Compression Neuropathies Info Evidence
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
Also on YouTube.
Video transcript
You might find yourself waking up in the middle of the night with a numb pinky finger that refuses to wake up no matter how much you shake it out. This happens when a nerve gets squeezed or stretched as it travels down your arm and into your hand. Think of a nerve like an electrical wire that carries signals to your muscles and skin. When that wire is pinched, the message gets blocked or distorted. Many people first notice this problem when they struggle to open a jar or feel clumsy while typing at their desk. You may notice a tingling, numbness, or burning sensation in your hand or fingers that feels like your hand has fallen asleep. The strange feeling usually does not disappear after you shake it out. Your grip might also feel noticeably weaker, making simple tasks like holding a coffee cup or turning a door handle quite difficult. These symptoms often become worse at night or whenever you keep your elbow bent for a long time. You might find yourself resting your arm on a hard desk edge or sleeping with your arms curled up against your chest. The two nerves most often affected are the ulnar nerve and the median nerve. The ulnar nerve runs from your neck down to your hand and passes through a narrow tunnel at your elbow. When you bend your elbow fully, that tunnel shrinks and puts direct pressure on the nerve. The median nerve travels through a tight space at the base of your palm and can become irritated by repetitive wrist movements or swelling. Poor posture, like slouching at a computer, or pressing your hands firmly against bicycle handlebars can also increase the strain on these pathways. Most compression neuropathies improve with non-surgical treatments that take pressure off the nerve and reduce inflammation. The first step usually involves resting the hand and modifying daily activities to avoid known triggers. Wearing a splint can keep your joint in a comfortable position, while specific exercises help the nerve slide smoothly through the surrounding tunnels. If discomfort remains significant, a cortisone injection may be recommended to calm the swelling and give the nerve time to heal. When symptoms persist after several months of conservative care, a simple procedure to release the tight structures around the nerve can provide lasting relief. You should speak with a clinician if numbness or tingling continues for more than a few days despite taking a break. Noticeable weakness in your hand, such as frequently dropping objects or struggling to button a shirt, also warrants a professional assessment. It is important to seek advice if you see muscle shrinking at the base of your thumb or between your fingers. Symptoms that regularly wake you from sleep or spread up your arm alongside neck pain should never be ignored. Early evaluation can prevent permanent nerve damage and help you return to your normal activities sooner.
What you're feeling
You may notice tingling or numbness in your hand or fingers. This happens when a nerve is squeezed in your arm or wrist. The pain often travels from your shoulder or elbow down to your hand. You might feel a sharp, electric shock or a dull ache. Sometimes the symptoms start in one nerve but affect another nearby. For example, issues with the ulnar nerve can make you more likely to develop carpal tunnel syndrome later.
The discomfort often flares up at night or when you wake up. You might find it hard to grip objects firmly. Simple tasks like turning a doorknob, holding a coffee cup, or typing on a keyboard can become difficult. Your hand may feel weak or clumsy. In some cases, you might drop things without meaning to. The pain can worsen after using your hands for a long time, such as during work or hobbies.
If the compression is near your elbow, you might feel pain on the inside of your arm. This can happen when you bend your elbow for a long time, like when sleeping or holding a phone. If the issue is in your wrist, you may notice swelling or a feeling of fullness. In rare cases, a small fluid-filled sac called a ganglion cyst presses on the nerve. This can cause sudden, sharp pain or numbness. You might also notice changes in your thumb or fingers, such as overgrowth or skin changes, though this is uncommon.
Your daily routine may change because of these symptoms. You might avoid lifting heavy items or using tools that vibrate. Simple movements like buttoning a shirt or zipping a jacket can feel frustrating. You may try to rest your hand to relieve the pressure, but the numbness can persist. It is important to pay attention to where the pain starts and where it moves. This helps your surgeon understand which nerve is affected and how to treat it effectively.
What's actually happening
Your nerves are like electrical cables that carry signals between your brain and your hands. When these cables get squeezed or compressed, the signals slow down or stop. This causes the tingling, numbness, or weakness you feel in your fingers and wrist. It is not just a local issue. Your whole body plays a part in how these nerves react to pressure.
