2005 Dec. 87 (12):1647-52. Wartenberg syndrome is best treated nonoperatively. In the absence of traumatic injury, initial treatment of nerve injuries should be conservative and includes patient education, relative rest, and activity modification. 2007 Dec. 15 (12):757-64. [QxMD MEDLINE Link]. Yamazaki H, Kato H, Hata Y, Murakami N, Saitoh S. The two locations of ganglions causing radial nerve palsy. Radial neuropathy occurs when there is damage to the radial nerve, which travels down the arm and controls: Movement of the triceps muscle at the back of the upper arm. Chapter 1, Part 2, Section 150.8 Fluidized Therapy Dry Heat for Certain Musculoskeletal Disorders, Section 160.12 Neuromuscular Electrical Stimulator (NMES), 160.15 Electrotherapy for Treatment of Facial Nerve Palsy (Bell's Palsy), Section 160.2 Treatment of Motor Function Disorders with Electric Nerve Stimulation Classification of Peripheral Nerve Injury, Transcutaneous Electrical Nerve Stimulation (TENS), http://www.intechopen.com/books/basic-principles-of-peripheral-nervedisorders/basics-of-peripheral-nerve-injury-rehabilitation, https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061, https://www.youtube.com/watch?v=OlNyp0RfiBg&feature=youtu.be, Peripheral nerve injuries clinical presentation, https://emedicine.medscape.com/article/1270360-clinical, https://pubmed.ncbi.nlm.nih.gov/10811744/, https://pubmed.ncbi.nlm.nih.gov/24867724/, https://pubmed.ncbi.nlm.nih.gov/22121093/, https://jnnp.bmj.com/content/87/2/188.short, https://www.foundationforpn.org/living-well/integrative-therapies/massage/. [QxMD MEDLINE Link]. For proximal nerve lesions, a sterile tourniquet may be needed, and the lateral decubitus position is preferred. for: Medscape. The innervation to the glenohumeral joint is complicated and overlapping: the axillary, suprascapular, supraclavicular, and lateral pectoral nerves are chiefly . Many patients with radial nerve palsy will see complete recovery or symptom relief after treatment. It develops insidiously over months to years, often exacerbated by activities with the arm in pronation, such as repetitive hammering or a backhand swing with a tennis racket. Radial nerve anatomy. Brachial Plexus Injury | Johns Hopkins Medicine xZ[o~/GVEQE I,ifh"v\o(:h,pO^|8|*Nx.4*q -_|d8WM#&u2_;0[?C?V}9b 1S7/0&_ Zf_N9_k\|LSb8gXF]:,NDq8D9~ H'? Treatment of radial nerve palsy may include: Your physician may recommend prescription or over-the-counter medication to decrease pain associated with radial nerve palsy. This nerve starts at the neck and travels through the entire length of the arm. Henry M, Stutz C. A unified approach to radial tunnel syndrome and lateral tendinosis. Open exploration is indicated if there is no relief of the palsy or if it is felt that the nerve may be entrapped between the fracture fragments. stream Spinner M. Injuries to the Major Branches of Peripheral Nerves of the Forearm. Eur Radiol. [19] Aerobic activity should also be encouraged ( aiming for 30 minutes 4 times a week) for its known health benefits. The distal margin of the supinator is identified, and the fascia is incised between the extensor carpi radialis longus and brevis and the extensor digitorum communis. 2006 Oct. 31 (5):542-6. If nerve entrapment has caused only mild damage to the nerve (neurapraxia), recovery should be rapid and complete in a short period of timeapproximately 2-8 weeks. . Improper use of crutches is a common cause of radial nerve compression at this point. 2007 Dec. 89 (12):2591-8. Radial Nerve Palsy The radial nerve is the commonly affected by compression injuries and most often results in the loss is loss of wrist, finger and thumb extension although triceps and forearm supination can also be affected depending on where the compression of the nerve has been. Their long course from the central nervous system through the extremity puts them at risk of compromise at narrow anatomic tunnels and areas of edema and trauma. HWK\@k~@"4d'3|866v:U}{S|b~~_~?5]? Chapter Objectives. J . stream The radial nerve palsy is one of the major nerves of the arm. Radial Tunnel Syndrome Therapeutic Exercise Program - OrthoInfo - AAOS Other causes include fractures, lipomas, ganglion cysts, and systemic diseases (e.g., diabetes mellitus, rheumatoid arthritis, hypothyroidism) that cause localized edema.38,45, Findings of ulnar nerve entrapment include atrophy of the hypothenar, lumbrical, and interosseous muscles.38 Motor dysfunction is less common because of the deep nature of the motor branch, but it results in weakness