Compressive neuropathies in the upper limb

Prolonged or intermittent compression of a nerve may cause a myriad of symptoms from pain and tingling to numbness and/or muscle weakness of the limb and extremity. Many different structures might be responsible for the compression, from fascial bands to bony outgrowths. Sometimes the ‘compression’ is indeed a tumour of the nerve itself, and needs a specialist hand surgeon with microsurgical expertise to dissect out the tumour from around the individual nerve bundles. As mentioned in the pathologies above, carpal tunnel syndrome is the most common compressive neuropathy encountered, but there are numerous others that cause common symptoms like numbness and tingling in the nerve distribution being compressed:

• Cubital tunnel syndrome – is a common nerve entrapment of the ulnar nerve at the elbow.
• Suprascapular nerve compression – this is caused by entrapment of the suprascapular nerve causing pain, aching and weakness in the shoulder.
• Cyclist’s Palsy – this is the compression of the ulnar nerve at the wrist.
• Quadrilateral Space Syndrome – this affects the axillary nerve in the shoulder.
• Pronator Syndrome – is caused by the compression of the median nerve at the elbow.
• Radial tunnel syndrome- this affects the radial nerve just distal to the elbow, causing pain and weakness of the wrist, hand and fingers.

Compressive neuropathies may be diagnosed on history and clinical exam if these findings clearly indicate the diagnosis. Supplementary investigations often provide valuable information on the severity and site of the compression. These may include a nerve conduction study, electromyography, an ultrasound or an MRI.

Non operative management targets alleviating the cause for the compression and easing the symptoms. This may involve adopting postural or ergonomic strategies, physical therapy, splints, braces, anti-inflammatory medication and steroid injections. If the compression is advanced, or non-operative management fails to provide adequate relief, then surgical release of the afflicted nerve is required.

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