Compressive Neuropathies of the Upper Extremity: A Comprehensive Guide to Treatment

Preface
Abbreviations
Contents
Contributors
1: The Basics of Electrodiagnostic Testing Carpal Tunnel and Cubital Tunnel Syndrome
	EMG/NCV
	Conclusion
	References
2: Ultrasound Anatomy of the Median and Ulnar Nerves
	Introduction
	Imaging Technique of Peripheral Nerves
		General Requirements
		Optimization of Sonographic Imaging
		Imaging of Healthy Peripheral Nerves
	Median Nerve (C6–T1)
		Introduction
		Innervation
		Topographic Ultrasound Anatomy
			Carpal Tunnel Syndrome
	Ulnar Nerve (C7–T1)
		Introduction
		Topographic Ultrasound Anatomy
			Cubital Tunnel Syndrome
	Conclusion
	References
3: Diagnosis and Clinical Presentation of Carpal Tunnel Syndrome
	Introduction
	Clinical Presentation
	Physical Examination
	Clinical Diagnostic Tools
		EMG/NCS
		Ultrasound
	References
4: Standard Open Carpal Tunnel Release
	Open Carpal Tunnel Release
		Technique
		Open Carpal Tunnel Release with Tenosynovectomy
			Technique
		Carpal Tunnel Release Using Indiana Tome
			Technique
	Conclusion
	References
5: Carpal Tunnel Release with Two Small Cross-Aligned Incisions
	Carpal Tunnel Syndrome: Demographics and Historical Data
	Anatomy of the Carpal Tunnel and the Variations of the Median Nerve
	Surgical Techniques and Complains or Complications Following CTS Surgery
	The Mini Open Surgical Technique with Two Small Cross Aligned Incisions (TSCAI)
		Postoperative Care
		Results
		Discussion
	References
6: Endoscopic Carpal Tunnel Release
	Introduction
	Indication: Contraindications
	Surgical Technique
		Anatomy
		Positioning
		Instrumentation
		Anaesthesia
		Approach and Release of TCL
	Follow-up Protocol
	Complications
	Outcomes
	Conclusions
	References
7: Complications of Carpal Tunnel Release
	Introduction
	Classification of Carpal Tunnel Surgery Complications
	Intraoperative Complications
		Intraoperative Magnification Can Minimize Intraoperative Complications!
	Early Complications
		Inadequate Decompression of the Median Nerve
		Hematoma
		Infection
		Rare Major Early Complications
	Late Postoperative Complications
		Recurrence of Carpal Tunnel Syndrome
	New Symptoms Appearance
		Loss of Hand Grip Strength
		Tendon Complications
			Trigger Finger
			Adhesions Between Flexor Tendons
			Bowstringing of the Flexor Tendons
			Painful Scar
			Pillar Pain
			Piso-Triquetral Pain Syndrome
		Complex Regional Pain Syndrome
	Conclusions
	References
8: Revision Carpal Tunnel Surgical Options
	Etiology of Recurrent Carpal Tunnel
	Evaluation
	Principles of Surgical Treatment for Revision Carpal Tunnel Syndrome
	Techniques with Expected Outcomes
		Repeat Simple Decompression
		Synovial and Tenosynovial Flap
		Hypothenar Fat Pad Flap
		Synthetic Wraps
		Vein Wrapping
		Muscle Flaps
		Vascularized Fascial Flaps
		Remote Pedicle or Free Flaps
	Outcomes Including Comparative Studies
	References
9: Hypothenar Fat Pad Flap: Surgical Technique
	Introduction
	Anatomic Dissections and Vascular Basis for the Hypothenar Fat Pad Flap
		Surgical Technique
		Pearls
	Conclusion
	References
10: Tumors and Tumor-Like Lesions Mimicking Peripheral Neuropathies
	General Aspects
		Diagnostic Approach
		Differential Diagnosis
		Treatment
	Categorization
		Lipomatous Tumors
			Lipomas
			Nerve Lipomatosis
			Parosteal Lipomas
		Ganglion and Synovial Cysts
		Reactive and Inflammatory Lesions
