0071643192.pdf

■ Ulnar mononeuropathy

■ Corticosteroid injection may help.

■ May require surgical intervention if persistent

■ Median mononeuropathy

■ Wrist splinting in neutral position

■ Corticosteroid injection into carpel tunnel

■ Oral corticosteroid burst

■ Surgery for persistent severe symptoms

■ Sciatic and common peroneal mononeuropathy

■ Splint ankle at 90º with posterior splint.

Mononeuropathy Multiplex

Mononeuropathy multiplex is characterized by the presence of multiple mono-

neuropathies. Unlike isolated mononeuropathies, it is not due to compression/

trauma.

ETIOLOGIES

■ Most common = diabetes mellitus

■ Most serious = vasculitis (must be considered in all cases)

■ Others include inflammatory/autoimmune disorders, Lyme disease (late),

HIV, toxic, neoplastic.

NEUROLOGY

TABLE 15.16. Common Peripheral Mononeuropathies Related to Trauma or Compression

MONONEUROPATHY LOCATION OFINJURY CLINICALFINDINGS

Radial (“Saturday Mid-humerus. Wrist and finger drop.

night palsy”) Numbness over 1st dorsal interosseus muscles.

Ulnar Elbow (cubital tunnel or ulnar Paresthesias to 4th and 5th digits.

condylar groove)—most common Inability to tightly adduct fingers or grasp with thumb

Wrist (Guyon’s canal). Claw hand is the result of paralysis of the ulnar nerve.

Median (“Carpal tunnel Wrist (carpal tunnel). Pain and paresthesias in palmar aspect of thumb, index,

syndrome”) 3rd and^1 / 2 of 4th digits

Thumb weakness.

Thenar atrophy and ulnar deviation.

Sciatic Buttock. Inability to flex knee

Inability to flex or extend ankle (→footdrop)

Lateral femoral Inguinal ligament. Dysesthesia and numbness to upper thigh

cutaneous (“Meralgia

paresthetica”)

Common peroneal nerve Proximal fibula. Numbness to web space between great and 2nd toe.

Footdrop