Carpal and cubital tunnel syndromes as the most common variants of upper extremity compression neuropathies

Upper and lower extremity tunnel neuropathies are classified as the peripheral nervous system disorders and are quite common in clinical practice. The development of tunnel syndrome is associated with compression, entrapment of the nerve in the narrow anatomical spaces (anatomical tunnel). Sensory, motor, and trophic disorders are the main clinical manifestations of the nerve compression syndromes. The article describes the main upper extremity tunnel neuropathies, their names and affected nerves. The main common upper extremity tunnel neuropathies such as carpal tunnel syndrome and cubital tunnel syndrome are considered in depth. The carpal tunnel syndrome is currently recognized as the most common peripheral neuropathy. Risk factors, gender and age characteristics, prevalence, incidence of carpal tunnel syndrome and cubital canal syndrome are presented. A scope of specialized skills comprising certain motions that can contribute to the development of carpal tunnel syndrome is presented. The clinical manifestations of these tunnel syndromes are described. Sensory, motor, and trophic disorders are the main clinical manifestations of nerve compression syndromes. The course and signs of carpal tunnel syndrome that can be divided into three stages are provided. The main diagnostic methods for the syndrome examination are shown. The article provides the main conservative and surgical methods for the treatment of these tunnel syndromes. It was noted that the cubital canal syndrome requires surgical treatment more often. The issue of using thiamine, pyridoxine, cyanocobalamin and their combination for the treatment of tunnel neuropathies is considered in more depth. A clinical case of effective conservative treatment for the carpal tunnel syndrome is discussed.

1. Assmus H., Antoniadis G., Bischoff C. Carpal and cubital tunnel and other, rarer nerve compression syndromes. Dtsch Arztebl Int. 2015;112(1-2):14-26. doi: 10.3238/arztebl.2015.0014.

2. Levin O.S. Polyneuropathy. Moscow: MIA; 2005.495 p. (In Russ.)

3. Assmus H., Antoniadis G., Bischoff C., Hoffmann R., Martini A.K., Preissler P. et al. Diagnosis and therapy of cubital tunnel syndrome-state of the art. Handchir Mikrochir Plast Chir. 2009;41(1):2-12. doi: 10.1055/s-0029-1185287.

4. Golubev V.L., Danilov A.B., Merkulova D.M., Orlova O.R. Hand tunnel syndromes. RMZH. Spetsialnyy vypusk “Bolevoy sindrom’’ = Russian Medical Journal. Special Issue: Pain Syndrome. 2009;(0):7-12. (In Russ.) Available at: https://www.rmj.ru/articles/bolevoy_sindrom/Tunnelynye_sindromy_ruki/.

5. Ibrahim I., Khan W.S., Goddard N., Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J. 2012;6(Suppl. 1):69-76. doi: 10.2174/1874325001206010069.

6. Yoshii Y., Zhao C., Amadio P.C. Recent Advances in Ultrasound Diagnosis of Carpal Tunnel Syndrome. Diagnostics (Basel). 2020;10(8):596. doi: 10.3390/diagnostics10080596.

7. Phalen G.S. The carpal-tunnel syndrome. Seventeen years’ experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am. 1966;48(2):211-228. doi: 10.2106/00004623-196648020-00001.

8. Atroshi I., Gummesson C., Johnsson R., Ornstein E., Ranstam J., Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153-158. doi: 10.1001/jama.282.2.153.

9. De Krom M.C., Knipschild P.G., Kester A.D., Thijs C.T., Boekkooi P.F., Spaans F. Carpal tunnel syndrome: Prevalence in the general population. J Clin Epidemiol. 1992;45(4):373-376. doi: 10.1016/0895-4356(92)90038-O.

10. Burton C.L., Chen Y., Chesterton L.S., Van der Windt D.A. Trends in the prevalence, incidence, and surgical management of carpal tunnel syndrome between 1993 and 2013: an observational analysis of UK primary care records. BMJ Open. 2018;8(6):e020166. doi: 10.1136/bmjopen-2017-020166.

