1
|
Babaeian Z, Ashraf A, Erfani F. Isolated medial antebrachial cutaneous nerve injury after blunt trauma: a case report. J Med Case Rep 2023; 17:91. [PMID: 36907903 PMCID: PMC10009992 DOI: 10.1186/s13256-023-03797-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/30/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND The medial antebrachial cutaneous nerve is a branch of the brachial plexus that contains C8-T1 segments. Injury of this nerve by various mechanisms has been reported in the literature; however, currently, there is no reported case of medial antebrachial cutaneous nerve injury in the setting of acute blunt trauma. CASE PRESENTATION This case report presents the case of a 34-year-old Persian female with dysesthesia and pain in the medial side of the forearm immediately following a blunt trauma by mechanism of elbow external rotation. On electrodiagnostic evaluation, the medial antebrachial cutaneous nerve sensory nerve action potential of the symptomatic side had a significant amplitude drop (more than 50%), compared with the other side. On follow-up electrodiagnosis, after several sessions of physical therapy, the medial antebrachial cutaneous nerve sensory nerve action potential still had a significant amplitude difference. CONCLUSION Blunt trauma can be one of the causes of medial antebrachial cutaneous nerve involvement. An electrodiagnostic study can be helpful in the diagnosis of this nerve injury after blunt trauma.
Collapse
Affiliation(s)
- Zahra Babaeian
- Student Research Committee, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Ashraf
- Department of Physical Medicine and Rehabilitation, Shiraz Geriatric Research Center, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Karimkhan Zand Street, Shiraz, 71348-44119, Iran.
| | - Fariba Erfani
- Student Research Committee, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
2
|
Medial cutaneous nerve neuroma-in-continuity within the ulnar nerve: a report of 2 cases. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01790-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
3
|
Bonshahi A, Biyani G, Sardesai N, Brassett C, Sherman K, Sardesai AM. Ultrasonographic visualisation of anatomical variation of the medial cutaneous nerve of forearm and its depiction by the novel use of a custom computer program to generate 2D diagrams. Reg Anesth Pain Med 2020; 46:182-183. [PMID: 32963076 DOI: 10.1136/rapm-2020-101878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Anosh Bonshahi
- Human Anatomy Centre, Anatomy Building, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Ghansham Biyani
- Anaesthesiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Neil Sardesai
- The Perse Sixth Form College, Cambridge, Cambridgeshire, UK
| | - Cecilia Brassett
- Human Anatomy Centre, Anatomy Building, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Kevin Sherman
- Human Anatomy Centre, Anatomy Building, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Anand M Sardesai
- Anaesthesiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| |
Collapse
|
4
|
Manoukov Y, Herisson O, Sali E, Sautet A, Masquelet AC, Cambon-Binder A. Anatomy of the posterior branch of the medial antebrachial cutaneous nerve: A cadaveric study. Orthop Traumatol Surg Res 2020; 106:771-774. [PMID: 32360558 DOI: 10.1016/j.otsr.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 02/03/2020] [Accepted: 02/28/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE The posterior branch of the medial antebrachial cutaneous nerve (MACN) is at risk to be damaged during cubital tunnel surgery. The purpose of this study was to identify the location of the posterior branch of the MACN (PBMACN) in relation to surgical landmarks pertinent in cubital tunnel surgery. METHODS We performed an anatomical study on 20 limbs from 13 fresh cadavers. The nerve was dissected from 10cm proximal to 10cm distal of the medial epicondyle. We measured the distance between the nerve and the medial epicondyle, and also the distance separating the PBMACN from the ulnar nerve passage between the two heads of the flexor carpi ulnaris. Measurements were performed with the elbow at 45° and 90° of flexion, as well as in full pronation and supination. RESULTS After its emergence from the main trunk of the MACN, the posterior branch ran anteriorly to the medial epicondyle, taking an oblique direction toward the ulnar shaft. The PBMACN was in average 2.53cm under the medial epicondyle when the elbow was flexed at 45°, and 2.96cm when the elbow was flexed at 90°. Average distance between the PBMACN and the penetrating point of the ulnar nerve within the flexor carpi ulnaris was 1.54cm when the elbow was flexed at 45°, and 1.62cm when the elbow was flexed at 90°. Pronation and supination positions of the forearm did not significantly modify our measurements. CONCLUSIONS Understanding the position of MACN posterior branch during ulnar nerve release surgery at the elbow may help in preventing iatrogenic injury. According to our measurements, incision and superficial dissection anterior to the medial epicondyle or distal to the ulnar nerve penetrating point between the two heads of the flexor carpi ulnaris should be avoided or done with an elbow flexed at 90°.