of abduction and adduction of the fingers as well as the pincer mechanism.46 The Froment sign (Figure 6) can be observed with ulnar nerve entrapment at any anatomic location, but it is more common when injury occurs to the deep branch at the wrist.38,46 Sensory disturbances occur over the hypothenar eminence, the fifth digit, and half of the fourth digit.38, The primary diagnostic tests for evaluation of nerve injury and entrapment include electrodiagnostic tests, subdivided into nerve conduction studies and electromyography (EMG), and imaging, which includes magnetic resonance imaging and ultrasonography. However, proper ergonomics and posture at work and pillows to correct awkward sleeping positions may help. Phone: 507.288.0100 Care must be taken during the dissection because 5-6 cm above the elbow, branches are given off to the brachioradialis and the extensor carpi radialis longus and brevis. see Otago Balance Program as an example of a good balanced program. J Bone Joint Surg Br. This is known as radial neuropathy, or sometimes Saturday night palsy.17 Compression also occurs at the axilla, as it passes through the triceps brachii lateral head.41 The nerve innervates the extensors of the wrist and fingers, causing wrist and finger drop. This content is owned by the AAFP. 1173185. Injury to the radial nerve caused by fracture of the humeral shaft: timing and neurobiological aspects related to treatment and diagnosis. Thomsen NO, Dahlin LB. The anterolateral approach offers excellent nerve exposure over the distal half of the humerus. <> 2nd ed. 'K2=AAZn?H6=b^\z RC:]@)go4Wxln"MAaF)#iSN~NtY(%DT68:VlB/gOe70{^2{)E2(> With your help, the American Neuromuscular Foundation can fund research that will improve the lives of patients with neuromuscular diseases. 142 0 obj <>stream <> These exercise Radial Nerve Flossing - Great Results - Ask Dr. Abelson Help for Forearm Pain with Radial Nerve. PROM exercises on a daily basis are useful to prevent these problems, and protective removable static splints can also be useful in contracture prevention. Physical Therapy Your physician or physical therapist may prescribe exercises to strengthen your muscles and increase your range of motion. But, some people may always experience varying degrees of radial nerve palsy. Physical therapy: Physical therapy helps you with special exercises. A health care practitioner may order a diagnostic test to determine the extent of nerve involvement. If the injury is more severe (axonotmesis), recovery will take longer, and the timetable is determined by how far the regenerating axon must grow to reinnervate the paralyzed muscles. J Am Acad Orthop Surg. A multidisciplinary approach is taken, with most input from the pharmacologist(s). Rehabilitation emphasizes motor and sensory reeducation and must be tailored to the individual patient. greatest force of contraction exerted when muscle is at resting length. 234. In some cases, complications may occur, including: Partial or complete loss of feeling in the hand: If the radial nerve doesnt heal completely, numbness may be permanent. been written for Occupational Therapy on traumatic injuries to the radial nerve have been based on studies made during the last war and about isolated industrial cases. Therapy for radial nerve palsy - Steady. Health Radial tunnel syndrome is a painful condition caused by pressure on the radial nerve one of the three main nerves in your arm. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Brachial plexopathy is an injury of the brachial plexus, that is commonly caused by trauma. Rotator cuff injury can present similarly; therefore, magnetic resonance imaging, ultrasonography, or electrodiagnostic studies are usually appropriate to determine the specific etiology if initial radiography is inconclusive.18,33, Radial Nerve. It controls the muscles that help straighten the elbow, wrist and fingers. Its fibers are derived from the fifth, sixth, seventh, and eighth cervical and first thoracic nerves. Findings on examination include scapular winging and weakness in shoulder shrugging and shoulder abduction past 180 degrees.21 Chronic injury may result in trapezius atrophy. match muscle strength. 