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Upper Limb Neuropathy

upper limb neuropathy

Upper extremity neuropathy is a very common condition that manifests in weakness, soreness, and changes in the hands’ sensitivity, depending on the location of the nerve damage. One or more nerves can be affected. It can develop at any age but is most common in people who spend a lot of time at the computer.

The main cause of upper limb neuropathy is nerve compression; this can occur in places where the nerve lies shallow under the skin or passes through a narrow bony canal (for example, the radial nerve). In some cases, the nerve can also be transmitted deep in the arm. The main causes of nerve compression are:

  • When the hand has been in an uncomfortable position where it is in an inverted state for a long time (during sleep, in a state of intoxication, or under anesthesia)
  • Injuries to the extremities, both direct trauma to the nerve (contusion, tear, rupture) and trauma to a bone or muscle tissue, in which the nerve is compressed by bone fragments or edema, hematoma
  • Consequences of injury or surgery. The nerve can be involved in the forming scar tissue and pinched in it, lack of blood circulation and, as a result, deterioration of muscle nutrition, compressing edema
  • Deformation of the joints in connection with professional activities (athletes, musicians, cooks, dentists, working with vibrating instruments)
  • Cervical osteochondrosis
  • Frequent hypothermia
  • Any swelling and inflammation in the muscles caused by infection (flu, herpes, tuberculosis, diphtheria, malaria, HIV) or endocrine diseases (diabetes mellitus)
  • Mechanical compression of a nerve by a tumor (for oncology and benign tumor diseases)
  • Lack of vitamins (usually vitamin B) or minerals in the body.

Symptoms 

A nerve is a channel through which information is sent from an organ to the brain about its position (organ/limb) in space, temperature, pressure, etc., and commands to act to the organ/limb are sent from the brain. In the event of nerve damage, this connection is broken, i.e., the brain does not know about the existence of a limb, incorrectly interprets (partially not reached) information, or the signal from the brain does not reach the limb. The most common symptoms are:

  • weakness of the muscles of the arms, difficulty in movement, difficulty to raise the arms up (especially over the sides)
  • because of this, a violation of coordination of movements develops
  • changes in hand sensitivity; decreased temperature sensitivity; creeping sensation (paresthesia)
  • upper limb muscle atrophy
  • spastic syndrome involuntary muscle contractions, cramps, and spasms
  • swelling of the limbs

Types of neuropathy. Three large main nerves pass along the human hand: the radial nerve, the median nerve, and the ulnar nerve. Depending on which nerve is affected and in what place, the disease’s picture, and the course will differ.

  • Radial nerve neuropathy. The radial nerve is responsible for the outer surface of the arm and hand. It is most often injured in the area of ​​the shoulder joint or clavicle due to the fracture in the elbow bend, where the nerve passes close under the skin and is easily squeezed (e.g., when wearing a heavy bag on the elbow) in the area of ​​the wrist joint, due to a dislocation or a long uncomfortable position (palm rest).

Depending on the location of the injury, false paralysis can form when a limb in the shoulder, elbow, or wrist hangs limply. The patient cannot control the hand (or can do it by willpower but does not feel the hand at all), and there is numbness and paresthesia of the hand and a loss of skin sensitivity.

  • Median nerve neuropathy. The median nerve runs along the center of the hand along its inner side and is responsible for the sensitivity and work of the entire hand, palm, and 1-3 fingers. The most common cause is hand overstrain (usually professional in musicians, seamstresses, carpenters/joiners), unusual physical exertion on the square pronator of the hand (in the wrist area), forearm injuries, and the consequences of an incorrect injection into the ulnar vein.
  • Ulnar nerve neuropathy. The ulnar nerve runs parallel to the median but closer to the outer edge of the hand, controlling the hand, ring finger, and little finger. Most often, ulnar nerve neuropathy develops in people who are in a position for a long time (usually work), straining the elbows. And, for sure, everyone has hit their elbow on hard objects and felt severe pain like an electric discharge, after which the hand became numb and itchy for a while. Deforming arthrosis and other diseases of the osteochondral apparatus are also prevalent causes of neuropathy.

Causes

Causes of Upper Limb Neuropathy

Radial nerve neuropathy is called sleep paralysis or drunken paralysis. A person under the influence of alcohol or drugs falls asleep in an uncomfortable position, often sitting with their hand under their head. Usually, when a nerve is compressed, the reflex of a change in posture will work, a person does not feel that their hand is lying down.

Compression of the radial nerve can also occur with honeymoon syndrome when the partner’s head is on the shoulder or forearm for a long time during sleep. When playing tennis, neurological tennis elbow can develop. The use of crutches or handcuffs can also lead to neuropathy of the radial nerve. Rarely, an injury (shoulder fracture) is the cause of neuropathy.

According to the mechanism of development, is a typical tunnel syndrome. Compression of the nerve occurs in narrow spaces (tunnels). The clinical picture- The hand hangs; there is no extension of the arm in the wrist joint. The thumb cannot be taken to the side. Sensitivity in 1-2-3 fingers of the hand is impaired.

Symptoms of radial nerve neuropathy. This disease is accompanied by movement disorders and changes in sensitivity in the innervation zone. Symptoms depend on the level of damage to the radial nerve.

Diagnostic tests and radial nerve treatment

Tests are performed  in the axillary fossa in the upper third of the shoulder:

  • When raising the hand forward, the hand hangs down.
  • I finger is brought to the II finger.
  • It is impossible to extend the forearm and hand, abduction of 1 finger, imposition of the second finger on adjacent ones, supination of the forearm with an extended arm: flexion in the elbow joint is weakened.
  • The elbow extensor reflex is lost, and the carporadial.
  • Disorder of sensitivity of I, II, and partially III fingers, excluding the terminal phalanges, is expressed mildly, more often in the form of paresthesia, crawling creeps, numbness).

With neuropathy of the radial nerve in the middle third of the shoulder, the extension of the forearm, the ulnar extensor reflex are preserved; there is no disorder of sensitivity on the shoulder when the other symptoms described above are found.

With neuropathy of the radial nerve in the lower third of the shoulder and the upper third of the forearm, sensitivity on the back of the forearm may persist, the function of the extensors of the hand and fingers falls out, and sensitivity on the back of the hand is impaired. Diagnostic tests can detect damage to the radial nerve:

  • In a standing position with hands down, supination of the hand and abduction of the first finger are impossible.
  • It is impossible to simultaneously touch the plane with the back of the hand and fingers.
  • If the hand lies on the table, palm down, and it is not possible to put the third finger on the adjacent fingers.
  • When the fingers are diluted (the palms are pressed against each other by the palmar surfaces), the fingers of the affected hand are not retracted but bend and slide over the palm of a healthy hand.

The diagnosis is made by neurological examination, taking into account complaints and anamnesis of the disease. There are diagnostic tests that can reliably suggest a diagnosis.

Treatment of neuropathy of the radial nerve. Complex treatment is prescribed:

  • antioxidants
  • vascular therapy
  • dehydration
  • anticholinesterase drugs
  • preparations of vitamins of group B.

Physio Balneotherapy, massage, exercise therapy, acupuncture, nerve and muscle stimulation, myotonic, and stimulus are used. Surgical treatment of neuropathy of the radial nerve is carried out only in case of complete disturbance of conduction along the nerve, violation of the integrity of the nerve.

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Lone Star Neurology
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Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been prepared.read more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well together.read more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your business.read more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any cookies.read more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going there.read more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my treatment.read more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to finish.read more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 stars.read more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his staff.read more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best treatment.read more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my doctor.read more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding solutions.read more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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