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Neuropathy

Hand neuropathies: compressive etiologies (CTS, CuTS) diagnosis, systemic causes, and surgical/non-operative management options.

Overview

A unique and common protocol for the treatment of hand neuropathy in cyclists is lacking despite a range of available treatments [1]. Demographics of patients with various compressive neuropathies in the upper extremity are not homogeneous, suggesting different etiologies [2]. Most diagnoses of distal peripheral neuropathy after shoulder surgery likely represent previously asymptomatic disease rather than surgical injuries [4]. Study findings could better define conservative interventions for the treatment of chemotherapy-induced peripheral neuropathy [3].

Patient age is the most important prognostic factor for nerve recovery [8]. Successful results following revision neurectomy for Morton neuroma range from 60% to 80% [25]. Revision procedures for persistent and recurrent cubital tunnel syndrome result in pain relief and paresthesia reduction in approximately 75% of patients, though results are inferior compared with primary procedures [36]. Optimal outcomes in older patients with peripheral nerve regeneration are associated with early surgical intervention, the strategic use of nerve transfers to shorten regeneration distances, and realistic patient expectations [37].

Current techniques and concepts for peripheral nerve injuries include developments in tolerance induction, cell-based supportive therapies, and bioengineering of nerve conduits [24]. Outcomes utilizing processed nerve allografts and tube conduits are comparable to nerve autograft and exceed those for nerve conduit in historical and registry controls [15]. A comprehensive and individualized treatment plan is crucial for optimizing patient outcomes with painful traumatic peripheral nerve neuromas [28]. The incidence of obstetric brachial plexus injury in Scotland has fallen over 16 years, implying that small numbers of cases may be insufficient to acquire and maintain expertise for early nerve repair or secondary surgery [38].

Anatomy & Pathophysiology

Vascular & Neural

Intrinsic hand muscles possess motor endplates at consistent distances from bony landmarks on both dorsal and volar aspects [35]. Increased ulnar nerve cross-sectional area correlates with decreased motor nerve conduction velocity but poorly predicts axonal loss [53]. Shoulder positioning alters ulnar nerve strain around the elbow in living patients with cubital tunnel syndrome [49]. Surgical strategies for nerve reconstruction include transferring median nerve branches innervating the palm to the ulnar proper digital nerve of the little finger, which predictably restores protective sensation on the ulnar side of the hand in lower-type brachial plexus injuries [65]. For high ulnar nerve injuries, supercharged end-to-side anterior interosseous nerve transfer improves hand motor function recovery [67] and allows sensory fiber recovery when combined with treatment of the proximal lesion [67]. Conversely, nerve grafting for high radial nerve injury achieves relatively good wrist extension but poor thumb extension [61].

Kinematics & Assessment

Kinematic and clinical measurements objectively and quantitatively evaluate skilled hand function in individuals with chemotherapy-induced peripheral neuropathy (CIPN) [31]. The I-HaND© Scale can detect change over 3 months and discriminate between improvers and non-improvers in peripheral nerve disorders of the hand [52]. Adaptive processes following a hand nerve disorder may inform future patient-therapist interactions [62]. Furthermore, an increased understanding of the complexities of brain plasticity translates into enhanced treatment opportunities for the clinician to optimize hand function [48].

Classification

General Context: A unique and common protocol for the treatment of hand neuropathy in cyclists is lacking [1]. The demographics of patients with various compressive neuropathies are not homogeneous, suggesting different etiologies [2]. Study findings could better define conservative interventions for the treatment of chemotherapy-induced peripheral neuropathy [3]. The diagnosis and treatment of neurogenic thoracic outlet syndrome (NTOS) remains an area of controversy with varying criteria and techniques among surgeons [56].

Rare and Specific Entities: Charcot neuroarthropathy (CNA) of the hand is rare but may develop after central or peripheral neurological disorders [6]. Symptomatic neural loops are a rare, diagnostic challenge and a diagnosis of exclusion [10]. Peripheral neuropathy due to direct nerve infiltration of tubercular infection is unusual yet must be taken into consideration in such cases [12]. There is a definite correlation between the degree of paralysis of the sixth and seventh nerves and the severity of deformities in the extremities in Möbius syndrome [55].

