DOCSLIB.ORG

MSK Self Management Workbook Carpal Tunnel Syndrome and Cubital Tunnel Syndrome

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
MSK Self Management Workbook Carpal Tunnel Syndrome and Cubital Tunnel Syndrome MSK Wrist and Hand MSK self management workbook Carpal Tunnel Syndrome and Cubital Tunnel Syndrome July 2020 1 MSK Wrist and Hand Disclaimer This workbook provides general advice which may not be specific to you. It is important that if you are in pain you see a health care professional for an assessment to rule out serious, albeit rare, pathology. Please talk to a health care provider if you have not seen one before. You can use this workbook on your own, however, we recommend that you do so alongside a health professional. Health and safety This workbook is designed to help you manage your condition. It is recommended that the workbook is used alongside advice from a health professional. Together you can work to help with your recovery. You may progress more rapidly or slowly through this workbook depending on your symptoms and other factors related to your condition. It is important that if you are experiencing pain during the activities in this workbook then you should discuss your symptoms with a health professional. Purpose of workbook This workbook provides a general overview of the management of your condition. The workbook is split into different sections with the main focus being education, self-management advice and exercise. We recommend reading all the sections over time, however, you may find that not all of this information is relevant to you. The exercise section gives you a choice of exercises, varying in difficulty. Begin with the level you feel is appropriate, based on your pain and confidence. You then have the option over time to make these exercises more challenging or reduce to a more basic level as required. The self-management section provides education on other management options that can be used in conjunction with exercise to improve your condition. Finally, the workbook also includes a range of additional resources available that may be of benefit, such as leaflets, videos and contact details for other services. 2 MSK Wrist and Hand Contents Page Page 5 What is an entrapment neuropathy? Page 6 How to use this workbook? Pages 7-16 Carpal Tunnel Syndrome (CTS) - wearing a splint (Page 20) - exercise (Page 21) - other treatments and general information about CTS (Page 22) Pages 17-22 Cubital Tunnel Syndrome - night time splint (Page 20) - exercise (page 21) - other treatments and general information (Page 22) Pages 23-25 General information on having an operation on your wrist or hand Pages 26-29 Self-Management Information Page 30 How to wear and look after any splints you have been given Page 31-32 Useful Links 3 MSK Wrist and Hand Notes 4 MSK Wrist and Hand What is an entrapment neuropathy? In the upper limb there are various nerves which travel down your arm providing feeling and sensation to your arm and hand. Nerves are important for transmitting electrical signals to and from the brain to our muscles and skin. This allows us to feel sensation through our skin and create movement with the help of muscles supplied by the nerve. During their journey down the arm, nerves pass between muscles and other soft tissues. They travel over and pass through joints occasionally becoming compressed or irritated at these points. An entrapment neuropathy is where pressure on a segment or a part of a nerve causes it to become irritated, compressed or sometimes even damaged. The most common entrapment neuropathy in the upper limb is Carpal Tunnel Syndrome (CTS). Carpal Tunnel Syndrome (CTS) is when the median nerve becomes irritated or compressed at the wrist. The second most common entrapment neuropathy is Cubital Tunnel Syndrome. Cubital Tunnel Syndrome is when the ulnar nerve becomes irritated or compressed at the elbow. 5 MSK Wrist and Hand How to use this workbook? You have been asked to look through this workbook because you have symptoms which could be due to either Carpal Tunnel or Cubital Tunnel Syndrome. If you suffer from neck pain or your symptoms tend to travel along the entire length of your arm, it is important to seek assessment and advice from a relevant health care professional before commencing this workbook. If you proceed through this workbook and you feel that the symptoms you are experiencing do not appear to be similar to those described for either Carpal or Cubital Tunnel Syndrome we would advise you seek assessment and advice from a health care professional. If you do choose to proceed, this is how to use the workbook. If your health care professional thinks you have Carpal Tunnel Syndrome (CTS) please read the section on CTS. If your health care professional thinks you have Cubital Tunnel Syndrome please read the section on that. The sections that follow are useful for both conditions. They will give you information to help support you with exercise as well as information on posture and positioning. There is also a section to help you look after any splints you may have been given, advised to buy or have already purchased. The ultimate aim is to give you as much advice and help as possible to enable you to improve and manage your symptoms. Please look at the table of contents and use this to work through the book. We hope you find it helpful. 