Nerves are
- are responsible for transmitting commands from the brain to the muscles,
- and vice versa for transmitting sensory impulses to the brain (pressure, temperature, etc.).
Damage to or irritation of a nerve therefore manifests itself in these areas. Depending on the nerve, this can lead to pain, numbness or motor function disorders.
Nerve compression is not direct damage, but indicates that a nerve is constricted or pressure is exerted on it.
Many nerves pass through anatomical bottlenecks. Under certain circumstances, the passage is too narrow or the nerve passing through is too thick: the nerve can then be constricted. Pressure on the nerve can lead to nerve irritation or even nerve compression syndrome.
We explain some of these possible nerve compression syndromes below.
Carpal tunnel syndrome is the best-known nerve compression syndrome. It is caused by constriction of themedian nerve in the area of the flexor side of the wrist. The median nerve is one of the three main nerves in the hand.
This condition affects around 10 percent of adults, 70 percent of whom are women.
Causes of carpal tunnel syndrome
The carpal tunnel is a tunnel-shaped canal enclosed by connective tissue on the inside of the wrist. The flexor tendons and the median nerve to the hand run through it. In the case of carpal tunnel syndrome, the nerve is constricted.
The cause of the constriction is often congenital, but can also be due to
are the cause.
Carpal tunnel syndrome is the most common form of nerve compression syndrome © Henrie | AdobeStock
Symptoms of carpal tunnel syndrome
The typical first symptom is pain occurring at night or early in the morning(brachialgia nocturna) in the area of
- the flexor side of the thumb,
- the index finger,
- the middle finger and
- the radial half of the ring finger.
The symptoms can range from mild to severe:
- Pain in the wrist area,
- Sensory disturbances such as tingling and numbness in the palm area,
- Muscle atrophy in the area of the ball of the thumb muscles in chronic CTS.
The symptoms usually develop over a longer period of time (months or years).
Treatment of carpal tunnel syndrome
Mild forms of carpal tunnel syndrome can be treated conservatively. Immobilization of the wrist with a splint is sufficient. Anti-inflammatory drugs (diclofenac, iboprofen) are recommended to relieve the pain.
Conservative treatment rarely leads to lasting success.
Splint for carpal tunnel syndrome © SPUI - Own work, Public domain, Link
If the symptoms persist, surgery is recommended. During the operation, the connective tissue roof of the canal(retinaculum flexorum) is split. This gives the nerve more space and relieves the pressure on it.
The operation can be performed using an open surgical technique or, in rare cases, by endoscopy. However, there is a greater risk of complications with the endoscopic method. Most hand surgeons therefore favor the open procedure.
The procedure takes around 15 to 30 minutes and is usually performed on an outpatient basis. Depending on the field of activity, the patient is unable to work for a few days to several weeks. The hand can be fully used after six weeks.
With early treatment, patients have a very good prognosis. Only in very advanced stages, where the nerve is already significantly damaged, can permanent loss of function occur.
Immobilization after surgery is no longer recommended.
Loge de Guyon syndrome describes an increase in pressure on theulnar nerve in the area of the wrist on the little finger side.
Symptoms of Loge de Guyon syndrome
Symptoms are manifested by discomfort in the area of the little finger and the ring finger. Muscular weaknesses when spreading and joining the fingers can also occur.
Causes of Loge de Guyon syndrome
The Guyon's box is a constriction located in the carpal region between the pea bone and the hook bone. In addition to the ulnar nerve, the ulnar artery also runs through it.
The cause of a constriction and the resulting increase in pressure on the nerve is often aganglion in this area. The constriction can also be caused by prolonged compression during work or sport (cycling or motorcycling).
Treatment of Loge de Guyon syndrome
Conservative treatment consists of immobilization with a splint. If this is not successful, surgery is recommended. As in the treatment of carpal tunnel syndrome, the roof of the Guyon's box is split to provide more space for the ulnar nerve. This reduces the pressure on the nerve.
The operation is performed on an outpatient basis and takes about half an hour. The nerve should normally recover well in the first few weeks after the operation.
Here too, you will only be unable to work for a short time. However, the hand should not be fully loaded for several weeks.
Pronator syndrome is caused by a constriction of the median nerve in the area of the pronator teres muscle. This muscle runs on the front (flexor side) of the forearm, starting on the underside of the humerus and running diagonally across the ulna. It attaches to the middle area of the radius. It is responsible for the inward rotation of the forearm (pronation).
