Upper limb nerve decompression

Our hand is a very important part of our body used to perform practically all activities. Any injury to the hand has a huge impact on our daily functioning. In the case of the hand and wrist, fractures, dislocations, tendon and nerve injuries are among the most frequent reasons for visiting an orthopedist.

Neuropathyis a medical condition affecting the nerves – structures that transmit impulses to different parts of the body outside the brain and spinal cord. The most common neuropathies in the upper limb include carpal tunnel syndrome and ulnar nerve neuropathy at the level of the ulnar nerve groove.

Symptoms of ulnar nerve neuropathy include sensory disturbances in the fourth and fifth fingers; forearm and outer part of the hand. Muscle weakness affects the knuckle of the little finger, the intercostals muscles, some of the knuckle muscles and part of the knuckle muscles of the thumb. As a result, the stabilisation of the fingers during grasping may be impaired and it may be difficult to manipulate objects.

The ulnar nerve groove is located on the posterior surface of the medial epicondyle of the humerus. The ulnar nerve is located in a narrow bone groove and covered by the medial collateral ligament. The ulnar nerve groove syndrome is most commonly seen in athletes performing javelin throw and shot put. Unnaturally increased tension of the ulnar nerve occurs during forced elbow valgus or elbow flexion before the throw

Symptoms of median nerve compressioninclude burning; numbness and pain in the palm of the thumb; second and third fingers; and half of the fourth finger on the thumb side. Entrapment of the nerve can occur in the carpal tunnel or between muscles in the upper part of the forearm.

The carpal tunnelis a bony and fibrous canal bounded from below by a series of bones and from above by the transverse carpal ligament. The median nerve and tendons of finger flexor muscles run through the canal. The presence of inflammation in the course of tendinitis, post-traumatic oedema or fibrosis of the transverse carpal ligament narrows the space in which the median nerve runs.

Another cause of compression of the median nerve may be its conflict with muscles or fascia in the upper forearm. To diagnose neuropathy at this level provocative tests can be performed:

• Resistant forearm rotationwith simultaneous elbow extension – nerve entrapment between the two heads of the hamstring muscle,
• Resistant tension of the biceps with flexion and inversion of the forearm – compression of the median nerve under the fibrous band, which is an extension of the biceps muscle tendon,
• Resistant flexion of the third finger– entrapment of the median nerve by the arch of the superficial flexor muscle of the fingers.

Nerve release surgery is usually performed using the classic openmethod, which requires making a 2-3cm incision on the palm of the wrist or a few centimetres incision along the course of the nerve at the elbow. Such an incision allows a precise assessment of the nerve area and precise excision of the tissues causing the conflict. The wound is closed with sutures, which are removed 10-14 days after the surgery.

The patient can be discharged home already on the day of the procedure. The patient is given recommendations concerning the care and position of the operated limb. Until the stitches are removed, limited movements should be performed, whereas after the stitches are removed it is important to mobilise the post-operative scar in order to avoid connective tissue adhesions and to achieve a good cosmetic effect, i.e. reduction of the scar’s visibility.

The patient should perform exercises to mobilise the nerve – initially under the supervision of a physiotherapist, and later continued by the patient on their own. In the period of several weeks after the surgery excessive overloading of the operated limb should be avoided. It is advisable to carry out safe exercises recommended by the physiotherapist, which are designed to gradually restore the mobility of the elbow and wrist joint, and to restore the muscle strength of the hand. Only after the hand function has been fully restoredcan you return to work or sports.