Abstract
Compressive neuropathies of the forearm are common and involve structures innervated by the median, ulnar, and radial nerves. A thorough patient history, occupational history, and physical examination can aid diagnosis. Electromyography, X-ray, and Magnetic Resonance Imaging may prove useful in select syndromes. Generally, first line therapy of all compressive neuropathies consists of activity modification, rest, splinting, and non-steroidal anti-inflammatory drugs. Many patients experience improvement with conservative measures. For those lacking adequate response, steroid injections may improve symptoms. Surgical release is the last line therapy and has varied outcomes depending on the compression. Carpal Tunnel syndrome (CTS) is the most common, followed by ulnar tunnel syndrome. Open and endoscopic CTS release appear to have similar outcomes. Endoscopic release appears to incur decreased cost baring a low rate of complications, although this is debated in the literature. Additional syndromes of median nerve compression include pronator syndrome (PS), anterior interosseous syndrome, and ligament of Struthers syndrome. Ulnar nerve compressive neuropathies include cubital tunnel syndrome and Guyon’s canal. Radial nerve compressive neuropathies include radial tunnel syndrome and Wartenberg’s syndrome. The goal of this review is to provide all clinicians with guidance on diagnosis and treatment of commonly encountered compressive neuropathies of the forearm.
Highlights
Compression neuropathies of the upper extremity are a common problem encountered among clinicians
We aim to provide the reader with a compressive understanding of common compressive neuropathies, aiding clinicians in diagnosis and treatment
Content included in this review was found through an extensive literature review performed using key terms: “compressive neuropathies”; “carpal tunnel syndrome”; ”; “carpal tunnel release”; “endoscopic carpal tunnel release”; “open carpal tunnel release”; “carpal tunnel release cost”; “anterior interosseous syndrome”; “cubital tunnel syndrome”; “pronator syndrome”; “ligament of Struthers syndrome”; “ulnar tunnel syndrome”; “Guyon’s canal”; “radial tunnel syndrome”; “Wartenberg syndrome
Summary
Compression neuropathies of the upper extremity are a common problem encountered among clinicians. Thorough diagnostic workup, and appropriate treatment is critical for these patients to prevent further complications and potential long-term sequalae Etiologies such as trauma, entrapment, compartment syndrome, and edema can cause acute nerve compression and acute nerve ischemia. Electromyography (EMG) or nerve conduction studies can be useful but are not always necessary for diagnosis, as these studies are often not indicated and are highly operator dependent [5] Imaging modalities such as X-ray or Magnetic Resonance Imaging (MRI) are often beneficial in patients with an acute or remote history of trauma, fracture, or oncologic disease in the affected extremity. Structures within the carpal tunnel include the median nerve, four flexor digitorum superficialis (FDS) tendons, four flexor digitorum profundus (FDP) tendons, and the flexor policus longus (FPL) tendon. Weakness, and sensory defects in median nerve distribution
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