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Review
. 2022 Dec 16;5(4):525-535.
doi: 10.1016/j.jhsg.2022.10.010. eCollection 2023 Jul.

Diagnostic Considerations in Compressive Neuropathies

Katherine McGurk  1 , Joseph Anthony Tracey  1 , Dane N Daley  1 , Charles Andrew Daly  1
Affiliations
Review

Diagnostic Considerations in Compressive Neuropathies

Katherine McGurk et al. J Hand Surg Glob Online. .

Abstract

Peripheral nerve compression of the upper extremity is a common pathology often necessitating surgical intervention, much is known, but much more is left to understand. For the more common pathologies, carpal tunnel syndrome, cubital tunnel syndrome, and ulnar tunnel syndrome, research and clinical efforts directed toward standardization and reduction of resource use have been attempted with varied success. Diagnosis of many of these syndromes is largely based on a proper history and physical examination. Electrodiagnostic studies continue to have value, but proportionally less than previous decades. In addition, emerging technologies, including magnetic resonance neurography, novel ultrasound evaluation techniques, and ultrasound-guided diagnostic injections, are beginning to demonstrate their ability to add value to the diagnostic algorithm, particularly when less common compressive neuropathies are present and/or the diagnosis is in question.

Keywords: Carpal tunnel syndrome; Cubital tunnel syndrome; Electrodiagnostic studies; Peripheral nerve compression; Peripheral neuropathy.

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Figures

Figure 1
Figure 1
Carpal tunnel syndrome-6. From Fowler JR et al.
Figure 2
Figure 2
Diagnostic parameters of the provocative tests used in CTS. Table adapted from Makanji et al depicting the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for common provocative tests used in CTS.
Figure 3
Figure 3
Diagnostic parameters for EDS, US, and MRI, in CTS. Summary of diagnostic tests used in CTS. The most common standard of practice EDS measurements from the American Association of Electrodiagnostic Medicine. Ultrasound and MRI findings based on the literature review.
Figure 4
Figure 4
Differentiating pronator syndrome and AIN syndrome from CTS. Differential diagnosis table adapted from Lee et al depicting diagnostic findings between CTS, pronator syndrome, and AIN syndrome.
Figure 5
Figure 5
Possible sites of compression in pronator syndrome. A Ligament of Struthers (Arcade VIII). B Pronator teres. C Bicipital aponeurosis. D Fibrous arcade from the proximal margin of the FDS to the middle finger.
Figure 6
Figure 6
Differentiating between CuTS and UTS. Electrodiagnostic studies practice guidelines by the American Association of Electrodiagnostic Medicine listed for CuTS and UTS. Ultrasound and MRI findings based on the literature review.
Figure 7
Figure 7
Clinical photograph and corresponding MR neurography demonstrating the hourglass compressions pathognomonic for PTS affecting the radial nerve.
Figure 8
Figure 8
Radial tunnel and PIN syndromes. Differential findings for radial tunnel and PIN syndromes focused on clinical presentation, physical examination, EDS, and injections.
Figure 9
Figure 9
Example of abundant radiocapitellar synovitis resulting in PIN compression on axial (A), and sagittal (B) MRI and clinical photograph (C).
See this image and copyright information in PMC

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