Other Considerations: Multidisciplinary strategies for treating painful mononeuropathies address four pillars: diagnosing the condition, clinical pain phenotyping, personalized pain treatment, and using a multidisciplinary team approach [18]. Findings suggest the applicability of cannabis-based medicines for peripheral neuropathy [13]. Sensory relearning is an integral component of rehabilitation for patients with nerve-related pathologies [47]. Scores on the DASH questionnaire reflect the clinical staging of ulnar neuropathy at the elbow [51]. There is a need for more detailed classification systems and agreed outcome measures to facilitate comparison of outcomes in the absence of high-level evidence for complete brachial plexus birth injury [50]. The book Peripheral Nerve Injuries. Principles of Diagnosis is an admirable companion for anyone concerned with the fundamentals of diagnosis of peripheral-nerve injuries [5]. The chapter provides an overview of neurologic disorders of the foot and ankle, including interdigital neuroma, tarsal tunnel syndrome, Charcot-Marie-Tooth disease, and nerve entrapments [20].

Clinical Presentation

A unique and common protocol for the treatment of hand neuropathy in cyclists is lacking despite a range of available treatments [1]. Patients with various compressive neuropathies in the upper extremity do not share homogeneous demographics, suggesting different etiologies [2]. Most diagnoses of distal peripheral neuropathy after shoulder surgery likely represent previously asymptomatic disease rather than surgical injuries, as surgery for shoulder-related distal peripheral neuropathy is likely coincidental or merely brings the problem to the patient's attention [4]. Clinicians must be aware of symptomatic neural loops as an anatomic variation and a rare diagnostic challenge of exclusion; microvascular decompression should be considered if other etiologies are absent [10].

Diagnostic Workup: A diagnosis of ulnar nerve compression merits a comprehensive workup by the treating surgeon with high suspicion for concomitant median nerve compression [11]. Adequate clinical diagnosis of isolated compression of the recurrent motor branch of the median nerve can be achieved through predominantly motor symptoms and electroneuromyography alterations [21]. Peripheral neuropathy due to direct nerve infiltration of tubercular infection is unusual yet must be considered in such cases [12]. Neuropathy can be a comorbid condition in Pompe disease, emphasizing the importance of screening for this disabling condition [19].

Neurologic Variants and Comorbidities: Charcot neuroarthropathy (CNA) of the hand is rare but may develop after central or peripheral neurological disorders [6]. Charcot neuroarthropathy of the knee due to idiopathic sensory peripheral neuropathy is rare and requires early diagnosis [16]. Neurologic disorders of the foot and ankle include interdigital neuroma, tarsal tunnel syndrome, Charcot-Marie-Tooth disease, and nerve entrapments [20]. Neuromuscular impairments in focal hand dystonia and upper extremity compression neuropathies are distinguishable through differences in patient history, clinical presentation, and physical examination findings [17].

Management and Prognosis: In cases of peripheral nerve localization where a clear cleavage plane is absent, management should include simple nerve decompression followed by biopsy and adequate prolonged follow-up [7]. Patient age is the most important prognostic factor for nerve recovery [8]. Early decompression for isolated compression of the recurrent motor branch of the median nerve allows for good postoperative functional outcomes [21]. Conservative interventions for chemotherapy-induced peripheral neuropathy require further definition [3]. Cannabis-based medicines are applicable for the treatment of peripheral neuropathy [13].

Pain and Sequelae: The painful neuroma is a debilitating sequela of nerve injury with poorly understood pathophysiology involving fascicular escape and scarring [22]. Treatment for painful neuroma must be tailored to the individual patient as a number of approaches are available [22]. Multidisciplinary strategies for treating painful mononeuropathies address four pillars: diagnosing the condition, clinical pain phenotyping, personalized pain treatment, and using a multidisciplinary team approach [18].

