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Musculoskeletal Imaging

E3163. Nerve Impingement of the Upper Extremities: Imaging Review With a Focus on Clinical Management

John J,  Loredo R,  Davis M,  Cone R,  Kukkar V. University of Texas Health Science Center San Antonio, San Antonio, TX

Address correspondence to J. John (j.mullasseril@gmail.com)

Background Information: Daily patients present to primary care physicians and specialists with upper extremity pain and/or weakness. There are many causes that can be elucidated from history and physical examination alone. However, when a more thorough evaluation is required diagnostic imaging is ordered. In particular imaging is ordered to tailor and refine management of the patient’s condition. Some of these conditions are treated conservatively and others invasively. The focus of this study is to review upper extremity impingement syndromes that cause pain and/or weakness. This will be done using radiographic and MRI of a variety of conditions and correlating it to the patients treatment options.

Educational Goals/Teaching Points: This will be a case-based review of multiple upper extremity impingement syndromes. Review anatomy of upper extremity nerves from the shoulder to wrist. Identify multiple causes of upper extremity impingement syndrome. Discuss management of upper extremity impingement so that radiologists can have a better understanding of how to help the ordering clinician.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Initially there will be a review on clinically pertinent peripheral nerve anatomy from the shoulder to wrist. The anatomy will then be correlated to various causes of impingement syndrome seen through a case-based review. The cases that will be reviewed include suprascapular nerve impingement, supracondylar process syndrome, ulnar neuritis, cubital tunnel syndrome, anconeus epitrochlearis, pronator syndrome, anterior interosseous syndrome, posterior interosseous syndrome, and ulnar tunnel syndrome. There will be a discussion of clinical management for each of these cases.

Conclusion: Upper extremity pain and/or weakness is a common daily problem that clinicians face. Impingement syndromes can be a cause of these symptoms. Oftentimes impingement syndromes are treated conservatively. However, there are reversible structural causes that also need to be identified by the radiologist. The idea of this study is to use a cases to review pertinent radiographic and MRI findings and apply it to clinical management of the patient to better help the ordering clinicians and improve patient care.