This text based course is a transcript of the live webinar titled "Nerve Compression" presented by Rebecca von der Heyde, PhD, OTR/L, CHT.
Today I am going to discuss nerve compression. As we go through this presentation, I hope that you are asking yourself the questions, “What do I currently do? What is the current practice I use? What are the things that I do?” and “Why do I do them?” A lot of evidence-based practice revolve around the idea of asking ourselves the questions, “Is there any support for what I do using the best practice?" or "Can I do it better?" It is important to ask ourselves these questions every day, especially since upper extremity can be really difficult. Hopefully this talk will encourage you to think about all the different ways that you could be doing things and answering the question, “Can I do my job any better?”
- For each section, we are going to go through the anatomical sites of compression. We will do this for the major peripheral nerves of the upper extremity. These anatomical sites of compression will be shown to you using cadavers. I have actually taken pictures and used thread and different things to demonstrate to you how nerves can be compressed.
- The second thing is to go through the typical signs and symptoms, the provocative tests that are suggested in the literature, and the evaluative techniques that we have in our arsenal to actually look at our clients very carefully.
- The third is then a review the literature.
We will discuss where the nerve is compressed, all the ways we can tell it is being compressed, and then what we should do to help these patients “get better” or to lessen the compression on those nerves. We will go through each of these learning objectives for each of the different sections of the upper extremity.
Proximal Median Nerve
I am going to start with the median nerve, the proximal median nerve.
Figure 1. This figure is a cadaver image with the yellow line representing the proximal median nerve.
You are going to find this small skeletal image on the bottom right corner of every slide. I have oriented him in the way that the arm was positioned on the cadaver, and then, I also created a circle around the section to let you see the particular part we are discussing. I will pause for a moment before each slide to make sure you can get yourself oriented.
Anatomical Sites of Compression.
- Ligament of Struthers
This ligament was suggested by Struthers back in 1854 and the idea here is that it is a supracondylar process protruding from the humeral shaft. It is actually a bony prominence. It is considered to be prehistoric. It is considered to be a remnant structure; often times the term for this is vestigial, and we are only going to find it in 0.6% to 2.7% of our population. The likelihood that one of those bodies was going to end up in my cadaver lab probably was slim to none. The literature then told me that this only represents 0.5% of all median nerve compressions.
- Lacertus Fibrosus
In Figure 1, I have put a yellow string over the median nerve as it courses medial to the biceps and then encounters the second potential site of compression. The blue arrow is what is called the lacertus fibrosus.