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Nerve Compression Syndromes of the Upper Limb
BOOK REVIEWS
Nerve Compression Syndromes of the Upper Limb. Edited by Yves Allieu, MD and Susan E. MacKinnon, MD. Martin Dunitz Ltd. United Kingdom. 2002. 206 pages. $65. “The term multilevel nerve compression or ‘double crush’ syndrome was first introduced in 1973, yet still remains controversial three decades later. Thus, the simplicity of the term nerve compressions belies its complexity in evaluation and management.” Susan E. MacKinnon Just mentioning the term double crush syndrome may send paresthesias down the spine of any self-respecting hand therapist or surgeon. To therapists and surgeons alike, double crush syndrome is thrown around like a hot potato. However, after reading Nerve Compression Sydromes of the Upper Limb, the clinician will have a thorough understanding of this term and the varied entrapment and compression diagnoses of the upper extremity. Drs. Yves Allieu and Susan MacKinnon have brought together an international group of contributing therapists and surgeons in an exceptional text that reviews the wide range of upper extremity nerve compression syndromes. Included from proximal to distal are thoracic outlet syndrome, suprascapular nerve entrapment, spontaneous high radial nerve entrapment, radial nerve compression, ulnar nerve compression, median nerve compression in the forearm, radial sensory nerve entrapment, distal ulnar nerve compression, and carpal tunnel syndrome. The text concludes with chapters about compression neuropathies of the upper extremities in athletes and
musicians and the role of the physical therapist. The clinician will crave more information after reading Dr. Allieu’s section of the introduction. Dr. Allieu points out that nerve compression syndromes are more frequent in the upper extremity than lower limb because of its increased mobility. These injuries are due to both static and dynamic factors. The static factors may include anatomical components such as an unyielding tunnel or musculotendinous anamoly. Dynamic factors include mobility, muscle contraction, and nerve mobility during repetitive movements. He further notes the importance of looking at nerve compression from a dynamic standpoint, which allows the clinician to gain a better understanding of evaluation and treatment of nerve compression syndromes. In Chapter 1, “Histopathology of Nerve Compression and the Double Crush Syndrome,” Christine Cheng will rock the reader’s world with an in-depth discussion of the fascinating, controversial subject of double crush syndrome. Initially, there are sections about anatomy of the peripheral nerve and acute and chronic nerve compression, with thorough, exact black-and-white diagrams and figures. Cheng does a superb job of discussing “double crush,” first described by Upton and McComas in 1973, in relation to nerve entrapment. She outlines convincing animal studies to support this theory with excellent diagrams demonstrating the relationship of histopathological changes with signs and symptoms associated with chronic nerve compression. She notes that good human clinical studies are lacking.
The author concludes that, although this phenomenon cannot be fully explained, double crush should be considered by the clinician. Even with normal electrodiagnostic and two-point discrimination, the clinician should consider all potential sites of entrapment along the course of a given nerve. The clinician should consider splinting, correction of muscle imbalances and postural abnormalities. Chapter 2, “Electrodiagnosis of the Upper Limb,” takes the reader through the methods of electrodiagnosis (EDX), including electromyography and the nerve conduction study. The authors include sections about when to use EDX for carpal tunnel syndrome, radial nerve lesions, and proximal nerve lesions. Six interesting case studies are included. An outstanding chapter about patient evaluation of nerve compression in the upper limb is followed by equally outstanding chapters about every possible site of nerve compression in the upper extremity. Concluding the text are chapters about suprascapular nerve entrapment, musicians, and the role of the physical therapist. The authors recognize that physical therapists (and occupational therapists) play a vital role in effectively evaluating and restoring correct posture and muscle balances in these often difficult patients. Particularly interesting is Theirry Fabre and Alaine Durandeau’s discussion of suprascapular nerve entrapment as a possible cause of shoulder pain. The authors point out that this syndrome may be mistaken for shoulder tendinitis, rotator cuff tear, or cervical disc disease. They discuss applied anatomy of the October–December 2002 379
