Member May 2026: Select Topics in Hand and Upper Extremity Physiatry (On-Demand)-Session Recording

Video Transcription

Video Summary

This session featured three hand and upper extremity PM&R presentations.<br /><br />Dr. Meiling discussed diagnostic ultrasound for peripheral nerve and brachial plexus injuries. He explained how ultrasound complements EMG/NCS by showing anatomic, not just functional, nerve health. Ultrasound can identify nerve transection, neuromas, stump neuromas, and nerve enlargement, and can help guide treatment decisions such as surgery or nerve transfer. He also reviewed ultrasound views of the brachial plexus and highlighted limitations, including difficulty visualizing deeper structures and root avulsions. He then shifted to inflammatory conditions like Parsonage-Turner syndrome, describing fascicular enlargement, torsion, and hourglass constriction.<br /><br />Dr. Homer presented on climbing-related hand injuries, especially flexor pulley injuries. He reviewed pulley anatomy, especially the A2 and A4 pulleys, and described how crimp grip and eccentric loading can cause rupture. Ultrasound was emphasized as the preferred diagnostic tool, with tendon-to-bone distance and dynamic resisted flexion used to assess bowstringing. He also discussed grading severity, treatment ranging from rest and taping to surgery, and the importance of counseling climbers to avoid premature return.<br /><br />Dr. Chu reviewed shock wave therapy for upper extremity conditions. He explained the difference between focused and radial shock waves and summarized proposed pain-relief mechanisms, including effects on tendinopathic nerve fibers. Evidence was strongest for chronic lateral epicondylitis and painful De Quervain’s tenosynovitis, with possible benefit for painful Dupuytren nodules and select trigger finger cases. He noted limited long-term benefit for carpal tunnel syndrome. The session ended with questions about ultrasound use, pulley splints, and insurance coverage for shock wave therapy.

Keywords

diagnostic ultrasound

peripheral nerve injuries

brachial plexus

EMG/NCS

nerve transection

neuroma

Parsonage-Turner syndrome

flexor pulley injuries

A2 pulley

shock wave therapy

lateral epicondylitis