Nerve Compression Syndromes of the Upper Limb

I felt compelled to read and review this book myself as five of its chapters concern nerve compression syndromes which, in my opinion, are over-diagnosed. The book consists of 15 chapters which are predominantly written by hand surgeons from France or North America. As well as chapters regarding nerve compression at specific sites, there are also chapters on the histopathology of nerve compression, the theory of the double-crush syndrome, patient evaluation, the role of the therapist, and compression neuropathies in musicians and athletes.

Some of the chapters, such as that on carpal tunnel syndrome, consist mainly of information found in any standard book of hand surgery. Although that particular chapter contains a useful discussion of the relative benefits of open and endoscopic carpal tunnel release, it does not address other controversial issues like the cause of pillar pain. Also, although the relationship between the use of hand-held vibrating equipment and carpal tunnel syndrome and other nerve problems is mentioned, the investigation and management of suspected carpal tunnel syndrome in workers exposed to vibration is not addressed. Such a discussion would have been a valuable asset at this time when, in the UK at least, hand surgeons are frequently being asked by lawyers to address such issues.

As I have always been uncertain about the double-crush syndrome, I took particular interest in this chapter and benefited from reading it as the author carefully explained the theoretical basis of this phenomenon. Furthermore, both the arguments for and against this condition were presented and discussed in a balanced manner and in sufficient detail to allow readers to come to their own tentative conclusions as to whether “double crush” is a real entity in humans or simply a theory that “provides an excuse to perform multiple surgeries and defends unexpected or unsatisfactory surgical results”. I consider it a shame that other chapters, particularly those on median nerve compression in the forearm and radial nerve compression at the elbow, did not adopt a similar stance, or discuss differential diagnoses such as neuritis. However, it was useful to read these chapters and remind oneself of all the structures which have been implicated as potential causes of nerve irritation and compression. I confess that by the end of the book I felt fortunate that, so far at least, the peripheral nerves of my arms have safely circumnavigated the many hypothesized hazards on their paths from my neck to my hand.

The authors failed to allay my scepticism about thoracic outlet syndrome, but again I found it was useful to refresh myself regarding the proposed pathophysiologies, presentations and signs, though I could not ignore the fact that there are few studies of the outcome of either conservative or operative treatment for this condition.

Throughout the book there is mention of forceful or repetitive work causing compression neuropathies and stretching nerves as a result of muscle hypertrophy, inflammation and muscle imbalance. Not all surgeons would agree with these opinions.

There is no doubt that I have benefited and gained some useful information from reading this book. However, the authors have not particularly mellowed my scepticism about some of the described conditions, especially their frequency of occurrence and diagnostic criteria. I found it easier to relate to the opinions expressed in some chapters, such as that on high radial nerve entrapment, than others.