CCEP Peripheral Nerve Entrapments & Neurological Conditions 2 — Questions and Answers
Question 1: Tinel's sign, when positive at a site of nerve compression, indicates:
- Joint instability at the tested site
- Inflammation of the tendon sheath
- Nerve irritability or regeneration at a point of compression (Correct answer)
- Muscle weakness due to upper motor neuron lesion
Correct answer: Nerve irritability or regeneration at a point of compression
Tinel's sign is positive when percussion over a compressed or regenerating nerve elicits distal paresthesia, indicating nerve irritability or regeneration at that site.
Question 2: Suprascapular nerve entrapment most commonly occurs at which site?
- The quadrilateral space
- The suprascapular notch (Correct answer)
- The spinoglenoid notch
- The axillary border of the scapula
Correct answer: The suprascapular notch
The suprascapular nerve most commonly becomes entrapped at the suprascapular notch, where it passes beneath the superior transverse scapular ligament.
Question 3: Ulnar nerve entrapment at Guyon's canal most commonly affects which structures?
- Flexor carpi ulnaris and pronator teres muscles
- Hypothenar muscles and ulnar-innervated intrinsics (Correct answer)
- Thenar muscles and median nerve territory
- Dorsal interossei and extensor carpi ulnaris
Correct answer: Hypothenar muscles and ulnar-innervated intrinsics
Guyon's canal syndrome affects the ulnar nerve at the wrist, producing weakness of the hypothenar muscles, ulnar-innervated intrinsics, and sensory changes in the ulnar digits.
Question 4: The concept of 'double crush syndrome' refers to:
- A nerve being entrapped at two separate anatomical sites simultaneously (Correct answer)
- Two separate nerves compressed by one structure
- Bilateral nerve entrapment at homologous sites
- A nerve compressed by both a ganglion cyst and a tendon
Correct answer: A nerve being entrapped at two separate anatomical sites simultaneously
Double crush syndrome describes a condition where a nerve is compressed at two locations along its course, with the proximal lesion making the distal nerve segment more susceptible to entrapment.
Question 5: Radial tunnel syndrome is best differentiated from lateral epicondylitis by the location of maximal tenderness, which in radial tunnel syndrome is found:
- At the lateral epicondyle itself
- Approximately 4–5 cm distal to the lateral epicondyle (Correct answer)
- At the radial styloid process
- Over the posterior interosseous nerve at the wrist
Correct answer: Approximately 4–5 cm distal to the lateral epicondyle
In radial tunnel syndrome, maximal tenderness is found over the radial tunnel (4–5 cm distal to the lateral epicondyle), whereas in lateral epicondylitis tenderness is at the epicondyle.
Question 6: Anterior tarsal tunnel syndrome involves entrapment of which nerve under the inferior extensor retinaculum on the dorsum of the foot?
- Posterior tibial nerve
- Sural nerve
- Superficial peroneal nerve
- Deep peroneal nerve (Correct answer)
Correct answer: Deep peroneal nerve
Anterior tarsal tunnel syndrome involves compression of the deep peroneal nerve and its branches under the inferior extensor retinaculum on the dorsum of the foot.
Question 7: Morton's neuroma most commonly occurs in which intermetatarsal space?
- 1st–2nd intermetatarsal space
- 2nd–3rd intermetatarsal space
- 3rd–4th intermetatarsal space (Correct answer)
- 4th–5th intermetatarsal space
Correct answer: 3rd–4th intermetatarsal space
Morton's neuroma most commonly occurs in the 3rd intermetatarsal space (between the 3rd and 4th metatarsal heads), where the medial and lateral plantar nerve branches communicate.
CCEP Peripheral Nerve Entrapments & Neurological Conditions 2
Tinel's sign, when positive at a site of nerve compression, indicates: