Diagnosis and Treatment of Work-Related Proximal Median and Radial Nerve Entrapment

Carter, Gregory T.; Weiss, Michael D.

doi:10.1016/j.pmr.2015.04.001

Cited by 13 publications

(19 citation statements)

References 38 publications

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“…Many articles do confirm this and state that although conservative medical management, as well as activity modification and splinting, may be the first line, further treatments with betterknown efficacies are often needed (20). Carter et al (2015), in an evidence-based review, argued that medical management should be trialed for a minimum of six weeks, with consecutive uninterrupted treatment before progressing to other treatments (21).…”

Section: Medical Managementmentioning

confidence: 99%

“…Corticosteroid injections are amongst the first methods tried. Several authors do mention the potential for corticosteroid injections (2,15,21,23,24). However, to date, no large-scale study has investigated the efficacy of corticosteroid injections for radial nerve entrapment.…”

Section: Minimally Invasive Techniquesmentioning

confidence: 99%

“…Surgical interventions for nerve entrapment syndromes continue to evolve in pursuit of smaller incisions, shorter recovery times, and utilization of surgical planes that minimize the risk of iatrogenic injury (29,30). Surgical treatment should only be pursued after the trial of at least 3 -6 months of non-operative options (21,23) . Ebrahimzadeh et al (2015) argued that surgical options demonstrated a success rate of up to 92% and 95% for release of the PIN only and PIN/SBRN, respectively (23).…”

Section: Surgical Techniquesmentioning

confidence: 99%

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Etiology Diagnosis and Management of Radial Nerve Entrapment

et al. 2021

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Context: The anatomy of the radial nerve is prone to entrapment, each with different symptomology. Compression of entrapment of the radial nerve can occur near the radiocapitellar joint, the spiral groove, the arcade of Frohse, the tendon of the extensor carpi radialis brevis (ECRB), and at the radial tunnel. Those who require repetitive motions are at increased risk of peripheral neuropathy syndromes, including repetitive pronation and supination, trauma, or systemic disease; however, t the influence of all risk factors is not well understood. Depending on the location of entrapment, radial nerve entrapment syndrome presents different symptoms. It may include both a motor component and a sensory component. The motor component includes a dropped arm, and the sensory component can include pain and paresthesia in the distribution of the radial nerve that resolves with rest and exacerbates by repetitive pronation and supination. Evidence Acquisition: Diagnostic evaluation for radial nerve entrapment, apart from clinical symptoms and physical exam, includes electromyography, nerve conduction studies, ultrasonography, and magnetic resonance imaging. Conservative management for radial nerve entrapment includes oral anti-inflammatory medications, activity modification, and splinting. Some recently performed studies mentioned promising minimally invasive techniques, including corticosteroid injections, peripheral nerve stimulation, and pulsed radiofrequency. Results: When minimally invasive techniques fail, open or endoscopic surgery can be performed to release the nerve Conclusions: Endoscopic surgery has the benefit of decreasing incision size and reducing time to functional recovery.

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Section: Medical Managementmentioning

confidence: 99%

Section: Minimally Invasive Techniquesmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

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Etiology Diagnosis and Management of Radial Nerve Entrapment

et al. 2021

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“…In daily practice, a greater occurrence of sensory changes over motor changes is found, as well as a slight presence of deformities [7] . The sensory and motor actions of INTRODUCTION __________________________________________________________________________________ M.leprae in the upper and lower limbs cause secondary injuries such as fingers [8] and toes in flexion and "fallen hands and foot" [9] .…”

Section: Introductionmentioning

confidence: 99%

“…The sensory and motor actions of M . leprae in the upper and lower limbs cause secondary injuries such as fingers [8] and toes in flexion and “fallen hands and foot” [9] .…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of early diagnostic tools for neural lesions in leprosy An observational cohort study