Investigations

Other Considerations: A unique and common protocol for the treatment of hand neuropathy in cyclists is lacking [1]. Patients with various compressive neuropathies in the upper extremity have heterogeneous demographics, suggesting different etiologies [2]. Most diagnoses of distal peripheral neuropathy after shoulder surgery likely represent previously asymptomatic disease rather than surgical injuries [4]. Nontraumatic pathologic conditions of the upper extremity, such as neuropathy, vascular disease, and degenerative arthritis, can have a profound effect on function and quality of life [9]. Peripheral neuropathy due to direct nerve infiltration of tubercular infection is unusual yet must be taken into consideration in such cases [12]. Symptomatic neural loops are a rare diagnostic challenge and a diagnosis of exclusion; clinicians must consider microvascular decompression if other etiologies are absent [10]. A diagnosis of ulnar nerve compression merits a comprehensive workup by the treating surgeon and a high suspicion for concomitant median nerve compression [11]. Multiple aberrant connections between the median and ulnar nerves occur frequently in various combinations, with positive and negative associations between variations that may explain unusual clinical findings related to nerve conduction after injuries [71].

Electrodiagnostic Testing: Electrodiagnostic tests provide significantly more information than ultrasonography regarding the condition and function of the nerve in carpal tunnel syndrome [54]. Adequate clinical diagnosis through predominantly motor symptoms and electroneuromyography alterations can allow for early decompression with good postoperative functional outcomes in isolated compression of the recurrent motor branch of the median nerve [21]. Ulnar nerve motor nerve conduction velocity (MNCV) at the upper arm should be measured alongside routine assessment of MNCV at the elbow and forearm, especially in clinically severe cases considering surgery [69].

Imaging: Measuring ulnar nerve cross-sectional area (UNCSA) with MRI or ultrasonography at 1 cm proximal to the medial epicondyle can discriminate patients with and without ulnar neuropathy at the elbow at a cutoff threshold of 11.0 mm² with high sensitivity, specificity, and reliability [68]. Charcot neuroarthropathy (CNA) of the hand is rare but may develop after central or peripheral neurological disorders [6]. The diagnosis of Charcot neuroarthropathy of the knee is rare and requires early diagnosis [16]. Neuropathy can be a comorbid condition in Pompe disease, emphasizing the importance of screening for this disabling condition [19]. Patients with progressive loss of elbow motion and end-range pain should be monitored for evidence of subclinical ulnar neuritis [59].

Clinical Management: In cases of peripheral nerve localization where a clear cleavage plane is absent, the correct management should be simple nerve decompression followed by biopsy and an adequate and prolonged follow-up period [7]. Study findings could better define conservative interventions for the treatment of chemotherapy-induced peripheral neuropathy [3]. The book Peripheral Nerve Injuries. Principles of Diagnosis is an admirable companion for anyone concerned with the fundamentals of diagnosis of peripheral-nerve injuries [5].

Treatment

Non-Operative

Conservative interventions for chemotherapy-induced peripheral neuropathy require further definition [3], while a comprehensive, conservative treatment program has a positive and lasting effect on pain and disability scores in patients with non-radicular peripheral neuropathic pain [33]. Conservative treatment may be efficacious for ulnar neuropathy at the elbow, though evidence from randomized, controlled trials is lacking [32]. Few patients with thoracic outlet syndrome in the pediatric and young adult population were successfully managed with nonoperative activity modification and physical therapy [45]. Cannabis-based medicines are applicable for the treatment of peripheral neuropathy [13], and Neurotropin (NTP) may be effective for chronic pain and peripheral nerve regeneration [40]. Recent advances in bioengineered drug delivery systems enable local FK506 delivery to promote peripheral nerve regeneration while circumventing systemic adverse effects [39].

Operative

Indications: A diagnosis of ulnar nerve compression warrants a comprehensive workup and high suspicion for concomitant median nerve compression [11]. Microneurolysis is recommended as a treatment option for patients with chronic neuralgic amyotrophy who have failed to improve with nonsurgical treatment [42]. In cases of peripheral nerve localization with an absent clear cleavage plane, management should consist of simple nerve decompression followed by biopsy and adequate prolonged follow-up [7]. The recommended treatment of choice for malignant schwannoma of the medial plantar branch of the posterior tibial nerve is amputation, or radical local excision when amputation is not feasible [46].

