TEAM APPROACH: UPPER-EXTREMITY NUMBNESS

Upper-extremity numbness has a wide differential diagnosis and can arise from pathology in the cervical spine, brachial plexus, shoulder, elbow, and hand. Physical examination must include evaluation of both nerve root and peripheral nerve function to aid in determining if symptoms are due to central or peripheral pathology. Double-crush syndrome, with both spinal and peripheral etiology, is not uncommon and, if not recognized, may lead to treatment failure. A team approach including orthopaedic surgeons, neurologists, physiatrists, radiologists, and occupational therapists can be crucial in making the diagnosis and designing the treatment plan. Nonoperative treatment can include observation, physical and occupational therapy, functional bracing, and injections of corticosteroids and/or local anesthetics. Operative treatment is appropriate after an appropriate course of nonoperative management has failed or with specific diagnoses in which a delay in definitive treatment may put a patient at risk for long-term functional deficits.