Download PDF
Z Orthop Unfall 2023; 161(02): 182-194
DOI: 10.1055/a-1498-3197
Review/Übersicht

Treatment of Peripheral Nerve Compression Syndromes of the Upper Extremities: a Systematic Review

Article in several languages: English | deutsch
Gerrit Freund
1   Department of Plastic, Hand and Burns Surgery, RWTH Aachen University Hospital, Aachen, Germany
,
Manuel Dafotakis
2   Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany
,
Jörg Bahm
3   Department of Plastic, Hand and Burns Surgery, Section for Brachial Plexus Surgery, RWTH Aachen University Hospital, Aachen, Germany
,
Justus P. Beier 
1   Department of Plastic, Hand and Burns Surgery, RWTH Aachen University Hospital, Aachen, Germany
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Nerve compression syndromes are referred to as chronic irritation or pressure palsies of peripheral nerves in areas of preformed anatomical constriction. Carpal tunnel syndrome is the most common nerve compression syndrome, followed by cubital tunnel syndrome. In addition, less frequent nerve compression syndromes of the upper extremities that affect the median, ulnar or radial nerves have been described. This review provides an overview of current treatment options for nerve compression syndromes of the upper extremities.

Study Design Systematic overview.

Methods Based on established national (AWMF) and international guidelines as well as the Cochrane Library, we performed a systematic literature search on PubMed (NLM), focusing on randomised controlled trials.

Results Over the research period (2012 – 2020), there were 43 randomised trials that investigated surgical carpal tunnel release methods, 68 that compared different conservative therapies and 12 that compared surgical versus conservative treatments. Furthermore, eight studies analysed surgical techniques and four analysed conservative techniques for cubital tunnel syndrome. No randomised trials were conducted on the less common peripheral nerve compression syndromes, but case reports and observational studies were conducted.

Conclusion For carpal and cubital tunnel syndromes, there are evidence-based diagnostic methods as well as therapeutic recommendations based on randomised and controlled trials. When diagnosis is made after clinical examination and supported by radiological and electrophysiological evaluation, surgical treatment is considered superior to conservative treatment. In particular, excellent long-term results can be achieved by surgery for carpal and cubital tunnel syndromes. More controlled studies are needed to establish evidence-based therapeutic recommendations for the less common nerve compression syndromes, which are somewhat controversially and inconsistently defined.

Key words

Cubital tunnelsyndrom nerve compression syndrome - carpal tunnel syndrome - cubital tunnel syndrome


Publication History

Article published online:
14 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References/Literatur

