Pamanhid at Pakiramdam ng Pakpak sa Kamay at Braso Impormasyon

Ano ang nararamdaman mo

Maaaring mapansin mo ang pamamanhid o pagkawala ng pakiramdam sa iyong kamay at braso. Karaniwang nangyayari ito pagkatapos ng mga operasyon sa ibang bahagi ng iyong katawan, tulad ng pagsasama ng mga vertebra sa leeg (neck fusion) o mga operasyon sa balikat. Maaaring parang may mga tusok-tusok o pamamanhid, o pagkawala ng pakiramdam ang pakiramdam. Maaari itong magsimula sa iyong mga daliri at kumalat pataas sa iyong braso.

Karaniwang lumala ang sakit sa gabi o kapag gumising ka. Maaaring mahirap kang matulog sa gilid dahil lumalala ang pamamanhid dahil sa presyon. Maaaring maging mahirap ang mga pang-araw-araw na gawain. Maaaring magmukhang hindi komportable ang pag-abot sa likod para isara ang bra. Maaaring magdulot ng hindi komportableng pakiramdam o kahinaan sa hawak ang pagtutukoy ng damit. Maaaring madalas mong mahulog ang mga bagay o mahirapan sa mga maliliit na kasanayan sa motor, tulad ng pag-button ng damit.

Kung mayroon kang nakaraang isyu sa nerbiyos, tulad ng mga problema sa ulnar nerve sa siko, mas mataas ang iyong panganib para sa carpal tunnel syndrome, lalo na sa loob ng unang dalawang taon. Ang kabiguan ng pamamanhid ay karaniwang katumbas ng kung gaano karaming pamamaga ang nerbiyos. Sa ilang kaso, hindi nawawala ang mga sintomas kahit pahinga o simpleng pag-aalaga. Kung nabigo ang mga konserbatibong paggamot, maaaring talakayin ng iyong doktor ang mga opsyon sa operasyon. Para sa maraming pasyente, ang operasyon ng decompression ay nagdudulot ng halos 90% na pagwawakas ng mga sintomas.

Susuriin ng iyong doktor ang iyong pakiramdam ng posisyon at pakiramdam ng hawak upang maunawaan kung paano ito nakakaapekto sa iyong pang-araw-araw na buhay. Maaaring magkaroon ka ng frustrasyon na ang mga simpleng aksyon ay nangangailangan ng karagdagang pagsisikap. Ang pag-unawa sa mga sintomas na ito ay tumutulong sa iyong koponan ng pag-aalaga na i-customize ang iyong paggamot. Kahit na ang isyu ay nagsisimula sa leeg, balikat, o pulso, ang layunin ay ibalik ang iyong kaginhawaan at kakayahan.

Ano ang nangyayari talaga

Ang pagkakaroon ng pamamanhid at pangangati sa iyong kamay at braso ay karaniwang nangyayari kapag may piga o iritasyon sa isang nerbiyo. Isipin ang nerbiyo bilang isang kable ng kuryente na nagpapadala ng mga signal mula sa iyong utak patungo sa iyong mga kalamnan at balat. Kapag may sumisikip sa kable na iyon, naa-block o nasisira ang mga signal. Ito ang nagdudulot ng mga kakaibang pakiramdam na nararamdaman mo, tulad ng pakiramdam ng mga karayom at karayom, pagsusunog, o pagkawala ng pakiramdam.

Ang isa sa mga karaniwang sanhi ay ang median nerve entrapment neuropathy. Ito ay isang kondisyon kung saan ang median nerve ay nahuhuli sa iba't ibang bahagi ng iyong braso. Ang isang tiyak na uri nito ay tinatawag na pronator syndrome, kung saan ang nerbiyo ay pinipiga malapit sa iyong siko. Ang isa pang kilalang isyu ay ang carpal tunnel syndrome, kung saan ang nerbiyo ay pinipiga sa iyong pulso. Minsan, maaaring magkaroon ka ng double entrapment, ibig sabihin ang ulnar nerve ay pinipiga sa parehong iyong siko at pulso. Ito ay minsan tinatawag na double crush syndrome.

