Elisabet Hagert

Peripheral neuropathy in athletes is increasingly recognized as a significant source of morbidity, with injury patterns varying according to the biomechanical demands of specific sports. Although peripheral nerve disorders in athletes may result from acute trauma, they more commonly arise from chronic, repetitive mechanical stress inherent to athletic activity. Despite their frequency, they frequently remain underdiagnosed, as clinical manifestations often overlap with other musculoskeletal disorders. Mechanisms of injury include compression, traction, laceration, ischemia, and repetitive microtrauma. Distinct athletic modalities are associated with characteristic neuropathies reflecting sport-specific kinematics and loading patterns. Awareness of these biomechanical factors and recognition of typical clinical presentations are essential for accurate assessment of athletes with suspected nerve injury. Diagnostic evaluation frequently requires advanced imaging modalities, particularly magnetic resonance neurography (MRN) and high-resolution ultrasound (HRUS), which enable detailed structural assessment of peripheral nerves and detection of secondary imaging findings. Electrodiagnostic studies may provide complementary functional information in selected cases. Early and precise diagnosis is critical to guide management, facilitate safe return to sport, and prevent long-term functional deficits. While most nerve disorders respond to conservative treatment, severe, progressive, or refractory cases may warrant surgical intervention to restore function and enable return to play (RTP). This review examines mechanisms of injury, clinical evaluation, classification systems, imaging findings, and sport-specific patterns of peripheral nerve injury across diverse athletic disciplines.

Purpose: Bone stress injuries of the upper limb are less common than those of the lower limb, but they can cause substantial diagnostic delay in athletes because symptoms are often subtle and non-specific. This narrative review summarizes clinically relevant mechanisms, risk factors, diagnostic challenges, anatomical patterns, management strategies, and return-to-sport considerations. Methods: This narrative review was developed from a targeted, non-systematic review of the current literature and clinical experience, with emphasis on sports that expose the shoulder, arm, forearm, wrist, and hand to repetitive loading. Particular attention was given to imaging features, regional presentations, and practical decision-making in athletic populations. Results: Upper-limb bone stress injuries occur when repetitive loading exceeds the capacity for skeletal adaptation, progressing from marrow oedema and periosteal reaction to cortical disruption if loading continues. Plain radiographs may be normal early, whereas magnetic resonance imaging is most useful for detecting early stress reactions. Injuries may affect the scapula, clavicle, humerus, ulna, radius, carpal bones, metacarpals, and phalanges. Management usually involves load modification, immobilization when appropriate, structured rehabilitation, and correction of biomechanical or training-related contributors. Surgery is reserved for selected displaced, non-union, or functionally limiting injuries. Conclusion: Recognition of upper-limb bone stress injuries requires a high index of suspicion. Individualized, multidisciplinary care is essential to prevent progression, guide safe return to sport, and reduce recurrence.

Introduction: Radial tunnel syndrome (RTS) remains an overlooked cause of chronic elbow pain. Clinical overlap with lateral epicondylitis, and the coexistence of other nerve entrapments contribute to diagnostic uncertainty. This study aimed to characterise the clinical presentation, and concomitant pain/nerve entrapment patterns following surgical decompression of posterior interosseous nerve (PIN) compression, and to explore the Neurogenic Elbow Disharmony Loop (NEDL) as a hypothesis-generating model for refractory elbow pain. Methods: A retrospective review of 157 operated arms in 143 patients who underwent PIN decompression between 2012–2021 was performed. RTS was diagnosed clinically using a triad consisting of extensor carpi ulnaris (ECU) weakness, a positive sensory collapse test, and focal tenderness at the arcade of Frohse. Demographics, pain distribution, concomitant procedures, Quick/Work-DASH scores, postoperative visual analogue scale (VAS) scores, and patient satisfaction were analysed. Results: The mean age was 45.9 years, and the majority (66.9%) had previously been diagnosed with lateral epicondylitis. Referred symptoms were common, involving the hand (45%), shoulder (38%), wrist (28%), and neck (14%). Concomitant lacertus syndrome requiring surgical release was identified in 72.6% of arms. Return of ECU power was confirmed in all operated arms intraoperatively or before discharge. Mean pre-/postoperative Quick-/Work-DASH scores improved from 43.4 to 11.0 ( p < 0.001), and 56.2 to 11.2 ( p < 0.001), respectively. Mean postoperative VAS scores were 1.8 (pain), 1.1 (numbness), and 8.5 (satisfaction), with 83% of patients reporting good/excellent outcomes. Conclusion: Surgery with PIN decompression resulted in significant functional improvement and high patient satisfaction. The high prevalence of concomitant lacertus syndrome and the bidirectional distribution of referred symptoms support a neurogenic–biomechanical interpretation of chronic elbow pain. The NEDL is proposed as a hypothesis-generating framework that may guide the evaluation and treatment of patients with refractory elbow pain.

