Formigamento e dormência na mão e no braço Folheto

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• A review of the current literature on pronator syndrome aims to consolidate existing knowledge within the spectrum of median nerve entrapment neuropathies to improve patient outcomes [1].
• Clear definitions distinguishing recurrence from persistent compression neuropathy are required for upper extremity revision nerve compression surgery [2].
• Standardized outcome measurements are necessary to enable comparison of results from different surgical techniques and clinics in upper extremity revision nerve compression surgery [2].
• Agreements on supplementary diagnostics are needed for upper extremity revision nerve compression surgery [2].
• Clinical signs and symptoms suggesting mild-to-moderate median neuropathy at the carpal tunnel are discordant from diagnoses based on electrodiagnostic studies and ultrasound [3].
• Patients and clinicians considering surgery for mild-to-moderate median neuropathy based on signs and symptoms might consider additional testing, such as electrodiagnostic studies or ultrasound, to increase the probability of 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].
• In neuropathy rehabilitation, the assessment of position and tactile sensations should not be ignored when determining participation in manual skills [5].
• Neuropathy symptoms following shoulder surgery were often refractory to conservative management [6].
• Surgical decompression for median and ulnar neuropathies 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].
• Assessing quality of life domains for two upper extremity conditions with different contextual factors provides insight into the implications of those factors on quality of life [9].
• 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].
• Factors that interfere with the examination of nerves in the hand include other injuries that may be life-threatening or limb-threatening, patient intoxication, anxiety, lack of cooperation, and extensive injury to the hand [15].
• If conditions are not satisfactory for a thorough examination during the initial evaluation of a hand injury, the hand should be reexamined within a reasonable period to determine the extent of nerve and other injuries sustained [15].
• An injury to digital nerves is frequently overlooked during the initial or preliminary examination of hand injuries [15].
• If a flexor tendon function deficit is present after a finger laceration, at least one digital nerve probably has been injured as well [15].
• A high index of suspicion is necessary in the evaluation of patients with hand injuries [15].
• Four areas of consideration are important when evaluating a patient with an injury to a nerve in the hand: type of injury, sensibility evaluation, motor function, and sudomotor function (sweating) [15].
• The Seddon classification of nerve injury includes neurapraxia, axonotmesis, and neurotmesis [15].
• The Sunderland classification of nerve injury includes degrees I through VI, with degree VI being a combination of any of degrees I–V [15].
• Magnetic resonance neurography (MRA) is reported to be able to provide details regarding nerve anatomic relationships, fascicular pattern, intraneural swelling, and evaluation of downstream muscle injury [15].
• Customary methods used to evaluate damaged sensory nerves include the use of a sharp pin to assess pain, a cotton-tipped applicator or finger eraser to assess light touch, and the tips of a paper clip or commercially prepared tool to assess two-point discrimination [15].
• Normal two-point discrimination usually is 6 mm or less [15].
• A patient with a transected nerve would not feel light touch, would not appreciate the pin as a sharp stimulus, and would be unable to discriminate between one and two points [15].
• Patients with closed injuries or partial injuries to nerves may show spotty appreciation of light touch and pain and have markedly widened two-point discrimination [15].

Background & Causes

Pathophysiology and Histopathology

• Chronic nerve compression histopathology begins with breakdown of the blood-nerve barrier and progresses to axonal degeneration with continued compression [16].
• Patient signs, symptoms, and sensory testing parallel the histopathologic changes occurring in the nerve during chronic compression [16].
• Abnormal postures or positions can compress nerves or place them on tension, leading to chronic nerve compression [16].
• Abnormal postures can place muscles in shortened positions, leading to secondary effects [16].
• Muscles in elongated or shortened positions become weakened and underused, causing other muscles to compensate and establish a pattern of muscle imbalance [16].

Anatomical and Structural Factors

• Bifid median nerve entrapment by forearm musculature is a potential cause of median nerve compression symptoms that surgeons should consider during assessment [10].
• The unique asymmetric neurologic innervation to the pectoralis minor predisposes the human shoulder to neurologic and musculoskeletal imbalance, producing the Human Disharmony Loop syndrome [29].
• The contribution of the anconeus epitrochlearis muscle to ulnar nerve compression neuropathy or protection of the ulnar nerve could not be discerned for the standard population [30].

