Upper Limb Nerve Entrapment Syndromes in Veterans With Lower Limb Amputations

Objective: To examine the prevalence and severity of upper limb entrapment syndromes in a sample of veterans with lower limb amputations. Design: A descriptive survey, pilot study. Setting: 2008 National Disabled Veterans Winter Sports Clinic. Participants: Twenty participants with various lower limb amputations. Methods: All study participants completed a questionnaire that included symptoms of both upper limbs, medical history, time since amputation, medication history, use of assistive technology, and wheelchair characteristics. A physical examination and electrodiagnostic testing were then performed on each participant. The physical examination included an assessment of bilateral upper limb weakness or sensory abnormalities, thenar/hypothenar atrophy, deep tendon reflexes, Tinel test of the wrist and elbow, and the Phalen maneuver. All nerve conduction studies were performed by an American Board of Electrodiagnostic Medicine-certified physiatrist. Outcome Measures: Correlation between symptoms, examination findings, and electrodiagnostic findings with the participant's demographic data in the questionnaire. Results: Twenty participants (19 men and 1 woman) were enrolled in the study, with a total of 38 upper limbs evaluated. The mean age of the study population was 59 ± 13 years, with an average of 23 years since the amputation. Sixteen (80%) of 20 participants had electrodiagnostic findings consistent with median neuropathy across the wrist (26/38 affected limbs, 6 participants with unilateral and 10 with bilateral findings), and 14 (70%) of 20 participants had ulnar entrapment neuropathy across the elbow (22/38 affected limbs, 6 participants with unilateral and 8 with bilateral findings). Several participants (6 of 20, 30%) were found to have electrodiagnostic evidence of ulnar entrapment neuropathy across the wrist (10 of 38 affected limbs, 2 participants unilateral and 4 bilateral findings). Conclusion: A high number of veterans with lower limb amputations presented with upper limb nerve entrapment syndromes. Careful attention to these nerve entrapment syndromes in lower limb amputees is necessary because the symptoms may be confounded by other chronic pain-related disorders.