Monday, 26 January 2015

Nerve Entrapment conditions

Nerve entrapment conditions :-

1.Median nerve :-

involved in carpal tunnel syndrome at wrist ( flexor retinaculum)

Compressed beneath the struther's ligament , bicipital aponeurosis or between two heads of pronator teres at elbow ( Anterior interosseous branch of median nerve )

2. Ulnar nerve

Involved at elbow by fracture medial condyle humerous/ compressed between the two heads of flexor carpi ulnaris( cubital tunnel syndrome)-
Cubital tunnel roof formed by -" OSBORNE'S LIGAMENT " which is aponeurotic arcade between humeroulnar head of flexor carpi ulnaris and floor formed by -" MEDIAL COLLATERAL LIGAMENT "

Compressed in Guyon's canal ( between hook of hamate and flexors tendons)

3. Lateral cutaneous nerve of thigh

Involved / compressed in meralgia parestethica between the fibres of inguinal ligament

Posterior tibial nerve :-

Involved / compressed in tarsal tunnel syndrome behind and below the medial malleolus

Morton's metatarsalgia :-

Compression of the interdigital nerves ( particularly 2 nd & 3rd ) beneath the plantar fascia

6. Lower trunk of brachial plexus (C8,T1) :-

Compressed by cervical rib / thoracic outlet syndrome /aberrantly inserted scaleneus anterior muscle / fracture clavicle along with involvement of subclavian vessels

7. Superficial sensory radial nerve :-

Wartenberg's Syndrome

Definition:-

compressive neuropathy of the superficial sensory radial nerve (SRN);

also called "cheiralgia patesthetica"

sensory manifestation only

no motor deficits

Patho anatomy:-

SRN compressed by scissoring action of brachioradialis and ECRL tendons during forearm pronation

also by fascial bands at its exit site in the subcutaneous plane

8. Piriformis syndrome :-

Entrapment neuropathy of sciatic nerve

9. Arcade of frohse :-

Compressive neuropathy of posterior interosseous branch of radial nerve -" RADIAL TUNNEL SYNDROME "

Posterior interosseous nerve syndrome is an entrapment neuropathy of the posterior interosseous nerve, at the location where this nerve passes through the radial tunnel.

The posterior interosseous nerve enters the radial tunnel underneath a musculotendious arch, the arcade of Frohse.

It is formed by the upper free border of the superficial head of the supinator.

The arcade of Frohse is a semicircular fibrous arch that medially remains fibrous. It is found in 30-80% of anatomical specimens.

The radial tunnel begins in the distal upper arm, between the brachioradialis and the bracialis. The tunnel ends at the distal edge of the supinator in the proximal forearm.The posterior interosseous nerve rests on the deep head of the supinator

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