Think of the nerve tunnel as a narrow hallway. If something grows inside this hallway, or if the walls swell, there is less room for the nerve to move. This can happen because of a small fatty lump near the ulnar nerve at your elbow. It can also happen if you have had a previous wrist fracture. Broken bone fragments or even the hardware used to fix the bone can press directly on the nerve. This extra pressure makes the symptoms start sooner than expected.
The pressure inside these tunnels is higher than we once thought. When you actively use your hand, the squeeze increases significantly. This is especially true in conditions like carpal tunnel syndrome. Your surgeon looks for these hidden causes to ensure the right treatment. Sometimes, a problem with one nerve, like the ulnar nerve, makes you more likely to develop compression in another nerve, such as the median nerve.
We understand that managing these compressions can be complex. We focus on relieving that pressure carefully. This might involve simple decompression or, in severe cases, using a nerve transfer to restore function. We also use advanced imaging like ultrasound to see exactly where the squeeze is happening. This helps us avoid complications and plan your recovery with confidence.
What we can do about it
The approach Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, takes in our clinic reflects how we manage nerve compression. Patients reach our clinic by GP or physiotherapist referral. A clinic assessment, including history, examination, and imaging where needed, establishes the diagnosis. For degenerative or long-standing problems, we usually try non-operative care first. This includes activity change, physiotherapy or hand therapy, splinting, and injections. We consider surgery when this has not given enough improvement. For structural or acute problems, surgery may be recommended straight away, without a preceding non-operative trial.
Self-management is the first step for many. Conservative treatment benefits the majority of patients with cubital tunnel syndrome who present with mild or moderate symptoms. Your physiotherapist will guide you through exercises to keep the nerve moving smoothly and reduce pressure. You might also use a splint to keep your elbow straight at night. Give this approach a fair trial, typically several weeks, to see if symptoms settle. If the cause is a ganglion cyst, which is the most common cause of ulnar tunnel syndrome, symptoms may vary based on the exact location of the compression.
Medical management focuses on reducing inflammation and pain. If simple measures do not help, we may discuss injections. Cortisone injections can calm inflammation around the nerve, providing relief that lasts for weeks or months. In some cases, hyaluronic acid or platelet-rich plasma (PRP) injections are used to support tissue health. These options aim to reduce swelling and pressure on the nerve without surgery. If a tumor, such as a collagenoma or perineural lipoma, is pressing on the nerve, debulking it along with decompression can relieve neurological symptoms. We also consider rare causes like pseudogout, which can cause acute compression in the hand.
Surgery is considered when conservative care has reached its limit. If your symptoms persist, worsen, or if you have significant weakness, we discuss operative options. The surgical goal is to create more space for the nerve so it can glide freely. Techniques range from minimally invasive endoscopic decompression, which uses a smaller incision, to open release. In severe cases, nerve transfer or advanced decompression techniques may be used. We review the specific procedure details with you during your consultation, ensuring you understand the risks and benefits before making a shared decision.
What to expect
Your outlook depends on how quickly the pressure on your nerve is relieved. When managed well, most people see a steady reduction in pain and numbness. Minimally invasive techniques allow for good functional outcomes with less tissue damage. You can expect a smoother recovery with smaller incisions and less blood loss compared to traditional open surgery.
If you have severe or long-standing compression, the path to feeling better may take longer. Early diagnosis and careful removal of any cysts or swelling around the nerve are associated with satisfactory results. However, if symptoms have been present for a prolonged period, complete recovery of nerve function may not occur. Nerve injuries following elbow procedures are likely under-reported, and severe injuries may be more common than previously thought. This is why your surgeon relies on a solid understanding of anatomy to prevent complications.
Treatment decisions for uncommon compression syndromes are often based on smaller studies rather than large trials. Despite this, management of failed decompressions remains challenging even with advanced imaging like ultrasound and MRN. If your initial treatment does not fully resolve symptoms, revision surgery combined with a collagen nerve wrap has shown good success in managing recurrent compression.
