Best Practice Case Studies-Upper Extremity Nerve Entrapment

Pdf Summary

The article by Shane Cass, DO, provides an update on upper extremity nerve entrapment syndromes in sports, emphasizing the complexities in diagnosing these conditions due to their vague symptoms that often mimic other musculoskeletal issues. For effective diagnosis, clinicians should rely on a thorough history and physical examination, with neurodiagnostic testing and imaging playing a supplementary role.

Peripheral nerve entrapment in athletes often stems from acute trauma or chronic overuse, particularly affecting the upper extremities. This review focuses on mononeuropathies, excluding conditions like thoracic outlet syndrome and brachial plexus injuries.

Significant attention is given to specific nerve entrapments:
- <strong>Spinal Accessory Nerve</strong>: Injuries are rare, seen in contact sports, and often involve pain and weakness due to nerve contusion.
- <strong>Long Thoracic Nerve</strong>: Common in sports with repetitive arm movements; symptoms include shoulder pain and winging scapula, typically resolving non-operatively.
- <strong>Axillary Nerve</strong>: Often due to traumatic injuries, particularly in contact sports, presenting with lateral arm numbness and weakened arm elevation.
- <strong>Suprascapular Nerve</strong>: Increasingly recognized among volleyball and baseball players, with a significant portion involving paralabral cysts leading to nerve compression.
- <strong>Median Nerve Syndromes</strong>: Includes pronator syndrome and anterior interosseous nerve syndrome, occurring in sports due to repetitive forearm exertion.
- <strong>Ulnar Nerve</strong>: Cubital tunnel syndrome is the second most common entrapment, often presenting with sensory deficits and weakness in hand grip.
- <strong>Radial Nerve</strong>: Radial tunnel and posterior interosseous syndromes are noted, though less common, causing pain and motor dysfunction respectively.

The document emphasizes mostly non-operative management, with surgical intervention reserved for cases resistant to conservative treatment. It highlights a lack of randomized trials but suggests surgery can be effective in chronic cases. Understanding anatomy, precise symptomatology, and employing a patient-specific treatment approach are vital in managing these syndromes in athletes.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 19

Topic Hand and Wrist

Keywords

2nd Edition, CASE 19

2nd Edition

Hand and Wrist

upper extremity nerve entrapment

sports injuries

diagnosis

mononeuropathies

spinal accessory nerve

long thoracic nerve

axillary nerve

suprascapular nerve

median nerve syndromes

ulnar nerve