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PRS - Nerve Entrapment - 2013 CME Update - Part 1

Part 1 - Compressive Neuropathy, Patient Evaluation, and Thoracic Outlet Syndrome; 4/24/2013

Andrew Yee

on 26 April 2013

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Transcript of PRS - Nerve Entrapment - 2013 CME Update - Part 1

Double Crush Syndrome Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 2:359-62, 1973. Diabetes
Cervical Disc Disease
Compression More Vulnerable to Compression Cubital Tunnel Syndrome Thoracic Outlet Syndrome Conservative Management Shoulder Thoracic Outlet
Posture Imbalance
Muscle Imbalance Forward Flexion of Neck Shoulder Ab/Adduction Shoulder Flexion/Extension Physical Therapy Poor Posture Posture Correction SCT(-) Parascapular Muscles w/ Posture Correction Initial Test: Secondary Test: SCT(+) Parascapular Muscles Pre-Therapy Examination
Scratch Collapse Pre-Therapy Post-Therapy Post-Therapy Examination
Scratch Collapse Scratch Collapse Test: (-) Parascapular Muscles (+) Thoracic Outlet Initial Presentation Post-Therapy Abnormal Posture / Position Increase in Nerve Tension / Compression Decrease in Muscle Length Increase in Muscle Length middle trapezius
lower trapezius Muscle Weakness middle trapezius
lower trapezius
serratus anterior Muscle Overuse upper trapezius
levator scapulae brachial plexus
radial sensory
cubital tunnel
median nerve forearm
carpal tunnel sternocleidomastoid
scalene muscles
pectoralis minor
serratus anterior
pronator teres Compression Neuropathy Radial Sensory Nerve Examination Symptoms Histopathology Blood Nerve Barrier
Breakdown Intermittent Paraesthesia
and/or Aching Provocative Maneuvers Subperineurial Edema,
Connective Tissue
Thickening Persistent Paraesthesia
and/or Weakness Abnormal Thresholds Fiber Demyelination
Localized / Diffuse Axonal Degeneration Numbness
and/or Atrophy Abnormal
2-Point Discrimination Progression of Compressive Neuropathy Mild Moderate Severe Compression Neuropathy Variable Histopathology Mild Moderate Severe (Carpal Tunnel) Animal Model Mild Moderate Severe Mild Moderate Severe Ulnar Nerve Normal Abnormal (+) Neuropathy Symptoms Clinical Experimental Progressive Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO Nerve Entrapment: 2013 CME Update I, Kristen M. Davidge, MD MSc, have no financial disclosure to declare.

I, Andrew Yee, BS, have no financial disclosure to declare.

I, Susan E. Mackinnon, MD, am the co-inventor of the PGA Neurotube and have received research funding from AxoGen Inc. Peripheral Nerve Worksheet Patient Evaluation Scratch Collapse Test Scratch Collapse Points Scratch Collapse Heirarchy SCT(-) Cubital Tunnel
w/ EtCL SCT(+) Guyon's Canal 1 - Cubital Tunnel 2 - Guyon's Canal Inital Test: Secondary Test: SCT(+) Cubital Tunnel SCT(-) Guyon's Canal Patient Education - Rate of Recovery Dynamic Ischemic Injury
immediate recovery

Demyelination Injury
3-4 months for remyelination

Axonal Injury
recovery rate at 1" per month

Mixed Injury
mixture of recovery rates Scratch Collapse Hierarchy Pain Evaluation Provocative Tests Phalen's Test Spurling's Test Shoulder Provocation Thoracic Outlet Elbow Provocation Median Nerve in the Forearm Wrist Provocation Provocation Tinel's Test Scratch Collapse Sensory Examination Ulnar Nerve Radial Nerve Median Nerve Compression Points (Ulnar Nerve) Tinel's Sign Sensory Tests Ten-Ten Test Semmes Weinstein Test Two Point Discriminator Dynamic Ischemic Injury
immediate recovery Demyelination Injury
3-4 months for remyelination Axonal Injury
recovery rate at 1" per month Surgical Management Thoracic Outlet Decompression - Scalenectomy TOS Controversy Sanders RJ, Haug CE. Thoracic Outlet Syndrome: A Common Sequela of Neck Injuries. JB Lippincott, 1991. Carpal Tunnel Syndrome Median Nerve Forearm Compression Guyon's Canal Compression I II IV III V VI Scratch Collapse Points Upper Trunk Middle Trunk Upper Trunk Mackinnon SE, Novak CB. Clinical commentary: Pathogenesis of cumulative trauma disorder. J Hand Surg Am, 1994. Kristen M. Davidge, MD MSc
Andrew Yee, BS
Susan E. Mackinnon, MD TOS Deep Motor Branch Cubital Tunnel Antebrachial Fascia Arcade of Struthers EtCl EtCl EtCl EtCl I. II. III. IV. V. Plastic and Reconstructive Surgery - CME
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