Nerve problems and compartment syndromes in the hand, wrist, and forearm

Most sports-related peripheral neuropathies occurring from the elbow distally are compressive in nature. These result from overuse or overload principles superimposed on normal or variant anatomy. Tensile injury occurs less often and is usually associated with the extremes of the throwing motion, i.e., cocking and follow-through phases of throwing. Neurogenic syndromes are usually incomplete, indicating the absence of severe motor or sensory deficits, but typically with subjective complaints of pain or vague sensory disturbance. As a result, nerve injuries are frequently overlooked as a source of acute or, more usually, chronic symptomatology. Further, distal symptoms are not always representative of distal pathology as evidenced by the double-crush phenomenon. Therefore, a strong neurologic and musculoskeletal evaluation is necessary in diagnosing sports-induced peripheral nerve trauma. When positive, electrodiagnostic testing can assist with localization and extent of injury, although absence of NCV or EMG abnormalities is not unusual. Accurate diagnoses are essential for planning specific treatment.