Surgical Approach / Technique: Treatment for painful neuroma must be tailored to the individual patient as a number of approaches are available [22], and a comprehensive and individualized treatment plan is crucial for optimizing patient outcomes with painful neuromas [28]. Successful results following revision neurectomy for Morton neuroma range from 60% to 80% [25]. Treatment options for peripheral nerve injuries include tolerance induction, cell-based supportive therapies, and bioengineering of nerve conduits [24].

Other Considerations: Patient age is the most important prognostic factor for nerve recovery [8]. Most diagnoses of distal peripheral neuropathy after shoulder surgery likely represent previously asymptomatic disease rather than surgical injuries [4]. A unique and common protocol for the treatment of hand neuropathy in cyclists is lacking despite a range of available treatments [1]. Nontraumatic pathologic conditions of the upper extremity, such as neuropathy, can have a profound effect on function and quality of life [9]. The best treatment for neuralgic amyotrophy remains unknown, though early corticosteroid therapy may shorten the duration of active symptoms and hasten recovery [14]. The painful neuroma is a debilitating sequela of nerve injury with poorly understood pathophysiology involving fascicular escape and scarring [22].

Complications

Nerve palsy: Most diagnoses of distal peripheral neuropathy following shoulder surgery likely represent previously asymptomatic disease rather than surgical injuries [4]. Brachial plexus blockade causes subtle subclinical decreases in sensibility at short-term follow-up, without any clinically relevant manifestations [27]. Temporary or permanent interference with intraneural microcirculation may cause disturbances in nerve function [64]. Outcomes for nerve repair utilizing processed nerve allografts are comparable to nerve autograft and exceed those for nerve conduit in historical and registry controls [15]. Follow-up time and age significantly influence the outcome following nerve repair, with significant improvements in the total score seen throughout the follow-up period [23]. Young children show better sensory recovery and are less likely to develop long-term chronic neuropathic pain syndromes than adults following nerve injury [26]. Greater cold intolerance is associated with worse sensory function in peripheral nerve injuries [29]. Isolated anterior interosseous nerve (AIN) palsy in patients with a history of allergic disease should prompt consideration of spontaneous AIN palsy complicated with primary systemic vasculitis to initiate early systemic immunotherapy [30].

Other Considerations: A unique and common protocol for the treatment of hand neuropathy in cyclists is lacking [1]. Patients with various compressive neuropathies in the upper extremity have heterogeneous demographics, suggesting different etiologies [2]. Study findings could better define conservative interventions for the treatment of chemotherapy-induced peripheral neuropathy [3]. Charcot neuroarthropathy of the hand is rare but may develop after central or peripheral neurological disorders [6]. Nontraumatic pathologic conditions of the upper extremity, such as neuropathy, can have a profound effect on function and quality of life [9]. The best treatment for neuralgic amyotrophy remains unknown, though early corticosteroid therapy may shorten the duration of active symptoms and hasten recovery [14]. Neuromuscular impairments in focal hand dystonia and upper extremity compression neuropathies are distinguishable through differences in patient history, clinical presentation, and physical examination findings [17]. The possibility of migration of a retained foreign body should be considered when there is a history of penetrating injury and progressive neuropathy in the upper extremity [70].

Recovery

Light activity (weeks): Evidence does not specify a distinct week range for light activity or return to desk work in the provided literature. However, brachial plexus blockade causes subtle subclinical decreases in sensibility at short-term follow-up without clinically relevant manifestations [27].

Full activity (months): The literature does not define a specific month range for full activity or sport return. Outcomes for nerve repair utilizing processed nerve allografts are comparable to nerve autograft and exceed those for nerve conduit in historical and registry controls [15]. Follow-up time and age significantly influence the outcome following nerve repair, with significant improvements in the total score seen throughout the follow-up period [23].

Complete recovery / outcome plateau (months): Patient age is the most important prognostic factor for nerve recovery [8]. Young children show better sensory recovery following nerve injury compared to adults and are less likely to develop long-term chronic neuropathic pain syndromes [26]. A shorter time to presentation leads to improved sensory recovery in combat-sustained peripheral nerve injuries [72]. Greater cold intolerance is associated with worse sensory function after peripheral nerve repair or decompression [29].