Background: Wide-Awake Local Anesthesia No Tourniquet (WALANT), offers a promising alternative to non-WALANT techniques, including tourniquet-assisted local or general anesthesia in upper limb surgeries. This systematic review and meta-analysis (SRMA) evaluated pain scores and complication rates in surgeries performed under WALANT vs tourniquet use. Methods: Following PRISMA guidelines, this PROSPERO-registered (CRD42023412583) SRMA searched Medline, Embase, Cochrane, Web of Science, and Scopus through November 2024, including randomized controlled trials (RCTs) comparing WALANT and tourniquet use in upper limb surgeries. Pain scores during injection, intra- and postoperatively, and complication rates, were analyzed. Results: Eleven RCTs with 794 patients (400 WALANT, 394 tourniquet) were analyzed. WALANT significantly reduced intraoperative pain (SMD -2.56, 95% CI -3.76 to -1.36, p < 0.01) and early postoperative pain (0–6 hours; SMD -1.37, 95% CI -2.61 to -0.12, p < 0.01). The reduction in early postoperative pain did not exceed the established MCID of 1.6. Similarly, reductions in pain during injection (SMD -1.05, 95% CI -2.27 to 0.16, I ² = 92%) and in the late postoperative period (6–12 hours; SMD -0.83, 95% CI -1.10 to -0.57) did not reach the threshold for clinical significance. Overall complication rates were similar between groups (RR 0.80, 95% CI 0.57 to 1.12) and remained consistent regardless of sodium bicarbonate use (RR 0.71, 95% CI 0.40 to 1.26). Conclusion: WALANT is a safe and effective alternative to the non-WALANT techniques, including tourniquet-assisted local or general anesthesia method for upper limb surgeries, offering significant pain reduction that exceeds the MCID intraoperatively.

Purpose: The purpose of this scoping review is to analyze the application of artificial intelligence (AI) in ultrasound (US) imaging for diagnosing carpal tunnel syndrome (CTS), with an aim to explore the potential of AI in enhancing diagnostic accuracy, efficiency, and patient outcomes by automating tasks, providing objective measurements, and facilitating earlier detection of CTS. Methods: We systematically searched multiple electronic databases, including Embase, PubMed, IEEE Xplore, and Scopus, to identify relevant studies published up to January 1, 2025. Studies were included if they focused on the application of AI in US imaging for CTS diagnosis. Editorials, expert opinions, conference papers, dataset publications, and studies that did not have a clear clinical application of the AI algorithm were excluded. Results: 345 articles were identified, following abstract and full-text review by two independent reviewers, 18 manuscripts were included. Of these, thirteen studies were experimental studies, three were comparative studies, and one was a feasibility study. All eighteen studies shared the common objective of improving CTS diagnosis and/or initial assessment using AI, with shared aims ranging from median nerve segmentation (n = 12) to automated diagnosis (n = 9) and severity classification (n = 2). The majority of studies utilized deep learning approaches, particularly CNNs (n = 15), and some focused on radiomics features (n = 5) and traditional machine learning techniques. Conclusion: The integration of AI in US imaging for CTS diagnosis holds significant promise for transforming clinical practice. AI has the potential to improve diagnostic accuracy, streamline the diagnostic process, reduce variability, and ultimately lead to better patient outcomes. Further research is needed to address challenges related to dataset limitations, variability in US imaging, and ethical considerations.

Purpose: Peripheral nerve compression syndromes are a common cause of pain, weakness, and functional limitations, yet they often remain underdiagnosed due to the limitations of traditional diagnostic methods such as electromyography and imaging. This article describes the clinical triad—manual muscle testing (MMT), sensory-collapse testing (SCT), and pain evaluation—as a structured, integrative approach to improving the diagnosis of nerve compressions. Methods: This narrative review examines the anatomical basis and diagnostic application of the clinical triad across common peripheral nerve compression syndromes. The review focuses on the median, ulnar, and radial nerves in the upper extremity, as well as the peroneal nerve in the lower extremity. Each component of the triad is analyzed for its role in detecting nerve compressions, including the reliability of MMT for identifying muscle weakness patterns, the specificity of SCT as a confirmatory tool, and the role of pain assessment in localizing entrapment sites. Results: The clinical triad provides a structured and accessible diagnostic framework that enhances the detection of nerve compressions, even in early-stage presentations that may evade standard diagnostic tools. It demonstrates adaptability to complex cases, including double- and multiple-crush syndromes, and offers a non-invasive, cost-effective alternative to traditional diagnostic approaches. Conclusion: The clinical triad enhances diagnostic precision in peripheral nerve compression syndromes by integrating motor, sensory, and pain assessments. Its structured methodology facilitates early detection and targeted interventions, potentially improving patient outcomes while reducing reliance on invasive or resource-intensive diagnostic methods.