Upper extremity compression neuropathies in rheumatoid patients

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.