  • 1 Assmus H, Antoniadis G, Bischoff C. et al. [Diagnosis and therapy of carpal tunnel syndrome–guideline of the German Societies of Handsurgery, Neurosurgery, Neurology, Orthopaedics, Clinical Neurophysiology and Functional Imaging, Plastic, Reconstructive and Aesthetic Surgery, and Surgery for Traumatology]. Handchir Mikrochir Plast Chir 2007; 39: 276-288
    PubMedGoogle Scholar
  • 2 Taser F, Deger AN, Deger H. Comparative Histopathological Evaluation of Patients with Diabetes, Hypothyroidism and Idiopathic Carpal Tunnel Syndrome. Turk Neurosurg 2017; 27: 991-997
    PubMedGoogle Scholar
  • 3 OʼConnor D, Page MJ, Marshall SC. et al. Ergonomic positioning or equipment for treating carpal tunnel syndrome. Cochrane Database Syst Rev 2012; (01) CD009600
    PubMedGoogle Scholar
  • 4 Neubrech F, Gentzsch T, Kotsougiani D. et al. [Prevalence and Co-prevalence of Complex Regional Pain Syndrome (CRPS) and Carpal Tunnel Syndrome (CTS) in Hand Rehabilitation]. Handchir Mikrochir Plast Chir 2016; 48: 136-142
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Schulte-Mattler W, Bischoff C. [Neurography]. Klin Neurophysiol 2019; 50: 141-142
    PubMedGoogle Scholar
  • 6 Cartwright MS, Hobson-Webb LD, Boon AJ. et al. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve 2012; 46: 287-293
    CrossrefPubMedGoogle Scholar
  • 7 Choi GH, Wieland LS, Lee H. et al. Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome. Cochrane Database Syst Rev 2018; (12) CD011215
    PubMedGoogle Scholar
  • 8 Vasiliadis HS, Georgoulas P, Shrier I. et al. Endoscopic release for carpal tunnel syndrome. Cochrane Database Syst Rev 2014; (01) CD008265 DOI: 10.1002/14651858.CD008265.pub2.
    CrossrefPubMedGoogle Scholar
  • 9 Scholten RJPM, Mink van der Molen A, Uitdehaag BM. et al. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev 2007; (04) CD003905 DOI: 10.1002/14651858.CD003905.pub3.
    CrossrefPubMedGoogle Scholar
  • 10 Verdugo RJ, Salinas RA, Castillo JL. et al. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev 2008; (04) CD001552 DOI: 10.1002/14651858.CD001552.pub2.
    CrossrefPubMedGoogle Scholar
  • 11 Jarvik JG, Comstock BA, Kliot M. et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet 2009; 374: 1074-1081
    CrossrefPubMedGoogle Scholar
  • 12 Oh WT, Kang HJ, Koh IH. et al. Morphologic change of nerve and symptom relief are similar after mini-incision and endoscopic carpal tunnel release: a randomized trial. BMC Musculoskelet Disord 2017; 18: 65
    CrossrefPubMedGoogle Scholar
  • 13 Gumustas SA, Ekmekci B, Tosun HB. et al. Similar effectiveness of the open versus endoscopic technique for carpal tunnel syndrome: a prospective randomized trial. Eur J Orthop Surg Traumatol 2015; 25: 1253-1260
    CrossrefPubMedGoogle Scholar
  • 14 Michelotti B, Romanowsky D, Hauck RM. Prospective, randomized evaluation of endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome: an interim analysis. Ann Plast Surg 2014; 73 (Suppl. 02) S157-S160
    CrossrefPubMedGoogle Scholar
  • 15 Rab M, Grunbeck M, Beck H. et al. Intra-individual comparison between open and 2-portal endoscopic release in clinically matched bilateral carpal syndrome. J Plast Reconstr Aesthet Surg 2006; 59: 730-736
    CrossrefPubMedGoogle Scholar
  • 16 Kang HJ, Koh IH, Lee TJ. et al. Endoscopic carpal tunnel release is preferred over mini-open despite similar outcome: a randomized trial. Clin Orthop Relat Res 2013; 471: 1548-1554
    CrossrefPubMedGoogle Scholar
