Entrapment Syndromes of the Upper Extremity

Name Supracondylar Pronator (Teres) Anterior Posterior Radial Tunnel Cubital Carpal Tunnel Guyon’s Canal
process Syndrome Interosseous Interosseous Nerve Syndrome tunnel Syndrome Syndrome
syndrome Nerve (AIN) (PIN) Syndrome Syndrome
Syndrome

Nerve Median Median Anterior Posterior Radial Ulnar Median Ulnar

interosseous interosseous (branch
(branch of median) of radial)

Symptoms - Aching pain in - Motor - Insidious onset - Pain in the - Tinglin - Numbness of 1st, - Muscular
proximal forearm with weakness - Pain in the dorsal aspect g of 4th 2nd, 3rd and radial atrophy
weakness/clumsiness (pronator forearm and of the upper and 5th half of 4th finger hypothenar,
of the hand quadratus, wrist forearm fingers - More intense at finger
- Insidious onset flexor - Pain distal to the - Any - Elbow night abductors,
- Numbness follows digitorum lateral weakness is flexion - Atrophy of thenar adductors,
median nerve profundus, epicondyle of secondary to may be eminence and thumb
distribution flexor pollicus elbow pain limited palmar abduction adductor
- Night pain not longus - Weakness with - Tenderness muscles muscles
common - Dull aching finger, wrist and over radial - Sensory
pain in the thumb neck loss and
volar aspect of movements painpalmer
proximal - Forearm surface of
forearm extensor 5th digit and
compartment medial
atrophy aspect of 4th
- Ulnar claw
may be
present
Test Pronator teres muscle Pinch sign, Resisted supination Middle finger test Tinnels, Tinnels sign
pronator quadratus increases pain (resisted middle elbow
finger extension) flexion test,
pressure
provocative
test, card
test

Name
Sciatic nerve entrapment
ILIOGUINAL NEURALGIA
OBTURATOR NEUROPATHY
GENITOFEMORAL NERVE ENTRAPMENT
MERALGIA PARESTHETICA
TIBIAL NERVE ENTRAPEMENT
COMMON PERONEAL (FIBULAR) NERVE
ENTRAPMENT
Entrapment Syndromes of the Lower Extremity
Nerve Symptoms Test
Sciatic - Radicular pain/radiculopathy
- No significant LBP
- Deep aching in sacral or gluteal region with posterior thigh
pain
- Pain increases with sitting and walking decreases lying supine
- Pain and paraesthesia can radiate along tibial and/or peroneal
nerve distributions
Ilioinguinal - Chronic lower abdomen pain
- Burning or shooting pain in the base of penis, scrotum (or
labium) and medial thigh
- Pain may be exacerbated by extension of hip
- Tenderness localised near ASIS
- Atrophy of internal oblique and transverse abdominus
Obturator - Altered sensation in medial thigh paraesthetic or burning Stretching the pectineus muscle
- Insidious pain at adductor origin on pubic bone and worsens
with exercise
- Pain may extend to knee
- Aggravated by extension and abduction
Genitofemoral - Chronic neuropathic groin pain
- Pain and/or numbness in an elliptical area on anterior aspect
of thigh
- May be scrotal or labial pain
- Increased by thigh extension
- Decreased perception of pinprick touch
Lateral femoral cutaneous nerve - Paresthesia (burning, tingling, stinging) in area covered by a Reproduced with tinnels sign
hand placed in a pant pocket
- Hypersensitivity to touch
- Decreased pain on sitting
- Increased pain on hip extension and prolonged walking/stand
Tibial - Sensory changes in bottom of foot and toes – burning
sensation, numbness, tingling
- Loss of plantar flexion
- Loss of toe flexion
- Weak inverters
Common peroneal nerve - Pain into common peroneals nerve cutaneous distributions
- Possible radiation into thigh
- Sensory abnormalities along anterolateral leg below knee and
along the top of the foot
- Overpressure at fibula head may increase paraesthesia
- Dorsiflexion paresis and foot drop
- Weakness of foot eversion
- Increased pain with plantar flexion and inversion of foot
SUPERFICIAL PERONEAL NERVE
DEEP PERONEAL NERVE
SURAL NERVE ENTRAPMENT
SAPHENOUS NERVE
TARSAL TUNNEL SYNDROME
MEDIAL PLANTARE NERVE SYNDROME
(JOGGER’S FOOT)
MORTON’S NEUROMA: INTERDIGITAL
PERINEURAL FIBROSIS
Superficial peroneal nerve
Deep peroneal nerve
Sural nerve
Saphenous nerve
Tibial nerve
Medial plantar nerve
Nerves in the metatarsal tunnel
- Pain increased with inversion
- Sensory loss at lateral lower half of calf and dorsum of foot
- Motor loss with higher lesions, weakness of foot eversion
- Pain aggravated by plantar flexion
- Sensory loss at web of great toe
- May include weak toe extensors, tibialis anterior, peroneus
tertius
- Atrophy of belly of extensor digitorum brevis
- Medial calf pain
- Often medial pseudo claudication-type pain
- Pain radiates to medial calf to medial malleolus
- May be paraesthetic or burning in character
- No motor deficit
- Burning throbbing pain on sole of foot Overpressure, tinnels sign, nerve conduction
- Aggrevated by prolonged standing or sitting studies
- Pain may radiate up leg
- Tenderness over tarsal tunnel
- Pain, burning, shooting, sharp and/or dysesthesia,
paraesthesia along medial arch of the foot
- Occurs during running – exercise induced
- Often occurs with new shoes/ new arch support
- Pain, numbness, paraesthesia in lateral side of one toe and
medial side of next
- Piercing or electric shock pain
- Increased pain with walking, crouching, wearing high heels
(activities that cause toe extension)