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  • Webnerves of The Hand

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    Fadila Ab Patah
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    The document discusses the median, ulnar, and radial nerves that innervate the hand and fingers, describing their anatomical pathways and sensory/motor functions. It also covers common compressive neuropathies like carpal tunnel syndrome caused by median nerve entrapment in the wrist, and Guyon's canal syndrome resulting from ulnar nerve compression at the wrist. Tests to diagnose these conditions and conservative treatment approaches are outlined.

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    Webnerves of the Hand

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    The document discusses the median, ulnar, and radial nerves that innervate the hand and fingers, describing their anatomical pathways and sensory/motor functions. It also covers common compressive neuropathies like carpal tunnel syndrome caused by median nerve entrapment in the wrist, and Guyon's canal syndrome resulting from ulnar nerve compression at the wrist. Tests to diagnose these conditions and conservative treatment approaches are outlined.

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    32 views17 pages

    Webnerves of The Hand

    Uploaded by

    Fadila Ab Patah
    The document discusses the median, ulnar, and radial nerves that innervate the hand and fingers, describing their anatomical pathways and sensory/motor functions. It also covers common compressive neuropathies like carpal tunnel syndrome caused by median nerve entrapment in the wrist, and Guyon's canal syndrome resulting from ulnar nerve compression at the wrist. Tests to diagnose these conditions and conservative treatment approaches are outlined.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as ppt, pdf, or txt
    of 17

    Nerves in the Hand

    • The Median & Ulnar


    nerves supply all of
    the muscles of the
    hand.
    • The Radial nerve
    supplies no muscles
    but does have a
    sensory distribution in
    the hand.
    Median Nerve
    • The median nerve enters the
    hand through the carpal tunnel Fig6.55 p 841
    with nine tendons from the
    FDS, FDP & FPL. The canal
    is located deep to the flexor
    retinaculum between the
    tubercles of the scaphoid and
    trapezoid bones (lateral) and
    the pisiform and hamate hook
    (medial).
    • Distal to the tunnel recurrent
    motor branches branch off to
    supply the thenar muscles.
    Direct branches supply the
    lumbricals of the 2nd & 3rd
    digits.
    Median Nerve
    Table 6.13 p 842

    • The palmar cutaneous branch separates prior to the


    carpal tunnel and passes over the flexor retinaculum to
    supply the midpalmar surface.
    • Sensory branches supply the palmar surfaces of digits 1-
    3 & the lateral half of the 4th, and the dorsum of the
    distal half of digits 1-4.
    Ulnar Nerve
    • The ulnar nerve runs distally in
    the forearm beneath the FCU
    and enters the wrist via the
    ulnar canal.
    • The nerve is bound to the
    anterior surface of the flexor
    retinaculum as it passes lateral
    to the pisiform and medial to
    the hamate hook. Just
    proximal to the wrist the
    palmar cutaneous branch
    passes superficial to the flexor
    retinaculum
    Ulnar Nerve
    Table 6.13 p842

    • The Dorsal cutaneous branch supplies the medial half of the dorsum of the
    hand and the 5th finger and medial half of the 4th digit. The superficial
    branch supplies the anterior surface of the 4th &5th digits.
    • The Deep branch supplies the hypothenar muscles, the interossei, the
    lumbricals of the 4th & 5th digits and the adductor pollicis and deep head of
    the FPB.
    • This branch also supplies local joints.
    • The ulnar nerve is “the nerve of fine movements”
    Radial Nerve
    • The superficial branch
    of the radial nerve
    pierces the fascia
    near the dorsum of
    the hand to supply the
    skin over the lateral
    2/3rds of the dorsum
    of the hand, thumb
    and proximal lateral
    1&1/2 digits.
    29
    ..

    28.

    30.
    Carpal Tunnel Syndrome
    • Paresthesias are the primary & initial complaint.
    • Usually worse at night and relieved by hand movement
    • Decreased grip strength and dropping things
    • Thenar wasting is an indication of chronic compression.
    • Relationship with repetitive motion activities has not
    been proven but is suggested.
    • Hypothyriodism, osterarthritis, diabetes, wrist trauma,
    pregnancy, hypothyroidism, Acromegaly, Tumor (lipoma,
    ganglion cyst (synovial cyst
    Carpal Tunnel Syndrome
    • Phalen's maneuver is performed by flexing the wrist gently as far as
    possible, then holding this position and awaiting symptoms. A
    positive test is one that results in numbness in the median nerve
    distribution when holding the wrist in acute flexion position within 60
    seconds. The quicker the numbness starts, the more advanced the
    condition.
    • Tinel's sign, a classic, though less specific test, is a way to detect
    irritated nerves. Tinel's is performed by lightly tapping (percussing)
    the area over the nerve to elicit a sensation of tingling or "pins and
    needles" in the nerve distribution.
    • The carpal compression test, or applying firm pressure of the palm
    over the nerve to elicit symptoms has also been proposed
    Fig B6.29 p 840
    • YouTube - Carpal Tunnel Release,
    DoctorMahoney.com
    A systematic review of conservative treatment
    of carpal tunnel syndrome.
    Clin Rehabil 2007 Apr;21(4):299-314
    Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, Rabini A, Piantelli S,
    Padua L
    Department of Physical Medicine and Rehabilitation, Catholic University, Rome,
    Italy.
    OBJECTIVE: To assess the effectiveness of conservative therapy
    in carpal tunnel syndrome.

    • CONCLUSION: There is: (1) strong evidence on efficacy of local


    and oral steroids; (2) moderate evidence (level 2) that vitamin
    B6 is ineffective and splints are effective and (3) limited or
    conflicting evidence (level 3) that NSAIDs, diuretics, yoga, laser
    and ultrasound are effective whereas exercise therapy and
    botulinum toxin B injection are ineffective.
    Ulnar Nerve Compression at the Wrist

    • Guyon's canal syndrome is


    caused by entrapment of the
    ulnar nerve in the Guyon canal
    as it passes through the wrist.
    • Symptoms begin with a feeling
    of pins and needles in the ring
    and little fingers. This is
    followed by decreased
    sensation and eventually
    weakness and clumsiness in
    the hand as the small muscles
    of the hand are involved.
    • If the nerve is compressed at
    the wrist, the back of the hand Lesions in zone 1 cause both
    will have normal sensation. motor and sensory symptoms.
    Lesions in zone 2 cause motor
    deficits. Lesions in zone 3 create
    sensory deficits

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