Collapse
Affiliation(s)
- Yvan Manoukov
- Hopital Saint Antoine, Sorbonne Universite, Faculté de Medecine, Campus Saint-Antoine, France.
| | - Olivier Herisson
- Hopital Saint Antoine Paris, Clinique des Maussins-Nollet Paris, Hôpital privé des peupliers Paris, Sorbonne Universite, Faculté de Medecine, Campus Saint-Antoine, France
| | - Eric Sali
- Hopital Saint Antoine, Sorbonne Universite, Faculté de Medecine, Campus Saint-Antoine, France
| | - Alain Sautet
- Hopital Saint Antoine, Sorbonne Universite, Faculté de Medecine, Campus Saint-Antoine, France
| | - Alain-Charles Masquelet
- Hopital Saint Antoine, Sorbonne Universite, Faculté de Medecine, Campus Saint-Antoine, France
| | - Adeline Cambon-Binder
- Hopital Saint Antoine, Sorbonne Universite, Faculté de Medecine, Campus Saint-Antoine, France
| |
Collapse
|
5
|
Belviso I, Palermi S, Sacco AM, Romano V, Corrado B, Zappia M, Sirico F. Brachial Plexus Injuries in Sport Medicine: Clinical Evaluation, Diagnostic Approaches, Treatment Options, and Rehabilitative Interventions. J Funct Morphol Kinesiol 2020; 5:jfmk5020022. [PMID: 33467238 PMCID: PMC7739249 DOI: 10.3390/jfmk5020022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/11/2023] Open
Abstract
The brachial plexus represents a complex anatomical structure in the upper limb. This "network" of peripheral nerves permits the rearrangement of motor efferent fibers, coming from different spinal nerves, in several terminal branches directed to upper limb muscles. Moreover, afferent information coming from different cutaneous regions in upper limb are sorted in different spinal nerves through the brachial plexus. Severe brachial plexus injuries are a rare clinical condition in the general population and in sport medicine, but with dramatic consequences on the motor and sensory functions of the upper limb. In some sports, like martial arts, milder injuries of the brachial plexus can occur, with transient symptoms and with a full recovery. Clinical evaluation represents the cornerstone in the assessment of the athletes with brachial plexus injuries. Electrodiagnostic studies and imaging techniques, like magnetic resonance and high-frequency ultrasound, could be useful to localize the lesion and to define an appropriate treatment and a functional prognosis. Several conservative and surgical techniques could be applied, and multidisciplinary rehabilitative programs could be performed to guide the athlete toward the recovery of the highest functional level, according to the type of injury.
Collapse
Affiliation(s)
- Immacolata Belviso
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (I.B.); (S.P.); (A.M.S.); (V.R.); (B.C.)
| | - Stefano Palermi
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (I.B.); (S.P.); (A.M.S.); (V.R.); (B.C.)
| | - Anna Maria Sacco
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (I.B.); (S.P.); (A.M.S.); (V.R.); (B.C.)
| | - Veronica Romano
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (I.B.); (S.P.); (A.M.S.); (V.R.); (B.C.)
| | - Bruno Corrado
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (I.B.); (S.P.); (A.M.S.); (V.R.); (B.C.)
| | - Marcello Zappia
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
- Musculoskeletal Radiology Unit, Varelli Institute, 80126 Naples, Italy
| | - Felice Sirico
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (I.B.); (S.P.); (A.M.S.); (V.R.); (B.C.)
