pronator teres syndrome
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Peripheral nerve entrapment
Provocative test
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Median Nerve
Ligament of strutherPronator teres muscle
Bicipital aponeurosis (Lacertus fibrosus)FDS arch
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor digitorum superficialis
Abductor pollicis brevis
½ Flexor pollicis brevis
Opponens pollicis
1st lumbrical
2nd lumbrical
½ Flexor digitorum profundus 1st 2nd
Flexor pollicis longus AIN
Pronator quadratus
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Carpal tunnel syndrome
• Phalen test *• Tinel test *
• Durkan test
*Positive เมื่��อเป็�น sunderland 2 ขึ้��นไป็ (CTS ส่�วนใหญ่�เป็�น Sunderland 1 ส่�วนน�อยเป็�น 2 หรื�อ 3)
* * Kaplan (success of non-operative treatment)
* * P-R-A-G-M-A-T-I-C
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Pronator syndrome
• PROVOCATIVE TEST– LIGAMENT OF STRUTER
• resist to elbow flexion 120-135 degree
– BICIPITAL APONEUROSIS• resist elbow flexion in supination position
– TWO HEAD OF PRONATOR TERES M.• resist forearm pronate when elbow extension
– FIBROUS ARCH OF FDS• resist flexion of PIP jt. Of middle finger
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Anterior Interosseous Nerve Syndrome
– Pinch deformity (Spinner ‘s sign)
*Pure motor neuropathy ( FPL, 2nd &3rd FDP, pronator quadratus)
*DDX Parsonage Turner Syndrome
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Radial Nerve
Fibrous band of radiocapitellar joint
Recurrent radial artery (leash of Henry)
ECRB
Proximal supinator (Arcade of Frohse )
Distal supinator
Triceps
Brachioraldialis
Anconeous
Extendor carpi radialis longus
Extendor carpi radialis brevis
Supinator
Extensor carpi ulnaris
Extensor digitorum communis
Extensor digiti quinti PIN
Abductor pollicis longus
Extensor pollicis longus
Extensor pollicis brevis
Extensor indicis propius
Superficial radial nerve
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Posterior interosseous nerve syndrome
• Finger and thumb extension weakness*• Radial deviation**
*No sensory loss
**Intact ECRL
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Radial tunnel syndrome
• Provocative test:– Pain with resist forearm supination– Pain at the edge of ECRB with resist middle finger extension
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Superficial radial nerve entrapment (Wartenberg syndrome)
• Provocative test:– Forearm pronation with ulnar flexion– Pressure over junction of brachioradialis/ECRL
*Cheiralgia paresthetica
*แยกจาก radial nerve 8 cm เหน�อ radial styloid
*ถู�กกดจาก BR ก�บ ECRL
*DDx de Quervain ‘s disease
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Ulnar Nerve
Arcade of strutherMedial intermuscular septum
Medial epicondyleCubital tunnel
Osbourne ‘ s ligamentFlexor pronator aponeurosis
Flexor carpi ulnaris
½ Flexor digitorum profundus 3rd 4th
Abductor digiti minimi
Opponens digiti minimi
Flexor digiti minimi
3rd & 4th lumbrical
1st -3rd palmar interosseous Deep Motor br.
1st -4th dorsal interosseous
½ Flexor pollicis brevis
Adductor pollicis
Dorsal cutaneous branch
Palmar cutaneous branch
Superficial terminal branch
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Cubital tunnel syndrome
• Provaocative test:Elbow flexion-forearm supination-wrist extension
Elbow FlexionElbow FlexionTestTest
Symptom developedin 1 min = + ve
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Guyon ‘s canal compression
• Zone 1: motor+ sensory• Zone 2: motor+/- sensory• Zone 3: sensory
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