Long-term improvement following carpal tunnel release is maintained to the same extent in patients with diabetes as in those without. For severe chronic ulnar nerve compression, combining nerve transfer with tunnel release results in sustained clinical improvements. Your surgeon will tailor the approach to your specific anatomy and symptoms.
If left alone, compression neuropathies can persist or worsen. Ulnar nerve issues may even increase your susceptibility to median nerve compression later on. While some mild cases may settle with rest, significant entrapment usually requires intervention to prevent permanent nerve damage. Your surgeon will guide you on the best path to sustained relief based on your individual condition.
When to see someone
See your GP if you have persistent pain, weakness, or instability that does not improve with rest. Ask for a specialist review if symptoms interfere with sleep or work, or if your hand locks or gives way. Sudden worsening of symptoms also warrants prompt attention. Be aware that compression neuropathies can involve a 'double-crush' mechanism, where one nerve issue increases susceptibility to another. Systemic factors may also contribute to these nerve problems. Because symptoms can vary based on the exact location of compression, early assessment helps identify the cause. This ensures you receive the right care before complications like pathologic pain syndromes develop.
Evidence & references
Overview
- Compression neuropathies of the upper extremity involve pathophysiology, clinical evaluation, and management considerations including the double-crush mechanism and systemic factors [1].
- Validated patient-reported outcome measures are useful in the evaluation and management of upper extremity compression neuropathies [1].
- Complications of compressive neuropathy management include iatrogenic injury, treatment failure, and pathologic pain syndromes [2].
- Prevention of complications in compressive neuropathy management relies on a solid understanding of normal anatomy and anatomic variations [2].
- Diagnosis and treatment of compressive neuropathies are evolving with technology, specifically shifting towards preoperative imaging with ultrasound and MRN [3].
- Management of failed decompressions for compressive neuropathies remains challenging [3].
- Most publications on uncommon upper extremity compression syndromes (radial, ulnar, and median nerves) are small retrospective series or case reports [4].
- Treatment decisions for uncommon upper extremity compression syndromes are not typically based on high levels of evidence [4].
- Debulking of a tumor along with median nerve decompression relieved neurological symptoms in a child with tuberous sclerosis complex causing carpal tunnel syndrome [5].
- Minimally invasive in situ decompression is technically simple, safe, and provides good results for severe ulnar nerve entrapment at the elbow [6].
- Ulnar nerve pathology may precede and increase susceptibility to median nerve compression, as indicated by the incidence of carpal tunnel syndrome after ulnar neuropathy diagnosis [8].
- Use of a collagen matrix wrap in recurrent compression neuropathies of the upper extremity has shown good success [9].
- Surgical decompression for carpal tunnel syndrome is associated with a greater decrease in median nerve cross-sectional area than nonsurgical treatment [10].
- Anterior interosseous nerve transfer combined with cubital and ulnar tunnel release results in sustained clinical and electrophysiological improvements in severe chronic ulnar nerve compression [14].
- Anterior interosseous nerve transfer combined with cubital and ulnar tunnel release is encouraged as a standard treatment for severe chronic ulnar nerve compression [14].
- Endoscopic decompression for anterior interosseous nerve syndrome can achieve the same proximal and distal extents of the nerve as open techniques [15].
- Endoscopic decompression for anterior interosseous nerve syndrome uses an incision nearly one fourth the size of open techniques, minimizing morbidity, blood loss, and recovery time [15].
- Extensive decompression of the ulnar nerve beyond the cubital tunnel is not routinely needed, supported by satisfactory outcomes with endoscopic detection of compressing fascial bands within the FCU [17].
Anatomy & Pathophysiology
- Compression neuropathies of the upper extremity involve a double-crush mechanism [1].
- Systemic factors play a role in the pathophysiology of compression neuropathies of the upper extremity [1].
- Intracarpal tunnel pressures during active hand use are substantially greater than previously reported in patients with carpal tunnel syndrome [21].
- Perineural lipoma of the ulnar nerve can occur within the cubital tunnel [25].
- Sensorimotor control impairment can occur after wrist trauma [27].
- Distal radius fracture management requires evaluation of all potential causes for early carpal tunnel syndrome findings, including prominent volar cortical fragments causing direct pressure or prominently placed hardware [34].