suprascapular nerve, its function and pathogenesis and further highlight clinical evaluation and the importance of electrodiagnosis and imaging studies. Concluding the chapter are conservative and operative options. Nerve Compression Syndromes of the Upper Limb is an outstanding, well-researched text that contains helpful anatomical and clinical information on every nerve compression site in the upper extremity. This text should become an essential part of the upper quarter therapist’s library.—ROBERT G. ROSS, MPT, CHT Rehabilitation of the Hand and Upper Extremity. Editors: Evelyn J. Mackin, LPT, Anne D. Callahan, MS, OTR/L, CHT, Terri M. Skirven, OTR/L, CHT, Lawrence H. Schneider, MD, and A. Lee Osterman, MD. Mosby. Philadelphia, PA. 2002. 2109 pages. $265. When cracking the cover of this massive, two-volume text, the reader cannot help but feel a sense of reverence for the hand surgeons and hand therapists of the past and present who have had a huge impact on their respective professions. The editors have asked “the best and the brightest” clinicians in upper extremity therapy and surgery to contribute their expertise to this vast, definitive text, which is certain to influence the future of hand therapy and hand surgery. This fifth edition is necessary as the professions of hand surgery and hand therapy continue to evolve. The editors understand the importance of drawing on an ever-broader range of information in the evaluation and treatment of upper extremity patients. There are excellent, expanded sections on the shoulder, elbow, and wrist. The editors understand that today’s hand therapist must be an “upper quarter” therapist. With the addition of 53 new chapters, viewing this text can make the hand therapist and 380
JOURNAL OF HAND THERAPY
hand surgeon feel almost like a kid in the proverbial candy store. The daunting array of new subjects includes fibrocartilage complex injuries, clinical examination of the wrist and elbow, stiff elbow, radial tunnel syndrome, nerve injuries about the shoulder, focal hand dystonia, electrical injuries, systemic lupus erythematosus of the hand, osteoarthritis, upper extremity outcome assessment, soft splints (indications and techniques), and kinesio taping. Also included are fascinating chapters addressing the lymphatic component in upper extremity edema: “Management of Breast Cancer-Related Edemas” and “Manual Edema Mobilization in the Subacute Hand.” Chapters on less common topics, such as focal hand dystonia and rehabilitation of the hand and upper extremity in tetraplegia, have also been added. The two volumes are divided into 27 sections. Each section includes from one to 12 chapters. Although every chapter varies in format, each author provides a vital foundation and thorough coverage of the specific subject. For example, in Chapter 27, “Postoperative Management of Flexor Tendon Injuries,” Pettengil and van Strien do a superb job of covering this complicated subject. The chapter includes fundamental concepts, anatomy, basic concepts of tendon healing and every option and rationale for postoperative management protocols. The reader will be pleased to read the rationale and find detailed week-by-week management strategies for early passive mobilization and early active mobilization of flexor tendon repairs. Splinting options are effectively outlined and diagrammed. The bibliography is exhaustive and up-to-date. Another example of the scope of this text is Chapter 53, “Manual Edema Mobilization: Treatment for Edema in the
Subacute Hand.” Sandra Artzberger deftly covers this subject. The chapter begins with a review of the literature, the anatomy of the lymphatic system, clinical application of lymphatic anatomy and physiology, and an overview of manual edema mobilization (MEM) treatment concepts. The author adds easy-tofollow manual edema mobilization techniques, case studies, and a final section of frequently asked questions about MEM. Wrist aficionados will be delighted with the expanded and complete section about common wrist injuries. In Chapter 70, “Ulnar Wrist Pain and Impairment: A Therapist’s Algorithmic Approach to the Triangular Fibrocartilage Complex,” Paul LaStayo definitively and expertly discusses the structures that can lead to ulnar wrist pain, including, for example, the triangular fibrocartilage complex (TFCC) and distal forearm, TFCC articular disc tears, ulnocarpal abutment, and TFCC radioulnar ligament tears. He then offers the therapist a systematic algorithm for evaluation and treatment of such patients. In addition to thorough treatment of virtually every topic on the upper extremity for the hand therapist and surgeon, the reader will find a plethora of well-conceived anatomical drawings, black-and-white and color photographs, clear and easy-to-follow radiographs, MRIs, figures, diagrams, tables, and charts that complement the text. The editors and authors have provided a vital service to every hand therapist and surgeon by publishing this fifth edition of Rehabilitation of the Hand and Upper Extremity. This two-volume text is so broad in its scope, yet so well put together and complete, that every upper quarter therapist and surgeon should seriously consider making this an integral part of his or her clinical library. —ROBERT G. ROSS, MPT, CHT