Ang iyong anatomiya ay maaari ring magkaroon ng papel. May mga tao na ipinanganak na may bifid median nerve, na ibig sabihin ang nerbiyo ay nahahati sa dalawang sanga. Ang karagdagang sanga na ito ay maaaring mahuli ng mga kalamnan ng forearms, na nagdudulot ng compression. Bukod dito, kung mayroon kang nakaraang mga isyu sa ulnar nerve, mas malaki ang iyong risk na makaranas ng carpal tunnel syndrome, lalo na sa loob ng unang 2 taon. Habang lumalala ang ulnar neuropathy sa siko, maaaring magpa-swollen at lumaki ang nerbiyo mismo.

Ang operasyon sa ibang bahagi ng iyong katawan ay maaari ring mag-trigger ng mga sintomas na ito. Halimbawa, ang upper-extremity neuropathy ay maaaring umusbong pagkatapos ng mga operasyon na hindi sa upper extremity, partikular ang anterior cervical discectomy and fusion (ACDF). Ito ay isang operasyon sa leeg na nagf-fuse ng mga vertebrae. Kung mayroon kang mga sintomas pagkatapos ng shoulder surgery, madalas itong refractory sa conservative management, ibig sabihin ang mga pamantayang non-surgical na paggamot tulad ng pahinga o gamot ay maaaring hindi gaanong epektibo. Gayunpaman, ang surgical decompression para sa neuropathy pagkatapos ng shoulder surgery ay nagresulta sa halos 90% na paglutas ng mga sintomas.

Ang pagdi-diagnose ng mga isyung ito ay maaaring maging mahirap. May malaking discordance sa tinatayang prevalence ng mild-to-moderate carpal tunnel syndrome batay sa clinical signs at symptoms (73%) kumpara sa electrodiagnostic studies at ultrasound (51%). Ito ay nangangahulugan na ang pagkakaroon ng mga sintomas ay hindi palaging kumakumpirma ng diagnosis. Kapag ang mga signs at symptoms ay nagpapahiwatig ng mild-to-moderate median neuropathy, ang karagdagang pagsubok tulad ng EDS o US ay nagpapataas ng probabilidad ng pagkumpirma ng aktwal na median neuropathy na maaaring makatanggap ng benepisyo mula sa operasyon. Ang iyong doktor ay gumagamit ng mga tool na ito upang tukuyin kung saan eksaktong nahuhuli ang nerbiyo upang maibsan ang presyon nang epektibo.

Ano ang maaari naming gawin para dito

Magsimula sa mga simpleng pagbabago sa bahay. Pahingahin ang iyong mga kamay at iwasan ang paulit-ulit na pagkapit. Maaaring imungkahi ng iyong doktor ang pagsusuot ng brace sa gabi upang panatilihing tuwid ang iyong pulso. Maaari nitong bawasan ang presyon sa nerbiyo. Ang mga banayad na paghuhubog at mga ehersisyo sa nerve gliding ay maaaring makatulong na mapabuti ang galaw. Layunin ng mga gawaing ito na bawasan ang stiffness at hikayatin ang nerbiyo na dumulas nang malaya. Bigyan ng patas na pagkakataon ang conservative treatment. Kung mayroon kang mild na mga sintomas, maaari itong magpakabuti sa mga hindi invasive na hakbang na ito.

Kung hindi sapat ang pahinga at ehersisyo, maaaring talakayin ng iyong doktor ang gamot. Maaaring makatulong ang mga over-the-counter na pain relievers o anti-inflammatory drugs upang mapahinahon ang pamamaga at mabawasan ang sakit. Sa ilang kaso, itinuturing ang hormone therapy, lalo na kung ang mga pagbabago sa hormone ay may kaugnayan sa iyong mga sintomas. Gayunpaman, mayroong mga trade-off ang pamamaraang ito. Maaaring hindi ito gumana sa lahat at maaaring magdulot ng mga side effects. Timbangin ng iyong doktor ang mga risk na ito laban sa potensyal na benepisyo para sa iyong partikular na sitwasyon. Laging talakayin ang anumang bagong gamot sa iyong care team upang matiyak na ligtas ito para sa iyo.

