Nerve Compresi 04 New

8/9/2019 Nerve Compresi 04 New

1/51

*Neurologist, DFM

Anwar Wardy W*

Nerve CompressionSyndromes

(Sindroma Jebakan)


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*Neurologist, DFM

Nerve CompressionSyndromes

• Median Nerve• Carpal Tunnel Syndrome

• Pronator Syndrome

• Ulnar Nerve • Cubital Tunnel Syndrome

• Ulnar Tunnel Syndrome

•

TOS


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*Neurologist, DFM

Carpal Tunnel Syndrome(CTS)

• e!nitionCompression o" t#e

Median Nerve in t#eCarpal Canal

• e!nisi %&ompresi dari sara" Median di Canal Carpal


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*Neurologist, DFM

CTS 'pidemioloy

• emale Male + ,%-

• No asso.iation wit# &eyboards(tidaada #ubunan denan /eyboard )


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CTS 'pidemioloy

• 0n.reased 0n.iden.e%

• iabetes

• T#yroid (/elen1ar ondo/)• 0n2ammatory Art#ritis

• Pea/ Ae% 34 years


6/51*Neurologist, DFM

5ow to 6e.oni7e

• Symptoms• Numbness (mati rasa)

• Ni#t Pain(Malam Sa/it)


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*Neurologist, DFM

5ow to 6e.oni7e

• P#ysi.al'8amination

• Tinel9s Sin• P#alen9s Test

• Sensory and Motor

:oss


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*Neurologist, DFM

5ow to Wor/ Up

• 'M;NC) :aten.y ? @4 mse.

• W#at is :aten.yB

•

W#at is Condu.tion


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*Neurologist, DFM

O.e Manaement

• Splint

• 0n1e.t

• No timelossD


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*Neurologist, DFM

W#en to 6e"er(terli#at

• Persistent Symptoms

• (>) 'M;NC< (motor laten.y ?@4 mse.E sensory ? FG mse.)


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*Neurologist, DFM

5ow We Treat 0t

• Carpal Tunnel6elease


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*Neurologist, DFM

6e#abilitation

• rivin% - day postoperatively

• Writin% -H, wee/s postoperatively

• Typin% @HG wee/s postoperatively• 5eavy li"tin% GHI wee/ postoperatively• Menemudi% - #ari pas.a operasi

Menulis% -H, minu pas.a operasiMeneti/% @HG minu pas.a operasiMenan/at beban berat% GHI minu pas.a operasi


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*Neurologist, DFM

Pronator Teres Syndrome

• e!nitionCompression o" t#e

Median Nerve at t#ePronator Teres


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*Neurologist, DFM

Pronator Teres'pidemioloy

• Male ? emale

• 6are lan/a

• Asso.iated wit# "orearm "atiue(Ter/ait denan /elela#an lenan)

• Neuritis(neuropati) vs

.ompressive neuropat#y


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*Neurologist, DFM

5ow to 6e.oni7e

• Wea/ness ?Numbness

•

&elema#an? &e/ebasan


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*Neurologist, DFM

5ow to 6e.oni7e

• 5allmar/%Anterior nerve

Palsy


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*Neurologist, DFM

W#en to 6e"er

• Persistent Symptoms espe.iallywea/ness

• (>) 'M;NC< (motor .#anes o"P: or P)


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*Neurologist, DFM

5ow We Treat 0t

• Pronator Teres 6elease


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*Neurologist, DFM

Cubital Tunnel Syndrome

• e!nition%Compression

o" t#e ulnarnerve in t#e.ubitaltunnel


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*Neurologist, DFM

Cubital Tunnel Syndrome

• iJerential

• Cubital tunnel syndrome

• Ulnar Tunnel syndrome

• T#ora.i. outlet syndrome (TOS)

•

Cervi.al radi.ulopat#y (CKECI)