Rehabilitation protocol: No specific rehabilitation protocols, immobilisation durations, or weight-bearing progressions are detailed in the evidence base. In cases of peripheral nerve localization where a clear cleavage plane is absent, management should consist of simple nerve decompression followed by biopsy and adequate prolonged follow-up [7].

Functional milestones: Nontraumatic pathologic conditions of the upper extremity, such as neuropathy, can have a profound effect on function and quality of life [9]. Most diagnoses of distal peripheral neuropathy after shoulder surgery likely represent previously asymptomatic disease rather than surgical injuries [4].

Other Considerations: A unique and common protocol for the treatment of hand neuropathy in cyclists is lacking despite a range of available treatments [1]. Conservative interventions for chemotherapy-induced peripheral neuropathy require further definition [3]. The best treatment for neuralgic amyotrophy remains unknown, though early corticosteroid therapy may shorten the duration of active symptoms and hasten recovery [14]. Isolated anterior interosseous nerve (AIN) palsy in patients with a history of allergic disease should prompt consideration of spontaneous AIN palsy complicated with primary systemic vasculitis to initiate early systemic immunotherapy [30].

Key Evidence

  • [L4] Despite the range of treatment available for peripheral neuropathies, a unique and common protocol is lacking on this specific topic. (10.1016/j.jht.2021.11.003)
  • [L3] The demographics of patients with various compressive neuropathies were not homogeneous, suggesting different etiologies. (10.1177/15589447221107701)
  • [L4] Study findings could better define conservative interventions for treatment of chemotherapy induced peripheral neuropathy. (10.1016/j.jht.2017.11.033)
  • [Letter] Most diagnoses of distal peripheral neuropathy after shoulder surgery likely represent previously asymptomatic disease rather than surgical injuries, as the surgery is likely coincidental or merely brings the problem to the patient's attention. (10.1016/j.jse.2015.03.020)
  • [L5] The book is an admirable companion for anyone concerned with the fundamentals of diagnosis of peripheral-nerve injuries. (10.2106/00004623-195436040-00035)
  • [L4] CNA of the hand is rare but may develop after central or peripheral neurological disorders. (10.1186/s12891-022-05502-7)
  • [L4] In case of peripheral nerve localization and when a clear cleavage plane is absent, the correct management should be simple nerve decompression followed by biopsy, along with an adequate and prolonged follow-up period. (10.1177/1558944719828008)
  • [Case_report] Symptomatic neural loops are a rare, diagnostic challenge and diagnosis of exclusion; clinicians must be aware of this anatomic variation and consider microvascular decompression if other etiologies are absent. (10.1016/j.jhsa.2012.07.012)
  • [L3] A diagnosis of ulnar nerve compression merits a comprehensive workup by the treating surgeon and a high suspicion for concomitant median nerve compression. (10.1177/1558944718813669)
  • [L4] Peripheral neuropathy due to direct nerve infiltration of tubercular infection is unusual yet must be taken into consideration in such cases. (10.1016/j.jhsa.2023.02.002)
  • [L2] These findings suggest the applicability of cannabis-based medicines for peripheral neuropathy. (10.1016/j.jhsa.2024.09.015)
  • [L5] The best treatment for neuralgic amyotrophy remains unknown, though early corticosteroid therapy may shorten the duration of active symptoms and hasten recovery. (10.1016/j.jhsa.2010.09.010)
  • [L3] Outcomes are comparable to nerve autograft and exceed those for nerve conduit in historical and registry controls. (10.1016/j.jhsa.2015.06.016)
  • [L4] The diagnosis of Charcot neuroarthropathy of the knee is rare and requires early diagnosis. (10.1186/s12891-019-2873-9)
  • [L5] Neuromuscular impairments in focal hand dystonia and upper extremity compression neuropathies are distinguishable through differences in patient history, clinical presentation, and physical examination findings, which should guide accurate diagnosis and therapeutic intervention. (10.1016/j.jht.2008.12.004)
  • [L5] This narrative review discusses multidisciplinary strategies for treating painful mononeuropathies, addressing four pillars: diagnosing the condition, clinical pain phenotyping, personalized pain treatment, and using a multidisciplinary team approach to overcome the limitations of monodisciplinary interventions. (10.1177/17531934241240389)