			Tenosynovitis
			Neuritis Ossificans
			Inflammatory Pseudotumor of Peripheral Nerve (IPPN)
		Peripheral Nerve Sheath Tumors
			Schwannomas
			Neurofibromas
		Peripheral Nerve Compression and Malignancy
			Compression from Lymph Nodes & Peripheral Nerve Lymphomatosis
			Metastatic Disease to Brachial Plexus and Peripheral Nerves
			Soft Tissue Sarcomas
			MPNST
			Synovial Sarcoma of Nerves
	References
11: Clinical Presentation and Diagnosis of Cubital Tunnel Syndrome
	Introduction
	Presentation
	Physical Examination
	Classification
	Electrodiagnostic Studies
	Imaging
		Plain Radiographs
		Ultrasound
		MRI
	Conclusion
	References
12: In Situ Decompression of Cubital Tunnel
	Introduction
	Operative Treatment
		In Situ Decompression
	Complications
	Conclusions
	References
13: Endoscopic Ulnar Nerve Release
	Introduction
	Endoscopic Cubital Tunnel Release (Decompression of Ulnar Nerve In-Situ)
		Indications
		Contra-indications
		Surgical Techniques
			Surgical Technique Using Storz Equipment (Karl Storz, Tuttlingen, Germany) [12, 16]
			Cannula Technique (Integra LifeSciences, Plainsboro, NJ, USA) [14, 15]
			Surgical Technique Using Agee Device (3M, Orthopaedic Products, St Pauls, MN, USA) [13, 17]
		Tips and Tricks
		Postoperative Protocol
		Complications
		Results
		Current Literature
	Endoscopic Cubital Tunnel Release and Anterior Transposition
		Indications
		Contraindications
		Surgical Technique
		Tips and Tricks
		Postoperative Protocol
		Complications
		Results
		Current Literature
	Learning New Techniques
	References
14: Subcutaneous Transposition of the Ulnar Nerve
	Introduction
	Pertinent Anatomical Considerations
	Biomechanical Considerations
	Techniques of Anterior Subcutaneous Transposition
		Subcutaneous Pocket
		Fasciodermal Sling
		Fascial Sling
		Adipose Flap
		Medial Intermuscular Septal Sling
		Ligamentofascial/Ligamentodermal Sling
	Additional Considerations
	Outcomes of Anterior Subcutaneous Transposition
	Complications
	Conclusions
	References
15: Submuscular Transposition of the Ulnar Nerve
	Introduction
	Background
		History of Submuscular Transposition
		Comparative Trials
		Surgical Indications
		Submuscular Transposition of the Author’s Preferred Surgical Technique
		Outcomes
	Summary
	References
16: Minimal Medial Epicondylectomy
	Introduction
	Indications
	Surgical Technique
	Complications
	Outcomes
	Conclusion
	References
17: Revision Cubital Tunnel: Surgical Options
	Introduction
	Etiology
	Evaluation
		History
		Physical Examination
		Testing
	Management
	Surgical Techniques
		Subcutaneous Transposition
	Submuscular Transposition
	Conclusion
	References
18: Nerve Transfers for Neuropathies of the Median and Ulnar Nerve
	Introduction
	Nerve Transfer Principles
		Diagnosis
		Ulnar Nerve Compression
			Ulnar Nerve Compression Below the Elbow
			Motor SETS Transfer in Cases of Severe Lower Ulnar Compression
		Surgical Technique: AIN to Deep Ulnar Motor Branch SETS Technique
			Sensory Reconstruction
	High Ulnar Neuropathy
		Motor Reconstruction
		Sensory Reconstruction
	Median Nerve Compression
		Low Median Neuropathy
		Motor Reconstruction
		Sensory Reconstruction
	High Median Neuropathy
		Motor Reconstruction
			Sensory Reconstruction
	Summary
	References
19: Ulnar Tunnel Syndrome (Guyon Canal)
	Introduction
	Anatomy
	Pathoetiology
	Clinical Findings
	Diagnostics
	Treatment
	Summary
