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Susan Emerson, MEd, OTR, CHT, CEES

David Hutchinson, PT, DSc, MS, ECS

Mark Walsh, PT, DPT, MS, CHT, ATC

Program Goals: Brief review of most common neuropathies

Functional anatomy / Diagnostics/Imaging

Specific Populations:

Pediatric Plexopathy

Proximal “opathies”:

Cervical Radiculopathy

TOS/ Neuropathic Brachialplexopathy

NeuroDynamic intervention: Current approaches

Lab: clinical testing

Proximal:

- Cervical Radiculitis

- Thoracic Outlet

- Brachialplexopathy

- Median

- Ulnar

- Radial

Holmes, F. Clark. 2014.

www.usuhs.edu/fap/resources/mt/CompressiveNeuropathies.ppt

Radial Nerve Radial nerve entrapment at

one of 5 sites, most common: Radial Tunnel

May be labeled: PINS or supinator syndrome

Mistaken for lateral epicondylitis

Rare condition Most commonly thought

idiopathic Insifficuent evidence for

work related causes

Melhorn et al. AMA Guides to the Evaluation of Disease and Injury

Causation. 2014.

Cubital Tunnel Syndrome Entrapment of ulnar

nerve at the elbow

May be entrapped as passing through fibro-osseous cubital tunnel (4 other locations)

2nd most common peripheral nerve entrapment

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Cubital Tunnel Evaluation Causes:

• Elbow hyper flexion

• Diabetes

• Age

• BMI Clinical tests:

Positive (asymmetric) Tinel’s sign

Possible intrinsic hand weakness and atrophy: Froments Pinch

Provocative testing with elbows fully flexed and wrist extended for 3 minutes

Cubital Tunnel Occupational Risk Factors:

Some: Combination: high force & repetition, High force & posture

Insufficient: vibration, repetition, keyboard, force, posture

Personal Risk factors: Strong: Age

Some: gender, diabetes, smoking

BMI: increases with higher BMI

???cell phone?

Ulnar Tunnel Syndrome Compression of ulnar

nerve at Guyon’s canal

Typically in cycling

Clinical Tests:

Tinel

MMT

Froments Sign

Card sign

Ulnar Tunnel Syndrome Treatment Occupational Risk Factors:

Insufficient evidence for any occupational risk factors

Case specific

Personal Risk factors • Some evidence: bycycling

• Low risk: BMI, anatomy

Pronator / AIN Syndromes Entrapment of median nerve at the

elbow / proximal forearm

Forearm aching, “flat pinch”

Not thought to be work-related, case specific

Resisted pronation

Carpal Tunnel Syndrome Compression of median

nerve deep to the transverse retinacular ligament in volar wrist

Most common Neurapathy in UE

Clinical tests: Tinel

Reverse Tinel

Phalens

Durkin

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Carpal Tunnel Causes: “Considered multifactorial” (WHO, AAOS, ASHS)

Occupational Risk Factors: Very Strong: combination force & repetition, force & posture,

force Force: hand requirements: 4 kg (8-10 lbs.) Repetition: cycle time < 30 seconds, more than 50% cycle same motion

Some: job satisfaction Low: awkward posture, vibration Conflicting: highly repetitive work alone Low: vibration, Insufficient: keyboard, cold, length of employment

Personal Risk Factors • Very strong: Age, BMI, gender, biopsychosocial, diabetes, co-

morbidity, genetic • Some: wrist size, non-occupational activity • Low: smoking

References: Harris-Adamson, C. et al (2014). Biomechanical risk

factors for carpal tunnel syndrome: a pooled study of 242 workers. Occupational and Environmental Medicine. Doi: 10.1136/oemed-2014-102378.

Melhorn, j. et al., AMA Guides to the Evaluation of Disease and Injury Causation, 2nd ed. (2014) Chicago, American Medical Association

Rodner, CM, Tinsley, BA, O’Malley, MP. (2013)Pronator syndrome and anterior interosseous nerve syndrome. Journal of the American Academy of Orthopedic Surgery. 21(5): 268-75.