- Ulnar nerve entrapment neuropathy at the elbow is associated with non-task-specific focal hand dystonia [41].
Classification
- Compression neuropathies of the upper extremity involve a double-crush mechanism [1].
- Systemic factors contribute to the pathophysiology of compression neuropathies of the upper extremity [1].
- Compressive neuropathy management complications include iatrogenic injury, treatment failure, and pathologic pain syndromes [2].
- Prevention of compressive neuropathy complications relies on understanding normal anatomy and anatomic variations [2].
- Diagnosis and treatment of compressive neuropathies are shifting towards preoperative imaging with ultrasound and MRN [3].
- Management of failed decompressions for compressive neuropathies remains challenging [3].
- Most publications on uncommon upper extremity compression syndromes (radial, ulnar, median nerves) are small retrospective series or case reports [4].
- Treatment decisions for uncommon upper extremity compression syndromes are not typically based on high levels of evidence [4].
- Debulking of a tumor along with median nerve decompression relieved neurological symptoms in a child with tuberous sclerosis complex causing carpal tunnel syndrome and thumb overgrowth [5].
- Minimally invasive in situ decompression is technically simple, safe, and provides good results for severe ulnar nerve entrapment at the elbow [6].
- Pseudogout is a rare cause of acute carpal tunnel syndrome and acute Guyon canal syndrome [7].
- Ulnar nerve pathology may precede and increase susceptibility to median nerve compression [8].
- Surgical decompression for carpal tunnel syndrome is associated with a greater decrease in median nerve cross-sectional area than nonsurgical treatment [10].
- Concurrent carpal tunnel syndrome and pronator syndrome are rarely considered, and proximal compression sites are easily overlooked [11].
- Ganglia are the most common cause of ulnar tunnel syndrome [12].
- Symptoms of ulnar tunnel syndrome vary based on the anatomic location of the compression within Guyon's canal [12].
- The term double crush syndrome is proposed to be expanded to multifocal neuropathy to describe the complex interplay of mechanical, systemic, pharmacological, and environmental factors contributing to nerve dysfunction [13].
- Unusual compression neuropathies of the forearm include posterior interosseous nerve syndrome, radial tunnel syndrome, and superficial radial nerve compression (Wartenberg's syndrome) [16].
- In-situ release is an alternative for managing McGowen grade 3 ulnar nerve compression neuropathy at the elbow, with a similar success rate to submuscular and intramuscular transpositions but a lower complication rate [23].
Clinical Presentation
- Compression neuropathies of the upper extremity involve a double-crush mechanism [1].
- Systemic factors contribute to the pathophysiology of compression neuropathies of the upper extremity [1].
- Ulnar nerve pathology may precede and increase susceptibility to median nerve compression [8].
- Concurrent carpal tunnel syndrome and pronator syndrome are rarely considered, and proximal compression sites are easily overlooked [11].
- Intracarpal tunnel pressures during active hand use in patients with carpal tunnel syndrome are substantially greater than previously reported [21].
- Ganglia are the most common cause of ulnar tunnel syndrome [12].
- Symptoms of ulnar tunnel syndrome vary based on the anatomic location of the compression within Guyon's canal [12].
- Pseudogout is a rare cause of acute neuropathic compression of the hand, including acute carpal tunnel syndrome and acute Guyon canal syndrome [7].
- Collagenoma in a child with tuberous sclerosis complex can cause carpal tunnel syndrome and thumb overgrowth [5].
- Uncommon compression syndromes of the radial, ulnar, and median nerves exist, with most publications being small retrospective series or case reports [4].
- Unusual compression neuropathies of the forearm include posterior interosseous nerve syndrome, radial tunnel syndrome, and superficial radial nerve compression (Wartenberg's syndrome) [16].
- A punched nerve syndrome of the deep motor branch of the ulnar nerve is a rare presentation [18].
- Multifocal neuropathy describes the complex interplay of mechanical, systemic, pharmacological, and environmental factors contributing to nerve dysfunction [13].