Nerve Compression Syndromes of the Upper Limb. Edited by Yves Allieu, MD and Susan E. MacKinnon, MD. Martin Dunitz Ltd. United Kingdom. 2002. 206 pages. $65. “The term multilevel nerve compression or ‘double crush’ syndrome was first introduced in 1973, yet still remains controversial three decades later. Thus, the simplicity of the term nerve compressions belies its complexity in evaluation and management.” Susan E. MacKinnon Just mentioning the term double crush syndrome may send paresthesias down the spine of any self-respecting hand therapist or surgeon. To therapists and surgeons alike, double crush syndrome is thrown around like a hot potato. However, after reading Nerve Compression Sydromes of the Upper Limb, the clinician will have a thorough understanding of this term and the varied entrapment and compression diagnoses of the upper extremity. Drs. Yves Allieu and Susan MacKinnon have brought together an international group of contributing therapists and surgeons in an exceptional text that reviews the wide range of upper extremity nerve compression syndromes. Included from proximal to distal are thoracic outlet syndrome, suprascapular nerve entrapment, spontaneous high radial nerve entrapment, radial nerve compression, ulnar nerve compression, median nerve compression in the forearm, radial sensory nerve entrapment, distal ulnar nerve compression, and carpal tunnel syndrome. The text concludes with chapters about compression neuropathies of the upper extremities in athletes and
musicians and the role of the physical therapist. The clinician will crave more information after reading Dr. Allieu’s section of the introduction. Dr. Allieu points out that nerve compression syndromes are more frequent in the upper extremity than lower limb because of its increased mobility. These injuries are due to both static and dynamic factors. The static factors may include anatomical components such as an unyielding tunnel or musculotendinous anamoly. Dynamic factors include mobility, muscle contraction, and nerve mobility during repetitive movements. He further notes the importance of looking at nerve compression from a dynamic standpoint, which allows the clinician to gain a better understanding of evaluation and treatment of nerve compression syndromes. In Chapter 1, “Histopathology of Nerve Compression and the Double Crush Syndrome,” Christine Cheng will rock the reader’s world with an in-depth discussion of the fascinating, controversial subject of double crush syndrome. Initially, there are sections about anatomy of the peripheral nerve and acute and chronic nerve compression, with thorough, exact black-and-white diagrams and figures. Cheng does a superb job of discussing “double crush,” first described by Upton and McComas in 1973, in relation to nerve entrapment. She outlines convincing animal studies to support this theory with excellent diagrams demonstrating the relationship of histopathological changes with signs and symptoms associated with chronic nerve compression. She notes that good human clinical studies are lacking.
The author concludes that, although this phenomenon cannot be fully explained, double crush should be considered by the clinician. Even with normal electrodiagnostic and two-point discrimination, the clinician should consider all potential sites of entrapment along the course of a given nerve. The clinician should consider splinting, correction of muscle imbalances and postural abnormalities. Chapter 2, “Electrodiagnosis of the Upper Limb,” takes the reader through the methods of electrodiagnosis (EDX), including electromyography and the nerve conduction study. The authors include sections about when to use EDX for carpal tunnel syndrome, radial nerve lesions, and proximal nerve lesions. Six interesting case studies are included. An outstanding chapter about patient evaluation of nerve compression in the upper limb is followed by equally outstanding chapters about every possible site of nerve compression in the upper extremity. Concluding the text are chapters about suprascapular nerve entrapment, musicians, and the role of the physical therapist. The authors recognize that physical therapists (and occupational therapists) play a vital role in effectively evaluating and restoring correct posture and muscle balances in these often difficult patients. Particularly interesting is Theirry Fabre and Alaine Durandeau’s discussion of suprascapular nerve entrapment as a possible cause of shoulder pain. The authors point out that this syndrome may be mistaken for shoulder tendinitis, rotator cuff tear, or cervical disc disease. They discuss applied anatomy of the October–December 2002 379
