Abstract
Clinically significant upper extremity peripheral neuropathy affects approximately 20 % of patients with rheumatoid arthritis. In addition to the intrinsic changes in nerve physiology resulting from chronic inflammation, rheumatoid synovitis may cause local compression of major peripheral nerves. The most common compression neuropathies in patients with rheumatoid arthritis are (1) carpal tunnel syndrome, (2) cubital tunnel syndrome, and (3) posterior interosseous nerve (PIN) compression. Diagnosis of these conditions is generally based on clinical findings, supported by imaging and electrodiagnostic studies. In contrast to patients without rheumatoid arthritis, there is little role for nonoperative treatment modalities. With appropriate diagnosis and meticulous surgical technique, nerve decompression with concomitant synovectomy offers excellent outcomes.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Waljee JF, Chung KC. Outcomes research in rheumatoid arthritis. Hand Clin. 2011;27(1):115–26.
Aneja R, Singh MB, Shankar S, et al. Prevalence of peripheral neuropathy in patients with newly diagnosed rheumatoid arthritis. Indian J Rheumatol. 2007;2(2):47–50.
Cimmino MA, Salvarani C, Macchioni P, et al. Extra-articular manifestations in 587 Italian patients with rheumatoid arthritis. Rheumatol Int. 2000;19(6):213–7.
Turesson C, Jacobsson LT. Epidemiology of extra-articular manifestations in rheumatoid arthritis. Scand J Rheumatol. 2004;33(2):65–72.
Agarwal V, Singh R, Wiclaf, et al. A clinical, electrophysiological, and pathological study of neuropathy in rheumatoid arthritis. Clin Rheumatol. 2008;27(7):841–4.
Lanzillo B, Pappone N, Crisci CDI, et al. Subclinical peripheral nerve involvement in patients with rheumatoid arthritis. Arthritis Rheum. 1998;41(7):1196–202.
Sivri A, Guler-Uysal F. The electroneurophysiological findings in rheumatoid arthritis patients. Electromyogr Clin Neurophysiol. 1999;39(7):387–91.
Bharadwaj A, Haroon N. Interstitial lung disease and neuropathy as predominant extra-articular manifestation in patients with rheumatoid arthritis. Med Sci Monit. 2005;11(10):CR498–502.
Nadkar MY, Agarwal R, Samant RS, et al. Neuropathy in rheumatoid arthritis. J Assoc Physicians India. 2001;49:217–20.
Lang AH, Kalliomäki JL, Puusa A, et al. Sensory neuropathy in rheumatoid arthritis: an electroneurographic study. Scand J Rheumatol. 1981;10(2):81–4.
Herbison GJ, Teng C, Martin JH, et al. Carpal tunnel syndrome in rheumatoid arthritis. Am J Phys Med. 1973;52(2):68–74.
Vallat J-M, Rabin M, Magy L. Peripheral neuropathies in rheumatic disease—a guide to diagnosis. Nat Rev Rheumatol. 2012;8(10):599–609.
Muramatsu K, Tanaka H, Taguchi T. Peripheral neuropathies of the forearm and hand in rheumatoid arthritis: diagnosis and options for treatment. Rheumatol Int. 2008;28(10):951–7.
Conn DL, McDuffie FC, Dyck PJ. Immunopathologic study of sural nerves in rheumatoid arthritis. Arthritis Rheum. 1972;15(2):135–43.
Bekkelund SI, Torbergsen T, Husby G, et al. Myopathy and neuropathy in rheumatoid arthritis. A quantitative controlled electromyographic study. J Rheumatol. 1999;26(11):2348–51.
Sivri A, Güler-Uysal F. The electroneurophysiological evaluation of rheumatoid arthritis patients. Clin Rheumatol. 1998;17(5):416–8.
Mackinnon SE, Novak CB. Compression neuropathies. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia, PA: Elsevier; 2011. p. 977–1014.
Cheng CJ, Mackinnon-Patterson B, Beck JL, et al. The scratch collapse test for evaluation of carpal and cubital tunnel syndrome. J Hand Surg Am. 2008;33(9):1518–24.
Phalen GS. The carpal tunnel syndrome: seventeen years’ experience in diagnosis and treatment of six hundred and fifty four hands. J Bone Joint Surg Am. 1966;48(2):211–28.
Durkan JA. A new diagnostic test for carpal tunnel syndrome. J Bone Joint Surg Am. 1991;73(4):535–8.
Papp SR, Athwal GS, Pichora DR. The rheumatoid wrist. J Am Acad Orthop Surg. 2006;14(2):65–77.
Szabo RM, Kwak C. Natural history and conservative management of cubital tunnel syndrome. Hand Clin. 2007;23(3):311–8.