6 MSK Wrist and Hand Carpal Tunnel Syndrome What is carpal tunnel syndrome (CTS)? The carpal tunnel is a tunnel in your wrist through which nine tendons (these control the movement of your fingers and thumb) and a large nerve (median nerve) pass. Over the front of the wrist there is a ligament and this forms the roof of the tunnel. The floor of tunnel is formed by the carpal bones. When the median nerve becomes irritated or squashed within this tunnel this is called Carpal Tunnel Syndrome (CTS). CTS is a common hand condition and is referred to as a “compressive neuropathy”. Diagram 1: Picture of the Site of Compression for Carpal Tunnel 7 MSK Wrist and Hand What are the symptoms of CTS? The main symptom of CTS is altered feeling in the hand, often felt or described as pins and needles and/or numbness. Pain can also be felt but this is usually less common. The median nerve gives feeling to the thumb, index, middle and the thumb side of the ring finger. This is why people who have CTS normally feel their symptoms more so in these digits. Diagram 2: Picture of Where Altered Sensation for Carpal Tunnel Occurs The symptoms experienced with CTS can often be felt more so; At night (sleep can be disturbed) First thing in the morning Carrying out activities which involve gripping (for example, holding the phone, driving and reading). In more severe cases the altered feeling may become more continuous. There may also be weakness and wasting (loss of muscle bulk) at the base of the thumb. In advanced or severe cases, some patients with CTS may describe a feeling of clumsiness and/or find they are dropping objects easily. The majority of people with 8 MSK Wrist and Hand CTS have much milder symptoms that come and go but these rarely affect the ability to carry out activities involved with daily living. How common is Carpal Tunnel Syndrome? Carpal Tunnel Syndrome (CTS) is a common condition of the upper limb. About 7%-11% of the population will experience CTS symptoms at some point in their lifetime. CTS is three times more common in women than men. CTS can occur at any age and occurs in both men and women but most commonly affect women in middle age. What causes it? In most people, the cause of Carpal Tunnel Syndrome is not known. Anything that reduces the space within, or increases the pressure within the Carpal Tunnel, can potentially lead to symptoms of Carpal Tunnel Syndrome. Factors that have strong evidence supporting an increased risk of Carpal Tunnel Syndrome include, obesity or being significantly overweight. Other factors that have been associated with an increased risk of Carpal Tunnel Syndrome include: o Overuse of the hand and wrist such as in gardening or renovating a house, activities requiring forceful grip/exertion (evidence on an association between computer work and Carpal Tunnel Syndrome is variable) o Osteoarthritis and rheumatoid arthritis o Wear and tear in your tendons or inflammation of your tendons o Hypothyroidism o Diabetes o Wrist trauma o Pregnancy 9 MSK Wrist and Hand Tests for Carpal Tunnel Syndrome Usually the diagnosis of CTS is made of the basis of your story about your symptoms. Symptoms of CTS tend to follow certain patterns and most patients report similar things. Examining the hand is helpful too. Most patients with CTS will find the splint and exercises in the following section helpful. This information can help to confirm, or exclude, the diagnosis and explains why patients are often encouraged to try this first. Some patients require electrical tests called nerve conduction studies. This is often because the diagnosis is in doubt or because you have diabetes. These tests can provide some evidence to confirm the CTS diagnosis and the level of severity. Blood tests Some conditions can cause symptoms similar to CTS, or make the symptoms of CTS worse. This is known as peripheral neuropathy. Therefore, your health care professional may request that you have simple blood testing to check for diabetes and to check that your thyroid, folate and Vitamin B12 levels are within are normal limits. Carpal Tunnel Syndrome Myths vs Facts Myth Everyone with Carpal Tunnel Syndrome needs an operation Fact The symptoms of Carpal Tunnel Syndrome can settle on their own. Many cases settle with simple treatment or advice.
