Neuropati Jepitan (Entrapment Neuropathy)

NEUROPATI JEPITAN
(Entrapment neuropathy)
dr. Lydia susanti, SpS, M.Biomed
Subdivisi Neurofisiologi dan gangguan saraf tepi
Bagian ilmu penyakit saraf FK Unand/ RS DR M Djamil
Pengantar
• Definisi : Gangguan fungsi saraf perifer oleh karena
keadaan / posisi yang abnormal, atau gangguan
vaskularisasi yang menyebabkan iskemik pada saraf.
• Saraf tepi dilindungi oleh tulang, ligamentum, dan otot.

• Gangguan pada komponen ini dapat menyebabkan
penjepitan pada saraf  aliran darah dan nutrisi ke saraf
terganggu.
• Bila tidak diatasi dapat menyebabkan kerusakan yang
permanen
Pengantar
Gejala yang timbul bervariasi :
• Sensorik :
• Positif : Parestesi, nyeri rasa terbakar
• Negatif : Hipoestesi
• Motorik : Kelemahan saraf yang mengalami penjepitan.
Diagnosis penunjang :
1. Nerve conduction study
2. Elektromyography.
3. USG Muskuloskeletal
Common entrapment site
Carpal tunnel
syndrome
Median Nerve
Anterior Interosseous
syndrome
Cubital Tunnel
Syndrome
Ulnar Nerve
Guyon Cannal
Common Entrapment syndrome
Site
Radial nerve palsy

(drop hand)
Radial Nerve
PIN syndrome
Peroneal Nerve Drop foot

Brachial Flexus
Brachial flexus, cont…
Brachial flexus, cont…
MEDIAN NERVE ENTRAPMENT
ANATOMY
- Receives contribution from C6-T1 spinal nerves
- No median nerve branches proximal to the elbow
- At the elbow supplying 4 muscles
- At the forearm suppling 3 muscles
- At the hand supplying 4 muscles deep to flexor
retinaculum : LOAF
- Lumbricals II-III
- Opponens policis
- Abductor pollicis brevis
- Flexor pollicis brevis
MEDIAN NERVE ENTRAPMENT AT THE WRIST
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome, cont…
Risk factors for CTS :
- Female
- Certain occupation
- Diabetes melitus
Sign and simptoms :

- Tingling and burning sensation worsen at night
- Sensory loss in the distribution of palmar digital branch of
median nerve
- Muscle weakness & atrophy in the muscles of hand
(thenar)  occur later
Provocatives test :
- Phalen test
- Tinnel test
- Luthy sign
Management
Farmacology :
• Steroid
• Neuropatic pain agents
Non Farmacology
• Splint
• Injection at the entrapment site
• surgery
ULNAR NERVE ENTRAPMENT
Anatomy :
- Receives contribution from C7, C8 and T1
- No branch distally arm
- At the elbow enter groove between medial humeral
epidondyle and olecranon, the groove covered by
aponeurosis (cubital tunnel)
- Forearm, 2 sensory branch : Palmar and dorsal cutaneus
- Hand : Intrinsic muscle of the hand & superficial cutaneus
branch
ULNAR NERVE ENTRAPMENT
• Anatomy
Cubital Tunnel Syndrome
Cubital Tunnel Syndrome
Clinical symptoms :
- Parethesias in ulnar distribution of the hand
- Handweakness, clumsiness. Impairment handgrip,
difficulty buttoning shirt
- Atrophy of hypothenar and dorsal interossei muscles
- Weakness and atrophy tend to occur early
- Pain is not prominent
- Claw hand and froment sign
Guyon Canal’s Syndrome
Guyon’s canal is
formed by :
Volar carpal ligament
(roof)
Pisiform bone (medial
wall)
Transverse carpa
ligament (floor)
Hook of the hammate
bone (lateral wall)
Guyon Canal’s Syndrome
RADIAL NERVE ENTRAPMENT
Anatomy
• Receives contribution from the C5-C8 nerves
• Innervate extensor muscle of the arm and forearm & skin
covering them
• Upper arm :
• Triceps  spiral groove
• Brachiradialis
• Ekstensor carpi radialis
• Forearm
• Superficial branch : radial aspect dorsum of the hand the first 4 fingers
• Deep branch : pure motor posterior interoseus nerve : extensor muscles
Common site entrapment :
1. Radial Nerve palsy
2. Posterior interosseus nerve sindrome
Radial Nerve Palsy (drop hand), cont…
Radial nerve palsy = Saturday night palsy
Etiology :
Humeral fracture
Hiperabduction of the arm
Clinical symptoms :
- Wrist drop
- Inability to extend finger at metacarpophalang joint
- Triceps spared
Radial Nerve Palsy (drop hand)
Posterior Interosseus (PIN Syndrome)
Cilinical symptoms :
• Unable to extend the fingers at the metacapophalangeal
joint.
• Finger extensor at the interphalangeal joint spare
• No wrist drop (spare of extensor carpi radialis)
• No sensory problem.
Posterior Interosseus (PIN Syndrome)
Peroneal Nerve Palsy (drop foot)
Anatomy
• Terminal branch of sciatic nerve
• Common peroneal nerve :

• Superficial peroneal :
• Motor : foot eversion (peroneus longus and brevis)
• Sensory innervation to skin and lower lateral leg and dorsum site of foot
• Deep peroneal
• Pure motor
• Foot dorsoflexion & toe extension
Common entrapment site :
Fibular head  superficial
Etiology :
• Fractur fibula
• Prolong extrinsic pressure
Clinical Symptoms :
• Weakness in foot eversion and dorsoflexion of foot & toes
• Sensory loss involving the lateral leg and the dorsum of
the foot and toes.
Tarsal Tunnel Syndrome
Tarsal Tunnel Syndrome, cont…
• Formed between the medial malleolus (part of the ankle bone,
this is the bump on the inside of the ankle) and the flexor
retinaculum (a band of ligaments that stretches across the
foot).
• Inside the tarsal tunnel are the nerves, arteries, and tendons
that provide movement and flexibility to the foot.
Etiology of tarsal tunnel syndrome
• Having flat feet or fallen arches, which can produce strain or
compression on the tibial nerve
• Swelling caused by an ankle sprain which then compresses on
the nerve
• Diseases such as arthritis or diabetes which can cause
swelling, thus resulting in nerve compression
• An enlarged or abnormal structure, such as a varicose vein,
ganglion cyst, swollen tendon, or bone spur, that might
compress the nerve
Symptoms of tarsal tunnel syndrome
• Shooting pain in the foot
• Numbness
• Tingling or burning sensation
Management
Conservative treatment
• Conservative management, including orthotics, manipulation.
• Arch supports and wider shoes
• Non-steroidal anti-inflammatory drugs may be beneficial.
• Steroid injections
• Orthotics for associated flat feet
Surgery
• Surgical decompression by section of the flexor retinaculum.
• Decompression should be performed early to prevent nerve
fibrosis.

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NEUROPATI JEPITAN

• Saraf tepi dilindungi oleh tulang, ligamentum, dan otot.

Radial nerve palsy

Peroneal Nerve Drop foot

Sign and simptoms :

• Terminal branch of sciatic nerve

• Common peroneal nerve :

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