Investigations
- Diagnosis and treatment of compressive neuropathies are shifting towards preoperative imaging with ultrasound and MRN [3].
- Most publications on uncommon upper extremity compression syndromes are small retrospective series or case reports, and treatment decisions are not typically based on high levels of evidence [4].
- Debulking of a tumor along with median nerve decompression relieved neurological symptoms in a child with tuberous sclerosis complex causing carpal tunnel syndrome [5].
- Pseudogout is a rare cause of acute neuropathic compression of the hand, including acute carpal tunnel syndrome and acute Guyon canal syndrome [7].
- Ulnar nerve pathology may precede and increase susceptibility to median nerve compression [8].
- Concurrent carpal tunnel syndrome and pronator syndrome are rarely considered, and proximal compression sites are easily overlooked [11].
- Ganglia are the most common cause of ulnar tunnel syndrome, and symptoms vary based on the anatomic location of the compression within Guyon's canal [12].
- Endoscopic decompression for anterior interosseous nerve syndrome can be achieved over the same proximal and distal extents of the nerve as open techniques but with an incision nearly one fourth the size, minimizing morbidity, blood loss, and recovery time [15].
- Unusual compression neuropathies of the forearm specifically include posterior interosseous nerve syndrome, radial tunnel syndrome, and superficial radial nerve compression (Wartenberg's syndrome) [16].
- High-resolution ultrasound (HRUS) is a viable method to demonstrate a punched nerve syndrome of the deep motor branch of the ulnar nerve [18].
- Ultrasound measurements have limited value in predicting clinical results of patients treated for entrapment neuropathy of the ulnar nerve [19].
- After surgery for perineural lipoma of the ulnar nerve within the cubital tunnel, shooting pain resolved, sensation normalized in digits four and five, and hand strength gradually improved [25].
- The diagnostic accuracy of nerve conduction studies for ulnar neuropathy at the elbow may be lower than 80%–90% and depends on the severity of the neuropathy [33].
- Short segment testing is suggested to improve the diagnostic accuracy of nerve conduction studies for ulnar neuropathy at the elbow [33].
Treatment
- Conservative treatment benefits the majority of patients with cubital tunnel syndrome who present with mild or moderate symptoms [22].
- Surgical decompression is associated with a greater decrease in median nerve cross-sectional area compared to nonsurgical treatment [10].
- Debulking of a tumor along with median nerve decompression provides relief of neurological symptoms in cases such as collagenoma causing carpal tunnel syndrome [5].
- Minimally invasive in situ decompression is technically simple, safe, and yields good results for severe ulnar nerve entrapment at the elbow [6].
- In-situ release is an alternative for managing McGowen grade 3 ulnar nerve compression neuropathy at the elbow, offering a similar success rate to submuscular and intramuscular transpositions with a lower complication rate [23].
- Anterior interosseous nerve transfer combined with cubital and ulnar tunnel release results in sustained clinical and electrophysiological improvements in patients with severe chronic ulnar nerve compression [14].
- Minimally invasive endoscopic decompression for anterior interosseous nerve syndrome achieves the same proximal and distal extents of the nerve as open techniques but with an incision nearly one-fourth the size, minimizing morbidity, blood loss, and recovery time [15].
- Extensive decompression of the ulnar nerve beyond the cubital tunnel is not routinely needed, as satisfactory outcomes are supported by endoscopic detection of compressing fascial bands within the flexor carpi ulnaris [17].
- A novel technique using a collagen matrix wrap in recurrent compression neuropathies has shown good success [9].
- Pseudogout should be considered a rare cause of acute neuropathic compression of the hand, including acute carpal tunnel syndrome and acute Guyon canal syndrome [7].
- Complications of compressive neuropathy management include iatrogenic injury, treatment failure, and pathologic pain syndromes, with prevention relying on a solid understanding of normal anatomy and anatomic variations [2].
- The management of failed decompressions remains challenging as diagnosis and treatment evolve with technology, shifting towards preoperative imaging with ultrasound and MRN [3].
Complications
- Complications of compressive neuropathy management include iatrogenic injury [2].
- Complications of compressive neuropathy management include treatment failure [2].