Load more

Recommended publications
  • Brachial-Plexopathy.Pdf
    Brachial Plexopathy, an overview Learning Objectives: The brachial plexus is the network of nerves that originate from cervical and upper thoracic nerve roots and eventually terminate as the named nerves that innervate the muscles and skin of the arm. Brachial plexopathies are not common in most practices, but a detailed knowledge of this plexus is important for distinguishing between brachial plexopathies, radiculopathies and mononeuropathies. It is impossible to write a paper on brachial plexopathies without addressing cervical radiculopathies and root avulsions as well. In this paper will review brachial plexus anatomy, clinical features of brachial plexopathies, differential diagnosis, specific nerve conduction techniques, appropriate protocols and case studies. The reader will gain insight to this uncommon nerve problem as well as the importance of the nerve conduction studies used to confirm the diagnosis of plexopathies. Anatomy of the Brachial Plexus: To assess the brachial plexus by localizing the lesion at the correct level, as well as the severity of the injury requires knowledge of the anatomy. An injury involves any condition that impairs the function of the brachial plexus. The plexus is derived of five roots, three trunks, two divisions, three cords, and five branches/nerves. Spinal roots join to form the spinal nerve. There are dorsal and ventral roots that emerge and carry motor and sensory fibers. Motor (efferent) carries messages from the brain and spinal cord to the peripheral nerves. This Dorsal Root Sensory (afferent) carries messages from the peripheral to the Ganglion is why spinal cord or both. A small ganglion containing cell bodies of sensory NCS’s sensory fibers lies on each posterior root.
    [Show full text]
  • Piriformis Syndrome Is Overdiagnosed 11 Robert A
    American Association of Neuromuscular & Electrodiagnostic Medicine AANEM CROSSFIRE: CONTROVERSIES IN NEUROMUSCULAR AND ELECTRODIAGNOSTIC MEDICINE Loren M. Fishman, MD, B.Phil Robert A.Werner, MD, MS Scott J. Primack, DO Willam S. Pease, MD Ernest W. Johnson, MD Lawrence R. Robinson, MD 2005 AANEM COURSE F AANEM 52ND Annual Scientific Meeting Monterey, California CROSSFIRE: Controversies in Neuromuscular and Electrodiagnostic Medicine Loren M. Fishman, MD, B.Phil Robert A.Werner, MD, MS Scott J. Primack, DO Willam S. Pease, MD Ernest W. Johnson, MD Lawrence R. Robinson, MD 2005 COURSE F AANEM 52nd Annual Scientific Meeting Monterey, California AANEM Copyright © September 2005 American Association of Neuromuscular & Electrodiagnostic Medicine 421 First Avenue SW, Suite 300 East Rochester, MN 55902 PRINTED BY JOHNSON PRINTING COMPANY, INC. ii CROSSFIRE: Controversies in Neuromuscular and Electrodiagnostic Medicine Faculty Loren M. Fishman, MD, B.Phil Scott J. Primack, DO Assistant Clinical Professor Co-director Department of Physical Medicine and Rehabilitation Colorado Rehabilitation and Occupational Medicine Columbia College of Physicians and Surgeons Denver, Colorado New York City, New York Dr. Primack completed his residency at the Rehabilitation Institute of Dr. Fishman is a specialist in low back pain and sciatica, electrodiagnosis, Chicago in 1992. He then spent 6 months with Dr. Larry Mack at the functional assessment, and cognitive rehabilitation. Over the last 20 years, University of Washington. Dr. Mack, in conjunction with the Shoulder he has lectured frequently and contributed over 55 publications. His most and Elbow Service at the University of Washington, performed some of the recent work, Relief is in the Stretch: End Back Pain Through Yoga, and the original research utilizing musculoskeletal ultrasound in order to diagnose earlier book, Back Talk, both written with Carol Ardman, were published shoulder pathology.
