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