In daily life, many people will unknowingly experience numbness and pain in the upper extremity of the hand, or partially accompanied by upper extremity weakness and muscle atrophy. If you have these symptoms, you should be careful, you may have peripheral nerve entrapment disease of the upper extremity.
Upper limb peripheral nerve entrapment is a common disease in hand surgery, with a high clinical incidence of 5%-20%. After upper extremity peripheral nerve entrapment, patients mainly present with hand numbness and pain, upper extremity weakness, and gradual muscle atrophy. In the past, many patients and clinicians did not know enough about peripheral nerve entrapment diseases, and some of them had muscle atrophy and thought it was a central nerve problem, so they consulted the neurology department, which made the disease not receive effective and active treatment. Clinically, we often treat patients referred from neurology, and most of them are eventually diagnosed with peripheral nerve entrapment disease of the upper extremity. With the development of medical technology and the improvement of medical level, the understanding of peripheral nerve entrapment disease of the upper extremity has gradually improved in recent years, and many patients who were once mistakenly thought to be patients with hand numbness and muscle atrophy in the scope of other departments have been treated in a timely manner.
After some patients develop hand numbness, they are treated as cervical spondylosis in local hospitals, but the treatment effect is not significant, or the symptoms are aggravated instead. At this time, you need to consider whether the peripheral nerve symptoms are caused by the entrapment of the cervical nerve.
Clinically, some patients come to our department and directly say that he asks to see cervical spondylosis. After careful examination, we find that the patient is not cervical spondylosis, but cervical nerve entrapment disease, and the numbness and discomfort of the upper limb hand similar to cervical spondylosis is mainly caused by discomfort of the cervical spine, but due to the entrapment of the cervical nerve. The main clinical manifestations of cervical nerve entrapment disease are discomfort and pain in the back of the shoulder, neck, and limited movement and sensation in the upper limbs, which are often classified as cervical spondylosis, cervicitis, cervical muscle strain, and frozen shoulder, etc.
Below I will introduce several typical upper extremity peripheral nerve entrapment disorders that are commonly seen in clinical practice. If you are experiencing similar symptoms, please let us help relieve your pain.
The first one is dorsal scapular nerve entrapment, which mainly affects young and middle-aged women. Clinically, the main discomfort sensations are: discomfort and soreness in the back of the shoulder and neck, weather-related, aggravated by rainy days and winter, and can be aggravated by exertion. It often leads to the inability to sleep and the feeling that the affected limb is uncomfortable even if it is placed, but there is no clear indication of the site of the pain. It may be accompanied by hand numbness. Examination may reveal significant pressure pain at the midpoint of the posterior border of the sternocleidomastoid muscle at 75px next to the spinous process of the 3 and 4 thoracic vertebrae. Due to the great similarity and overlap between the above manifestations and physical examination and cervical spondylosis and frozen shoulder, such patients are often misdiagnosed as cervical spondylosis and frozen shoulder and do not receive active and effective treatment. Symptoms do not relieve or aggravate the situation. For some patients whose symptoms are not significantly relieved, we recommend the treatment of surgical release of the pinched nerve, after which the patient’s symptoms completely disappear, thus regaining youthful vitality.
Secondly, with the improvement of living standards, some young patients have increased weekend party activities, and “weekend syndrome” is a kind of peripheral nerve entrapment disease of the upper extremities, which occurs in young alcoholics.
The main clinical manifestation of these patients is the inability to extend the wrist and fingers after waking up from a weekend of drunkenness, lying on one’s side, with the arm pressed underneath the body. These patients have neurological symptoms due to compressive ischemia of the peripheral nerves in the post-drinking sleeping state. For such patients, general treatment advocates joint fixation protection, adequate rest for the affected limb, local braking, and taking neurotrophic drugs. Generally, after the above conservative treatment, most patients’ symptoms can recover on their own within 2-4 weeks and recover completely. If the patient does not recover from peripheral nerve symptoms in 1-2 months, further examination in hospital is recommended and most of them need to be treated with nerve surgery exploration. Patients with this type generally recover better and function satisfactorily after surgery if the diagnosis and treatment are correct and timely.
It is necessary to be alert for posterior interosseous nerve entrapment.
