Compressive Neuropathy in the Upper Extremity: Pathophysiology, Diagnosis, and Treatment.

Abstract

Background: Compressive neuropathy in the upper extremity is a common and often debilitating condition that significantly impacts function and quality of life. Despite its prevalence, the diagnosis, and management of compressive neuropathies remain complex with promising innovations. Plastic surgeons play a critical role in both surgical and nonsurgical interventions for these conditions.

Methods: This comprehensive review synthesizes current literature on the pathophysiology, diagnostic evaluation, and management strategies for upper extremity compressive neuropathies, including carpal tunnel syndrome, cubital tunnel syndrome, and radial tunnel syndrome. We explore the underlying mechanisms of nerve compression, key anatomical considerations, and advancements in diagnostic modalities, including electrodiagnostic studies, ultrasound, and magnetic resonance neurography.

Diagnosis and management: A thorough clinical evaluation is critical in diagnosing compressive neuropathies, incorporating a detailed patient history, physical examination, and provocative maneuvers (ie, Tinel's sign, Phalen's maneuver, and the Durkan test) is essential to the workup. Electrodiagnostic studies, including electromyography and nerve conduction studies, remain first-line diagnostic tools, aiding in localization and severity assessment. Advanced imaging modalities, such as magnetic resonance neurography and diffusion tensor imaging, offer enhanced visualization of nerve pathology and may play an increasing role in diagnosis.Management strategies range from conservative interventions-including activity modification, splinting, nerve gliding exercises, and corticosteroid injections-to surgical decompression in cases of persistent symptoms or progressive functional decline. Emerging techniques, such as endoscopic decompression and ultrasound-guided carpal tunnel release, provide promising outcomes with reduced morbidity.

Conclusions: Advancements in diagnostic and therapeutic approaches continue to improve outcomes for patients with upper extremity compressive neuropathies. Plastic surgeons remain integral to the multidisciplinary care of these conditions, particularly in complex cases requiring surgical intervention. Future research should focus on optimizing minimally invasive techniques and enhancing early diagnostic capabilities through novel imaging modalities and artificial intelligence applications.