  • [L4] This study indicates that neuropathy can be a comorbid condition in Pompe disease, emphasizing the importance of screening for this disabling condition. (10.1186/s12891-024-08220-4)
  • [Case_report] Adequate clinical diagnosis through predominantly motor symptoms and electroneuromyography alterations can allow for early decompression with good postoperative functional outcomes. (10.1177/1558944721990779)
  • [L5] The painful neuroma is a debilitating sequela of nerve injury with poorly understood pathophysiology involving fascicular escape and scarring; treatment must be tailored to the individual patient as there are a number of approaches available. (10.1016/j.jhsa.2009.12.019)
  • [L3] Follow-up time and age significantly influence the outcome following nerve repair, with significant improvements in the total score seen throughout the follow-up period. (10.1054/jhsb.2001.0567)
  • [L5] This review summarizes treatment options for peripheral nerve injuries with current techniques and concepts, covering developments in research and clinical application including tolerance induction, cell-based supportive therapies, and bioengineering of nerve conduits. (10.1155/2016/4175293)
  • [L5] Successful results following revision neurectomy range from 60% to 80%. (10.5435/00124635-200808000-00016)
  • [L3] Young children show better sensory recovery and are less likely to develop long-term chronic neuropathic pain syndromes than adults following nerve injury. (10.1177/1753193408087029)
  • [L2] Brachial plexus blockade causes subtle subclinical decreases in sensibility at short-term follow-up, without any clinically relevant manifestations. (10.1177/1558944716650411)
  • [L5] A comprehensive and individualized treatment plan is crucial for optimizing patient outcomes with painful neuromas. (10.5435/jaaos-d-24-00581)
  • [L3] Greater cold intolerance is associated with worse sensory function in peripheral nerve injuries. (10.1177/1753193419881081)
  • [L4] The authors suggest that isolated AIN palsy in patients with a history of allergic disease should prompt consideration of spontaneous AIN palsy complicated with primary systemic vasculitis to initiate early systemic immunotherapy. (10.1016/j.jhsa.2016.12.005)
  • [L3] Our kinematic and clinical measurements objectively and quantitatively evaluate skilled hand function in individuals with CIPN in clinical settings. (10.1016/j.jht.2017.06.003)
  • [L5] Conservative treatment may be efficacious for ulnar neuropathy at the elbow but lacks evidence from randomized, controlled trials. (10.1258/ht.2011.011007)
  • [L3] A comprehensive, conservative treatment program has a positive and lasting effect on pain and disability scores in patients with non-radicular PNP. (10.1016/j.jht.2014.02.003)
  • [L5] The intrinsic hand muscles have MEPs at consistent distances from bony landmarks both dorsally and volarly. (10.1016/j.jhsa.2020.04.019)
  • [L4] Revision procedures result in pain relief and paresthesia reduction in approximately 75% of patients, but results are inferior compared with primary procedures. (10.1016/j.jhsa.2018.03.057)
  • [L4] Optimal outcomes in older patients are associated with early surgical intervention, strategic use of nerve transfers to shorten regeneration distances, and realistic patient expectations. (10.1016/j.jhsa.2025.07.013)
  • [L4] The falling incidence has implications for the provision of specialist services providing management of OBPI, since the small numbers of cases who may benefit from early nerve repair or secondary surgery, may be insufficient to acquire and maintain expertise. (10.1177/17531934231166824)
  • [L5] Recent advances in bioengineered drug delivery systems enable local FK506 delivery to promote peripheral nerve regeneration while circumventing systemic adverse effects. (10.1016/j.jhsa.2020.03.018)
  • [Paper] NTP may be effective for not only chronic pain but also peripheral nerve regeneration. (10.1016/j.jhsa.2017.06.023)
  • [L4] The authors recommend microneurolysis as a treatment option for patients with chronic neuralgic amyotrophy who have failed to improve with nonsurgical treatment. (10.1016/j.jhsa.2020.07.015)
  • [L4] Few patients were successfully managed with nonoperative activity modification and physical therapy. (10.1016/j.jhsa.2023.12.013)
