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

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

Publisher: Cambridge University Press
Print publication year: 2014

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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

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