Most people have heard of carpal tunnel syndrome. What you might not know is that carpal tunnel syndrome is only one of a family of ailments in the upper limbs known as entrapment neuropathies. The other entrapment neuropathies are not as well-known in the mainstream as carpal tunnel syndrome (CTS), so often those who suffer from nerve symptoms in their forearms and hands frequently jump to conclusions without having an accurate diagnosis.
An entrapment neuropathy, also called nerve compression syndrome, occurs when a nerve is wedged or “pinched” against a bone, inflamed muscle. Aside from the median nerve (the one associated with CTS) there are two main nerves that help to control your arm and hand: the radial nerve and the ulnar nerve. Both are susceptible to compression, and the results can be painful!
Entrapment occurs under a number of conditions, most commonly:
- When there is an injury originating at your neck or a disease of the cervical spine
- When your elbow has been injured due to fractures or improper use
- When your wrist has been injured due to fractures or Guyon canal alignment problems
- An aneurysm or thrombosis in your arteries
- Factors commonly associated with peripheral neuropathy, such as diabetes, rheumatism, alcoholism, or infection
Your radial nerve runs the length of your arm, and is responsible for both movement and sensation. Radial neuropathy usually occurs at the back of the elbow, and can present itself with many of the common symptoms of neuropathy such as tingling, loss of sensation, weakness and reduced muscle control (in this case, often difficulty in turning your palm upwards with your elbow extended).
A number of palsies affect the radial nerve, such as:
- Saturday night palsy (also called Honeymooner’s palsy), where your radial nerve is compressed in your upper arm by falling asleep in a position where pressure is exerted on it by either furniture or a bed partner
- Crutch palsy, where your nerve is pinched by poorly-fitted axillary crutches
- Handcuff neuropathy, wherein tight handcuffs compress your radial nerve at your wrists
Two main conditions affect the ulnar nerve: Guyon’s canal syndrome and cubital tunnel syndrome. Guyon’s canal syndrome is almost exactly the same in symptoms as carpal tunnel syndrome (pain and tingling in the palm and first three fingers), but involves a completely different nerve. Guyon’s canal syndrome is caused by pressure on your wrists, often by resting them at a desk or workstation, and is frequently experienced by cyclists due to pressure from the handlebars.
Nearly everyone has experienced cubital tunnel syndrome: it’s the “dead arm” sensation we’ve all felt when we wake up after sleeping on top of our arm! Sleeping with your arm folded up compresses the ulnar nerve at your shoulder, causing it to effectively “cut off” feeling to your arm. As you probably know from experience, this sensation is unsettling but temporary.
Diagnosis for all compression neuropathies is fairly consistent: We’ll examine your arms for signs of neuropathy, and will likely ask you to perform several demonstrations of dexterity. If we suspect you may have an underlying condition,lab tests may be recommended. To pinpoint the specific location of a compression, we may also suggest MRI.
Similar to carpal tunnel syndrome, most cases of compression neuropathy are mild. Good self care for mild cases involves ice, rest, and a change in habits of motion or stress that are causing the symptoms. Otherwise, professional care in office as well as at home is often indicated.
If you suffer from a compression neuropathy or have questions about this or any other kind of neuropathy, call us ASAP. As with any neuropathy, don’t wait! The sooner you get an accurate diagnosis, the more conservative options for treatment you’ll have.
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