Skip to main content Accessibility help
×
Home
Hostname: page-component-7ccbd9845f-6pjjk Total loading time: 0.274 Render date: 2023-02-01T05:07:26.014Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true
This chapter is part of a book that is no longer available to purchase from Cambridge Core

6 - Examination of the peripheral nerves in the hand and upper limb

John E. D. Wright
Affiliation:
Chesterfield Royal Hospital
L. Chris Bainbridge
Affiliation:
Royal Derby Hospital
Nick Harris
Affiliation:
Department of Orthopaedic Surgery, Leeds General Infirmary
Fazal Ali
Affiliation:
Department of Orthopaedic Surgery, Chesterfield Royal Hospital
Mark D. Miller
Affiliation:
James Madison University, Virginia
Get access

Summary

Introduction

Productive examination of the peripheral nerves in the upper limb is based on a comprehensive knowledge of the anatomy of the brachial plexus and the course of the nerves as they pass distally. Examination of the terminal components of the nerves informs us of the proximal pathology. Knowledge of dermatomal and specific sensory nerve cutaneous supply is essential (Figure 6.1).

Examination is guided by a full history. Hand dominance, main occupation, hobbies and past injuries or neurological disorders should be documented, as well as the patient’s age. Age significantly affects both the quality and quantity of nerve recovery following injury. It is better in children and young adults; the rate of nerve regeneration in children is 2–3 mm per day, compared with 1–2 mm in adults.

The nature of the injury, e.g. knife or hydraulic press, should be clearly documented, as this will have a profound impact on the results of nerve surgery. In the elective situation, localization of the site of injury along the course of the nerve may be comparatively difficult. However, enquiry should be made about previous injuries or operations in the upper limb. The timing of injury or the evolution and duration of a compressive neuropathy are important. For example, if the duration of carpal tunnel compression symptoms is less than 10 months, there is a significant chance of recovery utilizing conservative measures.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kaplan, SJ, Glickel, SZ, Eaton, RG. Predictive factors in the non-surgical treatment of carpal tunnel syndrome. J Hand Surg (Br) 1990;15:106–108.CrossRefGoogle ScholarPubMed
Kiloh, LG, Nevin, S. Isolated neuritis of the anterior interosseous nerve. Br Med J 1952;1(4763):850–851.CrossRefGoogle ScholarPubMed
Paley, D, McMurtry, RY. Median nerve compression test in carpal tunnel syndrome diagnosis reproduces signs and symptoms in affected wrist. Orthop Rev 1985;14:411.Google Scholar
Durkan, JA. A new diagnostic test for carpal tunnel syndrome. J Bone Joint Surg (Am) 1991;73:535–538.CrossRefGoogle ScholarPubMed
Gilliat, RW, Wilson, TG. A pneumatic-tourniquet test in the carpal-tunnel syndrome. Lancet 1953;265(6786):595–597.CrossRefGoogle Scholar
Sarhadi, NS, Korday, SN, Bainbridge, LC. Radial tunnel syndrome: diagnosis and management. J Hand Surg (Br) 1998;23:617–619.CrossRefGoogle ScholarPubMed
Dellon, AL, Mackinnon, SE. Radial sensory nerve entrapment in the forearm. J Hand Surg (Am) 1986;11:199–205.CrossRefGoogle ScholarPubMed
Lloyd, N, Sammut, D. The rectangular palm sign in ulnar nerve paralysis. Eur J Plastic Surg 2012;35(7):569–570.CrossRefGoogle Scholar
Leibovic, SJ, Hastings, H. Martin–Gruber revisited. J Hand Surg (Am) 1992;17:47–53.CrossRefGoogle ScholarPubMed
Birch, R, Bonney, G, Wynn-Parry, C B (eds). Surgical Disorders of the Peripheral Nerves. Edinburgh: Churchill Livingstone, 1998.Google Scholar
Dawson, D, Hallett, M, Millender, L. Entrapment Neuropathies. Boston: Little, Brown, 1990.Google Scholar
Gelberman, R (ed). Operative Nerve Repair and Reconstruction. Philadelphia: Lippincott, 1991.Google Scholar
The Guarantors of Brain. Aids to the Examination of the Peripheral Nervous System. London: Baillière Tindall, 1986.
Wolfe, SW, Hotchkiss, RN, Pederson, WC, Kozin, SH. Green’s Operative Hand Surgery, 6th edition. Amsterdam: Elsevier, 2010.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×