- Correspondence: ; Tel.: +39-081-746-3508
| |
Collapse
|
6
|
Bianchi S, Becciolini M, Urigo C. Ultrasound Imaging of Disorders of Small Nerves of the Extremities: Less Recognized Locations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2821-2842. [PMID: 31025409 DOI: 10.1002/jum.15014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/29/2019] [Accepted: 04/09/2019] [Indexed: 06/09/2023]
Abstract
Ultrasound is a well-proven imaging modality for showing peripheral nerve disorders and guiding perineural injections. The aim of this review is to focus on small peripheral nerve abnormalities, which are usually not recognized by sonologists. In fact, most of these small nerves have a tiny diameter (<2 mm), and their anatomy is less familiar. We describe the most common causes of small peripheral nerve disorders, providing an accurate description of their anatomic locations and relationships with adjacent structures; we also focus on technical hints that may help in their evaluation.
Collapse
Affiliation(s)
| | | | - Carlo Urigo
- London Northwest University Healthcare Trust, London, England
- Studio Radiologico Urigo, Sassari, Italy
| |
Collapse
|
7
|
Hong GH, Liu JB, Liu YZ, Gao KM, Zhao X, Lao J. Modified contralateral C7 nerve transfer: the possibility of permitting ulnar nerve recovery is confirmed by 10 cases of autopsy. Neural Regen Res 2019; 14:1449-1454. [PMID: 30964072 PMCID: PMC6524498 DOI: 10.4103/1673-5374.253530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Contralateral C7 nerve transfer surgery is one of the most important surgical techniques for treating total brachial plexus nerve injury. In the traditional contralateral C7 nerve transfer surgery, the whole ulnar nerve on the paralyzed side is harvested for transfer, which completely sacrifices its potential of recovery. In the present, novel study, we report on the anatomical feasibility of a modified contralateral C7 nerve transfer surgery. Ten fresh cadavers (4 males and 6 females) provided by the Department of Anatomy, Histology, and Embryology at the Medical College of Fudan University, China were used in modified contralateral C7 nerve transfer surgery. In this surgical model, only the dorsal and superficial branches of the ulnar nerve and the medial antebrachial cutaneous nerve on the paralyzed side (left) were harvested for grafting the contralateral (right) C7 nerve and the recipient nerves. Both the median nerve and deep branch of the ulnar nerve on the paralyzed (left) side were recipient nerves. To verify the feasibility of this surgery, the distances between each pair of coaptating nerve ends were measured by a vernier caliper. The results validated that starting point of the deep branch of ulnar nerve and the starting point of the medial antebrachial cutaneous nerve at the elbow were close to each other and could be readily anastomosed. We investigated whether the fiber number of donor and recipient nerves matched one another. The axons were counted in sections of nerve segments distal and proximal to the coaptation sites after silver impregnation. Averaged axon number of the ulnar nerve at the upper arm level was approximately equal to the sum of the median nerve and proximal end of medial antebrachial cutaneous nerve (left: 0.94:1; right: 0.93:1). In conclusion, the contralateral C7 nerve could be transferred to the median nerve but also to the deep branch of the ulnar nerve via grafts of the ulnar nerve without deep branch and the medial antebrachial cutaneous nerve. The advantage over traditional surgery was that the recovery potential of the deep branch of ulnar nerve was preserved. The study was approved by the Ethics Committee of Fudan University (approval number: 2015-064) in July, 2015.
