SENSORY TRACT

POSITIVE & NEGATIVE SENSORY SYMPTOMS

TYPES OF NERVE ENTRAPMENT
CARPAL TUNNEL SYNDROME
- Nerve entrapment disorder: compression of
median nerve yg kena nya di carpal tunnel
- Causes: pain, numbness, tingling (di: thumb,
index finger, middle finger, ring finger – thumb
side)
ANATOMY
HOW IT HAPPENS?
Inflammation of nearby tendons & tissues  local
edema  ↑fluid (in a very tight space)  neken median
nerve
SIGN & SYMPTOMS  biasanya kena 2 tangan krn ada:
Repetitive stress (typing), worsens at night (stlh dipake
saat siang hari)
- Paresthesia (tingling/prickling/burning/numb)
– di 4 hari tsb dan bs nyebar sampe forearm
- Muscle weakness  dropping things/ga bs do
simple things such as ngancing baju
- Thenar muscles atrofi (severe cases)
RF
- Repetitive stress – typing, prolonged period
- Hand & wrist position – activities that involve
extreme flexion/extension for prolonged
period
- Heredity – smaller anatomic carpal tunnel
- Obesity
- Pregnancy
- Underlying condition – e.g Rheumatoid
Arthristis (autoimmune), DM, thyroid gland
imbalance
DIAGNOSIS & PEMERIKSAAN PENUNJANG
- Anamnesis of symptoms
- Physical exam:
o Phalen’s maneuver: flex wrist for 1
minutes  numbness in the areas
innervated by median nerve
o Tinel’s sign: ketok carpal tunnel
ligament (pada sisi telapak) pake alat
 tingling/prickling in the areas
innervated by median nerve
o Durkan’s test: secara manual - teken
pake jempol kt carpal ligament for
30 seconds
- Electrophysiological testing
o Nerve conduction studies: ukur
signal that travels the nerves of the
hand (jd bs detect kalo gaada signal
yg travel: damaged pd nerve tsb)
o Electromyogram (EMG): ukur
electrical activity in muscles (bs liat
apakah ada nerve/muscle damage)
- USG
- X-ray: to exclude arthritis, ligament injury,
fracture
- MRI: better to see soft tissue. To see apakah
ada abnormal tissue yg impact median nerve,
atau liat struktur median nerve nya – misal:
scarring due to injury/tumor
TREATMENT
- Behaviour modification: hands parallel to each
other & table, use mouse, wrist support while
typing
- Physical therapy: stretching & isometric
exercises
- Non-surgical:
o Splinting or Bracing: pake splint sbg
pengaman wrist spy ga nekuk (flex)
saat tidur - reduce pressure
o NSAID – e.g ibuprofen, naproxen: to
relieve pain & inflammation
o Steroid injections
- Surgical: “Carpal tunnel release” : transverse
carpal ligament di cut, spy lig nya lebih gede
nggak neken gt
o Open carpal tunnel release
o Endoscopic carpal tunnel release
RECOVERY
- Stlh operasi  elevate hand above heart,
move fingers to avoid swelling and stiffness
- Symptoms yg msh terasa: pain, swelling,
stiffness, minor soreness – for several months
- Grip & pinch strength – return 2-3 months – 6-
12 months (severe cases)
- Wear splint for several weeks
COMPLICATIONS AFTER SURGERY
- Bleeding
- Infection
 - Nerve aggravation/injury
CUBITAL TUNNEL SYNDROME
- Pressure/stretching of the ulnar nerve
CAUSES
- Pressure: ulnar nerve nya keteken in a long
period of time
- Stretching: elbow bent for a long period of
time  stretch nerve behind the elbow
(happen during sleep)
- Anatomy: ulnar nerve ga stay in place: snaps
back anf forth bony bump as elbow is moved
(e.g kepentok elbow kita)  if repetitive bs
iritate nerve nya
SIGN & SYMPTOMS
- Pain
- Loss of sensation
- Tingling
- Weakness
DIAGNOSIS & PEMERIKSAAN PENUNJANG
- Anamnesis
- Physical exam:
o Tinnel’s sign: (ketok) at medial elbow
o Elbow flexion test: 3 menit at 120°
 produce symptoms
o Waternberg sign: kelingking nya
lebih jauh/abduksi gt
o Fromment sign: ambil kertas (posisi
tgn kyk salaman gitu)  jempol jadi
flexi krn ulnar nerve nya lemah jd
jempol flexi utk mempertahankan
TREATMENT
- Keep elbow extended (jgn ketindih)
- Anti-inflammatory medication
- Surgical: release
TARSAL TUNNEL SYNDROME
- Compression on posterior tibial nerve 
symptoms: from the ankle to foot
- Similar to CTS, compression of a nerve in a
confined space
CAUSES & RF
- Flat foot
- Enlarged/abnormal structure that occupies the
space within tunnel  neken nerve nya (e.g
varicose vein, ganglion cyst, swollen
tendon/arthritic bone spur)
- Injury (e.g ankle sprain)  inflammation near
tunnel
- Systemic dz: DM, arthritis
- Prolonged standing, walking, exercising
SIGN & SYMPTOMS – biasa dirasakan di ankle (medial
side)/telapak kaki  bs radiate ke: heel, arch, toes, calf
- Tingling/burning sensation
- Numbness
- Pain
DIAGNOSIS & PEMERIKSAAN PENUNJANG
- Tinnel’s sign: daerah medial maleolus (mata
kaki bagian medial)
TREATMENT
- Anti-inflammation med
- Steroid injection
- Surgery: release compression
NEUROPATHY
- Neuropathy: a term refers to general
dz/malfunction of the nerve
- Often classified according to types/locations of
nerves affected
- Bisa classified jg krn dz: e.g diabetic
neuropathy
TYPES
- Peripheral neuropathy
o Neuropathy at peripheral nervous
system (PNS) – nerves at extremitas
o Proximal neuropathy: nerve damage
that causes pain at shoulder, paha,
buttocks
- Cranial neuropathy
o Neuropathy at Cranial Nerve (CN)
o Specific types: optic neuropathy &
auditory neuropathy
- Autonomic neuropathy
o Damage to involuntary nervous
system (nerve yg control janting,
digestion tract, bowel and bladder,
sexual response, respiration)
- Focal neuropathy
o Neuropathy that is restricted to 1
nerve/group of nerves/1 area of the
body
ETIOLOGI/CAUSES
- Diabetes
- Vitamin deficiencies: vitamin B12, folate
- Autoimmune neuropathy: rheumatoid
arthritis, systemic lupus, Guillain-Barre
syndrome (GBS)
- Infection: HIV/AIDS, Lyme dz, leprosy, syphilis
- Post-herpetic neuralgia: komplikasi shingles
(varicella-zoster virus infection)
- Alcoholic nauropathy
- Genetic disorder
- Amyloidosis: abnormal protein fibers are
deposited in tissues and organs  lead to
organ damage and neuropathy
- Uremia: high conc of waste products in blood
due to kidney failure
- Toxins & poisons: lead. Arsenic, mercury, some
industrial solvents, nitrous oxide,
organophosphate pesticides
- Drugs/medication: cancer therapy (e.g
vincristine, antibiotic: metronidazole,
isoniazid)
- Trauma/injury: ijury to nerve: prolonged
pressure on nerves  ↓blood flow to the
nerves (ischemic)
- Tumors
- Idiopathic