title: Compression of lateral antebrachial cutaneous nerve in waitresses.
abstract: OBJECTIVE
  In a retrospective survey of our electrophysiology laboratory, we encountered 3 cases of lateral antebrachial cutaneous nerve (LACN) compression in waitresses and propose direct compression of LACN by carrying heavy trays on the lateral bicipital tendon. LACN, a branch of musculocutaneous nerve, provides sensory innervations to lateral forearm. Causes of LACN involvement include venipuncture, elbow surgery, and trauma.
  
  
  METHODS
  We encountered 6 cases of LACN neuropathy, 3 cases that were in slim waitresses carrying heavy trays. History and physical examination and forearm electrophysiologic studies (EPS) were performed in 3 waitresses at initial and follow-up visits. Antidromic stimulation of LACN was undertaken by Spindler and Felsenthals technique. Latency, amplitude, and conduction velocity were measured and compared with contralateral limb.
  
  
  RESULTS
  All 3 patients were female waitresses aged 35-42 years, presented with few months of painful paresthesias of distal forearm, worse during working hours. Tinel sign at lateral cubital fossa was positive in all. EPS confirmed delayed latency, low amplitude, and slow conduction velocity of LACN on symptomatic side compared with normal. All 3 patients revealed electrophysiologic abnormalities consistent with LACN compression due to heavy trays in slim waitresses and considered occupational hazard. Treatment included nortriptyline or gabapentin and avoidance of heavy trays. Clinical and EPS findings improved over 8 months.
  
  
  CONCLUSIONS
  We described 3 cases of LACN compression in waitresses from edges of heavy trays with typical symptoms and abnormal electrophysiological studies and improvement by avoiding compression and with analgesics. We propose inadequate fatty tissue in antecubital fossa contributed to compression of LACN.
authors.affiliation: *Department of Neurology, LIJ Medical Center, North-Shore University Hospital, New York, NY; and †Department of Neurology, North Shore University Hospital, New York, NY.
authors.forename: Chilvana
authors.initials: C
authors.lastname: Patel
authors.forename: Suryamurthy
authors.initials: S
authors.lastname: Vishnubhakat
mesh_terms: D000328:Adult; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D001176:Arthrogryposis / Q000188:drug therapy / Q000503:physiopathology*; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000294:innervation; D000077206:Gabapentin; D015417:Hereditary Sensory and Motor Neuropathy / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D009138:Musculocutaneous Nerve / Q000503:physiopathology*; D009661:Nortriptyline / Q000627:therapeutic use; D012189:Retrospective Studies; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D009661:Nortriptyline