Peripheral Nerve Injuries
The nerves that give movement to the muscles of the hand and the upper extremity, as well as sensitivity and other more specialized functions, are originated in the neck area, go down near the armpit and reach their final destinations in each muscle and on the skin. The nerves that give movement and strength are three main, the radial nerve, the median nerve and the ulnar nerve. There are other different groups of nerves that give movement to the shoulder, these are closer to the neck and armpit.
You have surely heard the term “Tunnel of the carpus” or “Carpal tunnel syndrome” this and other compressive diseases of the nerves of the upper extremity are a fundamental part of training as a hand surgeon, the three nerves of the limb can present with problems of the compressive type causing numbness and lack of sensitivity in the hands or fingers.
Carpal tunnel syndrome, what is it?
Carpal tunnel syndrome is caused by a compression of the median nerve at the level of the wrist generated by inflammation of the tendon sheaths and the tissue surrounding the nerve.
In this syndrome there are symptoms such as pain in the palm of the hand, thumb, forefinger and middle finger mainly, in this same area there is usually numbness or tingling due to the failure of the sensory function. Initially it can be treated with conservative methods, but if this disease progresses it can permanently affect the function of the thumb, the symptoms can be nocturnal and awaken the patient in the vast majority of cases.
Carpal tunnel in pregnancy
There is a gestational presentation, that is, it manifests during pregnancy due to fluid retention and the presence of edema in the extremities. The vast majority of these patients can be treated with medications or infiltrations compatible with pregnancy and lactation.
Mild and moderate cases of this syndrome can be treated conservatively with oral medications such as anti-inflammatories and neuromodulators. Local steroid infiltrations are a fundamental part of the conservative treatment, since they help quickly heal local inflammation of the tissues surrounding the nerve and thus eliminating local compression of the nerve. In severe cases or when the conservative treatment fails, it is advisable to release the pressure of the nerve through surgery, for which I prefer minimally invasive approach in the palm of the hand.
As for the ulnar nerve, the compression is the second most frequent it gets entrapped at the level of the elbow causing Cubital Tunnel Syndrome, the symptoms sometimes start at the level of the elbow and to the ring and little fingers, usually with tingling and numbness and there may also be pain in the same territory. Unlike the carpal tunnel, the cubital tunnel has a mechanical cause, the nerve is compressed during elbow flexion or when resting the elbow on a rigid surface like a table. Sometimes, the ligaments that hold the nerve in place are more lax or “loose” and allow the nerve to dislocate out of its channel, this increases nerve irritation worsening the symptoms. The ulnar tunnel is initially treated with elbow night splints and rehabilitation therapy, when non-op treatment fails or in moderate and severe cases it is advisable to perform a surgical decompression at the elbow.
The radial tunnel syndrome or the posterior interosseous nerve compression is a much less common disease, it is caused by mechanical compression of the radial nerve in the forearm near the elbow, by direct pressure exerted by a muscle over the nerve and its usually misdiagnosed with epicondylitis or tennis elbow for the place where pain usually occurs, in this pathology you may feel pain, numbness and tingling in the thumb and over the back of the hand.
Peripheral nerve compressions:
- Carpal tunnel syndrome
- Guyon canal syndrome
- Pronator teres syndrome
- Cubital tunnel syndrome
- Radial tunnel
- Nerve and tendon transfers
- Elbow prosthesis
- Treatments for elbow fractures and dislocations
- Elbow replacement
A fundamental part in hand care is the diagnosis and treatment of degenerative pathologies such as rheuathoid arthritis, degenerative arthritis and other metabolic diseases of the joints.