Systemic and Iatrogenic Causes

• A careful medical history suggests the correct diagnosis in approximately 90% of patients with hand problems [25].
• Systemic diseases such as rheumatoid arthritis, diabetes, other endocrine disorders, renal disease, or vascular disease should be included in the medical history when evaluating hand disorders [25].
• Recent pregnancies should be questioned in women of childbearing age when evaluating hand disorders [25].

Diagnostic Considerations

• Diagnosis of mild-to-moderate median neuropathy at the carpal tunnel based on signs and symptoms is discordant from diagnosis based on electrodiagnostic studies and ultrasound [3].
• 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].

Symptoms & Presentation

• Clinical signs and symptoms suggest a prevalence of mild-to-moderate carpal tunnel syndrome of 73% [12].
• Electrodiagnostic studies and ultrasound indicate a prevalence of mild-to-moderate carpal tunnel syndrome of 51% [12].
• There is a severe discordance between the estimated prevalence of mild-to-moderate carpal tunnel syndrome based on clinical signs and symptoms versus electrodiagnostic studies and ultrasound [12].
• When signs and symptoms suggest mild-to-moderate median neuropathy, additional testing such as electrodiagnostic studies or ultrasound may increase the probability of actual median neuropathy that can benefit from surgery [3].
• Upper-extremity neuropathy can develop following nonupper extremity surgeries, particularly anterior cervical discectomy and fusion [4].
• As the severity of ulnar neuropathy at the elbow increases, the cross-sectional area of the ulnar nerve correspondingly increases at the elbow [8].
• Surgical decompression for neuropathy following shoulder surgery led to nearly 90% symptom resolution [6].
• In neuropathy rehabilitation, the assessment of position and tactile sensations should not be ignored in determining participation in manual skills [5].
• If double crush syndrome is suspected but symptoms are mild, they may respond to conservative treatment [13].
• Invasive treatments for double crush syndrome should be initiated preferentially at sites with greater clinical suspicion [13].
• Surgeons should bear bifid median nerve anomalies in mind when assessing patients with symptoms of median nerve compression [10].

Management

Diagnostic and Preoperative Assessment

• When signs and symptoms suggest mild-to-moderate median neuropathy and surgery is being considered, patients and clinicians might consider additional testing, such as electrodiagnostic studies (EDS) or ultrasound (US), to increase the probability of actual median neuropathy that can benefit from surgery [3].
• A high index of suspicion is necessary in the evaluation of patients with hand injuries, as digital nerve injuries are frequently overlooked [15].
• If a nerve is transected, a patient would not feel light touch, would not appreciate the pin as a sharp stimulus, and would be unable to discriminate between one and two points [15].
• The use of a pain evaluation questionnaire that includes a body diagram, a subjective questionnaire, and visual analog scales is useful in the evaluation of patients with nerve compression and/or diffuse symptoms [16].
• The carpal tunnel syndrome questionnaire assesses symptom severity (11 items) and functional status (8 items), with higher scores indicating decreased functional status [16].
• The Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire uses a standardized 30 items to allow for comparison of upper extremity conditions, with higher scores indicating higher levels of disability [16].
• The Michigan Hand Outcomes Questionnaire (MHQ) is a 67-item questionnaire that addresses specific domains of overall hand function, physical function, cosmesis, and satisfaction [16].
• The Patient-Specific Functional Scale (PSFS) assesses items identified by patients, where each patient identifies three activities or tasks that they find difficult or impossible to perform [16].
• The physical examination of suspected complex regional pain syndrome (CRPS) patients should include a neurologic assessment and evaluation of the cervical and thoracic spine [20].
• The presence of cervical disease may exacerbate CRPS, representing a form of "double-crush syndrome" [20].
• Preexisting or acquired thoracic outlet or distant compression neuropathies can represent a "triple or more" crush syndrome [20].
• There are no objective laboratory tests to aid in the diagnosis of CRPS [20].
• Paresthesias are present in up to 95% of patients with thoracic outlet syndrome (TOS) and are the most common initial complaint [21].
• An association between distal nerve compression and TOS has been attributed to a form of double-crush syndrome [21].
• Carpal tunnel syndrome is described in 21% to 45% of patients with TOS [21].
• Cubital tunnel syndrome is described in up to 10% of patients with TOS [21].
• If there is a diagnosis of TOS and a peripheral compression, and electrical studies are positive with very positive clinical findings for a distinct compression that respond appropriately to a discrete block, a separate release of the involved nerve may be performed [21].
• 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].
• Surgeons are encouraged to bear anatomical anomalies such as bifid median nerves in mind when assessing patients with symptoms of median nerve compression [10].