1987 Jun. Frohse's arcade is not the exclusive compression site of the radial nerve in its tunnel. The radial nerve is vulnerable to injury and entrapment at several locations. [QxMD MEDLINE Link]. This can lead to subsequent degeneration distal to the lesion. By reviewing the published literature, we identified . De quervain tenosynovitis of the wrist. The radial nerve, the largest branch of the brachial plexus, is the continuation of the posterior cord of the brachial plexus. Available from: Dr Ben Kim. Treatment of C5 Palsy: An International Survey of Peripheral Nerve Surgeons Brachial plexus injury is commonly associated with contact sports. [QxMD MEDLINE Link]. [2] Watch the below to grasp the concepts of nerve damage and repair [3] Clinical Presentation Scand J Plast Reconstr Surg Hand Surg. 4 0 obj Prolongation of these injurious mechanisms causes fibrosis, resulting in a larger degree of injury.35 More specifically, nerve injury is divided into three grades of increasing severity: neurapraxia, axonotmesis, and neurotmesis. Functional disability due to nerve lesions is intertwined with the severity of the lesion. 2007. Long Thoracic Nerve. 2006 Jul. J Bone Joint Surg Am. After posterior interosseous nerve exploration and release, a similar long arm splint is used for a short duration postoperatively. Nfz P.w%U. Motion is initiated quickly with graduation to the appropriate functional splint. In this video, we'll show you 7 simple exercises for Radial Nerve Palsy. [QxMD MEDLINE Link]. In addition, splinting techniques, frequently have a place in management of peripheral nerve injuries, including postoperative splinting and casting, as well as splints to prevent deformities developing, or even to overcome established contractures and improve function, and in this way aid the patient's recovery[17]. The soft tissues of the region and adjacent regions supplied by the damaged nerve are at risk of contractures if left in shortened positions. It controls muscles in the back of the arm. Recurrent or unnoticed injuries to the wrist or hand: If the wrist or hand are numb, a person may not notice an injury. Protective splints may be utilized along with graduated muscle stretching and then strengthening. See permissionsforcopyrightquestions and/or permission requests. Toros T, Karabay N, Ozaksar K, Sugun TS, Kayalar M, Bal E. Evaluation of peripheral nerves of the upper limb with ultrasonography: a comparison of ultrasonographic examination and the intra-operative findings. Ask our physios about it. [QxMD MEDLINE Link]. The ulnar nerve branches off the brachial plexus nerve system and travels down the back and inside of the arm to the hand. It can confirm the presence of nerve damage and assess its severity. Imaging studies: The physician may order an X-ray, ultrasound or MRI to check for broken bones, cysts and other masses in the arm. force proportional to cross-sectional area. [QxMD MEDLINE Link]. You may have arm weakness, particularly if you're pushing something away. 127. The anterior interosseous nerve is the motor-only nerve for deep muscles of the forearm. The nerve is traced proximally and distally, releasing any possible points of compression. The brachial plexus branches into five peripheral nerves, three of which are commonly entrapped at the shoulder, elbow, and wrist. Surgical treatment of the radial nerve in the arm is carried out through either the anterolateral approach or the posterior approach. Proximally, middle to distal third humeral shaft fractures are the most common cause of traumatic injury.40 The most common compressive cause results from sustained pressure on the posterior arm at the location of the radial groove, where the nerve lies directly on periosteum and is not protected by muscle. Lo YL, Fook-Chong S, Leoh TH, Dan YF, Tan YE, Lee MP, et al. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. Axillary Nerve. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). PDF Radial Tunnel Syndrome - Brigham and Women's Hospital This can only be achieved if the depression, anxiety, and sleep disorders are also addressed. Peripheral nerves in the upper extremity are at risk for injury and entrapment. Suprascapular Nerve. xXMs6kFG "v:8OLl$!ewP6)KvPBb[0/ $@RAb%H 7x88Ux s"qKbq\YppEY*6(5UppW"umoWlUGXM^ In8 )8`6''t9rT?