  • 17 Brown RA, Gelberman RH, Seiler 3rd JG. et al. Carpal Tunnel Release. A Prospective, Randomized Assessment of Open and Endoscopic Methods. J Bone Joint Surg Am 1993; 75: 1265-1275
    CrossrefPubMedGoogle Scholar
  • 18 Larsen MB, Sorensen AI, Crone KL. et al. Carpal tunnel release: a randomized comparison of three surgical methods. J Hand Surg Eur Vol 2013; 38: 646-650
    CrossrefPubMedGoogle Scholar
  • 19 Atroshi I, Larsson GU, Ornstein E. et al. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ 2006; 332: 1473
    CrossrefPubMedGoogle Scholar
  • 20 Atroshi I, Hofer M, Larsson GU. et al. Open compared with 2-portal endoscopic carpal tunnel release: a 5-year follow-up of a randomized controlled trial. J Hand Surg Am 2009; 34: 266-272
    CrossrefPubMedGoogle Scholar
  • 21 Atroshi I, Hofer M, Larsson GU. et al. Extended Follow-up of a Randomized Clinical Trial of Open vs. Endoscopic Release Surgery for Carpal Tunnel Syndrome. JAMA 2015; 314: 1399-1401
    CrossrefPubMedGoogle Scholar
  • 22 Gaspar MP, Osterman MN, Shin EK. et al. Sleep disturbance and response to surgical decompression in patients with carpal tunnel syndrome: a prospective randomized pilot comparison of open versus endoscopic release. Acta Biomed 2019; 90: 92-96
    PubMedGoogle Scholar
  • 23 Peters S, Page MJ, Coppieters MW. et al. Rehabilitation following carpal tunnel release. Cochrane Database Syst Rev 2016; (02) CD004158
    PubMedGoogle Scholar
  • 24 Kiloh LG, Nevin S. Isolated Neuritis Of The Anterior Interosseus Nerve. Br Med J 1952; 1: 850-851
    CrossrefPubMedGoogle Scholar
  • 25 Pham M, Bäumer P, Meinck HM. et al. Anterior interosseous nerve syndrome: fascicular motor lesions of median nerve trunk. Neurology 2014; 82: 598-606
    CrossrefPubMedGoogle Scholar
  • 26 Helfenstein Júnior M. Uncommon compressive neuropathies of upper limbs. Best Pract Res Clin Rheumatol 2020; 34: 101516 DOI: 10.1016/j.berh.2020.101516.
    CrossrefPubMedGoogle Scholar
  • 27 Kómár J. Latenzbestimmungen am N. interosseus anterior. EEG EMG Z Elektroenzephalogr Elektromyogr Verwandte Geb 1988; 19: 75-76
    PubMedGoogle Scholar
  • 28 Rodner CM, Tinsley BA, OʼMalley MP. Pronator syndrome and anterior interosseous nerve syndrome. J Am Acad Orthop Surg 2013; 21: 268-275
    CrossrefPubMedGoogle Scholar
  • 29 Strohl AB, Zelouf DS. Ulnar Tunnel Syndrome, Radial Tunnel Syndrome, Anterior Interosseous Nerve Syndrome, and Pronator Syndrome. J Am Acad Orthop Surg 2017; 25: e1-e10
    CrossrefPubMedGoogle Scholar
  • 30 Damert HG, Hoffmann R, Kraus A. et al. Minimally invasive endoscopic decompression for anterior interosseous nerve syndrome: technical notes. J Hand Surg Am 2013; 38: 2016-2024
    CrossrefPubMedGoogle Scholar
  • 31 Leclere FM, Bignion D, Franz T. et al. [Endoscopically assisted decompression of the median nerve in the pronator and Kiloh-Nevin syndrome: Surgical technique]. Neurochirurgie 2014; 60: 170-173
    CrossrefPubMedGoogle Scholar
  • 32 Seyffarth H. Primary myoses in the M. pronator teres as cause of lesion of the N. medianus (the pronator syndrome). Acta Psychiatr Neurol Scand Suppl 1951; 74: 251-254
    PubMedGoogle Scholar
  • 33 Dididze M, Tafti D, Sherman A. Pronator Teres Syndrome. Treasure Island (FL): StatPearls; 2021
    Google Scholar
  • 34 Assmus H, Bischoff C, Dumont C, Frick A, Kretschmer T, Langer M, Lautenbach M, Mailänder P, Schädel-Höpfner M, Scheglmann K, Schwerdtfeger K, Schulte-Mattler W, Wüstner-Hofmann M. S3-Leitlinie 005-009, Diagnostik und Therapie des Kubitaltunnelsyndroms. 07.02.2018. Im Internet (Stand: 01.04.2021): https://www.awmf.org/uploads/tx_szleitlinien/005-009l_S3_Kubitaltunnelsyndrom-Diagnostik-Therapie_2018-02.pdf
