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

Gerrit Freund; Manuel Dafotakis; Jörg Bahm; Justus P. Beier

doi:10.1055/a-1498-3197

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

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

¹Department of Plastic, Hand and Burns Surgery, RWTH Aachen University Hospital, Aachen, Germany

,

Manuel Dafotakis

²Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany

,

Jörg Bahm

³Department of Plastic, Hand and Burns Surgery, Section for Brachial Plexus Surgery, RWTH Aachen University Hospital, Aachen, Germany

,

Justus P. Beier

¹Department of Plastic, Hand and Burns Surgery, RWTH Aachen University Hospital, Aachen, Germany

› Author Affiliations

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

Full Text

References

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