	References
20: Radial Tunnel Syndrome - Posterior Interosseous Nerve Compression Syndrome
	Introduction
	Anatomy
		The Radial Nerve
		The Radial Tunnel
	Etiology
	Controversy
	Physical Examination
		Radial Tunnel Syndrome
		Posterior Interosseous Nerve Compression Syndrome
	Imaging Studies
	Electrodiagnostic Testing
	Treatment
	Surgical Approaches
		Anterior Approach [84]
		Posterior Approach [85]
		Lateral Approaches
			Between BR and ECRL
			Transbrachioradialis [36] (Fig. 20.5)
		Endoscopic Assisted Methods
	Outcomes
	Conclusion
	References
21: Pronator Teres Syndrome: Anterior Interosseous Nerve Compressive Neuropathy
	Introduction
	Anatomy
		Pathoanatomy
	Clinical Manifestations
	Diagnosis
		Pronator Syndrome
		Anterior Interosseous Nerve Syndrome
		Electromyography and Nerve Conduction Studies
		Imaging Studies
	Treatment
		Nonsurgical Management
		Surgical Management
	References
22: Lateral Antebrachial Nerve Entrapment
	Lateral Antebranchial Cutaneous Neuropathy
	Anatomy
	Clinical Presentation
	Epidemiology
	Socioeconomic Effects
	Risk Factors
	Pathophysiology
	Diagnosis
	Differential Diagnosis
	Treatment
		Conservative
		Operative
	Conclusion
	References
23: Wartenberg’s Syndrome
	Introduction
	Anatomy
	Pathophysiology
	Presentation and Differential Diagnosis
	Further Investigation
		Electrodiagnostic Tests
		Ultrasound Examination
		Magnetic Resonance Imaging
	Treatment
	References
24: Thoracic Outlet Syndrome
	Anatomy
		History
	Classification
	Arterial Thoracic Outlet Syndrome
	Venous Thoracic Outlet Syndrome
	Neurogenic Thoracic Outlet Syndrome
		Diagnosis
		Physical Examination
		Adson’s Test
		Wright’s Hyperabduction Test
		Roos’ Test
		Hunter’s Test (Brachial Plexus Tension Test)
		Halsted Maneuver
		Upper Limb Tension Test of Elvey
		Diagnostic Studies
		Electrodiagnostic Testing
	Treatment
		Transaxillary Rib Resection
		Supraclavicular Rib Resection
		Anterior Scalenectomy and Brachial Plexus Neurolysis
		Combined Approach: Transaxillary Resection of the First Rib and Anterior and Middle Scalenectomy
		Treatment of Vascular Thoracic Outlet Syndrome
		Results
		Recurrent Thoracic Outlet Syndrome
	Summary
	References
25: Vein Wrapping of Peripheral Nerves: Surgical Technique
	Introduction
	Historical Perspective
	Indications
	Surgical Technique
	Outcomes
	References
26: Cervical Radiculopathy Mimicking Carpal Tunnel Syndrome
	Epidemiology
		Cervical Radiculopathy
		Carpal Tunnel Syndrome
	Etiology
		Cervical Radiculopathy
		Carpal Tunnel Syndrome
	Diagnosis
		Cervical Radiculopathy
		Carpal Tunnel Syndrome
		Electrodiagnostic Studies
	Treatment
		Cervical Radiculopathy
		Carpal Tunnel Syndrome
	Discussion
	The Double Crush Hypothesis
	Conclusion
	References
27: Suprascapular Neuropathy
	Introduction
	Anatomy
	Clinical Presentation and Exam
		Suprascapular Notch Compression
		Spinoglenoid Notch Compression
		Spinoglenoid Notch and/or Suprascapular Notch Due  to Ganglion Cyst
		Diagnostic Tests
			Radiological Imaging
			Nerve Conduction Velocity (NCV) and Electromyography (EMG)
			Diagnostic Injections
		Treatment
			Open Decompression of the Suprascapular Notch and Spinoglenoid Notch
			Arthroscopic Technique for Decompression of the Suprascapular Notch
		Arthroscopic Labral Repair with and without Ganglion Decompression
		Arthroscopic Spinoglenoid Ligament Release
		Results
	Conclusion
	References
Index