Cegana

Nardi

Pascoeto

et al. 2020

Preprint

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IntroductionLeprosy can cause different lesions in peripheral nerves and inervatory structures.ObjectivesTo analyse the effectiveness of evaluation protocols used to identify neural lesions in leprosy such as Degree of Physical Disability (DPD), Simplified Neurological Assessment (SNA), and Neurodynamic Assessment (NDA).MethodDescriptive analytical study, associative, with 27 individuals treated in two outpatient leprosy clinics in São Paulo State, between 2017 and 2019, and 27 individuals from the paired control group. The Mann-Whitney, Multivariate Linear Regression and association between variables and P<0.05 values were used.ResultsThe test that most captured the neurological alterations was the SNA, with 22 (81.5%) in the upper limbs (ULs) and 25 (92.6%) in the lower limbs (LLs), followed by the NDA, with 20 (74.1%) in the ULs and 11 (40.7%) in the LLs. The DPD showed handicap in the hands of 16 (59.2%) individuals and in the feet of 17 (62.9%) individuals, and they have expressed sensitivity. DPD showed agreement with SNA in 21 (77.8%) of the cases in ULs (p=0.010) and 19 (70,4%) of the cases in LLs (p=0.060). DPD and NDA showed that in 19 (70.4%) of the patients evaluated there was concordance of results in ULs (p=0.143); 9 (33.3%) in LLs (p=0.125). SNA and the NDA in the ULs found agreement in 21 (77.8%); 11 (40.7%) (p=0.786) in the LLs.ConclusionThe three assessment instruments are specific and will hardly produce false positive tests. DPD can produce more false negatives than SNA. If there is an instrument to be chosen, it should be the SNA, since it is more sensitive, more accurate and has a less negative likelihood ratio. Neurodynamic tests were positive in 7.4% of individuals while there were still no changes in the SNA; afterwards, these changes appeared.

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Lacertus syndrome: a ten year analysis of two hundred and seventy five minimally invasive surgical decompressions of median nerve entrapment at the elbow

Hagert

Jedeskog

Hagert

et al. 2023

International Orthopaedics (SICOT)

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Purpose This study aims to assess the clinical presentation and surgical outcomes of lacertus syndrome (LS) and concomitant median nerve entrapments. Methods A retrospective study of prospectively collected data was conducted on patients undergoing lacertus release (LR) from June 2012 to June 2021. Available DASH (Disability of the Arm Shoulder Hand questionnaire) scores and post-operative Visual Analogue Scale (VAS) of pain, numbness, subjective satisfaction with surgical outcome, and intra-operative return of strength were analyzed. Results Two-hundred-seventy-five surgical cases were identified of which 205 cases (74.5%) underwent isolated LR, and 69 cases (25.1%) concomitant lacertus and carpal tunnel release. The three most common presenting symptoms in LS patients were loss of hand strength (95.6%), loss of hand endurance/fatigue (73.3%), and forearm pain (35.4%). Numbness in the median nerve territory of the hand was found in all patients with combined LS and carpal tunnel syndrome. Quick-DASH significantly improved (pre-operative 34.4 (range 2.3–84.1) to post-operative 12.4 (range 0–62.5), p < 0.0001) as did work and activity DASH (p < 0.0001). The postoperative VAS scores were pain VAS 1.9 and numbness VAS 1.8. Eighty-eight percent of patients reported good/excellent satisfaction with the surgical outcome. Intra-operative return of strength was verified in 99.2% of cases. Conclusion LS is a common median nerve compression syndrome typically presenting with loss of hand strength and hand endurance/fatigue. Minimally invasive LR immediately restores hand strength, significantly improves DASH scores, and yields positive outcomes regarding VAS pain, numbness, and subjective satisfaction with surgery in patients with proximal median nerve entrapment at a minimum six month follow-up.

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Diagnosis and Treatment of Work-Related Proximal Median and Radial Nerve Entrapment

Cited by 13 publications

References 38 publications

Etiology Diagnosis and Management of Radial Nerve Entrapment

Etiology Diagnosis and Management of Radial Nerve Entrapment

The effectiveness of early diagnostic tools for neural lesions in leprosy An observational cohort study

Lacertus syndrome: a ten year analysis of two hundred and seventy five minimally invasive surgical decompressions of median nerve entrapment at the elbow

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