11. Middleton S.D., Anakwe R.E. Carpal tunnel syndrome. BMJ. 2014;349:g6437. doi: 10.1136/bmj.g6437.

12. Mondelli M., Giannini F., Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology. 2002;58(2):289-294. doi: 10.1212/wnl.58.2.289.

13. Rask M.R. Anterior interosseous nerve entrapment: (Kiloh-Nevin syndrome) report of seven cases. Clin Orthop Relat Res. 1979;(142):176-181. Available at: https://pubmed.ncbi.nlm.nih.gov/498633/.

14. Stevens J.C., Sun S., Beard C.M., O’Fallon W.M., Kurland L.T. Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology. 1988;38(1):134-138. doi: 10.1212/wnl.38.1.134.

15. Nordstrom D.L., Vierkant R.A., DeStefano F., Layde P.M. Risk factors for carpal tunnel syndrome in a general population. Occup Environ Med. 1997;54(10):734-740. doi: 10.1136/oem.54.10.734.

16. Newington L., Harris E., Walker-Bone K. Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol. 2015;29(3):440-453. doi: 10.1016/j. berh.2015.04.026.

17. Solomon D.H., Katz J.N., Bohn R., Mogun H., Avorn J. Nonoccupational risk factors for carpal tunnel syndrome. J Gen Intern Med. 1999;14(5):310-314. doi: 10.1046/j.1525-1497.1999.00340.x.

18. Palmer K.T., Harris E.C., Coggon D. Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occup Med (Lond). 2007;57(1):57-66. doi: 10.1093/occmed/kql125.

19. Mediouni Z., de Roquemaurel A., Dumontier C., Becour B., Garrabe H., Roquelaure Y., Descatha A. Is carpal tunnel syndrome related to computer exposure at work? A review and meta-analysis. J Occup Environ Med. 2014;56(2):204-208. doi: IO.IO97/JOM.OOOOOOOOOOOOOO8O.

20. Van Rijn R.M., Huisstede B.M.A., Koes B.W., Burdorf A. Associations between work-related factors and the carpal tunnel syndrome - a systematic review. Scand J Work Environ Health. 2009;35(1):19-36. doi: 10.5271/sjweh.1306.

21. Barcenilla A., March L.M., Chen J.S., Sambrook P.N. Carpal tunnel syndrome and its relationship to occupation: a meta-analysis. Rheumatology (Oxford. 2012;51(2):250-261. doi: 10.1093/rheumatology/ker108.

22. Katz J.N., Simmons B.P. Clinical practice. Carpal tunnel syndrome. N Engl J Med. 2002;346(23):1807-1812. doi: 10.1056/NEJMcp013018.

23. Alfonso C., Jann S., Massa R., Torreggiani A. Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci. 2010;31(3):243-252. doi: 10.1007/s10072-009-0213-9.

24. Bahrmann A., Zieschang T., Hein G., Oster P. Carpal tunnel syndrome in diabetes mellitus. Med Klin (Munich). 2010;105(3):150-154. doi: 10.1007/s00063-010-1024-8.

25. Hakim AJ., Cherkas L., El Zayat S., MacGregor AJ., Spector T.D. The genetic contribution to carpal tunnel syndrome in women: a twin study. Arthritis Rheum. 2002;47(3):275-279. doi: 10.1002/art.10395.

26. Hemminki K., Li X., Sundquist K. Familial risks for nerve, nerve root and plexus disorders in siblings based on hospitalisations in Sweden. J Epidemiol Community Health. 2007;61(1):80-84. Available at: https://www.jstor.org/stable/40666036.

27. Mondelli M., Curti S., Farioli A., Aretini A., Ginanneschi F., Greco G., Mattioli S. Anthropometric measurements as a screening test for carpal tunnel syndrome: receiver operating characteristic curves and accuracy. Arthritis Care Res. (Hoboken). 2015;67(5):691-700. doi: 10.1002/acr.22465.

28. Wright A.R., Atkinson R.E. Carpal Tunnel Syndrome: An Update for the Primary Care Physician. Hawaii J Health Soc Welf. 2019;78(11 Suppl. 2):6-10. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874691/.

29. Fowler J.R., Gaughan J.P., Ilyas A.M. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: A meta-analysis. Clin Orthop Relat Res. 2011;469:1089-1094. doi: 10.1007/s11999-010-1637-5.

