Common Idiopathic Mononeuropathies of the Upper Extremity

Abstract

This thesis focuses on conditions where a nerve is affected (neuropathy) by compression in the wrist or elbow. For most of these conditions, the cause is unknown (idiopathic). The two most common conditions in the arm are median nerve neuropathy at the carpal tunnel (MNCT) and ulnar nerve neuropathy at the elbow (UNE). The overarching term for the symptoms and signs of these conditions are carpal tunnel syndrome (CTS) and cubital tunnel syndrome, respectively. This thesis is divided in 4 parts. In part 1, multiple patient-reported outcome measures (PROMs) were examined to quantify subjective aspects of health. Strong correlations between PROMs, pain intensity, and quality of life were demonstrated, with psychosocial factors seeming to play a significant role. Part 2 focuses on electrodiagnostics (nerve conduction studies) as a diagnostic tool for MNCT and UNE. The results of the studies suggest diagnostic uncertainty in distinguishing between no and mild neuropathology, indicating a need for improved diagnostic criteria. The third part highlights that patients prefer to share decisions with their surgeon (shared decision-making) in the treatment of CTS. Additionally, a lack of personal financial responsibility was found to be the most common reason for choosing the (more expensive) treatment option; surgery. The final part shows geographical variation in the use of radiographs and corticosteroid injections for CTS and UNE. Finally, patients had less regret about their treatment choice when they had read a decision aid about their condition.