Peripheral nerve entrapment caused by motor vehicle crashes

During the era before seatbelts and air bags, extensive injury was common after motor vehicle collisions (MVCs). Yet upper extremity peripheral nerve problems, other than the brachial plexus injury, have not been ascribed previously to MVCs. Seven hundred twenty-five patients with the diagnosis of carpal tunnel syndrome (CTS), cubital tunnel syndrome (CT), and radial sensory nerve (RSN) entrapment in the forearm were reviewed. The number of MVC-caused nerve entrapments was 157 (68 for CTS, 64 for CT, and 25 for RSN). In 25% of the patients, the nerve entrapment was bilateral. This paper discusses the causal relationship between MVCs and subsequent nerve compressions in the upper extremity and discusses a suggested pathomechanism of injury. The most common pattern was for the injured person to be the driver, to have the injured hand or hands on the steering wheel, to be hit from the front or rear, and to develop a sudden onset of nerve compression symptoms within 1 week. Awareness of this causal relationship may allow early recognition and treatment.