    [Show full text]
  • The Efficacy and Safety of Gabapentin in Carpal Tunnel Patients: Open Label Trial
    Original Article The efficacy and safety of gabapentin in carpal tunnel patients: Open label trial A. Kemal Erdemoglu Ayhan Varlibas, Kirikkale University, Faculty of Medicine, Department of Neurology, Kirikkale, 07100, Turkey Abstract Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by median nerve compression at the wrist. It results in loss of considerable man days and the effectiveness the various treatment modalities are still debated. Aim: To study the efficacy of gabapentin in patients with CTS. The study aim is to investigate the efficacy of gabapentin in patients with CTS patients who were refractory to the other conservative measures or unwilling for the surgical procedure. Materials and Methods: Forty one patients diagnosed as idiopathic CTS were included in the study. Patients were assessed with symptom severity scale (SSS) and functional status scale (FSS) scores of Boston Carpal Tunnel Questionnaire (BCTQ) before and at 1, 3, and 6 months of the treatment. Response to therapy was determined by using SSS and FSS scores of Address for correspondence: BCTQ. Results: The median dosage of gabapentin was 1800 mg/daily. Side effects Dr. A. Kemal Erdemoglu were mild and transient. There was a statistically significant difference in both symptom Kirikkale University, Faculty of Medicine, SSS and FSS scores between before and after treatment in patient groups at the end Department of Neurology, of six months (P < 0.001). According to grading the changes in subscales of BCTQ, Kirikkale, 07100, TURKEY. of 41 patients, 34.1 and 29.3 had a ≥ 40% decrease in SSS and FSS, respectively. E-mail: [email protected] Conclusion: Gabapentin was found to be partially effective and safe in symptomatic treatment of CTS patients.
    [Show full text]
  • Wrist and Hand Examina[On
    Wrist and Hand Examinaon Daniel Lueders, MD Assistant Professor Physical Medicine and Rehabilitaon Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the wrist and hand • Outline evaluaon of and differen.aon between nerves to the wrist and hand • Describe special tes.ng of wrist and hand Wrist Anatomy • Radius • Ulna • Carpal bones Wrist Anatomy • Radius • Ulna • Carpal bones Wrist Anatomy • Radius • Ulna • Carpal bones Wrist Anatomy • Radius • Ulna • Carpal bones Inspec.on • Ecchymosis • Erythema • Deformity • Laceraon Inspec.on • Common Finger Deformies • Swan Neck Deformity • Boutonniere Deformity • Hypertrophic nodules • Heberden’s, Bouchard’s Inspec.on • Swan Neck Deformity • PIP hyperextension, DIP flexion • Pathology is at PIP joint • Insufficiency of volar/palmar plate and suppor.ng structures • Distally, the FDP tendon .ghtens from PIP extension causing secondary DIP flexion • Alternavely, extensor tendon rupture produces similar deformity Inspec.on • Boutonniere Deformity • PIP flexion, DIP hyperextension • Pathology is at PIP joint • Commonly occurs from insufficiency of dorsal and lateral suppor.ng structures at PIP joint • Lateral bands migrate volar/palmar, creang increased flexion moment • Results in PIP “buTon hole” effect dorsally Inspec.on • Nodules • Osteoarthri.c • Hypertrophic changes of OA • PIP - Bouchard’s nodule • DIP - Heberden’s nodule • Rheumatoid Arthri.s • MCP joints affected most • Distal radioulnar joint can also be affected
    [Show full text]
  • ICD9 & ICD10 Neuromuscular Codes
    ICD-9-CM and ICD-10-CM NEUROMUSCULAR DIAGNOSIS CODES ICD-9-CM ICD-10-CM Focal Neuropathy Mononeuropathy G56.00 Carpal tunnel syndrome, unspecified Carpal tunnel syndrome 354.00 G56.00 upper limb Other lesions of median nerve, Other median nerve lesion 354.10 G56.10 unspecified upper limb Lesion of ulnar nerve, unspecified Lesion of ulnar nerve 354.20 G56.20 upper limb Lesion of radial nerve, unspecified Lesion of radial nerve 354.30 G56.30 upper limb Lesion of sciatic nerve, unspecified Sciatic nerve lesion (Piriformis syndrome) 355.00 G57.00 lower limb Meralgia paresthetica, unspecified Meralgia paresthetica 355.10 G57.10 lower limb Lesion of lateral popiteal nerve, Peroneal nerve (lesion of lateral popiteal nerve) 355.30 G57.30 unspecified lower limb Tarsal tunnel syndrome, unspecified Tarsal tunnel syndrome 355.50 G57.50 lower limb Plexus Brachial plexus lesion 