    PubMedGoogle Scholar
  • 35 Buchner H, Dafotakis M. Sensible Neurografie. In: Diener H-C, Steinmetz H, Kastrup O. Hrsg. Referenz Neurologie. Stuttgart: Thieme; 2019: 1128-1130
    Google Scholar
  • 36 Caliandro P, La Torre G, Padua R. et al. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev 2016; (11) CD006839
    PubMedGoogle Scholar
  • 37 Ozkan FU, Saygi EK, Senol S. et al. New treatment alternatives in the ulnar neuropathy at the elbow: ultrasound and low-level laser therapy. Acta Neurol Belg 2015; 115: 355-360
    CrossrefPubMedGoogle Scholar
  • 38 Spies CK, Schäfer M, Langer MF. et al. Functional outcome after endoscopic assisted release of the ulnar nerve for cubital tunnel syndrome: mid-to-long term results. Int Orthop 2018; 42: 1331-1337
    CrossrefPubMedGoogle Scholar
  • 39 Schmidt S, Kleist Welch-Guerra W, Matthes M. et al. Endoscopic vs. Open Decompression of the Ulnar Nerve in Cubital Tunnel Syndrome: A Prospective Randomized Double-Blind Study. Neurosurgery 2015; 77: 960-970 discussion 970–971
    CrossrefPubMedGoogle Scholar
  • 40 Geutjens GG, Langstaff RJ, Smith NJ. et al. Medial epicondylectomy or ulnar-nerve transposition for ulnar neuropathy at the elbow?. J Bone Joint Surg Br 1996; 78: 777-779
    CrossrefPubMedGoogle Scholar
  • 41 Cirpar M, Turker M, Yalcinozan M. et al. Effect of partial, distal epicondylectomy on reduction of ulnar nerve strain: a cadaver study. J Hand Surg Am 2013; 38: 666-671
    CrossrefPubMedGoogle Scholar
  • 42 Hicks D, Toby EB. Ulnar nerve strains at the elbow: the effect of in situ decompression and medial epicondylectomy. J Hand Surg Am 2002; 27: 1026-1031
    CrossrefPubMedGoogle Scholar
  • 43 Schnabl SM, Kisslinger F, Schramm A. et al. Subjective outcome, neurophysiological investigations, postoperative complications and recurrence rate of partial medial epicondylectomy in cubital tunnel syndrome. Arch Orthop Trauma Surg 2011; 131: 1027-1033
    CrossrefPubMedGoogle Scholar
  • 44 Spies CK, Low S, Langer MF. et al. [Cubital tunnel syndrome: Diagnostics and therapy]. Orthopade 2017; 46: 717-726
    PubMedGoogle Scholar
  • 45 Hoogvliet P, Coert JH, Friden J. et al. How to treat Guyonʼs canal syndrome? Results from the European HANDGUIDE study: a multidisciplinary treatment guideline. Br J Sports Med 2013; 47: 1063-1070
    CrossrefPubMedGoogle Scholar
  • 46 Wartenberg R. Cheiralgia paraesthetica. (Isolierte Neuritis des Ramus superficialis nervi radialis.). Neur u Psych 1932; 141: 145-155
    CrossrefPubMedGoogle Scholar
  • 47 Jacobson JA, Fessell DP, Da Gama Lobo L. et al. Entrapment neuropathies I: upper limb (carpal tunnel excluded). Semin Musculoskelet Radiol 2010; 14: 473-486
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Knutsen EJ, Calfee RP. Uncommon upper extremity compression neuropathies. Hand Clin 2013; 29: 443-453
    CrossrefPubMedGoogle Scholar
  • 49 Spies CK, Muller LP, Oppermann J. et al. [Surgical decompression of the superficial radial nerve: Wartenberg syndrome]. Oper Orthop Traumatol 2016; 28: 145-152
    CrossrefPubMedGoogle Scholar
  • 50 Bevelaqua A, Hayter C, Feinberg J. et al. Posterior interosseous neuropathy: electrodiagnostic evaluation. HSS J 2012; 8: 184-189
    CrossrefPubMedGoogle Scholar
  • 51 Huisstede B, Miedema HS, van Opstal T. et al. Interventions for treating the radial tunnel syndrome: a systematic review of observational studies. J Hand Surg Am 2008; 33: 72-78
    CrossrefPubMedGoogle Scholar