Symptoms of pronator syndrome
The median nerve runs through the above-mentioned muscle in a connective tissue muscle channel. If this channel is too narrow, symptoms occur such as
- Tingling of the fingers and palm,
- pain when turning the arm inwards
- and even a reduction in the muscles of the ball of the thumb.
Causes of pronator syndrome
The causes of this condition are often related to the individual's increased strain on the pronator teres muscle, which causes the muscle to enlarge and no longer provides enough space for the nerve.
Treatment of pronator syndrome
For this reason, treatment is initially conservative after diagnosis by immobilizing the arm with a splint. This reduces the muscular strain. If this does not have the desired effect, surgery is required.
During the operation, the nerve in the constricted area is exposed. The surgeon enlarges the nerve canal so that there is enough space for the nerve.
The procedure takes around 45 minutes and is performed on an outpatient basis . The patient is only unable to work for a few days and can put full weight on the arm early on.
Sulcus ulnaris syndrome is a constriction of the ulnar nerve. It manifests itself in the area of the groove on the inside of the elbow, also known as the "musician's bone".
Symptoms of sulcus ulnaris syndrome
In healthy people, irritation of the nerve occurs with strong blows to this area. In the case of constriction, the nerve is permanently irritated by certain movements of the arm.
If the nerve is damaged, the symptoms can include
- numbness in the little finger and ring finger and
- motor disorders
motor disorders.
Treatment of sulcus ulnaris syndrome
The symptoms can usually be treated conservatively by padding the affected area of the elbow. This protects the area from irritation and means it is no longer exposed to pressure.
If this does not help, an operation is performed to create more space for the nerve canal.
It is generally sufficient to relieve the nerve by splitting the roof of the elbow groove. In some cases, the nerve protrudes out of the channel during surgery (dislocation) after the roof has been split. In this case, the nerve should be moved to a protected position outside the canal.
The duration of the operation is half an hour. It can be performed either endoscopically or on an outpatient basis.
Prognosis for sulcus ulnaris syndrome
The unpleasant tingling sensation should disappear quickly. However, if the nerve has been damaged by the pinching, it can take up to a year before you are completely pain-free.
In general, immobilization is not required, and the patient may be unable to work for up to two weeks, depending on the activity.
Supinator syndrome is caused by a constriction of theradial nerve. The constriction occurs on the outside of the forearm in the area of the supinator muscle and is generally rare.
The supinator is responsible for the outward rotation (supination) of the forearm. It originates in the upper arm and elbow joint and attaches to the upper part of the radius. It is pierced by a branch of the radial nerve.
Causes of supinator syndrome
An enlargement of this muscle (hypertrophy) can lead to compression of the nerve that runs through the muscle. Sometimes, however, the causes of the compression symptoms cannot be clarified.
Symptoms of supinator syndrome
The branch of the radial nerve that runs through this muscle only innervates extensor muscles of the hand and none of the forearm. It is not responsible for sensitivity. In the event of a disease, only a weakness in the extensor and abductor muscles of the thumb occurs.
Pain can also occur. It is usually felt in the area on the outside of the forearm approx. 5 cm below the elbow. This is where the constricted passage of the nerve through the muscle is located.
Treatment of supinator syndrome
Apart from a few exceptional cases, supinator syndrome can only be treated surgically. During an operation, the nerve is exposed along the course of the forearm. The surgeon can then split open and widen the nerve tunnel through the supinator muscle.
The operation is usually performed on an outpatient basis and takes around 45 minutes. The arm can be moved immediately after the operation and the period of incapacity to work is short.
The very rare Wartenberg syndrome is also caused by pressure damage to the radial nerve.
Symptoms of Wartenberg's syndrome
Patients with this disease often complain of loss of sensation and pain on the back of the wrist (extensor side). The thumb and index finger are particularly affected.
The main point of pain is slightly above the wrist, where the nerve passes between the extensor muscles.
Causes of Wartenberg's syndrome
The main cause of Wartenberg's syndrome is watches, bracelets or casts that are too tight above the wrist. These exert too much pressure on the nerve, which ultimately leads to damage.
Treatment of Wartenberg's syndrome
Wartenberg's syndrome is mainly treated conservatively. The affected areas are protected with a forearm plaster splint and the nerve is thus relieved.
If this treatment is not successful, surgery is recommended. An operation of this type takes around 45 minutes and can be performed on an outpatient basis.
No immobilization is required for this procedure either. The period of incapacity to work is short and full weight-bearing can soon be resumed.
