Exploring 20 years of peripheral nerve injuries of the upper extremity: An analysis of median, radial, and ulnar nerve injuries presenting to US emergency departments.

Abstract

Background: Upper extremity peripheral nerve injuries represent a significant source of patient morbidity, yet their epidemiology remains incompletely characterized.

Purpose: This study analyzes two decades of national data to provide comprehensive insights into patterns of nerve injury context/presentation.

Study design: This study employs a cross-sectional, epidemiological analysis of a national public database.

Methods: The National Electronic Injury and Surveillance System (NEISS) database was queried from 2003-2023 to identify patients presenting to the emergency department with a "nerve damage" diagnosis in the upper extremity. These injuries were subsequently delineated based on the primary nerve impacted (median, radial, ulnar). Demographic and clinical variables were analyzed using two-proportion z-tests with Bonferroni correction across these comparison groups.

Results: Analysis of 1199 cases revealed distinct patterns across nerve distributions. Radial nerve injuries occurred in significantly older patients (47.2 ± 20.0 years) compared to median (40.7 ± 18.1) and ulnar (35.5 ± 18.5) nerve injuries (p < 0.001). Gender distribution varied significantly, with females predominating in median nerve injuries (59.6%) and males in radial (71.3%) and ulnar (62.3%) nerve injuries. Activity-related mechanisms dominated median nerve injuries (96.5%), while sleeping position primarily affected radial nerves (62%), and direct trauma most commonly impacted ulnar nerves (42.9%). Hospital admission was highest for radial nerve injuries (6.1%) compared to ulnar (2.9%) and median (0.6%) nerve injuries (p = 0.010).

Conclusions: This study provides a critical overview of upper extremity peripheral nerve injuries. Ultimately, these findings can be leveraged to inform targeted preventative measures for peripheral nerve injuries and provide clinicians invaluable qualitative context for the most frequent types/mechanisms of nerve injury they will be treating.