Collapse
Affiliation(s)
- Guang-Hui Hong
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Jing-Bo Liu
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yu-Zhou Liu
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Kai-Ming Gao
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Xin Zhao
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Jie Lao
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| |
Collapse
|
8
|
Chang KV, Mezian K, Naňka O, Wu WT, Lou YM, Wang JC, Martinoli C, Özçakar L. Ultrasound Imaging for the Cutaneous Nerves of the Extremities and Relevant Entrapment Syndromes: From Anatomy to Clinical Implications. J Clin Med 2018; 7:E457. [PMID: 30469370 PMCID: PMC6262579 DOI: 10.3390/jcm7110457] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022] Open
Abstract
Cutaneous nerve entrapment plays an important role in neuropathic pain syndrome. Due to the advancement of ultrasound technology, the cutaneous nerves can be visualized by high-resolution ultrasound. As the cutaneous nerves course superficially in the subcutaneous layer, they are vulnerable to entrapment or collateral damage in traumatic insults. Scanning of the cutaneous nerves is challenging due to fewer anatomic landmarks for referencing. Therefore, the aim of the present article is to summarize the anatomy of the limb cutaneous nerves, to elaborate the scanning techniques, and also to discuss the clinical implications of pertinent entrapment syndromes of the medial brachial cutaneous nerve, intercostobrachial cutaneous nerve, medial antebrachial cutaneous nerve, lateral antebrachial cutaneous nerve, posterior antebrachial cutaneous nerve, superficial branch of the radial nerve, dorsal cutaneous branch of the ulnar nerve, palmar cutaneous branch of the median nerve, anterior femoral cutaneous nerve, posterior femoral cutaneous nerve, lateral femoral cutaneous nerve, sural nerve, and saphenous nerve.
Collapse
Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan.
| | - Kamal Mezian
- Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine, 12800 Prague, Czech Republic.
| | - Ondřej Naňka
- Institute of Anatomy, Charles University, First Faculty of Medicine, 12800 Prague, Czech Republic.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan.
| | - Yueh-Ming Lou
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan.
| | - Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey.
| |
Collapse
|
9
|
Chadwick N, Morag Y, Smith BW, Yablon C, Kim SM, Yang LJ. Imaging appearance following surgical decompression of the ulnar nerve. Br J Radiol 2018; 92:20180757. [PMID: 30359100 DOI: 10.1259/bjr.20180757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ulnar neuropathy at the elbow is the second most common entrapment neuropathy of the upper extremity. Yet, there is a paucity of literature focusing on the imaging appearance following surgical decompression of the ulnar nerve at the elbow. Diagnostic imaging studies obtained after surgical decompression at The University of Michigan were reviewed and imaging findings were documented. We aim to describe the various techniques of ulnar nerve decompression and corresponding post-operative appearance on imaging. Potential complications following decompression will also be described with imaging and clinical correlation of recalcitrant ulnar neuropathy. It is important for the radiologist who performs MRI or ultrasound of the elbow to be aware of the various ulnar nerve decompression procedures. This knowledge will facilitate rapid and accurate diagnosis of normal and abnormal appearance of the ulnar nerve in this context.
Collapse
Affiliation(s)
- Nicholson Chadwick
- 1 Department of Radiology, University of Michigan, Musculoskeletal Imaging , Ann Arbor, MI , USA
| | - Yoav Morag
- 1 Department of Radiology, University of Michigan, Musculoskeletal Imaging , Ann Arbor, MI , USA
| | - Brandon W Smith
- 2 Department of Neurosurgery, University of Michigan , Ann Arbor, MI , USA
| | - Corrie Yablon
- 1 Department of Radiology, University of Michigan, Musculoskeletal Imaging , Ann Arbor, MI , USA
| | - Sung Moon Kim
- 1 Department of Radiology, University of Michigan, Musculoskeletal Imaging , Ann Arbor, MI , USA
| | - Lynda Js Yang
- 2 Department of Neurosurgery, University of Michigan , Ann Arbor, MI , USA
| |
Collapse
|
10
|
Laumonerie P, Blasco L, Tibbo ME, Leclair O, Kerezoudis P, Chantalat E, Mansat P. Peripheral Nerve Injury Associated with a Subdermal Contraceptive Implant: Illustrative Cases and Systematic Review of Literature. World Neurosurg 2018; 111:317-325. [DOI: 10.1016/j.wneu.2017.12.160] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 11/30/2022]
|