30. Staples J.R., Calfee R. Cubital tunnel syndrome: current concepts. J Am Acad Orthop Surg. 2017;25(10):e215-224. doi: 10.5435/JAAOS-D-15-00261.

31. Mondelli M., Grippo A., Mariani M., Baldasseroni A., Ansuini R., Ballerini M. et al Carpal tunnel syndrome and ulnar neuropathy at the elbow in floor cleaners. Neurophysiol Clin. 2006;36(4):245-253. doi: 10.1016/j.neucli.2006.08.013.

32. Szabo R.M., Kwak C. Natural history and conservative management of cubital tunnel syndrome. Hand Clin. 2007;23(3):311-318. doi: 10.1016/j.hcl.2007.05.002.

33. Tonya W., Evanoff B.A., Boyer M.I., Osei D.A. The Prevalence of Cubital Tunnel Syndrome: A Cross-Sectional Study in a U.S. Metropolitan Cohort. J Bone Joint Surg Am. 2017;99(5):408-416. doi: 10.2106/JBJS.15.01162.

34. Mondelli M., Giannini F., Ballerini M., Ginanneschi F., Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci. 2005;234(1-2):5-10. doi: 10.1016/j.jns.2005.02.010.

35. Soltani A.M., Best MJ., Francis C.S., Allan BJ., Panthaki ZJ.Trends in the surgical treatment of cubital tunnel syndrome: an analysis of the national survey of ambulatory surgery database. J Hand Surg Am. 2013;38(8):1551-1556. doi: 10.1016/j.jhsa.2013.04.044.

36. Bozentka DJ. Cubital tunnel syndrome pathophysiology. Clin Orthop Relat Res. 1998;351:90-94. doi: 10.1097/00003086-199806000-00012.

37. Andrews K., Rowland A., Pranjal A., Ebraheim N. Cubital tunnel syndrome: Anatomy, clinical presentation, and management. J Orthop. 2018;15(3):832-836. doi: 10.1016/j.jor.2018.08.010.

38. Granger A., Sardi J.P., Iwanaga J., Wilson TJ., Yang L., Loukas M. et al. Osborne’s ligament: a review of its history, anatomy, and surgical importance. Cureus. 2017;9(3):e1080. doi: 10.7759/cureus.1080.

39. Mallete P., Zhao M., Zurakowski D., Ring D. Muscle atrophy at diagnosis of carpal and cubital tunnel syndrome. J Hand Surg Am. 2007;32(6):855-858. doi: 10.1016/j.jhsa.2007.03.009.

40. Wojewnik B., Bindra R. Cubital tunnel syndrome - Review of current literature on causes, diagnosis and treatment. J Hand Microsurg. 2009;1(2):76-81. Available at: https://link.springer.com/article/10.1007/s12593-009-0020-9.

41. Ciccotti M.C., Schwartz M.A., Ciccotti M.G. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med. 2004;23(4):693-705. doi: 10.1016/j.csm.2004.04.011.

42. Pizova N.V. Clinic, diagnostics and therapy of some tunnel syndromes of the upper limbs. RMZH = RMJ. 2017;(21):1548-1552. (In Russ.) Available at: https://www.rmj.ru/articles/nevrologiya/Klinika_diagnostika_i_terapiya_nekotoryh_tunnelynyh_sindromov_verhnih_konechnostey/.

43. Shi Q., MacDermid J.C. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res. 2011;6:17. doi: 10.1186/1749-799X-6-17.

44. Ono S., Clapham PJ., Chung K.C. Optimal management of carpal tunnel syndrome. Int J Gen Med. 2010;3:255-261. doi: 10.2147/ijgm.s7682.

45. Carlson H., Colbert A., Frydl J., Arnall E., Elliot M., Carlson N. Current options for nonsurgical management of carpal tunnel syndrome. Int J Clin Rheumtol. 2010;5(1):129-142. Available at: https://pubmed.ncbi.nlm.nih.gov/20490348/

46. Nalamachu S., Crockett R.S., Gammaitoni A.R., Gould E.M. A comparison of the lidocaine patch 5% vs naproxen 500 mg twice daily for the relief of pain associated with carpal tunnel syndrome: a 6-week, randomized, par-allel-group study. MedGenMed. 2006;8(3):33. Available at: https://pubmed. ncbi.nlm.nih.gov/17406167/.

