Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-24T00:09:01.319Z Has data issue: false hasContentIssue false

Chapter 6 - Examination of the Peripheral Nerves in the Hand and Upper Limb

Published online by Cambridge University Press:  22 April 2022

By
Kate Brown ,
L. Chris Bainbridge  and
John E. D. Wright
Edited by
Fazal Ali  and
Nick Harris
Fazal Ali
Affiliation:
Chesterfield Royal Hospital
Nick Harris
Affiliation:
Spire Hospital, Leeds
Get access

Summary

A system for examination of the peripheral nerves of the upper limb is described in this chapter. This includes the ulnar, median, radial, axillary and musculocutaneous nerves. The steps are inspection followed by a screen test to decide if the lesion is likely to be radial, median or ulnar. Then the nerve is examined in more detail by testing sensation and movement in relation to that nerve. Provocation tests are performed if necessary. This chapter also describes nerve compression as a result of thoracic outlet syndrome, as this may be a differential diagnosis. In the ‘Advanced corner’ Tinel’s sign and Valleix phenomenon as well as ‘double crush’ are described.

Keywords

peripheral nerveradial nerveulnar nervemedian nervecompressionthoracic outlet
Type
Chapter
Information
Orthopaedic Examination Techniques
A Practical Guide
 , pp. 89 - 111
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kaplan, SJ, Glickel, SZ, Eaton, RG. Predictive factors in the non-surgical treatment of carpal tunnel syndrome. J Hand Surg Br 1990;15:106–108.CrossRefGoogle ScholarPubMed
Reynolds, EH. The neurology of folic acid deficiency. Handb Clin Neurol 2014;120:927–943.CrossRefGoogle ScholarPubMed
Birch, R, Bonney, G, Wynn-Parry, CB (eds). Surgical Disorders of the Peripheral Nerves. Edinburgh: Churchill Livingstone, 1998.Google Scholar
Lee, EY, Karjalainen, TV, Sebastin, SJ, Lim, AYT. The value of the tender muscle sign in detecting motor recovery after peripheral nerve reconstruction. J Hand Surg Am 2015;40(3):433e437.CrossRefGoogle ScholarPubMed
Kiloh, LG, Nevin, S. Isolated neuritis of the anterior interosseous nerve. Br Med J 1952;1(4763):850–851.Google Scholar
Paley, D, McMurtry, RY. Median nerve compression test in carpal tunnel syndrome diagnosis reproduces signs and symptoms in affected wrist. Orthop Rev 1985;14:411.Google Scholar
Durkan, JA. A new diagnostic test for carpal tunnel syndrome. J Bone Joint Surg Am 1991;73:535–538.CrossRefGoogle ScholarPubMed
Gilliat, RW, Wilson, TG. A pneumatic-tourniquet test in the carpal-tunnel syndrome. Lancet 1953;265(6786):595–597.CrossRefGoogle Scholar
Sarhadi, NS, Korday, SN, Bainbridge, LC. Radial tunnel syndrome: diagnosis and management. J Hand Surg Br 1998;23:617–619.CrossRefGoogle ScholarPubMed
Dellon, AL, Mackinnon, SE. Radial sensory nerve entrapment in the forearm. J Hand Surg Am 1986;11:199–205.Google Scholar
Lloyd, N, Sammut, D. The rectangular palm sign in ulnar nerve paralysis. Eur J Plastic Surg 2012;35(7):569–570.CrossRefGoogle Scholar
Leibovic, SJ, Hastings, H. Martin–Gruber revisited. J Hand Surg Am 1992;17:47–53.CrossRefGoogle ScholarPubMed
Cahill, BR, Palmer, RE. Quadrilateral space syndrome. J Hand Surg Am 1983;8, 65–69.CrossRefGoogle ScholarPubMed
Hangge, PT, Breen, I, Albadawi, H, et al. Quadrilateral space syndrome: diagnosis and clinical management. J Clin Med 2018 Apr 21;7(4):pii:E86.CrossRefGoogle ScholarPubMed
Jones, MR, Prabhakar, A, Viswanath, O, et al. Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment. Pain Ther 2019;8:5–18.Google Scholar
Povlsen, S, Povlsen, B. Diagnosing thoracic outlet syndrome: current approaches and future directions. Diagnostics (Basel) 2018 Mar 20;8(1):21.CrossRefGoogle ScholarPubMed
Adson, AW, Coffey, JR. Cervical rib: a method of anterior approach for relief of symptoms by division of the scalenus anticus. Ann Surg 1927;85:839–857.CrossRefGoogle ScholarPubMed
Roos, DB. Transaxillary approach for first rib resection to relieve thoracic outlet syndrome. Ann Surg 1966;163:354–358.Google Scholar
Braun, RM, Rechnic, M, Shah, KN. Pulse oximetry measurements in the evaluation of patients with possible thoracic outlet syndrome. J Hand Surg Am 2012 Dec;37(12):2564–2569.CrossRefGoogle ScholarPubMed
Gillard, J, Pe´rez-Cousin, M, Hachulla, E, et al. Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine 2001;68(5):416–424.Google Scholar
Phelps, PE, Walker, E. Comparison of the finger wrinkling test results to established sensory tests in peripheral nerve injury. Am J Occup Ther 1977 Oct;31(9):565–572.Google ScholarPubMed
Moldaver, J. Tinel’s sign. Its characteristics and significance. J Bone Joint Surg Am 1978;60(3):412–414.CrossRefGoogle ScholarPubMed
Kane, PM, Daniels, AH, Akelman, E. Double crush syndrome. J Am Acad Orthop Surg 2015 Sep;23(9):558–562.CrossRefGoogle ScholarPubMed
Bouvier Note sur une paralysie partielle des muscles de la main. Bull Acad Nat Med (Paris) 1851;18:125.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×