  • [Case_report] The recommended treatment of choice is amputation, and when this is not feasible, radical local excision. (10.2106/00004623-197557050-00025)
  • [L4] Sensory relearning is an integral component of rehabilitation for patients with nerve-related pathologies, and the study provides the first step to formulation of a definition of sensory relearning. (10.1016/j.jht.2011.06.006)
  • [L5] An increased understanding of the complexities of brain plasticity will translate into enhanced treatment opportunities for the clinician to optimize hand function. (10.1016/j.jht.2012.12.009)
  • [L4] To the best of our knowledge, this is the first study showing that shoulder position changes the ulnar nerve strain around the elbow in living patients with CubTS. (10.1016/j.jse.2015.01.014)
  • [L5] There is a need for more detailed classification systems and agreed outcome measures to facilitate comparison of outcomes in the absence of high-level evidence. (10.1177/17531934251397218)
  • [L1] This study confirms that scores on the DASH questionnaire reflect the clinical staging of ulnar neuropathy at the elbow. (10.1016/j.jse.2009.02.010)
  • [L4] Responsiveness statistics showed that the I-HaND can detect change over 3 months and discriminate between improvers and non-improvers. (10.1177/1753193418780554)
  • [L3] Increased ulnar nerve cross-sectional area correlates with motor nerve conduction velocity decrease but poorly predicts axonal loss. (10.1177/15589447221127334)
  • [L2] Electrodiagnostic tests provide significantly more information than ultrasonography regarding the condition and function of the nerve. (10.1177/1753193413489046)
  • [L5] The diagnosis and treatment of neurogenic thoracic outlet syndrome (NTOS) remains an area of controversy with varying criteria and techniques among surgeons. (10.1177/17531934251361644)
  • [L3] We recommend a high index of suspicion and monitoring patients with progressive loss of elbow motion and end-range pain for evidence of subclinical ulnar neuritis. (10.1177/0363546514540448)
  • [L4] Nerve grafting for high radial nerve injury achieved relatively good wrist extension but poor thumb extension and is affected by certain prognostic factors. (10.1177/17531934221147651)
  • [L4] This study provides an explanatory theory on the adaptive process following a hand nerve disorder which may inform future patient-therapist interactions. (10.1016/j.jht.2017.10.015)
  • [L5] The article reviews the structure and function of intraneural microvessels and the pathophysiology of intraneural edema, emphasizing that temporary or permanent interference with intraneural microcirculation may cause disturbances in nerve function. (10.2106/00004623-197557070-00011)
  • [L4] In lower-type injuries of the brachial plexus, transfer of median nerve branches that innervate the palm of the hand to the ulnar proper digital nerve of the little finger predictably restored protective sensation on the ulnar side of the hand. (10.1016/j.jhsa.2012.02.047)
  • [L4] The technique improves recovery of hand motor function and allows recovery of sensory fibers when combined with treating the proximal lesion. (10.1186/s12891-024-07650-4)
  • [L3] By measuring UNCSA with MRI or US at 1 cm proximal to the medial epicondyle, patients with and without ulnar neuropathy at the elbow could be discriminated at a cutoff threshold of 11.0 mm2 with high sensitivity, specificity, and reliability. (10.1016/j.jhsa.2018.02.022)
  • [L3] Ulnar nerve MNCV at the upper arm should be measured alongside routine assessment of MNCV at the elbow and forearm, especially in clinically severe cases considering surgery. (10.1177/17585732241293360)
  • [L4] The possibility of migration of a retained foreign body should be considered when there is a history of penetrating injury and progressive neuropathy in the upper extremity. (10.1177/1753193411412149)
  • [L4] Multiple aberrant connections between the median and ulnar nerves occur frequently in various combinations, with positive and negative associations between variations that may explain unusual clinical findings related to nerve conduction after injuries. (10.1177/1753193415622760)
  • [L4] Although timely referral does not occur for most CSPNIs, a shorter time to presentation also led to improved sensory recovery. (10.1016/j.jhsa.2020.08.004)

