Compressive neuropathies of the upper and lower limbNerve compression syndrome, otherwise known as nerve entrapment syndrome, compression neuropathy or entrapment neuropathy, occurs when a nerve is squeezed or compressed. The nerves of the upper and lower limbs and extremities may be affected, causing pain, aches, tingling, numbness and/or muscle weakness of the limb and extremity.
Since there are many nerves in the upper and lower limbs, there are a variety of compressive neuropathies that can affect these areas. As specialists in hand, wrist and elbow conditions, The Garden Route Hand Unit commonly sees patients suffering from the following types of nerve entrapments:
- Carpal tunnel syndrome - this is by far the most common type, causing pain, numbness and weakness of the hand and lower arm due to the compression of the median nerve at the wrist.
- Cubital tunnel syndrome - this is a common nerve entrapment of the ulnar nerve at the elbow.
- Suprascapular nerve compression syndrome - caused by entrapment of the suprascapular nerve causing symptoms in the shoulder.
- Guyon's canal syndrome - affecting the hand and arm due to entrapment of the ulnar nerve.
- Cyclist's Palsy - this is the compression of the ulnar nerve at the wrist.
- Quadrilateral Space Syndrome - this affects the axillary nerve in the upper arm.
- Stinger - caused by the entrapment of the brachial plexus nerve in the upper arm.
- Pronator Syndrome - this is caused by the entrapment of the median nerve at the elbow.
- Radial nerve compression syndrome or handcuff neuropathy - affecting the radial nerve in the upper limb, causing pain and weakness of the wrist, hand and fingers.
- Meralgia paresthetica - due to entrapment of the cutaneous nerve in the thigh.
Compressive neuropathies of the upper and lower limb are often caused by repetitive injuries or movements and are associated with medical conditions such as arthritis, diabetes and hypothyroidism. Injuries such as sprains and fractures of the hand and the upper limb may also lead to compression neuropathy.
How are compressive neuropathies treated?
If you are experiencing sudden or progressive numbness, tingling and weakness in the arm or hand, you should make an appointment as soon as possible. Your hand surgeon will then use a physical examination and diagnostic tests to identify whether or not a nerve compression syndrome may be the cause, and if so, what type of neuropathy it may be. Diagnostic tests may provide valuable information on the severity and location of the compression, and may include a nerve conduction test, electromyography, ultrasound or an MRI.
Once diagnosed, conservative treatment may be aimed at treating the underlying condition causing the compression, and easing symptoms. This may involve adopting ergonomic strategies, physical therapy, splints, braces, medication and steroid injections.
In severe cases, however, more invasive treatment may be required, in which case surgery will be advised. Surgery will be dependent on the type of neuropathy, the nerves and structures affected, and its location. Each surgery will differ, but your hand surgeon will discuss this with you if you are deemed a candidate for surgery.