353.00 Brachial plexus disorders G54.0 Brachial neuralgia (or radiculitis NOS) 723.40 Radiculopathy, cervical region M54.12 Radiculopathy, cervicothoracic region M54.13 Thoracic outlet syndrome (Thoracic root Thoracic root disorders, not elsewhere 353.00 G54.3 lesions, not elsewhere classified) classified Lumbosacral plexus lesion 353.10 Lumbosacral plexus disorders G54.1 Neuralgic amyotrophy 353.50 Neuralgic amyotrophy G54.5 Root Cervical radiculopathy (Intervertebral disc Cervical disc disorder with myelopathy, 722.71 M50.00 disorder with myelopathy, cervical region) unspecified cervical region Lumbosacral root lesions (Degeneration of Other intervertebral disc degeneration,
    [Show full text]
  • Carpal Tunnel Syndrome: a Review of the Recent Literature I
    The Open Orthopaedics Journal, 2012, 6, (Suppl 1: M8) 69-76 69 Open Access Carpal Tunnel Syndrome: A Review of the Recent Literature I. Ibrahim*,1, W.S. Khan1, N. Goddard2 and P. Smitham1 1University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK 2 Department of Trauma & Orthopaedics, Royal Free Hospital, Pond Street, London, NW3 2QG, UK Abstract: Carpal Tunnel Syndrome (CTS) remains a puzzling and disabling condition present in 3.8% of the general population. CTS is the most well-known and frequent form of median nerve entrapment, and accounts for 90% of all entrapment neuropathies. This review aims to provide an overview of this common condition, with an emphasis on the pathophysiology involved in CTS. The clinical presentation and risk factors associated with CTS are discussed in this paper. Also, the various methods of diagnosis are explored; including nerve conduction studies, ultrasound, and magnetic resonance imaging. Keywords: Carpal tunnel syndrome, median nerve, entrapment neuropathy, pathophysiology, diagnosis. WHAT IS CARPAL TUNNEL SYNDROME? EPIDEMIOLOGY First described by Paget in 1854 [1], Carpal Tunnel CTS is the most frequent entrapment neuropathy [2], Syndrome (CTS) remains a puzzling and disabling condition believed to be present in 3.8% of the general population [14]. 1 commonly presented to Rheumatologists and Orthopaedic in every 5 subjects who complains of symptoms such as pain, Hand clinicians. It is a compressive neuropathy, which is numbness and a tingling sensation in the hands is expected to defined as a mononeuropathy or radiculopathy caused by have CTS based on clinical examination and electrophysio- mechanical distortion produced by a compressive force [2].
    [Show full text]
  • Chapter 30 When It Is Not Cervical Radiculopathy: Thoracic Outlet Syndrome—A Prospective Study on Diagnosis and Treatment
    Chapter 30 When it is Not Cervical Radiculopathy: Thoracic Outlet Syndrome—A Prospective Study on Diagnosis and Treatment J. Paul Muizelaar, M.D., Ph.D., and Marike Zwienenberg-Lee, M.D. Many neurosurgeons see a large number of patients with some type of discomfort in the head, neck, shoulder, arm, or hand, most of which are (presumably) cervical disc problems. When there is good agreement between the history, physical findings, and imaging (MRI in particular), the diagnosis of cervical disc disease is easily made. When this agreement is less than ideal, we usually get an electromyography (EMG), which in many cases is sufficient to confirm cervical radiculopathy or establish another diagnosis. However, when an EMG does not provide too many clues as to the cause of the discomfort, serious consideration must be given to other painful syndromes such as thoracic outlet syndrome (TOS) and some of its variants, occipital or C2 neuralgia, tumors of or affecting the brachial plexus, and orthopedic problems of the shoulder (Table 30.1). Of these, TOS is the most controversial and difficult to diagnose. Although the neurosurgeons Adson (1–3) and Naffziger (10,11) are well represented as pioneers in the literature on TOS, this condition has received only limited attention in neurosurgical circles. In fact, no original publication in NEUROSURGERY or the Journal of Neurosurgery has addressed the issue of TOS, except for an overview article in NEUROSURGERY (12). At the time of writing of this paper, two additional articles have appeared in Neurosurgery: one general review article and another strictly surgical series comprising 33 patients with a Gilliatt-Sumner hand (7).