^rNt\E Ultrasonography and magnetic resonance imaging should be used for diagnosing anatomic causes of nerve entrapment. With neurotmesis, the results are unsatisfactory even with surgical repair. Sunderland S. Nerves and Nerve Injuries. Treatment usually depends on the reason for the radial nerve palsy. Radial Nerve Block: Overview, Indications, Contraindications - Medscape [2], Watch the below to grasp the concepts of nerve damage and repair. Occupational risks: Jobs that require repetitive motion and awkward postures or working positions may increase the risk of radial nerve palsy. Clavert P, Lutz JC, Adam P, Wolfram-Gabel R, Liverneaux P, Kahn JL. Shoulder dislocations, repetitive use injuries, humeral neck fractures, and local pressure (e.g., from crutches) are mechanisms of injury.19 Damage to the axillary nerve results in paresthesia or pain of the lateral shoulder and weakness in shoulder external rotation, extension, abduction, and forward flexion. Peripheral nerve injuries have numerous causes including traumatic injuries; infections; metabolic problems ( one of the most common causes is diabetes mellitus ); inherited causes; exposure to toxins; tumors; iatrogenic causes. (2017). Splinting for Nerve Injuries | Musculoskeletal Key hbbd```b``! In radial tunnel syndrome, prolonged conservative treatment is indicated if the only symptom is pain. Aromatherapy Massage for Neuropathic Pain and Quality of Life in Diabetic Patients. Static and dynamic splints can help to rest paralyzed muscles in optimum positioning to avoid overstretching and or contractures. [3, 18, 19, 20]. The result of any surgery is dependent on the damage to the nerve preoperatively. The long thoracic nerve is vulnerable to traction injury at its nerve roots located at the middle scalene.20 Other mechanisms of injury include direct blows to the nerve as it exits the pectoralis muscle at the fourth or fifth rib, repetitive stretching (e.g., throwing a baseball, serving a volleyball), or iatrogenic damage (e.g., during a radical mastectomy).20,21 Injury to this nerve is the most common cause of scapular winging.20,21. Campbell's Operative Orthopaedics. Semin Musculoskelet Radiol. Carter GT, Weiss MD. At the wrist, the superficial radial nerve is susceptible to injury by compression because it runs superficially to the flexor retinaculum. Electrodiagnostic testing should be used as an adjunct to physical examination and imaging to help confirm the diagnosis of peripheral nerve injury, establish the severity of injury, and monitor progression of nerve damage. Clinical Neurophysiology (EMG) Fellowship Portal, American Association of Orthopaedic Surgeons. 2011 Sep. 45 (5):473-4. At Baptist Health, you have access to the regions most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. Techniques employed by physiotherapist to achieve the above goals are massage, US, hydrotherapy, splints, passive ROM stretches and correct transfer skill education. 28 (8):635-42. Verbeek DO, Helfet DL, Ring D. Factors associated with radial nerve palsy after operative treatment of diaphyseal humeral shaft fractures. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The radial nerve is 1 of the 4 important branches of the posterior cord of the brachial plexus and has the root values of C5, C6, C7, C8, and T1. If pain does not resolve after 12 weeks, surgery may be indicated. The radial nerve runs from the upper arm to the wrist and fingers. The primary clinical finding is pain in the proximal volar forearm. 4 0 obj The shock-emitting electrode sends repeated, brief electrical pulses to the nerve, and the recording electrode records the time it takes for the muscle to contract in response to the electrical pulse. Phys Med Rehabil Clin N Am. Peripheral nerve injuries have numerous causes including traumatic injuries; infections; metabolic problems ( one of the most common causes is diabetes mellitus); inherited causes; exposure to toxins; tumors; iatrogenic causes. [QxMD MEDLINE Link]. 2022 Feb 8. J Neurol Sci. The patient may not be able to return to normal activities for 3-4 months. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. It is designed to provide safe, practical guidance in the screening, diagnosis and management of complications related to long term high dose steroid therapy initiated in primary or secondary care. q2%lg>(6KEXOFRyW:1LG1>$G Tech Hand Up Extrem Surg. [QxMD MEDLINE Link]. Percutaneous Electrical Stimulation on Radial Nerve in Patients With https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743666/. Radial Nerve. A 6- to 12-week period of expectancy is indicated to allow the swelling and palsy to subside. There is loss of movement, sensation, or . 