- Complications of compressive neuropathy management include pathologic pain syndromes [2].
- Prevention of complications relies on a solid understanding of normal anatomy and anatomic variations [2].
- Management of failed decompressions remains challenging [3].
- Nerve injuries following elbow arthroscopy are likely under-reported in the literature [29].
- The number of severe nerve injuries following elbow arthroscopy may be much higher than previously thought [29].
Recovery
- Minimally invasive in situ decompression for severe ulnar nerve entrapment at the elbow is technically simple, safe, and provides good functional outcomes [6].
- Endoscopic decompression of the anterior interosseous nerve achieves the same proximal and distal extents as open techniques but with an incision nearly one-fourth the size, minimizing morbidity, blood loss, and recovery time [15].
- Extensive decompression of the ulnar nerve beyond the cubital tunnel is not routinely needed, as satisfactory outcomes are supported by endoscopic detection of compressing fascial bands within the flexor carpi ulnaris [17].
- Revision decompression combined with a collagen nerve wrap demonstrates good success in managing recurrent and persistent compression neuropathies of the upper extremity [9].
- Anterior interosseous nerve transfer combined with cubital and ulnar tunnel release results in sustained clinical and electrophysiological improvements in patients with severe chronic ulnar nerve compression [14].
- Early diagnosis and careful excision of epineural ganglia causing ulnar nerve compression in the cubital tunnel are associated with satisfactory outcomes, although complete electrophysiological recovery may not occur if symptoms have been present for a prolonged period [20].
- Debulking of a tumor along with median nerve decompression provides relief of neurological symptoms in cases such as collagenoma-induced carpal tunnel syndrome [5].
- Long-term improvement following carpal tunnel release in patients with diabetes is maintained to the same extent as in patients without diabetes [24].
- Treatment decisions for uncommon upper extremity compression syndromes are not typically based on high levels of evidence, as most publications are small retrospective series or case reports [4].
- Management of failed decompressions remains challenging despite evolving diagnostic and treatment technologies such as preoperative ultrasound and MRN [3].
Key Evidence
- [L5] Complications of compressive neuropathy management include iatrogenic injury, treatment failure, and pathologic pain syndromes, with prevention relying on a solid understanding of normal anatomy and anatomic variations. [2] (10.1016/j.hcl.2015.01.012)
- [L5] The diagnosis and treatment of compressive neuropathies continue to evolve with technology, shifting towards preoperative imaging with ultrasound and MRN, while the management of failed decompressions remains challenging. [3] (10.1016/j.jhsg.2022.10.009)
- [L4] This article reviews uncommon compression syndromes of the radial, ulnar, and median nerves, noting that most publications are small retrospective series or case reports and treatment decisions are not typically based on high levels of evidence. [4] (10.1016/j.hcl.2013.04.014)
- [Case_report] Debulking of the tumor along with median nerve decompression was performed with relief of neurological symptoms. [5] (10.1016/j.jhsa.2013.07.004)
- [L3] Minimally invasive in situ decompression is technically simple, safe and gives good results in patients with severe nerve compression. [6] (10.1177/1753193411416426)
- [L4] Pseudogout should be considered a rare cause of acute neuropathic compression of the hand. [7] (10.1016/j.jhsg.2022.07.010)
- [L2] This supports the hypothesis that ulnar nerve pathology may precede and increase susceptibility to median nerve compression. [8] (10.1016/j.jhsg.2026.100970)
- [L4] The authors report on the novel technique of using a collagen matrix wrap in recurrent compression neuropathies with good success. [9] (10.1097/sap.0b013e3182956475)
- [L3] Surgical decompression was associated with a greater decrease in median nerve cross-sectional area than nonsurgical treatment. [10] (10.1016/j.jhsa.2010.06.010)
- [L4] Concurrent carpal tunnel syndrome and pronator syndrome are rarely considered and proximal compression sites are easily overlooked. [11] (10.1016/j.otsr.2016.10.009)