    [Show full text]
  • Musculoskeletal Clinical Vignettes a Case Based Text
    Leading the world to better health MUSCULOSKELETAL CLINICAL VIGNETTES A CASE BASED TEXT Department of Orthopaedic Surgery, RCSI Department of General Practice, RCSI Department of Rheumatology, Beaumont Hospital O’Byrne J, Downey R, Feeley R, Kelly M, Tiedt L, O’Byrne J, Murphy M, Stuart E, Kearns G. (2019) Musculoskeletal clinical vignettes: a case based text. Dublin, Ireland: RCSI. ISBN: 978-0-9926911-8-9 Image attribution: istock.com/mashuk CC Licence by NC-SA MUSCULOSKELETAL CLINICAL VIGNETTES Incorporating history, examination, investigations and management of commonly presenting musculoskeletal conditions 1131 Department of Orthopaedic Surgery, RCSI Prof. John O'Byrne Department of Orthopaedic Surgery, RCSI Dr. Richie Downey Prof. John O'Byrne Mr. Iain Feeley Dr. Richie Downey Dr. Martin Kelly Mr. Iain Feeley Dr. Lauren Tiedt Dr. Martin Kelly Department of General Practice, RCSI Dr. Lauren Tiedt Dr. Mark Murphy Department of General Practice, RCSI Dr Ellen Stuart Dr. Mark Murphy Department of Rheumatology, Beaumont Hospital Dr Ellen Stuart Dr Grainne Kearns Department of Rheumatology, Beaumont Hospital Dr Grainne Kearns 2 2 Department of Orthopaedic Surgery, RCSI Prof. John O'Byrne Department of Orthopaedic Surgery, RCSI Dr. Richie Downey TABLE OF CONTENTS Prof. John O'Byrne Mr. Iain Feeley Introduction ............................................................. 5 Dr. Richie Downey Dr. Martin Kelly General guidelines for musculoskeletal physical Mr. Iain Feeley examination of all joints .................................................. 6 Dr. Lauren Tiedt Dr. Martin Kelly Upper limb ............................................................. 10 Department of General Practice, RCSI Example of an upper limb joint examination ................. 11 Dr. Lauren Tiedt Shoulder osteoarthritis ................................................. 13 Dr. Mark Murphy Adhesive capsulitis (frozen shoulder) ............................ 16 Department of General Practice, RCSI Dr Ellen Stuart Shoulder rotator cuff pathology ...................................
    [Show full text]
  • Hand Surgery: a Guide for Medical Students
    Hand Surgery: A Guide for Medical Students Trevor Carroll and Margaret Jain MD Table of Contents Trigger Finger 3 Carpal Tunnel Syndrome 13 Basal Joint Arthritis 23 Ganglion Cyst 36 Scaphoid Fracture 43 Cubital Tunnel Syndrome 54 Low Ulnar Nerve Injury 64 Trigger Finger (stenosing tenosynovitis) • Anatomy and Mechanism of Injury • Risk Factors • Symptoms • Physical Exam • Classification • Treatments Trigger Finger: Anatomy and MOI (Thompson and Netter, p191) • The flexor tendons run within the synovial tendinous sheath in the finger • During flexion, the tendons contract, running underneath the pulley system • Overtime, the flexor tendons and/or the A1 pulley can get inflamed during finger flexion. • Occassionally, the flexor tendons and/or the A1 pulley abnormally thicken. This decreases the normal space between these structures necessary for the tendon to smoothly glide • In more severe cases, patients can have their fingers momentarily or permanently locked in flexion usually at the PIP joint (Trigger Finger‐OrthoInfo ) Trigger Finger: Risk Factors • Age: 40‐60 • Female > Male • Repetitive tasks may be related – Computers, machinery • Gout • Rheumatoid arthritis • Diabetes (poor prognostic sign) • Carpal tunnel syndrome (often concurrently) Trigger Finger: Subjective • C/O focal distal palm pain • Pain can radiate proximally in the palm and distally in finger • C/O finger locking, clicking, sticking—often worse during sleep or in the early morning • Sometimes “snapping” during flexion • Can improve throughout the day Trigger Finger:
    [Show full text]
  • Medical Tests, Signs & Maneuvers Guide
    Medical Tests, Signs & Maneuvers Guide Achilles Squeeze test: For Achilles This can be performed with tendon rupture. Squeezing the calf Doppler placed on the digits muscle fails to produce plantar during test. The test is valuable flexion of the ankle joint. Also called prior to an invasive procedure on Simmons Test, Thompson test. the arteries at the wrist, Addis test: For determination of Allis' sign: Relaxation of the leg length discrepancy. With fascia between the crest of the patient in prone position, flexing ilium and the greater trochanter: a the knees to 90 degrees reveals the sign of fracture of the neck of the potential discrepancies of both femur. tibial and femoral lengths. Amoss' sign: In painful flexure of Adson's maneuver: See under the spine, the patient, when rising Adson's test to a sitting posture from lying in bed, does so by supporting him- For thoracic outlet Adson's test: self with his hands placed far syndrome. With the patient in a behind him in the bed. sitting position, his hands resting on thighs, the examiner palpates Anghelescu's sign: Inability to both radial pulses as the patient bend the spine while lying on the rapidly fills his lungs by deep back so as to rest on the head and inspiration and, holding his breath, heels alone, seen in tuberculosis hyperextends his neck and turns of the vertebrae. his head toward the affected side. If the radial pulse on that side is Anterior drawer sign: See under decidedly or completely obliter- drawer sign. ated, the result is considered Anterior tibial sign: Involuntary positive.
