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

Syllabus
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The 2025 ASSH On Demand CME Webinar titled "The Elusive Entrapment: Modern Approaches to Common and Atypical Nerve Compression Syndromes," chaired by Dr. Martin I. Boyer, offers continuing education on diagnosing and managing uncommon and typical nerve compression syndromes crucial for hand surgeons. The program covers current diagnostic modalities including electrophysiologic assessments, ultrasound (US), questionnaires, and differentiates between vascular and neurogenic thoracic outlet syndrome (TOS).

Key sessions include:

1. <strong>Carpal and Cubital Tunnel Syndromes (CTS & CuTS)</strong> — Dr. John R. Fowler updates on 2024 guidelines emphasizing history and physical exam for CTS diagnosis, supported by confirmatory US or nerve conduction studies for low CTS-6 scores. AI applications harness radiomic features from US images for nuanced CTS detection beyond human capability. A large randomized clinical trial indicates surgery offers better 18-month recovery than corticosteroid injections for CTS. CuTS diagnostic criteria from expert consensus include symptoms in the ulnar nerve distribution, positive provocative tests, and sensory/motor deficits. Studies show ulnar nerve gliding exercises improve symptoms and US is more sensitive than electrophysiologic studies.

2. <strong>Pronator and Lacertus Syndromes</strong> — Dr. Sameer Kumar Puri discusses proximal median neuropathies caused by compression near the elbow and forearm. Key diagnostic features include motor findings in median nerve-innervated muscles and specific provocative tests. Multiple potential compression sites are reviewed including pronator teres, lacertus fibrosus, and FDS arch. EMG/NCS findings may be absent in many cases, requiring careful clinical evaluation. Surgical decompression options are presented with emphasis on understanding anatomy and differential diagnosis.

3. <strong>Radial Tunnel Syndrome</strong> — Dr. David Brogan outlines the spectrum from vague pain to nerve palsy, diagnoses by tenderness over radial tunnel and resisted supination pain, and identifies five potential compression sites (e.g., fibrous bands, arcade of Frohse). Treatment ranges from steroid injections for pain to surgical decompression for weakness, with tendon transfers as salvage. Recovery from surgery may take up to a year.

4. <strong>Quadrangular Space Syndrome</strong> — Dr. Amy Moore details axillary nerve compression within the quadrangular space causing shoulder pain and weakness, commonly in overhead athletes. Diagnosis includes clinical exam, nerve conduction studies, MRI, and US. Management involves nonoperative therapies like NSAIDs and PT, with surgical decompression as needed.

5. <strong>Thoracic Outlet Syndrome (TOS)</strong> — Dr. Harvey Chim reviews neurogenic and vascular TOS affecting the neurovascular bundle between clavicle and first rib. Diagnosis relies on history, physical exam maneuvers (Adson’s, Roos), imaging (XR, MRI, US), and nerve conduction studies. Treatment starts conservatively with PT and injections; surgery including first rib resection or rib-sparing scalenectomy is reserved for refractory or severe cases. New evidence favors rib-sparing approaches for better outcomes and fewer complications. Addressing double-crush phenomena (multiple compression sites) is emphasized.

The course includes pre/post-tests and offers 1 AMA PRA Category 1 CME credit. It features faculty disclosures consistent with ACCME standards to ensure unbiased education. Overall, the webinar equips hand surgeons with modern, evidence-based strategies for identifying and managing elusive nerve entrapments that may be overlooked in routine practice.
Keywords
nerve compression syndromes
carpal tunnel syndrome
cubital tunnel syndrome
pronator syndrome
lacertus syndrome
radial tunnel syndrome
quadrangular space syndrome
thoracic outlet syndrome
electrophysiologic assessment
ultrasound imaging