Nerve entrapment syndromes in the upper extremity contralateral to amputation

Area of Science:

• Orthopedics
• Neurology
• Rehabilitation Medicine

Background:

• Nerve entrapment syndromes can occur in the intact limb of individuals with upper extremity amputations.
• These syndromes are often associated with heavy manual labor and pre-existing conditions like carpal tunnel syndrome.

Observation:

• Patients presented with pain, paresthesia, and weakness in the intact extremity.
• Electrophysiologic studies confirmed entrapment neuropathies, including carpal tunnel syndrome in all cases.
• Some patients also exhibited cubital tunnel syndrome and brachial plexus or axillary nerve compression.

Findings:

• Surgical release of carpal tunnel and cubital tunnel syndromes was ineffective for prosthesis users until their figure-8 harness was modified.
• Patients not using prostheses experienced symptom relief after surgical decompression.
• Potential causes include prolonged heavy manual work, harness-induced neural compression, and axillary nerve entrapment.

Implications:

• Altering the figure-8 harness is a crucial consideration for prosthesis users experiencing entrapment syndromes post-amputation.
• This non-invasive intervention may obviate the need for surgical decompression in some cases.
• Understanding harness design's role is vital for optimizing patient outcomes in amputee rehabilitation.