Evaluation of multiple level nerve compression

In this retrospective study, the charts of 100 patients (81 females and 19 males, mean age 41 years) with a diagnosis of multiple level nerve compression were reviewed. Forty-five patients were involved with Workers' Compensation. The most common referral diagnosis was carpal tunnel syndrome (43%); only one patient was referred with the diagnosis of ‘multiple crush’. Of the 43 patients referred with a diagnosis of carpal tunnel syndrome, 35% had two levels of nerve compression (carpal and cubital tunnel or carpal tunnel and thoracic outlet) and 65% had three levels of nerve compression (carpal tunnel, cubital tunnel and thoracic outlet). This study suggests that multiple level nerve compression is frequently unrecognized and recommends full upper extremity evaluation, especially in patients referred with a diagnosis of carpal tunnel syndrome, to identify all levels of nerve compression.

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Compression Neuropathies of the Upper Extremity

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0100 ◽

2019 ◽

pp. 1003-1014

Author(s):

Wendy Kar Yee Ng

Keyword(s):

Carpal Tunnel Syndrome ◽

Upper Extremity ◽

Carpal Tunnel ◽

Cubital Tunnel Syndrome ◽

Nerve Compression ◽

Cubital Tunnel ◽

Peripheral Neuropathies ◽

Tunnel Syndrome ◽

Radial Tunnel Syndrome

Compression neuropathies of the upper extremity are common, and these conditions can be symptomatically debilitating for patients. Although the author acknowledges that nerve compression can still occur at various sites from the neck proximally to the hand distally for all of the described nerves herein, the author aims with this chapter to describe a series of straightforward, reproducible, and reliable approaches to the evaluation and management of three upper extremity peripheral neuropathies to each of the three major nerves to the hand: carpal tunnel syndrome, cubital tunnel syndrome, and radial tunnel syndrome.

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Evaluation of PROMIS Outcomes for Surgical Treatment of Cubital Tunnel Syndrome With and Without Carpal Tunnel Syndrome

Hand ◽

10.1177/15589447211028921 ◽

2021 ◽

pp. 155894472110289

Author(s):

Amy Phan ◽

Warren Hammert

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Postoperative Period ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Measurement Information ◽

Level Of Evidence ◽

Patient Reported ◽

Tunnel Syndrome ◽

Measurement Information System

Background: Assessment of outcomes for cubital tunnel syndrome (CuTS) surgeries has been difficult due to heterogeneity in outcome reporting. Our objective was to evaluate the outcomes for 2 cohorts treated surgically for isolated CuTS and for combined CuTS and carpal tunnel syndrome (CTS) using Patient Reported Outcomes Measurement Information System (PROMIS). Methods: There were 29 patients in the isolated CuTS cohort and 30 patients in the combined CuTS and CTS cohort. PROMIS Physical Function (PF), Pain Interference (PI), Depression, and Upper Extremity (UE) were completed preoperatively and 1-week, 6-weeks, and 3-months postoperatively. Responsiveness was evaluated by standardized response means (SRM). Results: Significant improvements from the 1-week to 6-week postoperative period are shown in the isolated CuTS cohort for PROMIS PF ( P = .002), PI ( P = .0002), and UE ( P = .02), but scores plateau after 6-weeks postoperatively. A similar pattern for the same time points was seen for the combined CuTS and CTS group for PROMIS PF ( P = .001), PI ( P = .02), and UE ( P = .04), with a plateau of scores beyond 6 weeks postoperatively. PROMIS UE was more responsive (SRM range: 0.11-1.03) than the PF (SRM range: 0.02-0.52) and PI (SRM range: 0.11-0.40), which were both mildly responsive for both cohorts. Conclusions: PROMIS lacks the sensitivity to show improvement beyond 6-weeks postoperatively for both isolated CuTS and combined CuTS and CTS. Patients with combined nerve compressions follow similar trajectories in the postoperative period as those with isolated CuTS. Level of Evidence: Level IV.

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