Upper extremity peripheral nerve entrapment disorders are common in hand surgery, and their main clinical symptoms are hand numbness and pain, upper extremity weakness, and progressive muscle atrophy. As the understanding of this disease has improved, many patients who were once mistaken for neurological hand numbness and muscle atrophy have been treated promptly. Cervical nerve entrapment disease is a very common clinical disease, whose main clinical manifestations are discomfort and pain in the back of the shoulder and neck, limited movement and sensation in the upper limbs, etc. It is often classified as cervical spondylosis, cervicitis, cervical and collar muscle strain, frozen shoulder, etc., but some cases have poor outcomes. Correct diagnosis coupled with timely treatment is the most effective way to control the progression of the disease and reduce the patient’s pain.
Typical diseases.
1. Scapulodorsal nerve entrapment.
Prevalent population: young and middle-aged women.
Clinical manifestations: 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 pain. It may be accompanied by hand numbness. Examination may reveal significant pressure pain at 3cm next to the spinous process of the 3 and 4 thoracic vertebrae and at the midpoint of the posterior border of the sternocleidomastoid muscle. It is often misdiagnosed as cervical spondylosis, frozen shoulder, etc.
Treatment: Closed treatment for 1-2 courses.
Effect: Of the 24 patients treated, 18 cases (75%) showed basic disappearance or significant relief of symptoms, 5 cases (21%) showed improvement, and 1 case (4%) was ineffective.
2. “Weekend syndrome”.
Prevalent population: young alcoholics.
Clinical manifestations: It often occurs on the weekend after drunkenness, lying on the side, pressing the arm underneath the body to sleep, and waking up with the inability to extend the wrist and fingers.
Treatment: Joint fixation for protection, adequate rest for the affected limb, and neurotrophic drugs can generally recover on their own within 2-4 weeks. If it does not recover in 1-2 months, surgery is required.
Effect: timely diagnosis and treatment, satisfactory results.
3. Posterior interosseous nerve entrapment.
Prevalent population: frequent hand activity, especially prevalent in dominant hands, such as handicraft workers.
Clinical manifestations: pain in the lateral aspect of the elbow, characterized by rest pain and nocturnal pain. Weakness in finger extension, thumb extension and forearm rotation posteriorly, with muscle atrophy and severe dysfunction in advanced stages. Examination may reveal pressure pain limited to 2-4 cm below the lateral epicondyle of the humerus, and pain may be induced by resistance rotation of the forearm. It is often misdiagnosed as intractable tennis elbow.
Treatment.
(1) Closed treatment for 1-2 courses of treatment.
(2) Surgical treatment: 2 cases with good prognosis after surgery.
Results: 4 of the 6 patients seen and treated improved significantly (67%). The remaining 2 cases had unsatisfactory results and were treated surgically.
4. Carpal tunnel syndrome.
Prevalent population: middle-aged women aged 40-60 years and workers with repeated wrist vibration such as typists and instrumentalists.
Clinical manifestations: numbness and pain in the radial side of the three fingers, aggravated at night, may have a history of numbness wake up, after waking up shaking hands or rubbing hands and other activities to improve. The development of lesions can lead to muscle atrophy, limited fine movements, hand weakness and inflexibility. For example, it is difficult to hold coins and tie buttons. It is often misdiagnosed as cervical spondylosis and nerve damage from diabetes.
Treatment.
(1) Splint fixation, oral neurotrophic and antipyretic analgesic drugs, and closure therapy.
(2) Surgical treatment.
(3) Arthroscopic surgical treatment.
Effects.
(1) Conservative treatment: good results in the early stage. Dozens of cases of early mild disease were treated, and the excellent rate was about 90%.
(2) Surgical treatment: the earlier the surgery, the less severe the symptoms, the better the results. Surgical treatment of 25 cases, recovery is good.
5. Anterior interosseous nerve entrapment.
Clinical manifestations: spontaneous pain on the deep side of the forearm palm without obvious causative factors, with unclear localization. Suddenly, the thumb and index finger could not lift objects, and the fingertips could not be relative, but there was no sensory impairment. The thumb and index finger flexors are found to have decreased strength and cannot be pinched into a circular “0” shape. It is often misdiagnosed as flexor tendon rupture.
Treatment: Surgical treatment: 5 cases were treated with good results.
6. Elbow tube syndrome.
Prevalent population: computer keyboard operators, drivers, ambulatory workers, production line assemblers and other workers who often maintain a flexed elbow position.
Clinical manifestations: numbness and tingling sensation in the ring and little finger. Pain and discomfort in the medial elbow with radiating sensation. There may be a history of nighttime numbness and awakening. Weakness of the hands, loss of grip strength, muscle atrophy, inflexible hand movement, and inability to grasp things. It is often misdiagnosed as cervical spondylosis.
Treatment.
(1) Splint fixation, oral neurotrophic and antipyretic analgesic drugs, and closed treatment.
(2) Surgical treatment.
Effectiveness.
(1) Conservative treatment: early results are good.
(2) Surgical treatment: the earlier the surgery, the less severe the symptoms, the better the results.