See Also

References

[1] Preventive strategies, exercises and rehabilitation of hand neuropathy in cyclists: A systematic review. Journal of Hand Therapy. 2022. DOI: 10.1016/j.jht.2021.11.003

[2] Demographics of Common Compressive Neuropathies in the Upper Extremity. HAND. 2022. DOI: 10.1177/15589447221107701

[3] Home Intervention for Chemotherapy Induced Peripheral Neuropathy, Sensorimotor Program. Journal of Hand Therapy. 2018. DOI: 10.1016/j.jht.2017.11.033

[4] Regarding “Distal peripheral neuropathy after open and arthroscopic shoulder surgery: an under-recognized complication”. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.03.020

[5] Peripheral Nerve Injuries. Principles of Diagnosis. Ed. 2. Webb Haymaker, M.D., and Barnes Woodhall, M.D. Philadelphia, W. B. Saunders Company, 1953. $7.00. The Journal of Bone & Joint Surgery. 1954. DOI: 10.2106/00004623-195436040-00035

[6] Case series on the Charcot neuroarthropathy in hands after cervical central cord syndrome. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05502-7

[7] Sleeve-Shaped Neurothekeoma of the Ulnar Nerve: A Unique Case of a Still Unclear Pathological Entity. HAND. 2019. DOI: 10.1177/1558944719828008

[8] Chapter 28 Nerve Injuries and Nerve Transfers. 2019.

[9] Chapter 31 Neuropathies, Vascular Conditions: Buerger’s, Raynaud’s; Degenerative Conditions. 2020.

[10] Symptomatic Neural Loop Causing Hemidigital Anesthesia: Case Report. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.07.012

[11] The Association Between Concomitant Ulnar Nerve Compression at the Elbow and Carpal Tunnel Syndrome. HAND. 2018. DOI: 10.1177/1558944718813669

[12] Peripheral Tubercular Neuritis. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.02.002

[13] The Use of Cannabinoids in the Treatment of Peripheral Neuropathy and Neuropathic Pain: A Systematic Review. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.015

[14] Neuralgic Amyotrophy: Parsonage-Turner Syndrome. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.09.010

[15] Evaluating Nerve Repair Outcomes in Upper Extremity Nerve Injuries Utilizing Processed Nerve Allografts, Tube Conduit, and Nerve Autograft. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.06.016

[16] Charcot neuroarthropathy of the knee due to idiopathic sensory peripheral neuropathy. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2873-9

[17] Clinical Relevance of Neuromuscular Findings and Abnormal Movement Patterns: A Comparison between Focal Hand Dystonia and Upper Extremity Entrapment Neuropathies. Journal of Hand Therapy. 2009. DOI: 10.1016/j.jht.2008.12.004

[18] Multidisciplinary strategies to treat painful mononeuropathies in the upper extremity: from lab to bedside. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241240389

[19] Sensory neuropathy in patients with Pompe disease: a case series in Iran. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-08220-4

[20] Chapter 117 Neurologic Disorders of the Foot and Ankle. 2019.

[21] Isolated Compression of the Recurrent Motor Branch of the Median Nerve: A Case Report. HAND. 2022. DOI: 10.1177/1558944721990779

[22] Neuromas of the Hand and Upper Extremity. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2009.12.019

[23] The Long Term Recovery Curve in Adults after Median or Ulnar Nerve Repair: A Reference Interval. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2001.0567

[24] The Role of Current Techniques and Concepts in Peripheral Nerve Repair. Plastic Surgery International. 2016. DOI: 10.1155/2016/4175293

[25] Morton Neuroma: Primary and Secondary Neurectomy. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200808000-00016

[26] Age-Dependent Development Of Chronic Neuropathic Pain, Allodynia and Sensory Recovery after Upper Limb Nerve Injury in Children. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408087029

[27] Brachial Plexus Blockade Causes Subclinical Neuropathy. HAND. 2016. DOI: 10.1177/1558944716650411

[28] Current Concepts of the Management of Painful Traumatic Peripheral Nerve Neuromas. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00581

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[30] Low Median Nerve Palsy as Initial Manifestation of Churg-Strauss Syndrome. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2016.12.005

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