Celiker R, Arslan S, Inanici F. Corticosteroid injection vs. nonsteroidal antiinflammatory drug and splinting in carpal tunnel syndrome. Am J Phys Med Rehabil. 2002;81(3):182–6.
Bickel KD. Carpal tunnel syndrome. J Hand Surg Am. 2010;35(1):147e–52.
Grabois M, Puentes J, Lidsky M. Tarsal tunnel syndrome in rheumatoid arthritis. Arch Phys Med Rehabil. 1981;62(8):401–3.
White SH, Goodfellow JW, Mowat A. Posterior interosseous nerve palsy in rheumatoid arthritis. J Bone Joint Surg Br. 1988;70(3):468–71.
Geoghegan JM, Clark DI, Bainbridge LC, et al. Risk factors in carpal tunnel syndrome. J Hand Surg Br. 2004;29(4):315–20.
Karadag O, Kalyoncu U, Akdogan A, et al. Sonographic assessment of carpal tunnel syndrome in rheumatoid arthritis: prevalence and correlation with disease activity. Rheumatol Int. 2012;32(8):2313–9.
Stevens JC, Beard CM, O’Fallon WM, et al. Conditions associated with carpal tunnel syndrome. Mayo Clin Proc. 1992;67(6):541–8.
Shinoda J, Hashizume H, McCown C, et al. Carpal tunnel syndrome grading system in rheumatoid arthritis. J Orthop Sci. 2002;7(2):188–93.
Feldon P, Terrono AL. Carpal tunnel syndrome in rheumatoid arthritis. Tech Orthop. 2006;21(1):42–7.
Duckworth AD, Jenkins PJ, McEachan JE. Diagnosing carpal tunnel syndrome. J Hand Surg Am. 2014;39(7):1403–7.
Hayton M. Vascular and neurological considerations in rheumatoid arthritis. Int Congr Ser. 2006;1295:34–42.
Clayton ML. Surgical treatment at the wrist in rheumatoid arthritis: a review of thirty-seven patients. J Bone Joint Surg Am. 1965;47:741–50.
Britz GW, Haynor DR, Kuntz C, et al. Carpal tunnel syndrome: correlation of magnetic resonance imaging, clinical electrodiagnostic, and intraoperative findings. Neurosurgery. 1995;37(6):1097–103.
Pierre-Jerome C, Bekkelund SI, Mellgren SI, et al. The rheumatoid wrist: bilateral MR analysis of the distribution of rheumatoid lesions in axial plain in a female population. Clin Rheumatol. 1997;16(1):80–6.
Dang AC, Rodner CM. Unusual compression neuropathies of the forearm, part II: median nerve. J Hand Surg Am. 2009;34(10):1915–20.
Jabaley M, Wallace W, Heckler F. Internal topography of major nerves of the forearm and hand: a current view. J Hand Surg Am. 1980;5(1):1–18.
Sunderland S. The intraneural topography of the radial, median and ulnar nerves. Brain. 1945;68:243–99.
Belcher HJ, Varma S, Schonauer F. Endoscopic carpal tunnel release in selected rheumatoid patients. J Hand Surg Br. 2000;25(5):451–2.
Ertel AN, Millender LH, Nalebuff EA, et al. Flexor tendon ruptures in patients with rheumatoid arthritis. J Hand Surg Am. 1988;13(6):860–6.
Louie DL, Earp BE, Collins JE, et al. Outcomes of open carpal tunnel release at a minimum of ten years. J Bone Joint Surg Am. 2013;95(12):1067–73.
Adkinson JM, Chung KC. Minimal-incision in situ ulnar nerve decompression at the elbow. Hand Clin. 2014;30(1):63–70.
Mainard D, Saury P, Delagoutte JP. Ulnar nerve compression at the elbow caused by synovial cyst of rheumatoid origin. Rev Rhum Mal Osteoartic. 1991;58(9):611–4.
Cho C-H, Kim B-S, Bae K-C, et al. Attritional rupture of ulnar nerve in a patient with rheumatoid arthritis. J Rheum Dis. 2012;19(6):348–50.
Nakagawa N, Abe S, Saegusa Y, et al. Giant geode at the olecranon in the rheumatoid elbow—two case reports. Clin Rheumatol. 2004;23(4):358–61.
Waugh RP, Zlotolow DA. In situ decompression of the ulnar nerve at the cubital tunnel. Hand Clin. 2007;23(3):319–27. vi.
McGowen A. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Joint Surg Br. 1950;32(3):293–301.
Posner MA. Compressive neuropathies of the ulnar nerve at the elbow and wrist. Instr Course Lect. 2000;49:305–17.
Idler RS. General principles of patient evaluation and nonoperative management of cubital syndrome. Hand Clin. 1996;12(2):397–403.
