Median Nerve Compression syndromes课件.ppt

23 April 2007 RVI Median Nerve Compression syndromes Jeff Auyeung SpR Freeman Content Anatomy Median Nerve Pronator Syndrome Anterior Interosseous Nerve Syndrome Carpal Tunnel Syndrome Anatomy Pronator Syndrome Sites of Compression Supracondylar process Ligament of Struthers Bicipital aponeurosis Between two heads of pronator teres Under origin of FDS Pronator Syndrome 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 Investigation Xray Elbow EMG/NCT Treatment Splint/NSAIDs Release all potential sites of compression 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 Anterior Interosseous Nerve Syndrome Sites of compresion Fibrous bands in PT FDS origin Enlarged bicipital bursa Gantzer’s muscle 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 Anterior Interosseous Nerve Syndrome Anterior Interosseous Nerve Syndrome Investigation EMG/NCT Treatment Splint elbow at 90°/NSAIDs Release all potential sites of compression Carpal Tunnel Syndrome- Epidemiology Most common peripheral nerve compression syndrome FM 43 to 74/100’000 decompression in UK Plus countless conservatively treated 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 Carpal Tunnel Syndrome –Work 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, Cog