program goals - hand rehabilitation...
TRANSCRIPT
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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.