This type of peripheral nerve entrapment of the upper extremity is mainly seen in: people with frequent hand movements, especially in the dominant hand, such as handicraft workers. The main clinical manifestation in the self-referential type is pain in the lateral aspect of the elbow, characterized by rest pain and nocturnal pain. There is weakness in finger extension, thumb extension and forearm rotation backwards, with muscle atrophy and severe dysfunction in advanced stages. Examination may reveal pressure pain limited to 2-100px below the lateral epicondyle of the humerus, and pain may be induced by resistance rotation of the forearm. Because of the similarity of the symptomatic presentation to tennis elbow, posterior interosseous nerve entrapment is often misdiagnosed clinically as intractable tennis elbow. If the diagnosis is clear, then the treatment is mainly to take 1-2 courses of closed therapy. According to our experience, patients with such peripheral nerve injury generally recover better after surgery, and most patients can relieve the symptoms and obtain clinical cure. However, after the above conservative treatment is ineffective, some patients can be considered for treatment by surgical nerve release. Postoperative patients can generally obtain satisfactory clinical results.
Carpal tunnel syndrome
Middle-aged women aged 40-60 years and workers with repeated wrist vibrations such as typists and musical instrument players are prone to semi-numbness and pain in the radial third finger, which is aggravated at night and may have a history of waking up with numbness, which improves after activities such as shaking or rubbing the hand after waking up. The more severe symptoms may lead to muscle atrophy, limited fine movements, hand weakness and inflexibility. For example, it is difficult to hold coins and tie buttons. If you have the above symptoms, are you still being treated according to cervical spondylosis or diabetic peripheral nerve injury? Is the effect of treatment not significant? If you are experiencing the above symptoms, then you are probably suffering from carpal tunnel syndrome. Carpal tunnel syndrome is a peripheral nerve symptom caused by the compression of the median nerve in the carpal tunnel.
Treatment
Clinically, if the symptoms are not treated actively and effectively, the symptoms will gradually worsen and the hand muscles will become atrophied and deformed, so early diagnosis and active and effective treatment is essential. The clinical treatment of carpal tunnel syndrome is mainly conservative treatment, advocating plate fixation, oral neurotrophic and antipyretic drugs, and closed therapy. After surgery, the patient can achieve satisfactory results and the symptoms of peripheral nerve entrapment can be completely relieved, and the patient can resume normal daily work and life.
Anterior interosseous nerve entrapment
It is another common peripheral nerve entrapment disease in the upper extremity. The main clinical indication is spontaneous pain on the deep side of the forearm palm with no obvious cause, and the localization is not clear. The thumb and index finger suddenly become weak in lifting objects and the fingertips cannot be opposed, but there is no sensory impairment. The thumb and index finger flexor strength is decreased, and the thumb and index finger cannot be pinched into a circular “0” shape. Due to the above clinical manifestations, the patient is often misdiagnosed as a flexor tendon rupture. For this type of peripheral nerve entrapment disease of the upper extremity, traditional conservative treatment methods are often not effective, and surgical treatment is recommended. If the diagnosis and treatment are timely, this type of peripheral nerve entrapment disease can often achieve satisfactory clinical treatment results.
History of nocturnal numb awakening
If you are a computer keyboard operator, driver, ambulatory worker, production line assembler, and other workers who often maintain a flexed elbow position, if you experience numbness and tingling sensation in the ring and little finger. Soreness and discomfort with radiating sensation on the inner side of the elbow. There may be a history of nocturnal numbness and awakening.
Elbow tube syndrome
This hand weakness, loss of grip strength, muscle atrophy, inflexible hand movement, and inability to grasp things. Then you do not have cervical spondylosis or rheumatoid, you probably have elbow canal syndrome. Elbow canal syndrome mainly refers to the dysfunction of forearm and hand caused by the ulnar nerve jamming in the elbow canal area. Due to the special role of the ulnar nerve, if this disease is not treated in a timely and effective manner, it will have a great impact on the function of the patient’s hand.
Recommended treatment for elbow canal syndrome
The treatment of patients with elbow canal syndrome is mainly recommended to be carried out by conservative treatment methods, including splinting, oral neurotropic and antipyretic drugs, and closed therapy. However, some patients with more severe symptoms may not have significant symptom relief or further aggravation, for this type of patients, we mainly carry out surgical treatment, mainly using ulnar nerve anterior surgery for treatment, and most patients recover from symptoms after surgical treatment.
Upper extremity peripheral nerve entrapment
Upper extremity peripheral nerve entrapment is a combination of multiple complex peripheral nerve entrapments. If multiple upper extremity peripheral nerve entrapments occur, there may be a mixture of clinical manifestations. If you have some of the above manifestations, please be alert to the occurrence of peripheral nerve entrapment disease of the upper extremity.