Subacute nerve compressions after trauma and surgery of the hand.

BACKGROUND

It is accepted that major injuries of the upper limb may require not only fasciotomies but also nerve decompressions. That nerve compression(s) may occur after less dramatic injuries and "routine" surgery distal to the elbow is less well documented in the literature but well known to experienced clinicians. The aim of this study was to identify a possible link between injuries or elective surgery to the distal upper limb and "subacute nerve compressions."

METHODS

Over a 5-year period, data of patients who developed clinical symptoms of nerve compressions distal to the elbow within 6 months after trauma or elective surgery to the same upper limb that affected postoperative management were collected prospectively.

RESULTS

This study identified 91 patients (49 after trauma and 42 after elective surgery). Compression of the median nerve in the carpal tunnel was the most common syndrome (73 cases). Fasciectomy for Dupuytren's disease was the most frequent operation involved (23 cases). The average time from injury or surgery to diagnosis of nerve compression(s) was 8 weeks (range, 1 to 24 weeks). Surgical decompression of the involved nerves was performed in 43 patients (47.2 percent), with an average time from diagnosis to surgery of 30.4 weeks (range, 28 to 44 weeks). In the carpal tunnel syndrome group (47 men and 26 women), mean age was 49 years (men, 48 years; women, 50 years) and the male-to-female ratio was 1.8:1.

CONCLUSION

Subacute nerve compressions should be considered as a complication during the recovery period after injury and surgery of the upper limb.