Kung nananatiling severe ang iyong mga sintomas o hindi nagpapabuti pagkatapos subukan ang mga hakbang sa itaas, oras na para humingi ng input mula sa espesyalista. Maaaring irefer ka ng iyong primary doctor sa isang hand specialist o neurologist para sa karagdagang assessment. Maaari silang gumamit ng karagdagang mga pagsusuri, tulad ng nerve conduction studies o ultrasound, upang kumpirmahin ang diagnosis. Sa ilang kaso, maaaring ituring ang isang procedure upang bawasan ang presyon sa nerbiyo. Ito ay karaniwang inilaan para sa mga sitwasyon kung saan nabigo ang mga conservative measures. Gabayin ka ng iyong espesyalista kung ang susunod na hakbang na ito ay angkop para sa iyong paggaling.

Ano ang inaasahan

Maaaring mawala, manatili, o lumabas at pumasok ang iyong mga sintomas depende sa dahilan. Para sa mild hanggang moderate carpal tunnel syndrome, maaaring mag-order ang iyong doktor ng karagdagang mga pagsusuri tulad ng electrodiagnostic studies o ultrasound. Tumutulong ang mga pagsusuring ito upang kumpirmahin ang diagnosis dahil hindi laging tugma ang mga sintomas sa resulta ng mga pagsusuri. Humigit-kumulang 73% ng mga tao ay may mga sintomas, ngunit 51% lamang ang nagpapakita ng mga pagbabago sa nerbiyos sa mga pagsusuri. Ibig sabihin ng pagkakaibang ito ay ginagamit ng iyong doktor ang lahat ng available na impormasyon upang gabayan ang iyong paggamot.

Kung may kaalaman ka pagkatapos ng shoulder surgery, madalas na hindi tumutulong ang mga conservative treatments. Sa mga kaganapang ito, ang surgical decompression ay nagdudulot ng halos 90% na paglutas ng mga sintomas. Kung mayroon kang kasaysayan ng mga isyu sa ulnar nerve, mas mataas ang iyong risk para sa carpal tunnel syndrome, lalo na sa loob ng unang 2 taon. Babantayan ito ng iyong doktor nang mahigpit.

Ang recovery ay higit pa sa simpleng pagpapagaan ng sakit. Magtatrabaho ka upang muling makuha ang pakiramdam at lakas ng kamay. Titingnan ng iyong care team ang iyong position sense at touch sensitivity upang matulungan kang bumalik sa mga pang-araw-araw na gawain. Para sa severe ulnar nerve compression, ang mga partikular na surgeries ay maaaring payagan ang nerbiyos na magpagaling mismo. Gagamitin mo ang mga hand movement tracings upang subaybayan ang iyong progreso sa paglipas ng panahon.

Kung hindi ka magpapasurgery para sa carpal tunnel syndrome, maaaring manatili ang mga sintomas. Higit sa 50% ng mga pasyente na may mga tiyak na sugat sa pulso na lumaktaw sa initial release ay nangangailangan nito sa huli. Titingnan ng iyong doktor ang lahat ng mga salik, kabilang ang mga bihirang nerbiyos variations, upang pumili ng pinakamainam na landas. Ang layunin ay ibalik ang iyong hand function at mapabuti ang iyong kalidad ng buhay. Magkaroon ng pasensya sa proseso. Kinakailangan ng oras ang paggaling ng nerbiyos, ngunit ang steady na progreso ang karaniwan.

Kailan kumonsulta sa doktor

Humingi ng pagsusuri ng espesyalista kung mayroon kang patuloy na pagkakaantala o pangangati na hindi gumagaling sa pamamagitan ng pahinga. Humingi ng medikal na tulong kung napapansin mo ang kahinaan, kawalan ng katatagan, o kung nakakaapekto ang mga sintomas sa iyong pagtulog o trabaho. Ang biglaang paglala ng mga nararamdaman na ito ay nangangailangan din ng mabilisang pagtugon. Magkaroon ng kamalayan na ang mga pasyente na may kasaysayan ng mga pinsala sa ulnar nerve ay may malaking pagkakataong makaranas ng carpal tunnel syndrome, lalo na sa loob ng unang 2 taon. Bukod dito, ang mga sintomas ng neuropathy pagkatapos ng operasyon sa balikat ay madalas na hindi gumagaling sa pamamagitan ng konservatibong pamamahala. Kung ikaw ay nakakaranas ng mga isyung ito, ang iyong doktor ay maaaring suriin kung kailangan ng karagdagang pagsusuri upang matukoy ang dahilan at gabayan ang iyong paggaling.