47. Nalamachu S., Nalamasu R., Jenkins J., Marriott T. An Open-Label Pilot Study Evaluating the Effectiveness of the Heated Lidocaine/Tetracaine Patch for the Treatment of Pain Associated with Carpal Tunnel Syndrome. Pain Pract. 2014;14(7):607-612. doi: 10.1111/papr.12105.

48. Piravej K., Boonhong J. Effect of ultrasound thermotherapy in mild to moderate carpal tunnel syndrome. J Med Assoc Thai. 2004;87(Suppl. 2):100-106. Available at: https://pubmed.ncbi.nlm.nih.gov/16083171/.

49. Maddali B., Signorini M., Bassetti M., Del Rosso A., Orlandi M., De Scisciolo G. A manual therapy intervention improves symptoms in patients with carpal tunnel syndrome: a pilot study. Rheumatol Int. 2013;33(5):1233-1241. doi: 10.1007/s00296-012-2507-0.

50. Roelofs P., Deyo R., Koes B., Scholten R, van Tulder M. Non-steroidal antiinflammatory drugs for low back pain. Cochrane Database Syst Rev. 2008;(1):CD000396. doi: 10.1002/14651858.CD000396.pub3.

51. Franca D.S., Souza A.L., Almeida K.R., Dolabellaa S.S., Martinelli C., Coelhoa M.M. B vitamins induce an antinociceptive effect in the acetic and formaldehyde models of nociception in mice. Eur J Pharmacol. 2001;421(3):157-164. doi: 10.1016/S0014-2999(01)01038-X.

52. Bruggemann G., Koehler C.O., Koch E.M. Results of double-blind study of diclofenac + vitamin B1, B6, B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study. Klin Wochenschr. 1990;68(2):116-120. doi: 10.1007/BF01646858.

53. Barinov A.N., Makhinov K.A., Komarova O.A. Preliminary results of Russian open-label multicenter study MINERVA (Milgamma for neurological disorders and pain syndromes). RMJ. 2016;24:1650-1656. Available at: https://www.rmj.ru/articles/nevrologiya/Predvaritelynye_rezulytaty_otkrytogo_mnogocentrovogo_vserossiyskogo_nablyudeniya_MINERVA_MIlygamma_pri_zabolevaniyah_NERVnoy_sistemy_i_Algicheskih_sindromah/.

54. Boone S., Gelberman R.H., Calfee R.P. The management of cubital tunnel syndrome. J Hand Surg Am. 2015;40(9):1897-1904. doi: 10.1016/j.jhsa.2015.03.011.

55. Osei D.A., Groves A.P., Bommarito K., Ray W.Z. Cubital tunnel syndrome: incidence and demographics in a national administrative database. Neurosurgery. 2017;80(3):417-420. doi: 10.1093/neuros/nyw061.

56. Padua L., Aprile I., Caliandro P., Foschini M., Mazza S., Tonali P. Natural history of ulnar entrapment at elbow. Clin Neurophysiol. 2002;113(12):1980-1984. doi: 10.1016/S1388-2457(02)00295-X.

57. Aroori S., Spence R.A. Carpal tunnel syndrome. Ulster Med J. 2008;77(1):6-17. Available at: https://pubmed.ncbi.nlm.nih.gov/18269111/.

58. Bartels R.H. History of the surgical treatment of ulnar nerve compression at the elbow. Neurosurgery. 2001;49(2):391-399. doi: 10.1097/00006123200108000-00023.

59. Oertel J., Keiner D., Gaab M.R. Endoscopic decompression of the ulnar nerve at the elbow. Neurosurgery. 2010;66(4):817-824. doi: 10.1227/01.NEU.0000367551.41503.58.

60. Caliandro P., La Torrre G., Padua R., Giannini F., Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2016;(11):CD006839. doi: 10.1002/14651858.CD006839.pub4.