- [L5] The article provides a comprehensive review of the anatomy, pathophysiology, and causes of ulnar tunnel syndrome, noting that ganglia are the most common cause and that symptoms vary based on the anatomic location of the compression within Guyon's canal. [12] (10.1016/j.hcl.2007.06.006)
- [L5] The authors propose expanding the term from double crush syndrome to multifocal neuropathy to better describe the complex interplay of mechanical, systemic, pharmacological, and environmental factors contributing to nerve dysfunction. [13] (10.1016/j.jhsa.2016.09.009)
- [L4] Anterior interosseous nerve transfer, along with cubital and ulnar tunnel release, results in sustained clinical and electrophysiological improvements in patients with severe chronic ulnar nerve compression, which encourages its adoption as a standard treatment for severe chronic ulnar nerve compression. [14] (10.1177/17531934251381023)
- [L4] Endoscopic decompression can be achieved over the same proximal and distal extents of the nerve as open techniques but with an incision nearly one fourth the size, minimizing morbidity, blood loss, and recovery time. [15] (10.1016/j.jhsa.2013.07.026)
- [L5] This article is a review examining unusual compression neuropathies of the forearm, specifically focusing on the radial nerve, including posterior interosseous nerve syndrome, radial tunnel syndrome, and superficial radial nerve compression (Wartenberg's syndrome). [16] (10.1016/j.jhsa.2009.10.016)
- [L4] The satisfactory outcomes support the perception that extensive decompression of the ulnar nerve beyond the cubital tunnel is not routinely needed. [17] (10.1007/s11552-011-9377-x)
- [L4] HRUS is a viable method to demonstrate a punched nerve syndrome. [18] (10.1007/s00402-015-2216-8)
- [L3] Ultrasound (US) measurements seem to have a limited value in clinical results of patients treated for entrapment neuropathy of the ulnar nerve. [19] (10.1177/1558944719857816)
- [Case_report] Early diagnosis and careful excision of epineural ganglia are associated with satisfactory outcomes, although complete electrophysiological recovery may not occur if symptoms have been present for a prolonged period. [20] (10.1007/s11552-006-9013-3)
- [L4] In patients with carpal tunnel syndrome, intracarpal tunnel pressures during active hand use are substantially greater than previously reported. [21] (10.1016/j.jhsa.2009.09.019)
- [L2] The majority of patients suffering from cubital tunnel syndrome with mild or moderate symptoms benefit from conservative treatment. [22] (10.1177/1753193408098480)
- [L4] Thus, in-situ release could be an alternative in management of patients with McGowen grade 3 ulnar nerve compression neuropathy at the elbow with a similar success rate as the submuscular and intramuscular transpositions with a lower complication rate. [23] (10.1016/j.jhsa.2015.06.068)
- [L2] Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes. [24] (10.1016/j.jhsa.2014.01.012)
- [L4] After surgery, shooting pain resolved, sensation normalized in digits four and five, and hand strength gradually improved. [25] (10.1016/j.jhsg.2025.100889)
- [L5] This clinical review discusses the organization, neuroanatomy, assessment, clinical relevance, and rehabilitation of sensorimotor control impairment after wrist trauma, proposing promising rehabilitation strategies that require more rigorous evaluation in clinical trials. [27] (10.1016/j.jht.2015.12.003)
- [L4] Nerve injuries are likely under-reported in the literature, and this study indicates that the number of severe nerve injuries may be much higher than previously thought. [29] (10.1016/j.jhsa.2013.08.025)
- [L5] The diagnostic accuracy of nerve conduction studies for ulnar neuropathy at the elbow may be lower than 80%–90% and depends on the severity of the neuropathy; short segment testing is suggested to improve accuracy. [33] (10.1177/17531934241288802)
- [Paper] If early carpal tunnel syndrome findings are noted during distal radius fracture management, all potential causes should be evaluated, including prominent volar cortical fragments causing direct prominently placed hardware. [34] (10.1016/j.ocl.2012.07.021)
- [L4] This case establishes a clear-cut relationship between ulnar nerve entrapment neuropathy at the elbow and non-task-specific focal hand dystonia, demonstrated by the dramatic recovery of clinical and electrophysiological parameters after surgical decompression. [41] (10.1007/s11552-010-9280-x)
References
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