Nerve Compression Syndromes

Nerve Compression Syndromes Nerve compression syndromes such as carpal tunnel syndrome (CTS), ulnar nerve palsy, and thoracic outlet syndrome (TOS) can lead to significant symptoms due to compression or irritation of nerves at various anatomical locations. Each syndrome presents with distinct clinical features, which are crucial for accurate diagnosis and appropriate management. Here’s a detailed discussion on the clinical features of each syndrome: Carpal Tunnel Syndrome (CTS) Anatomy and Pathophysiology:   CTS results from compression of the median nerve as it passes through the carpal tunnel, a narrow passageway in the wrist formed by bones and the transverse carpal ligament. Compression can lead to ischemia and damage to the nerve fibers, causing symptoms. Clinical Features: 1. Paresthesia: Numbness, tingling, and pain in the thumb, index finger, middle finger, and radial half of the ring finger. 2. Night Symptoms: Symptoms often worsen at night or during activities that involve repetitive use of the wrist. 3. Weakness: Weakness and clumsiness in the hand, affecting grip strength and fine motor skills. 4. Sensory Loss: Decreased sensation in the affected fingers. 5. Positive Phalen's Test: Reproduction of symptoms (tingling or numbness) with wrist flexion, indicative of median nerve compression. 6. Positive Tinel's Sign: Tingling or paresthesia provoked by tapping over the median nerve at the wrist. Diagnostic Evaluation:  Clinical Assessment: History and physical examination focusing on sensory deficits, muscle weakness, and provocative tests.   Electrodiagnostic Studies: Nerve conduction studies (NCS) and electromyography (EMG) to assess nerve function and severity of compression. Imaging: Sometimes used to rule out other conditions or confirm severe cases. Management:   Conservative: Wrist splinting, activity modification, NSAIDs, corticosteroid injections. Surgical: Carpal tunnel release if conservative measures fail or for severe cases. Ulnar Nerve Palsy Anatomy and Pathophysiology:   The ulnar nerve can be compressed at several points along its course, most commonly at the elbow (cubital tunnel) or wrist (Guyon's canal). Compression leads to dysfunction of ulnar nerve motor and sensory fibers. Clinical Features: 1. Motor Weakness: Weakness of the intrinsic hand muscles, affecting grip strength and fine motor skills (e.g., difficulty with pinching or gripping objects). 2. Sensory Loss: Numbness and tingling in the ulnar distribution, including the little finger and ulnar half of the ring finger. 3. Claw Hand Deformity: Hyperextension of the metacarpophalangeal joints and flexion of the interphalangeal joints due to weakness of the lumbrical muscles. 4. Pain: Pain along the course of the nerve, aggravated by activities that involve repetitive flexion or pressure on the elbow or wrist. 5. Positive Tinel's Sign: Tapping over the ulnar nerve at the elbow or wrist elicits tingling or paresthesia in the ulnar distribution. Diagnostic Evaluation:   Clinical Examination: Assessment of muscle strength, sensory deficits, and provocative tests (e.g., Tinel's sign). Electrodiagnostic Studies: NCS and EMG to confirm nerve dysfunction and localize the site of compression. Management:   Conservative: Activity modification, elbow padding, splinting, NSAIDs, corticosteroid injections. Surgical: Decompression or transposition of the ulnar nerve if conservative measures fail or for severe cases.