Evidence & references

Overview

Median nerve entrapment neuropathy encompasses a spectrum of conditions, including pronator syndrome, which requires consolidated knowledge to improve patient outcomes [1].
Clear definitions distinguishing recurrence from persistent compression neuropathy are necessary to enable comparison of results across different techniques and clinics [2].
Agreements on supplementary diagnostics and standardized outcome measurements are needed for upper extremity revision nerve compression surgery [2].
Diagnosis of mild-to-moderate idiopathic median neuropathy at the carpal tunnel based on signs and symptoms is discordant from diagnosis based on electrodiagnostic studies (EDS) and ultrasound (US) [3].
There is severe discordance between the estimated prevalence of mild-to-moderate carpal tunnel syndrome based on clinical signs and symptoms (73%) versus EDS and US (51%) [12].
This discordance calls into question whether clinicians can confidently diagnose patients with mild-to-moderate carpal tunnel syndrome based on clinical presentation alone [12].
When signs and symptoms suggest mild-to-moderate median neuropathy and surgery is being considered, additional testing such as EDS or US may increase the probability of identifying actual median neuropathy that can benefit from surgery [3].
Upper-extremity neuropathy can develop following nonupper extremity surgeries, particularly anterior cervical discectomy and fusion (ACDF) [4].
Neuropathy symptoms following shoulder surgery were often refractory to conservative management [6].
Surgical decompression for neuropathy following shoulder surgery led to nearly 90% symptom resolution [6].
Patients with a history of ulnar nerve lesions are at a significantly increased risk of developing carpal tunnel syndrome, especially within the first 2 years [7].
As the severity of ulnar neuropathy at the elbow increases, the cross-sectional area (CSA) of the ulnar nerve correspondingly increases at the elbow [8].
Assessment of position and tactile sensations is important in determining participation in manual skills during neuropathy rehabilitation [5].
Quality of life domains are impacted by distal radius fracture and ulnar neuropathy, with contextual factors influencing these implications [9].

Background & Causes

Median nerve entrapment neuropathy includes pronator syndrome [1].
Upper-extremity neuropathy can develop following nonupper extremity surgeries, particularly anterior cervical discectomy and fusion (ACDF) [4].
Patients with a history of ulnar nerve lesions are at a significantly increased risk of developing carpal tunnel syndrome, especially within the first 2 years [7].
The anconeus epitrochlearis muscle's contribution to compression neuropathy or protection of the ulnar nerve could not be discerned for the standard population [19].
A bifid median nerve can cause entrapment by forearm musculature [10].
The pectoralis minor's unique asymmetric neurologic innervation predisposes the human shoulder to neurologic and musculoskeletal imbalance, producing the Human Disharmony Loop syndrome [18].
Double entrapment neuropathy of the ulnar nerve at the elbow and wrist may represent double crush syndrome [13].

Symptoms & Presentation

Median nerve entrapment neuropathy includes pronator syndrome [1].
Upper-extremity neuropathy can develop following nonupper extremity surgeries, particularly anterior cervical discectomy and fusion (ACDF) [4].
Neuropathy symptoms following shoulder surgery were often refractory to conservative management [6].
Patients with a history of ulnar nerve lesions are at a significantly increased risk of developing carpal tunnel syndrome, especially within the first 2 years [7].
As the severity of ulnar neuropathy at the elbow increases, the cross-sectional area (CSA) of the ulnar nerve correspondingly increases at the elbow [8].
There is a severe discordance between the estimated prevalence of mild-to-moderate carpal tunnel syndrome based on clinical signs and symptoms (73%) versus electrodiagnostic studies and ultrasound (51%) [12].
If double crush syndrome is suspected but symptoms are mild, they may respond to conservative treatment [13].
Assessment of position and tactile sensations is relevant for determining participation in manual skills in patients with upper extremity neuropathy [5].
Assessing quality of life domains provides insight into the implications of contextual factors on quality of life for patients with distal radius fracture and ulnar neuropathy [9].

