Upper Extremity Nerve Entrapments

Hagert, Elisabet; Hagert, Carl-Göran

doi:10.1097/prs.0000000000000259

Cited by 23 publications

(22 citation statements)

References 31 publications

(18 reference statements)

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“…Both these studies, however, were case reports on a single patient. Hagert 27 and Hagert and Hagert 28 have also performed studies to demonstrate the clinical utility of the SCT in proximal median nerve entrapment. However, none of the studies examined the efficacy of the SCT, as the data on the sensitivity and specificity were not published or collected.…”

Section: Discussionmentioning

confidence: 99%

Scratch Collapse Test for Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis

Huynh¹,

Karir²,

Bennett³

2018

Plastic and Reconstructive Surgery - Global Open

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Background:Despite the fact that carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, the diagnostic accuracy of clinical screening examinations for CTS is controversial. The scratch collapse test (SCT) is a novel test that may be of diagnostic advantage. The purpose of our study was to determine the diagnostic accuracy of the SCT for CTS.Methods:A literature search was performed using PubMed (1966 to April 2018); Ovid MEDLINE (1966 to April 2018); EMBASE (1988 to April 2018); and Cochrane Central Register of Controlled Trials (The Cochrane Library, to April 2018). We examined the studies for the pooled sensitivity, specificity, and likelihood ratios of the SCT. This review has been registered with PROSPERO (CRD42018077115).Results:The literature search generated 13 unique articles. Seven articles were included for full text screening and 3 articles met our inclusion criteria, all of which were level II evidence with low risk of bias (165 patients). Pooled sensitivities, specificities, positive likelihood ratio, and negative likelihood ratios were 0.32 [95% CI (0.24–0.41)], 0.62 [95% CI (0.45–0.78)], 0.75 [95% CI (0.33–1.67)], and 1.03 [95% CI (0.61–1.74)], respectively. The calculated area under the summary receiver operating characteristic (AUSROC) curve was 0.25, indicating a low diagnostic accuracy.Conclusion:The SCT has poor sensitivity; however, it is moderately specific. Based on the current literature and their variable quality of the evidence, we conclude that the SCT is not an adequate screening test for detecting CTS.

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Section: Discussionmentioning

confidence: 99%

Scratch Collapse Test for Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis

Huynh¹,

Karir²,

Bennett³

2018

Plastic and Reconstructive Surgery - Global Open

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“…Upper extremity nerve entrapment may cause symptoms such as pain, paresthesia, and muscle weakness [15]. Nerve compression between muscles or other structures in the neck may also affect arm and shoulder strength, because of the involvement of neck muscles in arm and shoulder movements, which illustrates the complexity of the condition.…”

Section: Discussionmentioning

confidence: 99%

Decompression of the greater occipital nerve improves outcome in patients with chronic headache and neck pain — a retrospective cohort study

et al. 2021

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Background Compression of the greater occipital nerve (GON) may contribute to chronic headache, neck pain, and migraine in a subset of patients. We aimed to evaluate whether GON decompression could reduce pain and improve quality of life in patients with occipital neuralgia and chronic headache and neck pain. Methods In this retrospective cohort study, selected patients with neck pain and headache referred to a single neurosurgical center were analyzed. Patients (n = 22) with suspected GON neuralgia based on nerve block or clinical criteria were included. All patients presented with occipital pain spreading frontally and to the neck in various degree. Surgical decompression was performed under local anesthesia. Follow-up was made by an assessor not involved in the treatment of the patients, by telephone 2–5 years after the surgical procedure and an interview protocol was used to collect information. The data from the follow-up protocols were then analyzed and reported. Results When analyzing the follow-up protocols, decreased headache/migraine was reported in 77% and neck pain was reduced in 55% of the patients. Conclusions Decompression of GON(s) may reduce neck pain and headache in selected patients with persistent headache, neck pain, and clinical signs of GON neuralgia. Based on the limitations of the present retrospective study, the results should be considered with caution.

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“…As in this case, observation with cessation of exercise for 1 month, a physical therapy plan, anti-inflammatory medicines, an EMS, a NCS, a non-exercise MRI of the forearm, a cervical MRI, and a cervical CT angiogram have all demonstrated to only rule out a few differential diagnoses or have proven inconclusive. Even though the first step taken by the initial physician in March was to rule out any concomitant nerve compression through EMG/NCS studies, these exams may prove misleading or inaccurate at times [15, 21–24]. Other investigations not done in this case have proven futile as well; including X-rays, blood tests, and Doppler ultrasound scans [2, 13].…”

Section: Discussionmentioning

confidence: 99%

Chronic Exertional Compartment Syndrome in the Forearm of a Collegiate Softball Pitcher

et al. 2017

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BackgroundChronic exertional compartment syndrome (CECS) is a recognized condition in the lower limb, with many reports in the literature. However, very few instances include CECS of the upper limb. This article presents the case of a collegiate softball pitcher presenting with CECS in her right forearm. To our knowledge, this is the first case report of a softball player with CECS, with only one similar incident in a major league baseball player.PurposeThe rarity of this condition normally places it low on the differential diagnosis. However, we hope that the presentation of this case and the review of the literature will aid in making swift and accurate diagnoses of CECS in future patients. We discuss the importance of three specific modalities in the diagnosis of this patient, what diagnostic criteria proved less conclusive, and the paradoxical course the syndrome presented with.Study DesignCase ReviewResultsOver a six-month period, the patient presented with peculiar presentations and exam results. A broad list of differential diagnoses had to be narrowed down through the presence or absence of relevant findings. These included cessation of exercise for 1 month, physical therapy, anti-inflammatory medicines, an electromyography/electromyogram (EMG), nerve conduction study (NCS), non-exercise magnetic resonance imaging (MRI) of the forearm, cervical MRI, and cervical computed tomography (CT) angiogram. After the above interventions were attempted and the relative findings of three important modalities were summarized, a fasciotomy and release of the dorsal, volar, and mobile wad compartments was performed. The patient’s symptoms were relieved, and she eventually returned to full play in softball at the university.ConclusionsThe three diagnostic criteria we believed to be most helpful in this case, and for future cases of CECS in the forearm, include the clinical presentation, pre- and post-exercise MRI, and pre- and post-exercise compartment pressure measurements.Clinical RelevanceChronic exertional compartment syndrome of the forearm is extremely rare, especially in the female athlete. This case report and review of the literature may be helpful to the clinician facing similar cases. It describes which clinical tests are most helpful for diagnosis and which findings may be distracting.

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Upper Extremity Nerve Entrapments

Abstract: The clinical triad of muscle testing, scratch-collapse test, and pain at the level of nerve compression provides the clinician with a clinical foundation for analyzing patients with brachialgia in a structured fashion.

Cited by 23 publications

References 31 publications

Scratch Collapse Test for Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis

Scratch Collapse Test for Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis

Decompression of the greater occipital nerve improves outcome in patients with chronic headache and neck pain — a retrospective cohort study

Chronic Exertional Compartment Syndrome in the Forearm of a Collegiate Softball Pitcher

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