Abstract 28

HAND PARESTHESIA IN SUBACROMIAL IMPINGMENT SYNDROME

Sivan M, Venkateswaran B, Mullett H, Even T, Copeland S, Levy O

Reading Shoulder Unit, Reading, United Kingdom.

We have noticed that some patients presenting with impingement syndrome complain of tingling and numbness in their affected arm & hand. The association of paresthesias with impingement syndrome of the shoulder has not been studied before. 100 consecutive patients (mean age 54.7yrs, mean duration of symptoms 2.5 yrs) undergoing surgery were enlisted for the study.

54% had paresthesias during the course of the shoulder problem. Of these, 62.3% patients had radial sided symptoms, 30.2% ulnar-sided symptoms, while 7.5% involving all fingers. A highly significant association was observed between the occurrence of paresthesias and previous pain levels (p=0.0053, table)

Factor	Odds Ratio (OR) estimate	95% CI for Odds Ratio	p-value (Chi -Square test)
Pain (Severe vs. Mild)	5.05	(1.62, 15.73)	0.0053
Impingment (Severe vs. Mild)	3.20	(1.07, 9.59)	0.0377

Nerve conduction studies done in seven patients with paresthesias selected at random revealed mild carpal tunnel syndrome in four and no evidence of carpal tunnel syndrome in three. The four patients with proven carpal tunnel syndrome had good relief following ASD. On follow-up, 48 of 54 (88%) had complete relief of paresthesias and 50 (92.5%) were satisfied.

It seems that there is an association between shoulder impingement syndrome and hand paresthesia, which is strongly associated with the pain of impingement. In the majority of patients, the paresthesia symptoms were relieved after treatment of the impingement with arthroscopic subacromial decompression only. The cause of these paresthesias could not be explained by the nerve conduction studies and is subject for further studies.

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