Management

Median nerve entrapment neuropathy reviews aim to consolidate existing knowledge to improve patient outcomes [1].
Clear definitions of recurrence versus persistent compression neuropathy are needed to enable comparison of results from different techniques and clinics [2].
Agreements on supplementary diagnostics and standardized outcome measurements are required for comparing results across different techniques and clinics [2].
When signs and symptoms suggest mild-to-moderate median neuropathy and surgery is being considered, additional testing such as electrodiagnostic studies (EDS) or ultrasound (US) can increase the probability of identifying actual median neuropathy that can benefit from surgery [3].
Upper-extremity neuropathy can develop following nonupper extremity surgeries, particularly anterior cervical discectomy and fusion (ACDF) [4].
Assessment of position and tactile sensations should not be ignored in determining participation in manual skills during neuropathy rehabilitation [5].
Neuropathy symptoms following shoulder surgery were often refractory to conservative management [6].
Surgical decompression led to nearly 90% symptom resolution for neuropathy following shoulder surgery [6].
Patients with a history of ulnar nerve lesions are at a significantly increased risk of developing carpal tunnel syndrome, especially within the first 2 years [7].
As the severity of ulnar neuropathy at the elbow increases, the cross-sectional area (CSA) of the ulnar nerve correspondingly increases at the elbow [8].
Assessing quality of life (QoL) domains for upper extremity conditions provides insight into the implications of contextual factors on QoL [9].
Surgeons should bear anomalies such as bifid median nerve entrapment by forearm musculature in mind when assessing patients with symptoms of median nerve compression [10].
Hand abduction tracings are a quantitative outcome measure to follow recovery over time for intrinsic hand function and can be used in patients with severe ulnar neuropathy following surgical intervention [11].
If double crush syndrome is suspected but symptoms are mild, they may respond to conservative treatment [13].
In cases of suspected double crush syndrome, invasive treatments should be initiated preferentially at sites with greater clinical suspicion [13].
Decompressing the deep motor branch of the ulnar nerve caused by heterotopic ossification allowed for spontaneous nerve recovery and reinnervation of ulnar nerve-innervated intrinsic muscles [14].
More than 50% of patients who did not undergo carpal tunnel release at the initial surgery for perilunate injuries required a release within the follow-up period [15].
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 [16].
Anterior interosseous nerve transfer combined with cubital and ulnar tunnel release encourages adoption as a standard treatment for severe chronic ulnar nerve compression [16].
Sensory interventions on motor function, activities of daily living, and spasticity of the upper limb in people with stroke are inexpensive, noninvasive, and easy to perform [17].
Sensory interventions can be easily implemented into conventional therapy practice in any setting [17].

