Compression Neuropathies of the Upper Extremity: A Review

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.

Dextrose hydrodissection with ultrasound-guided as optional therapy in pronator teres syndrome: A case report

Pronator teres syndrome (PTS) is a rare peripheral neuropathy of the proximal median nerve that occurs due to compression of the pronator teres muscle or its surrounding anatomical structures. Treatment options in cases of pronator syndrome include conservative therapy (oral, physical, intervention) to surgical therapy. Dextrose hydrodissection with ultrasound guided is an interventional therapy option in cases of peripheral neuropathy. This study presented a case of 50 year old female with chronic pronator teres syndrome who received ultrasound-guided 5% dextrose hydrodissection therapy and experienced satisfactory resolution within 6 months of post injection evaluation.

Compression Neuropathies

Compression neuropathies result from entrapment at specific anatomic locations. They are a common clinical problem, particularly in the upper extremity, where a patient’s underlying medical conditions can affect the likelihood of symptoms. Early recognition from the clinical history and a detailed examination, including provocative maneuvers, combined with electrodiagnostic testing or imaging modalities is imperative to guide treatment and prevent permanent dysfunction. This review contains 7 figures, 2 tables, and 45 references. Keywords: carpal tunnel syndrome, cubital tunnel syndrome, radial tunnel syndrome, ulnar tunnel syndrome, pronator syndrome, anterior interosseous syndrome, entrapment neuropathy, electrodiagnostic studies