Nerve Entrapment Syndromes Workup

  • Author: Amgad Saddik Hanna, MD; Chief Editor: Allen R Wyler, MD   more...
 
Updated: Jan 13, 2012
 

Imaging Studies

Magnetic resonance imaging (MRI) using the short inversion imaging recovery (STIR) technique displays high signal intensity in the affected nerve segment at the site of the compression, probably due to the presence of edema in the myelin sheath and perineurium. Magnetic resonance neurography is evolving as an important tool in sorting out various painful limb syndromes involving the forearm and shoulder. This technique has been incorporated by some groups into the management of patients with routine entrapment syndromes (eg, carpal and cubital tunnel syndrome). For many, MRI and other imaging modalities are used for patients with atypical presentations of common disorders, recurrent symptoms after previous operation, and in those suspected of having rare entrapments. For example, MRI is especially helpful in identifying a mass lesion in patients with a lesion compressing the suprascapular nerve, ulnar nerve at the wrist or PIN.

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Diagnostic Procedures

  • The diagnosis of most entrapment neuropathies can usually be established on clinical grounds alone. For typical cases of carpal tunnel and ulnar cubital syndromes, electrodiagnostic tests (nerve conduction study and electromyography) are not always necessary. Still, they provide useful information: confirming the clinical diagnosis and localization, grading the lesion, identifying an underlying or superimposed peripheral neuropathy, and distinguishing other entities. Additionally, a baseline electrodiagnostic study may allow comparison to a postoperative study in patients with persistent symptoms. In more unusual entrapment neuropathies, such as those involving the suprascapular nerve, ulnar nerve at the wrist, or PIN, they may be invaluable.
  • Local nerve block with a local anesthetic agent is useful in confirming the diagnosis of certain entrapments, such as meralgia paresthetica.
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Contributor Information and Disclosures
Author

Amgad Saddik Hanna, MD  Assistant Professor, Department of Neurosurgery, University of Wisconsin, Madison

Amgad Saddik Hanna, MD is a member of the following medical societies: American Association of Neurological Surgeons, Central Neuropsychiatric Association, and Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

James S Harrop, MD  Associate Professor, Departments of Neurological and Orthopedic Surgery, Jefferson Medical College of Thomas Jefferson University

James S Harrop, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Spinal Injury Association, Cervical Spine Research Society, Congress of Neurological Surgeons, and North American Spine Society

Disclosure: Depuy spine Consulting fee Consulting; Geron None None; Neural Stem None None; Axiomed Ownership interest None; Stryker Spine Honoraria None

Dachling Pang, MD, FRCS(C), FACS  Professor of Pediatric Neurosurgery, University of California, Davis, School of Medicine; Chief, Regional Center for Pediatric Neurosurgery, Kaiser Permanente Hospitals of Northern California

Dachling Pang, MD, FRCS(C), FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, Congress of Neurological Surgeons, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Kamran Sahrakar, MD, FACS  Clinical Professor, Department of Neurosurgery, University of California at San Francisco

Kamran Sahrakar, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Medical Association, California Medical Association, Florida Medical Association, and Nevada State Medical Association

Disclosure: Nothing to disclose.

Robert J Spinner, MD  Professor of Anatomy, Neurosurgery, and Orthopedics, College of Medicine, Mayo Clinic; Co-Director, Brachial Plexus Clinic, Consultant, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota

Robert J Spinner, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Association for the Advancement of Science, American Association of Clinical Anatomists, American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, American Orthopaedic Association, Congress of Neurological Surgeons, and Congress of Neurological Surgeons

Disclosure: Mayo Medical Ventures Consulting fee Consulting

Specialty Editor Board

Michael G Nosko, MD, PhD  Associate Professor of Surgery, Chief, Division of Neurosurgery, Medical Director, Neuroscience Unit, Medical Director, Neurosurgical Intensive Care Unit, Director, Neurovascular Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School

Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, Canadian Congress of Neurological Sciences, Congress of Neurological Surgeons, New York Academy of Sciences, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ryszard M Pluta, MD, PhD  Associate Professor, Neurosurgical Department Medical Research Center, Polish Academy of Sciences at Warsaw, Poland; Clinical Staff Scientist, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH); Fishbein Fellow, JAMA, Chicago ,IL

Ryszard M Pluta, MD, PhD is a member of the following medical societies: Congress of Neurological Surgeons and Polish Society of Neurosurgeons

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD  Former Medical Director, Northstar Neuroscience, Inc

Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons

Disclosure: Nothing to disclose.

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Chest PA radiograph showing a right cervical rib (arrows), a possible cause of thoracic outlet syndrome.
Ulnar nerve (U) transposition at the elbow. A: The medial intermuscular septum (arrows) is resected to prevent compression of the transposed nerve. Vasoloops are around the ulnar nerve and a vascular pedicle between the nerve and the septum that has been preserved. B: After subcutaneous transposition, the ulnar nerve is observed lax in elbow flexion. The ulnar nerve and its distal branches are surrounded by vasoloops.
Common peroneal nerve decompression at the fibular neck. A: The common peroneal nerve (P) has been identified and mobilized proximal to the fibular tunnel region, fascia (F) covering peroneus longus. B: The common peroneal nerve has been traced through the fibular tunnel. The fascia overlying the peroneus longus muscle has been divided and the muscle (M) has been retracted. The fascial band overlying the nerve is released.
Median nerve (M) after decompression at the wrist; note the congestion from the longstanding compression. The transverse carpal ligament (arrows) has been transected. Fat is observed distally.
 
 
 
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