Key Considerations

Median nerve entrapment neuropathy encompasses a spectrum of conditions, including pronator syndrome [1].
Clear definitions distinguishing recurrence from persistent compression neuropathy are necessary to enable comparison of results across different techniques and clinics [2].
Agreements on supplementary diagnostics and standardized outcome measurements are required for comparing results from different techniques and clinics in upper extremity revision nerve compression surgery [2].
Diagnosis of mild-to-moderate idiopathic median neuropathy at the carpal tunnel based on signs and symptoms is discordant from diagnosis based on electrodiagnostic studies (EDS) and ultrasound (US) [3].
When signs and symptoms suggest mild-to-moderate median neuropathy and surgery is being considered, additional testing such as EDS or US increases the probability of identifying actual median neuropathy that can benefit from surgery [3].
Upper-extremity neuropathy can develop following nonupper extremity surgeries, particularly anterior cervical discectomy and fusion (ACDF) [4].
Assessment of position and tactile sensations should not be ignored in determining participation in manual skills during neuropathy rehabilitation [5].
Neuropathy symptoms following shoulder surgery were often refractory to conservative management [6].
Surgical decompression led to nearly 90% symptom resolution for neuropathy following shoulder surgery [6].
Patients with a history of ulnar nerve lesions are at a significantly increased risk of developing carpal tunnel syndrome, especially within the first 2 years [7].
As the severity of ulnar neuropathy at the elbow increases, the cross-sectional area (CSA) of the ulnar nerve correspondingly increases at the elbow [8].
There is a severe discordance between the estimated prevalence of mild-to-moderate carpal tunnel syndrome based on clinical signs and symptoms (73%) versus electrodiagnostic studies and ultrasound (51%) [12].
The severe discordance between clinical prevalence estimates (73%) and EDS/US prevalence estimates (51%) calls into question whether clinicians can confidently diagnose patients with mild-to-moderate carpal tunnel syndrome [12].
Surgeons should bear anomalies such as bifid median nerve entrapment by forearm musculature in mind when assessing patients with symptoms of median nerve compression [10].
Hand abduction tracings serve as a quantitative outcome measure to follow recovery over time for intrinsic hand function in patients with severe ulnar neuropathy following surgical intervention [11].
Decompression of the deep motor branch of the ulnar nerve caused by heterotopic ossification allowed for spontaneous nerve recovery and reinnervation of ulnar nerve-innervated intrinsic muscles [14].
More than 50% of patients with perilunate injuries who did not undergo carpal tunnel release at initial surgery required a release within the follow-up period [15].

Key Evidence

[L5] By reviewing the current literature within the spectrum of median nerve entrapment neuropathies, this review aimed to enhance and summarize the current understanding by consolidating the existing knowledge for improved patient outcomes. [1] (10.1016/j.xrrt.2024.10.001)
[L5] The authors emphasize the need for clear definitions of recurrence versus persistent compression neuropathy, agreements on supplementary diagnostics, and standardized outcome measurements to enable comparing results from different techniques and clinics. [2] (10.1177/17531934241311822)
[L3] When signs and symptoms suggest mild-to-moderate median neuropathy and surgery is being considered, patients and clinicians might consider additional testing, such as EDS or US, to increase the probability of actual median neuropathy that can benefit from surgery. [3] (10.1097/corr.0000000000002751)
[L3] Upper-extremity neuropathy can develop following nonupper extremity surgeries, particularly ACDF. [4] (10.1016/j.jhsg.2026.100972)
[L3] In neuropathy rehabilitation, the assessment of position and tactile sensations should not be ignored in determining participation in manual skills. [5] (10.1016/j.jht.2024.12.005)
[L4] Neuropathy symptoms were often refractory to conservative management, while surgical decompression led to nearly 90% symptom resolution. [6] (10.1016/j.jseint.2024.05.011)
[L2] Patients with a history of ulnar nerve lesions are at a significantly increased risk of developing carpal tunnel syndrome, especially within the first 2 years. [7] (10.1016/j.jhsg.2026.100970)
[L2] As the severity of ulnar neuropathy at the elbow increases, the CSA of the ulnar nerve correspondingly increases at the elbow. [8] (10.1016/j.jhsa.2024.12.004)
[L3] Assessing QoL domains for two upper extremity conditions with different contextual factors provides insight into the implications of those factors on QoL. [9] (10.1016/j.jht.2024.11.006)
[L5] We encourage surgeons to bear such anomalies in mind when assessing patients with symptoms of median nerve compression. [10] (10.1177/17531934251401431)
[L4] Hand abduction tracings are a quantitative outcome measure to follow recovery over time for intrinsic hand function and can be used in patients with severe ulnar neuropathy following surgical intervention. [11] (10.1016/j.jht.2023.09.005)
[L5] There is a severe discordance between the estimated prevalence of mild-to-moderate carpal tunnel syndrome based on clinical signs and symptoms (73%) versus electrodiagnostic studies and ultrasound (51%), calling into question whether clinicians can confidently diagnose patients with mild-to-moderate CTS. [12] (10.1097/corr.0000000000002822)
[L4] If double crush syndrome is suspected but symptoms are mild, they may respond to conservative treatment, while invasive treatments should be initiated preferentially at sites with greater clinical suspicion. [13] (10.1186/s12891-024-07574-z)
[L4] Decompressing the patient's deep motor branch of the ulnar nerve allowed for spontaneous nerve recovery and reinnervation of his ulnar nerve innervated intrinsic muscles. [14] (10.1016/j.jhsg.2024.02.001)
[L3] More than 50% of patients who did not undergo carpal tunnel release at the initial surgery required a release within the follow-up period. [15] (10.1016/j.jhsg.2023.09.003)
[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. [16] (10.1177/17531934251381023)
[L2] These interventions are inexpensive, noninvasive, and easy to perform, so can be easily implemented into conventional therapy practice in any setting. [17] (10.1016/j.jht.2024.08.051)
[L4] The unique asymmetric neurologic innervation to the pectoralis minor predisposes the human shoulder to neurologic and musculoskeletal imbalance, producing the Human Disharmony Loop syndrome. [18] (10.3390/jcm14051769)
[L3] The contribution of the anconeus epitrochlearis to compression neuropathy or protection of the ulnar nerve could not be discerned for the standard population. [19] (10.1016/j.jse.2024.09.039)

