Tremors associated with peripheral nerve entrapments of the upper limb.

Peripherally-induced movement disorder (PIMD) is a group of conditions manifested by involuntary movements or other motor abnormalities that are induced by or emerge in the context of injury to the peripheral nervous system. Peripheral nerve entrapment (PNE) in the upper extremities is common and their clinical signs are very well known by hand surgeons. Only 3 cases of tremor with PNE have already been reported (one in 1986 and two very recently). The aim of this multicentric retrospective study is to report clinical cases of tremors caused by PNE and to analyze their clinical findings and treatment. 17 patients was referred to 5 hand centers for tremors of their hand after being examined by a neurologist clinically and electrophysiologically. The clinical examination showed simple, double or multiple crush nerve entrapment at the upper limb (elbow was involved for all of them except one). The treatment was conservative (myofascial manipulation and taping) for 8 patients and surgical (wide awake nerve release) for 9 others after failure of conservative treatments. The tremors disappeared for all of them. Our study showed upper limb peripheral nerve entrapment can be a cause of tremor of the hand in rare but misdiagnosed situations. We suggest that tremor induced by peripheral nerve entrapment can be a new type of tremor classified in the PIMD group. Hand physiotherapist and surgeons must be questioned by medical doctors who take care of tremors (family doctors, neurologists …) and so, be awared of that etiology.