Nerve Compression/Upper Extremity

Nerves form the central nervous system and are involved in conducting messages from the brain to other parts of the body. They are of two types – motor, which help in movement and sensory, which lets us sense pressure, temperature and pain. Many nerve fibers are grouped together to form a bundle and are protected by an insulating cover.

Messages in the form of electric pulses pass through nerves, to and from the brain, through cells called neurons. Neurons are made up of 3 parts: a cell body, a long tube-like axon which transmits signals to the next nerve cells and dendrites that receive signals from other neurons.

Nerve Injury

Nerves are fragile and can get easily injured by stretching, pressure, or laceration. Injury can involve only the nerve or the outer protective covering as well, which obstructs the transmission of messages to and from the brain. This stops the muscles from moving the affected part of the body and sensations from being felt in the part supplied by the damaged nerve.

Nerve conduction velocity (NCV) and electromyography (EMG) tests help evaluate the transmission of electric currents through the nerves. Imaging tests, including CT scans, MRI and MRI neurography, also help identify the extent of injury. Nerve injury can be classified into five types:

1. First-degree injury blocks message transmission locally and is reversible, usually recovering within hours to a few weeks
2. Second-degree injury involves a loss of continuity in axons
3. Third-degree injury damages axons and their supporting structures
4. Fourth-degree injury harms axons and surrounding tissues, creating scars that prevent regeneration of the nerve
5. Fifth-degree injuries usually involve tearing or severe stretching where the nerve is separated into two

Nerve injuries can be treated with medication and conservative treatments including rehabilitation, physical and massage therapy, acupuncture, orthotics, and weight loss management. Surgery may include a simple cleaning of the nerve (neurolysis) or grafting when the tests show that there is passage of electric signals through them.

Nerve Compression

Nerves may get compressed or ‘pinched’ when pressure is exerted because of repetitive movement or holding the body in one position for a long time. Compression usually occurs between bones, ligaments and tendons present in various sites of the body. Nerves get inflamed when pressure is applied and do not function properly. If the pressure is released within a short time, no permanent damage occurs and the nerve continues its normal functioning. However, nerves that remain compressed for a long time can produce chronic pain, swelling, scarring and cause permanent nerve damage.

A compressed nerve can lead to pain, numbness or tingling sensations, and twitching or muscle weakness.

If these symptoms continue for many days and do not improve with rest and over-the-counter pain relievers, you should visit your doctor.

Your doctor may conduct a few tests including

• Nerve conduction study which involves passing a mild electrical impulse to the affected area to note the damage of nerves
• Electromyography measures the electric activity of muscles during movement
• Magnetic resonance imaging (MRI) helps the doctor take images of your body

Your doctor will recommend the following conservative treatments:

• Rest
• Immobilization of the affected region with a splint or brace
• Physical therapy exercises or modification of activities that cause or aggravate the pressure on nerves
• Pain relievers such as non-steroidal anti-inflammatory drugs

If these methods do not help even after several weeks or a few months, your doctor may recommend surgery. If the nerves in the wrist are affected, your surgeon will cut the ligament pressing against the nerve to create more space for the nerve.