Uncommon Compressive Neuropathies of Upper Limb: A Case Series

Abstract

Known by different names like peripheral compressive neuropathies, tunnel syndromes, entrapment neuropathies, and so forth, over 30 clinical syndromes have been identified afflicting the peripheral nerves of upper limb. Due to the inherent dynamic nature of the compressive process the nerve pathophysiology remains in a state of flux which varies with limb position, exertion, or duration of compression. This leads to a plethora of clinical presentations, often noncharacteristic results of electrodiagnostic studies and no other standard diagnostic investigation. As a result the diagnosis and management of all compressive neuropathies except carpal tunnel syndrome remains difficult. This article presents a series of uncommon compressive neuropathies. In a tertiary care referral center, 14 cases of compression neuropathy excluding the carpal tunnel syndrome and thoracic outlet syndrome diagnosed over the past 11 years have been described. A representative case each of quadrangular space syndrome, anterior scalene syndrome, long thoracic nerve syndrome, suprascapular nerve syndrome, cubital tunnel syndrome, Guyon’s canal syndrome, posterior interosseous nerve syndrome, radial tunnel syndrome, and syndrome of superficial branch of radial nerve will be discussed including their presentation, work-up, conservative management, surgical steps, and follow-up. High index of clinical suspicion following exhaustive clinical examination was the bedrock of diagnosis. Further evaluation with nerve conduction studies (NCS), electromyography (EMG), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA)/CT angiography was mostly inconclusive. We also came across anomalies of anatomy of radial nerve during surgical exploration. The most important aid in diagnosis of rare compressive neuropathies is to be aware of the same and entertain this possibility. A thorough knowledge of anatomy and clinical examination clinches the diagnosis. Investigations may be of some assistance. Outcome after surgery is almost always gratifying