Median and Ulnar Nerve Compressions: Simplifying Diagnostics and Surgery at the Elbow and Hand | Journal CME Article-Journal CME Article: Median and Ulnar Nerve Compressions: Simplifying Diagnostics and Surgery at the Elbow and Hand Article

Journal CME Article: Median and Ulnar Nerve Compressions: Simplifying Diagnostics and Surgery at the Elbow and Hand Article

Back to course

Pdf Summary

The article "Median and Ulnar Nerve Compressions: Simplifying Diagnostics and Surgery at the Elbow and Hand" reviews the prevalence and challenges in diagnosing median and ulnar nerve entrapments, common causes of hand numbness and strength loss. Carpal tunnel syndrome, a common median nerve entrapment, impacts 5% of adults. This article aims to improve diagnostic accuracy by reviewing nerve anatomy, offering clinical examination tips, and discussing surgical simplifications.<br /><br />For an accurate diagnosis, the clinician must gather a comprehensive patient history, understand nerve anatomy, use physical examination tools, perform neurologic assessments for conditions like diabetes and thyroid issues, and interpret diagnostic tests such as electrodiagnostics and imaging.<br /><br />Clinical examination tools include sensory mapping using the "ten test," motor strength comparison against the uninvolved side, and provocative tests including the Tinel sign and Scratch Collapse Test (SCT). Limitations in these tests necessitate gathering multiple data points for diagnosis.<br /><br />While electrodiagnostic testing has limitations, especially with ulnar nerve entrapments, ultrasound emerges as a promising alternative for diagnosing nerve compressions due to its cost-effectiveness and safety.<br /><br />The anatomy of the median and ulnar nerves shows different potential entrapment sites from proximal sites near the cervical spine to distal compressions at the wrist. Median nerve entrapments can occur not just at the carpal tunnel but also at sites like the lacertus fibrosus and pronator teres.<br /><br />The article emphasizes the importance of recognizing potential multifocal nerve compression (multicrush syndrome), performing thorough physical evaluations, and adapting treatment approaches, such as surgeries under local anesthesia, to improve efficiency and patient care.<br /><br />Surgeries for disorders like lacertus syndrome and carpal tunnel syndrome can be performed using wide-awake anesthesia with in situ techniques that minimize recovery times and reduce the need for postoperative opioids.<br /><br />Conclusively, thorough examination and anatomical knowledge can refine diagnosis and treatment for nerve entrapments, aligning with modern healthcare efficiency demands, especially post-COVID-19.

Keywords

median nerve entrapment

ulnar nerve compression

carpal tunnel syndrome

nerve anatomy

diagnostic accuracy

electrodiagnostic tests

ultrasound diagnosis

multicrush syndrome

wide-awake anesthesia

surgical simplifications