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*Neurologist, DFM

'pidemioloy

• Male + emale

• 0n.reased 0n.iden.e

• iabetes

• 5istory o" elbow "ra.ture


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*Neurologist, DFM

5ow to 6e.oni7e

• Symptoms

• Ulnar sided

numbness• Ni#t Pain


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*Neurologist, DFM

5ow to 6e.oni7e

• P#ysi.al'8amination

• Tinel9s Sin• Stret.# Test


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*Neurologist, DFM

5ow to 6e.oni7e

• Motor'8amination

• Wea/ness• Atrop#y


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*Neurologist, DFM

5ow to 6e.oni7e

• Motor'8amination

• Wea/ness• Atrop#y


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*Neurologist, DFM

5ow to 6e.oni7e

• Sensory'8amination

• Widened , pt• e.reased SHWmono!laments


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*Neurologist, DFM

O.e Manaement

• A.tivity Modi!.ation

• Ni#t Splints% a so"t wrap around

t#e elbow


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*Neurologist, DFM

5ow We Treat 0t

• Simple e.ompression i" nomotor involvement


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*Neurologist, DFM

5ow We Treat 0t

• Submus.ular Transposition "orMotor 0nvolvement


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*Neurologist, DFM

5ow We Treat 0t• Submus.ular Transposition "or Motor 0nvolvemen

6e#abilitation% Simple


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*Neurologist, DFM

6e#abilitation% Simple6elease

• rivin% - day postoperatively

• Writin% -H, wee/s postoperatively

• Typin% FH@ wee/s postoperatively• 5eavy li"tin% G wee/s

postoperatively


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*Neurologist, DFM

Ulnar Tunnel Syndrome

• e!nition% .ompression o" t#eulnar nerve in t#e ulnar tunnel

(;uyon9s .anal)


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*Neurologist, DFM

'pidemioloy

• Male + emale

• 6are

• I4 due to mass in ulnar tunnel

• ;anlion

•Aneurysm


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*Neurologist, DFM

5ow to 6e.oni7e

• e.reasedsensation in

palm spareddorsally

i


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*Neurologist, DFM

5ow to 6e.oni7e

• Tinel9s wit#ulnar nerve

parest#esias

Location of fascicles

for deep motor branch

5 6 i


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*Neurologist, DFM

5ow to 6e.oni7e

• Motor(0ntrinsi.s)

Sensorydependin ont#e site o"

.ompression


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T# i O tl t S d


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*Neurologist, DFM

T#ora.i. Outlet Syndrome

• e!nition% TOS is

.ompressiono" t#ebra.#ial

ple8us

' id i l


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*Neurologist, DFM

'pidemioloy

• emaleMale + F3%-

• L 33 years

• 0n.reased in.iden.e o" vas.ularanomalies in men

•

6are

5 t 6 i


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*Neurologist, DFM

5ow to 6e.oni7e

• Symptoms• Ulnar sided

numbness• atiue wit#arm

over#ead

The lower

trunk

(C8,T1)most

commonly

affected

5 t 6 i


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*Neurologist, DFM

5ow to 6e.oni7e

• Tinel9s at'rb9s point

5 t 6 i


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*Neurologist, DFM

5ow to 6e.oni7e

• (>) Wri#t9sand Adson9s

Test

5o to 6e.oni e


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*Neurologist, DFM

5ow to 6e.oni7e

• (>)


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*Neurologist, DFM

5ow to 6e.oni7e

• (>) 'M;NC< = SS'P• Cervi.al paraspinals (rule out.ervi.al radi.ulopat#y

• P wave "orm

• wave

O.e Manaement


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*Neurologist, DFM

O.e Manaement

• PT "or Strent#enin = Posture

• Corre.t droop s#oulder

• Strent#en r#omboids andtrape7ius

5ow We Treat


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*Neurologist, DFM

5ow We Treat

• 6ese.tiono" -st rib

6e#abilitation


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*Neurologist, DFM

6e#abilitation

• S#oulder e8er.ise% FH@ wee/spostoperatively

•

Strent#enin% 3HG wee/spostoperatively

• 5eavy li"tin% GHI wee/s

postoperatively


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*Neurologist, DFM

Thank UWassalamE WrE Wbr

Nerve Compresi 04 New

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