    [Show full text]
  • Free PDF Download
    Eur opean Rev iew for Med ical and Pharmacol ogical Sci ences 2014; 18: 2766-2771 Peripheral neuropathy in obstetrics: efficacy and safety of α-lipoic acid supplementation M. COSTANTINO, C. GUARALDI 1, D. COSTANTINO 2, S. DE GRAZIA 3, V. UNFER 3 Chemistry and Pharmaceutical Technologies, University of Ferrara, Ferrara, Italy 1Obstetrics and Gynaecology Unit, Ospedale di Valdagno (VI), Italy 2Female Health Centre, Azienda USL, Ferrara, Italy 3A.G.UN.CO. Ostetric and Gynecological Center, Rome, Italy Abstract. – OBJECTIVE : Neuropathic pain more prone to the development of neuropathic during pregnancy is a common condition due to syndromes. First and foremost, the physical the physical changes and compression around changes caused by the enlargement of the uterus pregnancy and childbirth that make pregnant women more prone to develop several medical and the development of the foetus cause postural conditions such as carpal tunnel syndrome, sci - changes and nutation of the pelvic girdle that fa - atica, meralgia paraesthetica and other nerve en - cilitate the development of low back pain and en - trapment syndromes. Most of the treatments trapment neuropathies. The mutation of the usually performed to counteract neuropathic pelvic girdle is favoured during pregnancy also pain are contraindicated in pregnancy so that, by the presence of high concentrations of relaxin, the management of these highly invalidating conditions remains an issue in the clinical prac - which is produced from the tenth week of gesta - tice. We aimed to review the efficacy and safety tion and causes a laxity in the joints not only in of alpha lipoic acid supplementation in the treat - the pelvis, but also on a vertebral level, which ment of neuropathic pain.
    [Show full text]
  • Trigeminal Sensory Neuropathy and Bilateral Carpal Tunnel Syndrome: the Initial Manifestation of Mixed Connective Tissue Disease
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.43.5.458 on 1 May 1980. Downloaded from Journal of Neurology, Neurosurgery, and Psychiatry, 1980, 43, 458-460 Short report Trigeminal sensory neuropathy and bilateral carpal tunnel syndrome: the initial manifestation of mixed connective tissue disease F M VINCENT AND R N VAN HOUZEN From the Munson Medical Center, Traverse City, Michigan, USA SUMMARY A patient is described who developed a bilateral carpal tunnel syndrome and a tri- geminal sensory neuropathy as the initial manifestations of mixed connective tissue disease. Either condition can occur in other connective tissue diseases, but this combination has not been reported previously in mixed connective tissue disease, in which, however, trigeminal sensory neuropathy is frequently seen. Protected by copyright. Involvement of the sensory portion of the trigeminal Case report nerve occurs in various disorders. "Primary" idiopathic sensory involvement is not associated A 52 year old male, employed as a grinder in an iron with other neurological or systemic disorders, works, complained of numbness and paresthesias in whereas "secondary" involvement is seen with both hands. He soon developed aching in his neck tumours, connective tissue diseases, demyelinating and proximal upper extremities, and numbness which disorders, trauma, or secondary to toxic substances.' started in the maxillary area on the right, but which Likewise, the causes of the carpal tunnel syndrome in one week involved the entire right side of his face. are many and varied; any condition causing an He also complained of swelling of the hands with increase of mass in the carpal tunnel can cause tightness ofthe skin, without arthralgia or Raynaud's compression of the median nerve.
    [Show full text]