91 (6):762-5. Chapter 1, Part 2, Section 150.5 Diathermy Treatment, Section 150.8 Fluidized Therapy Dry Heat for Certain Musculoskeletal Disorders, Section 160.2 Treatment of Motor Function Disorders with Electric Nerve Stimulation, Section 160.12 Neuromuscular Electrical Stimulator (NMES), Section 160.15 Electrotherapy for Treatment of Facial Nerve Palsy . [QxMD MEDLINE Link]. hTP;o +nl,TwKlA^X gB8h hV[M2 K~#N3b#p7N1!wB%N"p4_ex+8)u t#BJ< @Q?]zwdxk|WVQQS[*9\> dDy Table 2 summarizes specific physical examination findings and treatment options associated with each nerve.1338, Brachial Plexus. Ilyas AM, Ast M, Schaffer AA, Thoder J. Treatment options can include medications, therapies, surgical procedures and other treatments as needed. MR imaging features of radial tunnel syndrome: initial experience. Risk factors that may contribute to radial nerve palsy include: Gender: Radial nerve palsy is more common in men than women. Splints and activity modification help limit repetitive elbow extension, forearm pronation, and wrist flexion. [1], Chronic neuropathic pain has a life-debilitating effect causing emotional stress and reduced QOL. In the case of immunologically mediated wrist drop, as in mixed cryoglobulinemia, drugs such as rituximab may facilitate a rather rapid recovery. <>>> Following a first episode, return to play is acceptable when there is complete resolution of symptoms and cervical spine injury has been excluded.32,39 Persistent or recurrent stingers prompt additional evaluation for cervical stenosis or other bony abnormalities.32. Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society, Florida Medical Association, Florida Orthopaedic SocietyDisclosure: Nothing to disclose. Treatment is dependent on the site and cause of the lesion. Management of long term high steroid therapy - RefHelp https://www.youtube.com/watch?v=J-YE4lAVEmo&t=30s, https://www.youtube.com/watch?v=CK6Uq7JGy0g&t=6s, https://www.youtube.com/watch?v=XT68ZcEXG5A, Voluntary exercise increases axonal regeneration from sensory neurons, https://www.youtube.com/watch?v=KDvJpp6-ID0, A Review of the Emotional Aspects of Neuropathic Pain, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701895/, https://www.physio-pedia.com/index.php?title=Nerve_Injury_Rehabilitation&oldid=323925, Musculocutaneous/ upper trunk brachial plexus, Fascicle within ulnar nerve subserving Flexor carpi ulnaris, Axillary nerve/upper trunk brachial plexus, Motor branches of radial nerve to triceps (long or medial head), Branches of the tibial nerve (eg, lateral gastrocnemius). The incision continues in the biceps-brachialis interval. Michael D Robinson,Steven Shannon.Rehabilitation of peripheral nerve injuries.PMID:11878078.DOI: Gok Metin, Zehra & Arikan Dnmez, Aye & Izgu, Nur & Ozdemir, Leyla & Emre Arslan, Ismail. In this exposure, all the potential sites of compression of the posterior interosseous nerve (ie, arcade of Frohse, supinator muscle, and distal fascia) are released. A brachial plexus schematic, radial nerve sensory distribution, and . Author disclosure: No relevant financial affiliations. work capacity = (force) x (amplitude) motor strength will decrease one grade after transfer. Nerves typically heal at a rate of 1 mm/day. Reza Salman Roghani and Seyed Mansoor Rayegani (2012). 2621 Superior Drive NW Rochester, MN 55901 Radial Nerve Palsy Medical Therapy Conservative treatment for radial nerve damage or palsy depends on the severity of the condition. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Compression of the superficial radial sensory nerve (RSN) in the distal forearm is best treated conservatively by eliminating any possible external compression, decreasing inflammation by utilizing a thumb spica forearm-based splint (allowing interphalangeal motion), and administering anti-inflammatory medications and cortisone injections. Atrophy of the thenar muscles occurs with prolonged injury.36 The Tinel sign and Phalen test are often used in the evaluation of carpal tunnel syndrome but have a wide range of sensitivity (38% to 100% and 42% to 85%, respectively) and specificity (54% to 98% and 55% to 100%, respectively).23,24 Electrodiagnostic testing is used to increase the diagnostic likelihood of carpal tunnel syndrome and should be performed if surgery is being considered.26,43, Radial Nerve. [13, 14, 15, 16, 17] Nerve injuries in continuity to an open fracture are gently explored and followed for 6-12 weeks before any further treatment is initiated. If needed, both approaches can be employed together for wide exposure. The majority of radial nerve palsies represents neurapraxic injuries and will improve with observation alone (> 90%). Patients with nerve injury typically present with pain, weakness, and paresthesia. The tendon of palmaris longus was transferred to the tendon of extensor pollicis longus and tendon of flexor carpi radialis was transferred to the tendon of extensor digitorum communis. C23P7 The nerve roots of the brachial plexus combine to form trunks (superior [C5, C6], middle [C7], and inferior [C8, T1]) that pass between the anterior and middle scalene muscles. Proximally, compression of the radial nerve at the lateral intermuscular septum must be suspected, especially in cases associated with humerus fractures. Sensory deficit usually affects the posterior forearm and dorsal hand.17, Median Nerve. Radial nerve palsy- Inability to extend the wrist, digits, and thumb and weakness with supination due to loss of the supinator, ECRL, ECRB, ECU, EDC, APL, EPL, and EPB. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTI0NDExMC10cmVhdG1lbnQ=, Proximally, watch for the branches to the brachioradialis and the extensor carpi radialis longus and brevis, as well as the superficial branch of the radial nerve, Release the supinator along its entire course, Remember that compression may be present not only at the arcade of Frohse but also where the nerve exits the muscle, Incise the superficial layer of the supinator very carefully to avoid injuring the enclosed nerve, Protect the numerous muscular branches given off distal to the supinator, Distally, protect branches of the RSN and lateral antebrachial cutaneous nerve. [QxMD MEDLINE Link]. A Lee Osterman, MD Director of Hand Surgery Fellowship, Director, Philadelphia Hand Center; Director, Professor, Department of Orthopedic Surgery, Division of Hand Surgery, University Hospital, Thomas Jefferson UniversityDisclosure: Nothing to disclose. It is understood that most of the prin-ciples related to the treatment of . The patient has met the . With findings of severe weakness or multiple nerve involvement, imaging should be performed immediately; otherwise, it can be initiated after six to eight weeks of conservative treatment.4750 A summary of imaging indications is provided in Table 3.4749, Electrodiagnostic testing is helpful to confirm the diagnosis, determine severity, and monitor progression of nerve damage.50 This can be especially helpful in presurgical planning for more common nerve entrapments, such as carpal tunnel syndrome and cubital tunnel syndrome.51,52 Nerve conduction studies evaluate the speed and time of conduction across the nerve; EMG measures the tested muscle's response to stimulation.50 Changes to both nerve conduction studies and EMG will occur depending on the chronicity and degree of injury, so they should be ordered simultaneously.5052 The ability of EMG or nerve conduction studies to detect nerve injury is variable and requires subjective interpretation; they are best used as an adjunct to physical examination and imaging.50, Magnetic resonance imaging and ultrasonography are used for evaluating deeper soft tissue pathology and bony abnormality compressing a nerve or for increased signal and nerve thickness indicative of nerve injury.40,53 Magnetic resonance imaging can identify local muscular atrophy consistent with denervation.53 Ultrasonography can evaluate for a variety of changes that occur in peripheral nerve entrapment syndromes.47,48 A useful point-of-care application of ultrasonography is determining specific sites of entrapment by compression with the ultrasonography transducer to recreate symptoms.47,48 Specifically, ultrasonography is helpful in the diagnosis of carpal tunnel syndrome; one meta-analysis found that a cross-sectional area of the median nerve at the carpal tunnel inlet of 9 mm2 or more is 87.3% sensitive and 83.3% specific for carpal tunnel syndrome.49 Accurate interpretation is dependent on sonographer experience, and correlation to EMG has yet to be shown.49, In the absence of traumatic injury, initial treatment of nerve injuries should be conservative and includes patient education, relative rest, and activity modification.1322,2931,3335,37,38 Physical therapy, yoga, and acupuncture may be helpful, although conclusive evidence is lacking.1322,2931,3335,37,38 Surgical options include nerve decompression, exploration for anatomic causes and treatment, or nerve transfers.54,55 Despite low complication rates, these procedures are often associated with lack of full resolution of symptoms, even when patients complete a rehabilitation program.54,55 Carpal tunnel syndrome is one of the few entrapment neuropathies to have evidence-based treatment.1316,2428 Conservative treatment options and surgical indications for each of the nerves are listed in Table 2.1338, This article updates a previous article on this topic by Neal and Fields.12.
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