Five cases are reported of upper extremity
amputation with no
metabolic disease. Patients experienced
pain,
paresthesia and weakness in the intact extremity associated with electrophysiologic evidence of
entrapment neuropathies. All patients did heavy manual work, and all had
carpal tunnel syndrome. One patient also had
cubital tunnel syndrome and compression of the medial cord of the brachial plexus in the axilla, and another patient had
cubital tunnel syndrome and axillary neuropathy. Surgery did not relieve symptoms of carpal tunnel and
cubital tunnel syndromes for
prosthesis users until the figure-8 harness was changed. Patients who did not use a
prosthesis felt relief of symptoms following surgical release. Possible mechanisms which produce
nerve entrapment syndromes in patients with upper extremity
amputations are use of one limb for heavy manual work over prolonged periods, direct compression of neural structures from the axilla loop of a figure-8 harness, and compression of neural structures in the axilla resulting in entrapment at a distal site. Changing the figure-8 harness should be considered prior to
surgical decompression for patients who have upper extremity
amputations with entrapment syndromes.