Nerve compressions

Davidge, Kristen M.; Mackinnon, Susan E.

doi:10.1002/9781118655412.ch58

Cited by 2 publications

(11 citation statements)

References 63 publications

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“…Median nerve compression neuropathy is a progressive process characterized by ischemic changes, blood–nerve barrier breakdown, perineural edema, focal demyelination, and eventually axonal loss. The etiology of CTS is multifactorial, with associated local (eg, trauma, tumor) and systemic (eg, pregnancy, obesity, diabetes, hypothyroidism, amyloidosis) factors …”

Section: Methodsmentioning

confidence: 99%

“…Electrodiagnostic studies can confirm the diagnosis of CTS and guide management by quantifying nerve compression . In a 2015 study that surveyed members of the American Society for Surgery of the Hand, 72% of hand surgeons (513 of 714 who responded) used electrodiagnostic testing before surgery .…”

Section: Methodsmentioning

confidence: 99%

“…The etiology of CTS is multifactorial, with associated local (eg, trauma, tumor) and systemic (eg, pregnancy, obesity, diabetes, hypothyroidism, amyloidosis) factors. 1 Epidemiology CTS is the most common upper extremity compressive neuropathy. According to a report from 2013, the incidence in adults was approximately 2.3 per 100 person-years.…”

Section: Carpal Tunnel Syndrome Definition and Pathophysiologymentioning

confidence: 99%

“…Although people who regularly engage in repetitive tasks (computer or mouse use), excessive force or gripping (use of heavy machinery), and occupations associated with hand tasks that include vibration that have a higher prevalence of CTS, 1 no causal associations have been established. 5 A 2015 meta-analysis that included 6 studies (5 cross-sectional and 1 cohort) including 5202 patients reported that office workers with more than 4-hour computer use had a higher prevalence of CTS than those with less than 4 hours of use.…”

Section: Occupational Risksmentioning

confidence: 99%

“…8 Electrodiagnostic studies can confirm the diagnosis of CTS and guide management by quantifying nerve compression. 1 In a 2015 study that surveyed members of the American Society for Surgery of the Hand, 72% of hand surgeons (513 of 714 who responded) used electrodiagnostic testing before surgery. 9 If history and physical examination results are classic (numbness or tingling in the thumb and in the index, middle, and radial ring fingers, oftentimes nocturnal), then adjunctive electrodiagnostics can be left to the discretion of the hand surgeon.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

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Common Hand Conditions

Currie

Tadisina

Mackinnon

2022

JAMA

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ImportanceCarpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and basilar (carpometacarpal) joint arthritis of the thumb can be associated with significant disability.ObservationsCarpal tunnel syndrome is characterized by numbness and tingling in the thumb and the index, middle, and radial ring fingers and by weakness of thumb opposition when severe. It is more common in women and people who are obese, have diabetes, and work in occupations involving use of keyboards, computer mouse, heavy machinery, or vibrating manual tools. The Durkan physical examination maneuver, consisting of firm digital pressure across the carpal tunnel to reproduce symptoms, is 64% sensitive and 83% specific for carpal tunnel syndrome. People with suspected proximal compression or other compressive neuropathies should undergo electrodiagnostic testing, which is approximately more than 80% sensitive and 95% specific for carpal tunnel syndrome. Splinting or steroid injection may temporarily relieve symptoms. Patients who do not respond to conservative therapies may undergo open or endoscopic carpal tunnel release for definitive treatment. Trigger finger, which involves abnormal resistance to smooth flexion and extension (“triggering”) of the affected finger, affects up to 20% of adults with diabetes and approximately 2% of the general population. Steroid injection is the first-line therapy but is less efficacious in people with insulin-dependent diabetes. People with diabetes and those with recurrent symptoms may benefit from early surgical release. de Quervain tenosynovitis, consisting of swelling of the extensor tendons at the wrist, is more common in women than in men. People with frequent mobile phone use are at increased risk. The median age of onset is 40 to 59 years. Steroid injections relieve symptoms in approximately 72% of patients, particularly when combined with immobilization. People with recurrent symptoms may be considered for surgical release of the first dorsal extensor compartment. Thumb carpometacarpal joint arthritis affects approximately 33% of postmenopausal women, according to radiographic evidence of carpometacarpal arthritis. Approximately 20% of patients require treatment for pain and disability. Nonsurgical interventions (immobilization, steroid injection, and pain medication) relieve pain but do not alter disease progression. Surgery may be appropriate for patients unresponsive to conservative treatments.Conclusions and RelevanceCarpal tunnel syndrome, trigger finger, de Quervain tenosynovitis, and thumb carpometacarpal joint arthritis can be associated with significant disability. First-line treatment for each condition consists of steroid injection, immobilization, or both. For patients who do not respond to noninvasive therapy or for progressive disease despite conservative therapy, surgical treatment is safe and effective.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Carpal Tunnel Syndrome Definition and Pathophysiologymentioning

confidence: 99%

Section: Occupational Risksmentioning

confidence: 99%

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

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Common Hand Conditions

Currie

Tadisina

Mackinnon

2022

JAMA

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Fascicular Involvement of the Median Nerve Trunk in the Upper Arm: Manifestation as Anterior Interosseous Nerve Syndrome With Unique Imaging Features

Park,

Sneag,

Choi

et al. 2024

Korean J Radiol

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Selective fascicular involvement of the median nerve trunk above the elbow leading to anterior interosseous nerve (AIN) syndrome is a rare form of peripheral neuropathy. This condition has recently garnered increased attention within the medical community owing to advancements in imaging techniques and a growing number of reported cases. In this article, we explore the topographical anatomy of the median nerve trunk and the clinical features associated with AIN palsy. Our focus extends to unique manifestations captured through MRI and ultrasonography (US) studies, highlighting noteworthy findings, such as nerve fascicle swelling, incomplete constrictions, hourglass-like constrictions, and torsions, particularly in the posterior/posteromedial region of the median nerve. Surgical observations have further enhanced the understanding of this complex neuropathic condition. High-resolution MRI not only reveals denervation changes in the AIN and median nerve territories but also illuminates these alterations without the presence of compressing structures. The pivotal roles of high-resolution MRI and US in diagnosing this condition and guiding the formulation of an optimal treatment strategy are emphasized.

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Nerve compressions

Cited by 2 publications

References 63 publications

Common Hand Conditions

Common Hand Conditions

Fascicular Involvement of the Median Nerve Trunk in the Upper Arm: Manifestation as Anterior Interosseous Nerve Syndrome With Unique Imaging Features

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