![]() Non-myelinated fibres contain multiple axons within the cytoplasm of a surrounding Schwann cell. Myelinated fibres are those in which each axon is surrounded by single Schwann cells arranged longitudinally to form a continuous chain. The axon is surrounded by Schwann cells and, together, axon and Schwann cells make up a nerve fibre. The history and examination findings suggest a diagnosis of bilateral carpal tunnel syndrome and her GP recommended she wear a wrist splint at night to keep her wrist in the neutral position. However, sustained wrist flexion for 1 min reproduced her symptoms of numbness affecting both hands. She also takes non-steroidal anti-inflammatory medications for osteoarthritis affecting the small joints in her hands, neck and back.Įxamination of her hands reveals no swelling of her joints and a normal range of movement. She was diagnosed as having late-onset diabetes 2 years earlier, which has been reasonably controlled by diet and oral hypoglycaemic medication. She also describes neck stiffness and discomfort with pain radiating from her left shoulder to her hand and swelling in both hands, more so in the early mornings. She presented complaining of pins and needles in both hands, which wake her at night and occur intermittently during the day. She works an 8-hour day in four shifts divided by half-hour rest periods between shifts. Mrs Fotini, aged 55, is a production line worker in a factory with a packaging company. This chapter will focus on nerve compression syndromes in the diagnosis of hand and upper limb pain and will review normal peripheral nerve anatomy and physiology. When present, reversible causes must be addressed. Treatment of individual patients may vary according to the duration and severity of symptoms and signs, age and general medical condition. Electrophysiological examination is the main investigation used to support or clarify clinical diagnoses based upon precise history taking and careful examination. Understanding these syndromes requires knowledge of nerve anatomy, the classification and pathophysiology of nerve injury and the causes of nerve injury. ![]() Other examples include the cubital tunnel syndrome due to compression of the ulnar nerve at the elbow, the tarsal tunnel syndrome due to entrapment of the posterior tibial nerve at the ankle and meralgia paraesthetica due to entrapment of the lateral cutaneous nerve of the thigh in the inguinal region. ![]() The most common of these is the carpal tunnel syndrome in which the median nerve is compressed at the wrist. Nerve compression (entrapment) syndromes are a common cause of limb pain. ![]()
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