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Peripheral neuropathy
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
In CTS, which of the following are true and which are false? The radial nerve is compressed, leading to paraesthesia, numbness and weakness of the muscles of the hand.It is more common in women early in their pregnancy.Phalen’s manoeuvre is used to help diagnose CTS clinically and is performed by extending the wrist and holding it in acute extension.Tinel’s sign is the reproduction of pain (or numbness and tingling) over the distribution of the compressed nerve by tapping over the flexor retinaculum.There is weakness of the flexor pollicis brevis, opponens pollicis and abductor pollicis brevis.
Peripheral Nerve Examination in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
The examiner percusses distal to proximal along the nerve route to elicit this test. The sequential recording of Tinel’s sign can corroborate with nerve regeneration. If the sign remains fixed in one spot for several consecutive weeks or even months, there may be an obstacle, and they may be grouped together, forming a neuroma. If the location of the sign moves progressively in a distal direction, this is a favorable sign. The sign can be elicited by gentle tapping with the eraser on the end of a pencil to avoid widespread mechanical stimulus over the involved nerve trunk or branches of the nerve distal to the site of injury or tapping over the belly of the muscle innervated by the nerve. A genuine Tinel’s sign is never considered painful and is due to the growth of touch fibers. If there is pain on tapping, this is not Tinel’s sign but evidence of neuroma or a neuroma-like sign.
Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
If the dorsal sensory branch (arises 7 cm proximal to the pisiform) is involved (altered sensation to the dorso-ulnar hand), then the compression cannot be in Guyon’s canal – it must be proximal to it, e.g. within the cubital tunnel. Tinel’s sign is the best provocation test. EMG (first dorsal interosseous) will demonstrate slow conduction at the wrist.
Short-term effects of dry needling of thenar muscles in manual laborers with carpal tunnel syndrome: a pilot, randomized controlled study
Published in Physiotherapy Theory and Practice, 2023
Maedeh Rezazadeh, Atefeh Aminianfar, Daryoush Pahlevan
The participants enrolled in the study based on history, physical examination, and nerve conduction study (NCS), diagnosed by a physician as CTS. The diagnostic NCV tests were as follows: distal motor latency ≥4 ms, distal sensory latency ≥3.6 ms, and W-P SNCV < 41 ms (Keith et al., 2009). The following criteria were considered as the clinical diagnosis of CTS: 1) positive Tinel sign and Phalen test; 2) numbness and tingling in fingers and median nerve compression (Tetro, Evanoff, Hollstien, and Gelberman, 1998); 3) presence of a fairly unique set of criteria (i.e. taut band, local tenderness, patient pain recognition, and pain referral) (Donnelly, Fernandez-de-las-penas, Finnegan, and Freeman, 2019), or referred pain from trapped thenar branch of median nerve (Mumford, Morecraft, and Blair, 1987)).
Rare case of Intraneural Lipoma of Digital Nerve
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Yu-Jung Su, Laxminarayan Bhandari
A 68-year-old man presented to our clinic with a mass on both the volar and dorsal surface of the right ring finger for 2 years. The mass was gradually enlarging. He reported no pain or numbness but had cold intolerance over the mass. Patient denied any trauma. On examination, the mass was noted to be 2 cm × 1 cm at the volar aspect of the middle phalanx. It had a dorsal extension of 1 cm × 1 cm. Right ring finger had a full range of motion. The sensation was normal with 2-point discrimination same as that of the other fingers. On palpation, the mass was firm, painless, immobile, non-translucent, non-pulsatile. There was no tinel sign. Magnetic resonance imaging demonstrated a 2.4 × 1.5 × 2.7 cm multilobulated mass with predominantly hypointense in T2-weighted images and hyperintense in T1- weighted images (Figure 1). These characteristics were suggestive of a lipoma.
A rare cause of sciatica discovered during digital rectal examination: case report of an intrapelvic sciatic notch schwannoma
Published in British Journal of Neurosurgery, 2019
Peter Y. M. Woo, Jason M. K. Ho, Joanna W. K. Ho, Calvin H. K. Mak, Alain K. S. Wong, Hoi-Tung Wong, Kwong-Yau Chan
Sciatic nerve schwannomas can be classified in terms of their relationship with the pelvis into intrapelvic, extrapelvic or intra-extrapelvic.2 The intrapelvic location of our patient’s tumor explains the presence of a palpable mass during digital rectal examination. Tinel’s sign involves percussion of a peripheral nerve to elicit a tingling sensation in the distribution of its sensory component. Although it is not pathognomic of neurogenic tumors, it does represent irritable nerve compression. Given the normal MRI spine findings, the physical examination findings alerted the clinician to the possibility of a sciatic nerve lesion and the arrangement of a pelvic scan. Other signs in favor of an extraspinal cause for sciatica include buttock mass asymmetry and a positive Trendelenberg test i.e. dropping of the pelvis on the unsupported side when the patient is requested to stand unassisted on each leg. These signs arise when significant gluteus medius wasting occurs. In non-obese patients we believe that deep palpation of the sciatic notch through the gluteus maximus may also reveal an intrapelvic-extrapelvic mass.