NERVE COMPRESSION SYNDROME OF THE UPPER EXTREMITY

Question 1

Many different nerves may be compressed causing symptoms.

(1) More common:

Answer 1

(a) Cubital tunnel syndrome
(b) Median nerve compression
1) Usually occurs in the wrist/hand (ie: Carpal Tunnel)

Question 2

Many different nerves may be compressed causing symptoms.

(2) Less common:

Answer 2

(a) Posterior interosseous nerve compression
(b) Pronator syndrome
(c) Radial tunnel syndrome

Question 3

Cubital Tunnel Syndrome:

Causes

Answer 3

(1) Compression of the Ulnar Nerve
(a) Compression of ulnar nerve is second only to carpal tunnel syndrome as a source of
nerve entrapment in the upper extremity
(b) Most common site is where ulnar nerve passes in groove on posterior aspect of
medial epicondyle (cubital tunnel)

Question 4

Cubital Tunnel Syndrome:

Etiology

Answer 4

(a) Direct blow to cubital tunnel
(b) Nerve stretched from flexed elbow for prolonged periods on time
(c) Cubitus valgus (carrying angle greater than 10 degree)
(d) Osteophytes or scar tissue

Question 5

Cubital Tunnel Syndrome:

Clinical Symptoms

Answer 5

1) Numbness and tingling in the 4th and 5th digits
2) Elbow pain/ache
3) May radiate proximally to shoulder and neck
4) Inability to do activities of daily living (ADL) such as opening jars or turning
key in door are late signs
5) Intrinsic muscle atrophy implies nerve compression of several months

Question 6

Cubital Tunnel Syndrome:
  Physical Exam
(1) Visual
(2) Neurovascular
(3) Special Tests
(4) Diagnostic Tests

Answer 6

(1)a) Usually unremarkable
b) Carrying angle greater than 10 degrees may be aggravating findings for
ulnar nerve neuritis
c) Visible muscle wasting implies ulnar nerve compression of several months to years duration
(2)a) Vibration and light touch will be affected in the 5th digit and ulnar half of the 4th digit
b) Two point discrimination will be affected with progressive nerve
degeneration
(3) a) Vibration and light touch will be affected in the 5th digit and ulnar half of the 4th digit
b) Two point discrimination will be affected with progressive nerve
degeneration
(4) (a) EMG/NCV study with velocity reduction of 30% or more suggests significant ulnar nerve compression
(b) Radiographs of elbow are indicated when previous elbow trauma has occurred

Question 7

Treatment

Answer 7

1) Modify activities to limit elbow flexion and direct pressure on the ulnar nerve is
the most important step in treatment
2) Splint elbow or wrap towel around elbow to avoid greater than 90 degree flexion
at night
3) NSAIDS
4) Surgical decompression and transposition of ulnar nerve if 3-4 months of
conservative management failed