Best Practice Case Studies-Upper Extremity Nerve Entrapment (CUBITAL TUNNEL SYNDROME)

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The article "Upper Extremity Nerve Entrapment Syndromes in Sports: an Update" by Shane Cass, DO, highlights the complexities of diagnosing peripheral nerve entrapment syndromes in athletes. These conditions present with vague symptoms often mimicking other musculoskeletal issues. The diagnosis relies mainly on a comprehensive patient history, physical examination, and anatomical knowledge, while neurodiagnostic testing and advanced imaging play a secondary role. Most conditions resolve with nonoperative treatments.

The paper reviews various upper extremity nerve entrapment neuropathies with updates from recent literature. 

1. <strong>Spinal Accessory Nerve (SA) Injuries</strong>: These are rare in sports, presenting in disciplines like judo and kickboxing due to direct trauma. Symptoms include pain, weakness, and scapular winging. Diagnosis relies on clinical examination, and treatments are largely conservative, focusing on rehabilitation.

2. <strong>Long Thoracic Nerve (LTN) Palsy</strong>: Common in athletes like archers and tennis players due to repetitive micro-trauma. It presents as shoulder or neck pain with scapular winging. Most recover without surgery, and initial treatment is conservative.

3. <strong>Axillary Nerve Injury</strong>: Rare but often due to traumatic events like dislocations in football. Symptoms include arm numbness and weakness. Non-surgical treatments assist recovery in most cases, which usually occurs within a year.

4. <strong>Quadrilateral Space Syndrome</strong>: Involves axillary nerve compression, causing vague symptoms like dull shoulder pain. Diagnosis and treatment rely on identifying anatomical problems, with surgery considered for persistent cases.

5. <strong>Suprascapular Nerve Entrapment</strong>: Increasingly recognized in volleyball players, it causes shoulder pain and muscle atrophy. Treatment focuses on conservative management unless structural abnormalities necessitate surgical intervention.

6. <strong>Median Nerve Entrapment</strong> (such as Pronator and Anterior Interosseous Nerve Syndromes): Presents with forearm pain and motor deficits, particularly in sports requiring repetitive arm use. Diagnosis is challenging, and often conservative treatment suffices.

7. <strong>Carpal Tunnel Syndrome (CTS)</strong>: Common in various sports, presenting with hand and forearm pain. Treatment combines conservative measures, with surgery as an option for unresolved symptoms.

8. <strong>Ulnar Nerve Entrapment</strong>: Includes Cubital Tunnel Syndrome and Ulnar Tunnel Syndrome, often seen in activities stressing the elbow or wrist. Mainly managed conservatively, with surgery as needed for persistent cases.

9. <strong>Radial Nerve Issues</strong>: Includes Radial Tunnel and Posterior Interosseous Nerve Syndromes, mainly causing pain and motor issues. Diagnosis is controversial, with conservative treatments preferred.

Overall, this extensive review underscores the importance of recognizing nerve entrapment syndromes in athletes and prioritizing non-surgical treatments, reserving surgery for particularly persistent or severe cases.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 14

Topic Elbow and Forearm

Keywords

3rd Edition, CASE 14

3rd Edition

Elbow and Forearm

nerve entrapment syndromes

athletes

nonoperative treatments

spinal accessory nerve injuries

long thoracic nerve palsy

axillary nerve injury

quadrilateral space syndrome

suprascapular nerve entrapment

median nerve entrapment

ulnar nerve entrapment