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Occupational Therapy - Article #2

BJACH Leadership

Below is a brief explanation of the symptoms and aggravating factors of two of the most common upper extremity nerve compressions. If identified early, many times they can be effectively managed with conservative treatment. If left untreated they can lead to persistent lack of sensation and muscle weakening, resulting in a decreased ability to use ones' hands.

Carpal tunnel syndrome is the compression of the median nerve at the carpal tunnel of the wrist. It is one of the most common and highly publicized upper extremity nerve irritations. It occurs most commonly in females between the ages of 40 and 60 years of age. Symptoms can include numbness and/or tingling sensation in the thumb, index, middle, and half of the ring finger, which is the nerve's area of sensation. Other symptoms include burning or throbbing pain in the palm side of the wrist and/or thumb side of the palm. The nerve becomes more irritated and symptoms are generally greater when the wrist is bent out of a neutral position for a period of time, as with holding a steering wheel while driving, typing on the computer with improper positioning or while sleeping at night.

Cubital tunnel syndrome is a compression of the ulnar nerve at the cubital tunnel area of the elbow. The ulnar nerve is the nerve responsible for giving the "funny bone" feeling when struck. It's symptoms most commonly include numbness or tingling in the small finger, half of the ring finger and the half of the hand and/or forearm proximal to those fingers. The nerve is more aggravated and symptoms generally more severe when the elbow is bent as with talking on the phone, resting on ones' elbows, or sleeping at night with the elbows flexed, hand under ones' head.

To complicate matters, a person can have one nerve compressed in more than one area or have more than one nerve compressed in the arm. Compression of a nerve in the neck or shoulder area can cause numbness and/or tingling in the hands or forearms similar to signs of the above mentioned irritations. Pregnancy can make one more susceptible to a nerve compression due to the swelling of the soft tissues. Normally the irritation resolves a month or so after delivery. Additionally, diabetes and other conditions can cause numbness and tingling in the upper extremities.

Conservative treatment consists of patient education on proper positioning of the extremities and may include splinting, activity modification, and the prescription of medications. Generally, conservative treatment for nerve compressions is performed for several months prior to considering surgical intervention.

The above article was written by CPT Jeffrey P. Nelson, Occupational Therapist, Bayne Jones Army Community Hospital (BJACH). Who reminds you that the BJACH Occupational Therapy Clinic continues to work with military beneficiaries to assist them in leading the most productive self-sufficient lives possible.

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COL Mark C. Wilhite
CSM David L. Hunt
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