References

[1] Median nerve entrapment neuropathy: a review on the pronator syndrome. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2024.10.001 [2] Re: van der Heijden EPA, Dailiana ZH, Giele HP. State of the art review. Upper extremity revision nerve compression surgery. J Hand Surg Eur. 2024, 49: 687–97. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934241311822 [3] Diagnosis of Mild-to-moderate Idiopathic Median Neuropathy at the Carpal Tunnel Based on Signs and Symptoms is Discordant From Diagnosis Based on Electrodiagnostic Studies and Ultrasound. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002751 [4] Incidence of Median and Ulnar Neuropathy Following Nonupper Extremity Surgery. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.100972 [5] The effect of wrist position sense and tactile recognition on manual skills in patients with upper extremity neuropathy. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.12.005 [6] The incidence and decompression rates of median and ulnar neuropathies following shoulder surgery. JSES International. 2024. DOI: 10.1016/j.jseint.2024.05.011 [7] Incidence of Carpal Tunnel Syndrome After the Diagnosis of Ulnar Neuropathy. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.100970 [8] Association of Ultrasound and Electrodiagnostic Studies in Patients Evaluated for Ulnar Neuropathy. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.12.004 [9] A retrospective analysis of quality of life domains impacted by distal radius fracture and ulnar neuropathy. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.11.006 [10] Bifid median nerve entrapment by forearm musculature – a case report and systematic literature review. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251401431 [11] The hand diagram: A novel outcome measure following supercharged end-to-side anterior interosseous nerve to ulnar nerve transfer in severe compressive ulnar neuropathy. Journal of Hand Therapy. 2024. DOI: 10.1016/j.jht.2023.09.005 [12] CORR Insights®: Diagnosis of Mild-to-moderate Idiopathic Median Neuropathy at the Carpal Tunnel Based on Signs and Symptoms is Discordant From Diagnosis Based on Electrodiagnostic Studies and Ultrasound. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002822 [13] Double entrapment neuropathy of the ulnar nerve at the elbow and the wrist : double crush syndrome?. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07574-z [14] Posttraumatic Compressive Neuropathy of the Deep Motor Branch of the Ulnar Nerve Caused by Heterotopic Ossification. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.02.001 [15] Predicting Acute Median Neuropathy in Perilunate Injuries. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2023.09.003 [16] Anterior interosseous nerve transfer combined with cubital and ulnar tunnel release for severe ulnar nerve compression. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251381023 [17] CRITICAL APPRAISAL PAPER: “SENSORY INTERVENTIONS ON MOTOR FUNCTION, ACTIVITIES OF DAILY LIVING, AND SPASTICITY OF THE UPPER LIMB IN PEOPLE WITH STROKE: A RANDOMIZED CLINICAL TRIAL”. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.08.051 [18] The Human Disharmony Loop: A Case Series Proposing the Unique Role of the Pectoralis Minor in a Unifying Syndrome of Chronic Pain, Neuropathy, and Weakness. Journal of Clinical Medicine. 2025. DOI: 10.3390/jcm14051769 [19] Is the anconeus epitrochlearis muscle a predictor for ulnar nerve compression?. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.09.039