Non-Operative Management

• Conservative treatment of neuroma pain should consist of medical management, including pain-modulating medications, behavior modification, therapy, and modalities such as protective garments, desensitization, massage, nerve gliding, and TENS [24].
• Local corticosteroid injections have been described for neuroma pain, though atrophy of local adipose tissue can exacerbate neuroma pain [24].
• Sensory interventions for upper limb conditions are inexpensive, noninvasive, and easy to perform, allowing them to be easily implemented into conventional therapy practice in any setting [28].
• Tricyclic antidepressants, neurotropics, or low doses of benzodiazepines may help patients with TOS sleep [21].
• Narcotics should rarely be prescribed preoperatively for TOS [21].
• If a vascular malformation is asymptomatic, it usually can be left alone [22].
• Some patients with vascular malformations are effectively treated with a fitted compression glove if the lesion tends to swell when dependent or with activity [22].
• Early management of CRPS will diminish the development of contractures, and manipulation under sympathetic blockade may prevent such contractures [19].
• Surgery on contracted joints in CRPS should not be performed until maximal nonoperative improvement has been achieved, generally requiring a waiting period of a minimum of 3 to 6 months after successful elimination of active dystrophic pain [19].

Operative Management

• Decompressing the deep motor branch of the ulnar nerve allowed for spontaneous nerve recovery and reinnervation of ulnar nerve innervated intrinsic muscles in a case of posttraumatic compressive neuropathy caused by heterotopic ossification [14].
• 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 [18].
• 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 [17].
• The best treatment for a symptomatic neuroma is prevention, which involves repairing even nonessential sensory nerves whenever possible [24].
• For established neuromas, the best strategy is to excise the neuroma and give the axons an innervation target to avoid neuroma regrowth and restore central nervous system connectivity [24].
• For a small-diameter neuroma-in-continuity, the neuroma may be excised and the nerve ends mobilized and primarily repaired [24].
• For small gaps in neuroma repair, the freshened proximal stump can be repaired via graft, conduit, or autologous nerve allograft (ANA) to the distal nerve stump [24].
• If the distal nerve is unavailable for neuroma repair, the freshened nerve end can be sewn in a reverse end-to-side (supercharging) fashion to a nearby nerve trunk [24].
• Neuroma resection was reported as the most consistently effective treatment for neuroma pain in a 25-year retrospective review [24].
• When a neuroma is not repairable and not associated with neuropathic pain, simple surgical excision and proximal transposition to a less vulnerable location are often effective [24].
• More intensive surgical methods for neuromas include open exposure and formal repositioning of the nerve stump into a deeper anatomic location such as within a muscle belly or within a medullary canal [24].
• Targeted muscle reinnervation involves identifying and dividing a motor branch of a neighboring functional muscle and performing a nerve transfer of the prepared nerve stump to the motor branch near its entry point into the muscle [24].
• Results for targeted muscle reinnervation are better if performed as part of the initial amputation procedure or soon after neuropathic pain begins [24].
• The radial sensory nerve is released at its point of compression between the tendons of the extensor carpi radialis longus and brachioradialis [23].
• A full tenotomy of the brachioradialis tendon is performed and a portion of the tendon is resected to completely decompress the radial sensory nerve [23].
• Neurolysis is not performed during radial sensory nerve decompression [23].
• A piece of bioresorbable adhesion barrier is placed over the nerve to decrease scarring after radial sensory nerve decompression [23].
• Indications for median nerve neurolysis in CRPS include quiescent or stable sympathetically maintained CRPS with mechanical pain and previous neurolysis with scar and decreased nerve mobility [19].
• Preoperative evaluation for median nerve neurolysis in CRPS includes demonstrating painful nerve gliding and evaluating peripheral nerve conduction velocities [19].
• Autogenous saphenous vein or allograft can be wrapped directly around the median nerve with an opening to allow the palmar cutaneous branch to exit [19].
• The vein graft should be sutured proximally and distally with a 5-0 or 6-0 nonreactive suture [19].
• Chromic suture should be avoided because chemicals released from the suture can create a nociceptive neural focus [19].
• An injured palmar cutaneous branch of the median nerve can be resected and moved to an unscarred area or repaired by using an end-to-end interposition antebrachial cutaneous nerve [19].
• Postoperatively, the limb is protected from pain and dystrophic flare-up by the use of continuous autonomic blockade [19].
• Motion of the affected extremity is initiated in a controlled active therapy program or by using continuous passive motion over the 3- to 5-day period of hospitalization [19].
• Surgical correction of secondary joint deformities from arthrofibrosis may be necessary after CRPS, with indications including joint pain without diffuse dystrophic symptoms and arthrofibrosis that interferes with function [19].
• Release of the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joints (or both) can be performed when nonoperative improvement has plateaued and the deformity warrants intervention [19].
• If necessary, all four MCP joints and all four PIP joints can be released in a single operation for CRPS-related contractures [19].
• Restoration of full flexion or extension is an unreasonable goal or expectation for surgery on contracted joints in CRPS [19].
• The range of motion achieved during surgery for CRPS contractures is rarely maintained after surgery as some loss is expected [19].
• Surgical management of vascular malformations aims to completely extirpate the lesion, preserving tendons, bone, nerve, and uninvolved muscle [22].
• Vascular supply is reconstituted as needed with microvascular repairs and vein grafting for vascular malformations [22].
• An aggressive surgical approach in symptomatic vascular lesions in all but the worst high-flow lesions leads to acceptable outcomes with low complication rates [22].
• Venous malformations are often seen on or around nerves, and great care should be taken to limit damage to any significant nerve in the hand [22].
• Surgical excision of venous malformations usually reduces pain and improves function for a significant period of time [22].
• For high-flow arteriovenous malformations, a surgeon should plan to excise the involved abnormal arteries and reconstruct whatever is necessary with vein grafts [22].
• The other, uninvolved artery often needs ligation to decrease the large amount of inflow characteristic of high-flow arteriovenous malformations [22].
• Ischemic digits associated with high-flow arteriovenous malformations are probably best amputated [22].