Minami M, Kato S, Kondo M, et al. Posterior interosseous nerve palsy secondary to rheumatoid cyst of the elbow joint: case report. Mod Rheumatol. 2004;14:191–5.
Ogawa H. Posterior interosseous nerve palsy related to rheumatoid synovitis of the elbow. Mod Rheumatol. 2007;17:327–9.
Polatsch DB, Melone Jr CP, Beldner S, et al. Ulnar nerve anatomy. Hand Clin. 2007;23(3):283–9.
Kalaci A, Aslan B, Yanat AN. Spontaneous rupture of ulnar nerve due to neglected cubital tunnel syndrome associated with rheumatoid arthritis. J Clin Rheumatol. 2007;13(4):217–8.
Moore JR, Weiland AJ. Bilateral attritional rupture of the ulnar nerve at the elbow. J Hand Surg Am. 1980;5:358–60.
Ochi K, Ikari K, Momohara S. Attrition rupture of ulnar nerve in an elbow of a patient with rheumatoid arthritis. J Rheumatol. 2014;41(10):2085.
Feldon P, Terrono AL, Nalebuff EA, et al. Rheumatoid arthritis and other connective tissue diseases. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia, PA: Elsevier; 2011. p. 1993–2065.
Kishner S, Biundo Jr JJ. Posterior interosseous neuropathy in rheumatoid arthritis. J Clin Rheumatol. 1996;2(1):29–32.
Millender LH, Nalebuff EA, Holdsworth DE. Posterior interosseous-nerve syndrome secondary to rheumatoid synovitis. J Bone Joint Surg Am. 1973;55(4):753–7.
Malipeddi A, Reddy VR, Kallarackal G. Posterior interosseous nerve palsy: an unusual complication of rheumatoid arthritis: case report and review of the literature. Semin Arthritis Rheum. 2011;40(6):576–9.
Hirachi K, Kato A, Minami T, et al. Clinical features and management of traumatic posterior interosseous nerve palsy. J Hand Surg Br. 1998;23(3):413–7.
Hanna BD, Robertson FW, Ansell BM, et al. Nerve entrapment at the elbow in rheumatoid arthritis. Rheumatol Rehabil. 1975;14(4):212–7.
Chan JK, Kennett R, Smith G. Posterior interosseous nerve palsy in rheumatoid arthritis: case report and literature review. J Plast Reconstr Aesthet Surg. 2009;62(12):e556–60.
Dang AC, Rodner CM. Unusual compression neuropathies of the forearm, part I: radial nerve. J Hand Surg Am. 2009;34(10):1906–14.
Abrams RA, Ziets RJ, Lieber RL, et al. Anatomy of the radial nerve motor branches in the forearm. J Hand Surg Am. 1997;22(2):232–7.
Thomas SJ, Yakin DE, Parry BR, et al. The anatomical relationship between the posterior interosseous nerve and the supinator muscle. J Hand Surg Am. 2000;25(5):936–41.
Eaton CJ, Lister GD. Radial nerve compression. Hand Clin. 1992;8(2):345–57.
Naam NH, Nemani S. Radial tunnel syndrome. Orthop Clin North Am. 2012;43(4):529–36.
Ishikawa H, Hirohata K. Posterior interosseous nerve syndrome associated with rheumatoid synovial cysts of the elbow joint. Clin Orthop Relat Res. 1990;254:134–9.
Westkaemper JG, Varitimidis SE, Sotereanos DG. Posterior interosseous nerve palsy in a patient with rheumatoid synovitis of the elbow: a case report and review of the literature. J Hand Surg Am. 1999;24(4):727–31.
Roth AI, Stulberg BN, Fleegler EJ, et al. Elbow arthrography in the evaluation of posterior interosseous nerve compression in rheumatoid arthritis. J Hand Surg Br. 1986;11(1):120–2.
Muratmatsu K, Kojima T, Yoshida K. Peripheral neuropathies associated with rheumatoid synovial cysts of the elbow joint: three case reports. J Clin Rheumatol. 2006;12:287–90.
Hall HC, Mackinnon SE, Gilbert RW. An approach to the posterior interosseous nerve. Plast Reconstr Surg. 1984;74(3):435–7.
Kahlenberg JM, Fox DA. Advances in the medical treatment of rheumatoid arthritis. Hand Clin. 2011;27(1):11–20.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Adkinson, J.M. (2016). Upper Extremity Compression Neuropathies in Rheumatoid Patients. In: Chung, K. (eds) Clinical Management of the Rheumatoid Hand, Wrist, and Elbow. Springer, Cham. https://doi.org/10.1007/978-3-319-26660-2_5
Download citation
DOI: https://doi.org/10.1007/978-3-319-26660-2_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-26658-9
Online ISBN: 978-3-319-26660-2
eBook Packages: MedicineMedicine (R0)