2025 ASSH On Demand CME Webinar: Common and Atypical Nerve Compression Syndromes-Recording

Video Transcription

Video Summary

The American Society for Surgery of the Hand hosted a detailed webinar exploring modern approaches to both common and atypical nerve compression syndromes. Key topics included updates on carpal and cubital tunnel syndromes, proximal median neuropathy (pronator syndrome), radial tunnel syndrome, quadrangular space syndrome, and thoracic outlet syndrome (TOS).<br /><br />Dr. John Fowler highlighted the 2024 guidelines for carpal tunnel syndrome, emphasizing that nerve conduction studies, while commonly used, are not mandatory for diagnosis. Diagnostic tools like CTS-6, ultrasound, or nerve studies are recommended, with corticosteroid injections offering only short-term relief. Surgical techniques, including awake local anesthesia, are effective, and postoperative therapy or immobilization is generally unnecessary. He also addressed misconceptions, such as the lack of a strong causal link between typing and carpal tunnel. AI applications show promise in improving diagnostic accuracy via ultrasound imaging.<br /><br />Dr. Samir Puri discussed pronator syndrome, outlining the anatomy and common compression sites of the median nerve proximal to the carpal tunnel. Diagnosis relies heavily on detailed motor exams and provocative tests, while imaging and nerve studies may supplement but often yield variable results. Surgical release requires an extensile approach to address potential compressive structures comprehensively.<br /><br />Dr. David Brogan reviewed radial tunnel syndrome, distinguishing it from related conditions like posterior interosseous nerve syndrome. Diagnosis is clinical, with ultrasound and electrodiagnostic tests assisting in select cases. Treatment begins conservatively with bracing, therapy, and injections, progressing to surgical decompression of key anatomic sites if needed, though outcomes vary widely.<br /><br />Dr. Amy Moore focused on quadrangular space syndrome, often affecting overhead athletes, with diagnosis based on clinical exam and exclusion of other pathologies. Surgical decompression via a posterior approach can relieve axillary nerve compression, with outcomes modest due to the condition’s rarity.<br /><br />Finally, Dr. Harvey Chim addressed neurogenic thoracic outlet syndrome, emphasizing diagnosis primarily through history and physical exam. Recent consensus favors rib-sparing scalenectomy over first rib resection due to lower morbidity and similar efficacy, reserving rib resection for anatomical anomalies or symptom recurrence. Conservative management includes physiotherapy and injections, with surgery considered for failure or motor deficits.<br /><br />Overall, the webinar underscored the importance of anatomy-based diagnosis, cautious use of diagnostic tests, individualized treatment plans, and emerging technologies like AI to enhance nerve compression syndrome management.

Keywords

American Society for Surgery of the Hand

nerve compression syndromes

carpal tunnel syndrome

cubital tunnel syndrome

pronator syndrome

radial tunnel syndrome

quadrangular space syndrome

thoracic outlet syndrome

2024 guidelines

diagnostic techniques

AI in ultrasound imaging