Date Presented 04/02/2022
Nerve entrapment syndromes are among the most common types of clinical neuropathy. Frequent misdiagnosis of these conditions has been identified in the literature. This study explored emerging methods used in the assessment of upper extremity nerve entrapments. A systematic protocol was developed on the basis of these advanced techniques. The protocol was implemented by upper extremity specialists, and a descriptive survey was conducted to gain insight into the benefits of the protocol.
Primary Author and Speaker: Sunni Alford
Additional Authors and Speakers: Katie Lause, Olivia Eckert, Emma Gettes, Alexis Mijares, Paige Renner
Billions of dollars are spent each year managing nerve entrapment syndromes. The symptoms produced by these diagnoses have significant effects on occupational performance and overall well-being. Unfortunately, several incidences of the failure to accurately identify the site of entrapment have been reported in the literature. This can lead to increased healthcare costs, time off work, wasted resources, unnecessary risks to the client, and failure to relieve the symptoms. Dr. Elisabet Hagart and Dr. Susan Mackinnon have suggested the utilization of systematic assessment protocols to improve the accuracy in locating the site of nerve entrapment. The purpose of this study was to explore emerging methods used in the assessment of upper extremity nerve entrapment and to develop a systematic protocol based on these findings.
DESIGN: A descriptive survey of certified hand therapists was conducted to gain insight regarding the value of the assessment recommendation. Questions included the time it takes to perform, value in identifying neuropathy, and recommendations for future modification.
METHOD: Therapists were recruited from hand therapy clinics in the Kansas City area. All participants were currently licensed & practicing occupational, physical, and/or certified hand therapists who worked with individuals diagnosed with nerve entrapment syndromes. Training materials and forms were created based on Dr. Elizabet Hagert’s Clinical Triad protocol and Dr. Susan Mackinnon’s Scratch Collapse Test. An informative training session was conducted via Zoom and the therapists were provided with the written forms and illustrations on how to conduct the assessments. An online survey was conducted 2 months following training regarding the ease and efficacy of the assessment protocol. The data from the survey was analyzed using SPSS 27 to perform frequency analyses and descriptive statistics.
RESULTS: Thirty therapists took part in the survey. Some of the participants were not familiar with how to perform the assessments prior to the study. The forms and training videos were found to be helpful for guiding the assessment process. Overall, the protocol was found to be beneficial when used in conjunction with assessments traditionally used in the clinical setting and was determined to be helpful in identifying multiple and/or more proximal entrapment sites that might get overlooked.
CONCLUSION: The development of a systematic assessment protocol can help provide more accurate information regarding the site of nerve entrapment. This can lead to less misidentification and more proper use of occupational therapy interventions. This study serves as a springboard for future studies assessing the accuracy of identifying the precise entrapment site compared to electromyography and sonography. This assessment battery can be used by an interprofessional audience including physicians, occupational and physical therapists whom routinely assess these conditions.
Hagert, E. & Hagert, C. (2014). Upper extremity nerve entrapments-axillary and radial nerves: clinical examination and surgical technique. Plastic and Reconstructive Surgery, 134(1),71-80. https://10.1097/PRS.0000000000000259
Davidge, K. M., Gontre, G., Tang, D., Boyd, K. U., Yee, A., Damiano, M. S., & Mackinnon, S. E. (2015). The ‘hierarchical’ Scratch Collapse Test for identifying multilevel ulnar nerve compression. Hand (New York, N.Y.), 10(3), 388–395. https://doi- org.lib.rockhurst.edu/10.1007/s11552-014-9721-z
Lalonde, D. (2015). Lacertus syndrome: a commonly missed and misdiagnosed median nerve entrapment syndrome. BMC Proceedings. 9(Suppl 3): A74.
Witt, J.C. & Stevens, J.C. (2000). Neurologic Disorders Masquerading as Carpal Tunnel Syndrome:12 Cases of Failed Carpal Tunnel Release. Mayo Clin Proc, 75, 409-413.