Key Considerations

• Clinical signs and symptoms for mild-to-moderate median neuropathy at the carpal tunnel are discordant from diagnoses based on electrodiagnostic studies and ultrasound [3].
• The estimated prevalence of mild-to-moderate carpal tunnel syndrome based on clinical signs and symptoms is 73%, compared to 51% based on electrodiagnostic studies and ultrasound [12].
• Surgical decompression following shoulder surgery led to nearly 90% symptom resolution for neuropathy [6].
• 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].
• Hand abduction tracings are a quantitative outcome measure to follow recovery over time for intrinsic hand function in patients with severe ulnar neuropathy following surgical intervention [11].
• Surgeons should consider bifid median nerve anomalies when assessing patients with symptoms of median nerve compression [10].
• Clear definitions of recurrence versus persistent compression neuropathy are needed for upper extremity revision nerve compression surgery [2].
• Agreements on supplementary diagnostics and standardized outcome measurements are needed to enable comparing results from different techniques and clinics in upper extremity revision nerve compression surgery [2].

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. [17] (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. [18] (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. [28] (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. [29] (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. [30] (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] Campbell S Operative Orthopaedics 4 Volume Set. NERVE INJURIES AT THE LEVEL OF THE HAND AND WRIST > EVALUATION.

[16] Green S Operative Hand Surgery. Median Nerve Compression at the Elbow and Forearm > Authors’ Opinion.

[17] Predicting Acute Median Neuropathy in Perilunate Injuries. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2023.09.003

[18] 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

[19] Green S Operative Hand Surgery. A Practical Guide for Complex Regional Pain Syndrome in the Acute Stage and Late Stage > CRITICAL POINTS > Management of Patients With a Painful Median Nerve and Complex Regional Pain Syndrome.

[20] Green S Operative Hand Surgery. A Practical Guide for Complex Regional Pain Syndrome in the Acute Stage and Late Stage > Physical Examination.

[21] Green S Operative Hand Surgery. CLINICAL FINDINGS.

[22] Green S Operative Hand Surgery. Vascular Malformations.

[23] Green S Operative Hand Surgery. Median Nerve Compression at the Elbow and Forearm > COMPRESSION OF THE RADIAL NERVE > Superficial Radial Nerve Compression.

[24] Green S Operative Hand Surgery. NEUROMAS.

[25] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > DIAGNOSIS OF DISORDERS OF THE HAND.

[28] 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

[29] 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

[30] 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