A Medical Navigator or Curbside Medical Consult For Patients: Clinical Grading Of Entrapment Neuropathies Helps One Diagnose And Formulate An Appropriate Treatment Plan

The diagnosisandtreatmentof peripheral nerve entrapment syndromes (eg
Carpal Tunnel Syndrome, Ulnar Nerve Compression Across the Elbow, to mention only a few)  depends on an understanding of their different clinical grades that reflect severity of nerve damage and the resulting symptoms.

Diagnosis:

A mildclinical grade occurs with intermittent symptoms but no evidence of axonal loss as shown on clinical exam by muscle atrophy (loss or wasting) on motor examination and/or increased 2 point discrimination (the ability to detect two small points applied to the skin, usually on the finger tips, several millimeters apart) on sensory examination and no evidence of muscle denervation on EMG (electromyographic) testing.  A moderateclinical grade occurs with constant symptoms but no clinical or EMG evidence of axonal loss.  A severeclinical grade occurs with clinical and EMG evidence of axonal loss.

Treatment Possibilities:

A mild clinical grade entrapment syndrome is initially treated with non-surgical measures (eg splinting, ergonomic modifications, and physical/hand therapy) while in the case of a severe clinical grade entrapment syndrome surgical decompression is usually recommended.  A moderate clinical grade entrapment syndrome can be treated either surgically or non-surgically:  if non-surgical therapy fails then surgery is recommended.

Reference: 

G.A. Grant, R. Goodkin, and M. Kliot.  Evaluation and surgical management of peripheral nerve problems.  Neurosurgery 44:  825-840.  1999.

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