGl Max 3 mths MODERATE Deterioration • Elderly • Neck pain • Bilateral • Phalen/Tinel -ve SEVERE SURGERY

  39. RESOLVED MILD Improvement • Night splints • Steroid injctn • Hand therapy TFTs, BlGl Max 3 mths MODERATE Deterioration • Elderly • Neck pain • Bilateral • Phalen/Tinel -ve NCS SEVERE SURGERY

  40. RESOLVED MILD Improvement • Night splints • Steroid injctn • Hand therapy TFTs, BlGl Max 3 mths MODERATE Deterioration • Elderly • Neck pain • Bilateral • Phalen/Tinel -ve NCS SEVERE SURGERY

  41. RESOLVED MILD Improvement • Night splints • Steroid injctn • Hand therapy TFTs, BlGl Max 3 mths MODERATE Deterioration • Elderly • Neck pain • Bilateral • Phalen/Tinel -ve NCS SEVERE SURGERY

  42. Hypothenar muscles Interossei Ulnar 2 lumbricals Adductor Pollicis Ulnar half of palm Ulnar Nerve MOTOR SENSORY Deep Branch Superficial Branch

More Related