suprascapular nerve, its function and pathogenesis and further highlight clinical evaluation and the importance of electrodiagnosis and imaging studies. Concluding the chapter are conservative and operative options. Nerve Compression Syndromes of the Upper Limb is an outstanding, well-researched text that contains helpful anatomical and clinical information on every nerve compression site in the upper extremity. This text should become an essential part of the upper quarter therapist’s library.—ROBERT G. ROSS, MPT, CHT Rehabilitation of the Hand and Upper Extremity. Editors: Evelyn J. Mackin, LPT, Anne D. Callahan, MS, OTR/L, CHT, Terri M. Skirven, OTR/L, CHT, Lawrence H. Schneider, MD, and A. Lee Osterman, MD. Mosby. Philadelphia, PA. 2002. 2109 pages. $265. When cracking the cover of this massive, two-volume text, the reader cannot help but feel a sense of reverence for the hand surgeons and hand therapists of the past and present who have had a huge impact on their respective professions. The editors have asked “the best and the brightest” clinicians in upper extremity therapy and surgery to contribute their expertise to this vast, definitive text, which is certain to influence the future of hand therapy and hand surgery. This fifth edition is necessary as the professions of hand surgery and hand therapy continue to evolve. The editors understand the importance of drawing on an ever-broader range of information in the evaluation and treatment of upper extremity patients. There are excellent, expanded sections on the shoulder, elbow, and wrist. The editors understand that today’s hand therapist must be an “upper quarter” therapist. With the addition of 53 new chapters, viewing this text can make the hand therapist and 380
JOURNAL OF HAND THERAPY
hand surgeon feel almost like a kid in the proverbial candy store. The daunting array of new subjects includes fibrocartilage complex injuries, clinical examination of the wrist and elbow, stiff elbow, radial tunnel syndrome, nerve injuries about the shoulder, focal hand dystonia, electrical injuries, systemic lupus erythematosus of the hand, osteoarthritis, upper extremity outcome assessment, soft splints (indications and techniques), and kinesio taping. Also included are fascinating chapters addressing the lymphatic component in upper extremity edema: “Management of Breast Cancer-Related Edemas” and “Manual Edema Mobilization in the Subacute Hand.” Chapters on less common topics, such as focal hand dystonia and rehabilitation of the hand and upper extremity in tetraplegia, have also been added. The two volumes are divided into 27 sections. Each section includes from one to 12 chapters. Although every chapter varies in format, each author provides a vital foundation and thorough coverage of the specific subject. For example, in Chapter 27, “Postoperative Management of Flexor Tendon Injuries,” Pettengil and van Strien do a superb job of covering this complicated subject. The chapter includes fundamental concepts, anatomy, basic concepts of tendon healing and every option and rationale for postoperative management protocols. The reader will be pleased to read the rationale and find detailed week-by-week management strategies for early passive mobilization and early active mobilization of flexor tendon repairs. Splinting options are effectively outlined and diagrammed. The bibliography is exhaustive and up-to-date. Another example of the scope of this text is Chapter 53, “Manual Edema Mobilization: Treatment for Edema in the
Subacute Hand.” Sandra Artzberger deftly covers this subject. The chapter begins with a review of the literature, the anatomy of the lymphatic system, clinical application of lymphatic anatomy and physiology, and an overview of manual edema mobilization (MEM) treatment concepts. The author adds easy-tofollow manual edema mobilization techniques, case studies, and a final section of frequently asked questions about MEM. Wrist aficionados will be delighted with the expanded and complete section about common wrist injuries. In Chapter 70, “Ulnar Wrist Pain and Impairment: A Therapist’s Algorithmic Approach to the Triangular Fibrocartilage Complex,” Paul LaStayo definitively and expertly discusses the structures that can lead to ulnar wrist pain, including, for example, the triangular fibrocartilage complex (TFCC) and distal forearm, TFCC articular disc tears, ulnocarpal abutment, and TFCC radioulnar ligament tears. He then offers the therapist a systematic algorithm for evaluation and treatment of such patients. In addition to thorough treatment of virtually every topic on the upper extremity for the hand therapist and surgeon, the reader will find a plethora of well-conceived anatomical drawings, black-and-white and color photographs, clear and easy-to-follow radiographs, MRIs, figures, diagrams, tables, and charts that complement the text. The editors and authors have provided a vital service to every hand therapist and surgeon by publishing this fifth edition of Rehabilitation of the Hand and Upper Extremity. This two-volume text is so broad in its scope, yet so well put together and complete, that every upper quarter therapist and surgeon should seriously consider making this an integral part of his or her clinical library. —ROBERT G. ROSS, MPT, CHT