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Canoso JJ, Murillo-González J, Mérida-Velasco JR, Kalish RA, Olivas-Vergara O, Gómez-Moreno C, Blas EGC, Fuensalida-Novo G, Naredo E. Anconeus and pronation: a palpatory and ultrasonographic study. Surg Radiol Anat 2024:10.1007/s00276-024-03399-6. [PMID: 39043949 DOI: 10.1007/s00276-024-03399-6] [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: 04/10/2024] [Accepted: 05/24/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE Depending on its axis, pronation varies from the radius rotation around the steady ulna to the reciprocal adduction of the radius and abduction of the ulna. While there is no question that pronator teres is a central pronation agonist, anconeus's role is not settled. The current investigation comparing palpation and ultrasonography in these two muscles during pronation along the axis capitulum-second digit evolved from a serendipitous finding in a clinical anatomy seminar. METHODS Single-hand palpation and two-transducer ultrasonography over anconeus and pronator teres were used on ten normal subjects to investigate their contraction during pronation around the capitulum-second digit axis. These studies were done independently and blind to the results of the other. The statistical analysis between palpation and ultrasonography was performed with Cohen's kappa coefficient and the χ2 test. RESULTS On palpation, on resisted full pronation, anconeus contracted in 8/10 subjects and pronator teres in 10/10 subjects. Without resistance, the corresponding ratios were 5/10 and 9/10. On two-transducer ultrasonography, the comparable ratios were 7/10 and 10/10, and 3/10 and 10/10. A fair concordance (Cohen's kappa = 0.21) between palpation and ultrasonography in detecting the simultaneous status of anconeus and pronator teres during resisted full pronation. Anatomic dissection illustrated the elements involved. CONCLUSIONS Plain palpation confirmed by ultrasonography showed the simultaneous contraction of anconeus and pronator teres during resisted pronation in most of the studied subjects. The study suggests that palpation can be helpful in directly studying muscle activity during movement.
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Affiliation(s)
- Juan J Canoso
- Department of Medicine, ABC Medical Center, Mexico City. CDMX, Emeritus, Mexico
- Division of Rheumatology, Tufts University School of Medicine, Boston, MA, USA
| | - Jorge Murillo-González
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, Madrid, 28040, Spain.
| | - José Ramón Mérida-Velasco
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, Madrid, 28040, Spain
| | - Robert A Kalish
- Division of Rheumatology, Tufts University School of Medicine, Boston, MA, USA
| | - Otto Olivas-Vergara
- Department of Rheumatology and Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Gema Fuensalida-Novo
- Department of Nursing, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
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Chen S, Ho T, Asubonteng J, Sobel RE, Eng S, DiMartino SJ, Manthripragada A. Risk of carpal tunnel syndrome among patients with osteoarthritis: a US population-based study. BMC Musculoskelet Disord 2024; 25:468. [PMID: 38879540 PMCID: PMC11179394 DOI: 10.1186/s12891-024-07459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/19/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS), an entrapment neuropathy caused by pressure of the median nerve, is a progressive condition that can lead to a decreased quality of life. Studies suggest an association between CTS and arthritis; however, previous studies examining osteoarthritis (OA) and CTS are limited in number, scope and study design. This study estimated the incidence and risk of CTS among patients with OA, both overall and by specific joints, in a large population-based cohort in the United States. METHODS Patients from the Optum claims database aged ≥ 45 years and diagnosed with OA between January 1, 2018, and December 31, 2022, were eligible for the OA cohort. The non-OA cohort included those without a diagnosis of OA at the index date and no history of OA for 12 months pre-index. Baseline characteristics were balanced using propensity score matching. The risk of CTS in the OA and non-OA cohort were evaluated using incidence rates and adjusted hazard ratios that were estimated using Cox regression. RESULTS After applying the inclusion/exclusion criteria, 3,610,240 of the 6,023,384 adults with a diagnosis of OA remained in the OA cohort. After propensity-score matching, each cohort included 1,033,439 individuals. The incidence rates for CTS per 1000 person-years were 7.35 (95% confidence interval [CI] 7.21-7.49) in the OA cohort and 1.44 (95% CI 1.38-1.50) in the non-OA cohort. The risk of developing CTS in patients with OA was ~ 4 times that of patients without (hazard ratio = 3.80; 95% CI 3.54-4.07). This increased risk was found across all OA joint types, with OA of the hand/wrist having the highest risk for CTS. Additionally, multiple OA joints presented a higher risk compared with a single affected joint. CONCLUSIONS OA increases the risk of CTS, but this is not limited to patients with hand/wrist OA, suggesting a systemic impact of OA on CTS. While the risk appears highest for patients with hand/wrist OA, patients with more distant affected joints like knee or hip also have an increased risk of CTS.
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Affiliation(s)
- Shuang Chen
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, USA.
| | - Tina Ho
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, USA
| | - Julius Asubonteng
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, USA
| | - Rachel E Sobel
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, USA
| | - Simon Eng
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, USA
| | - Stephen J DiMartino
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, USA
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Apard T, Martinel V, Batby G, Draznieks G, Descamps J. Lacertus syndrome: recent advances. HAND SURGERY & REHABILITATION 2024:101738. [PMID: 38852811 DOI: 10.1016/j.hansur.2024.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024]
Abstract
Lacertus syndrome consists in proximal median nerve entrapment with median nerve compression at the lacertus fibrosus, causing hand weakness and fatigue, forearm pain and occasional numbness. Recent advances emphasized the importance of clinical examination, due to limitations in electromyographic diagnosis and delayed diagnosis. The Hagert clinical triad, lacertus notch sign, lacertus antagonist test and taping help accurate diagnosis. Non-operative treatment should be tried; and surgical techniques, whether open or ultrasound-guided under WALANT (wide-awake, local anesthesia, no tourniquet) show promising outcomes. Improved awareness, accurate diagnosis and innovative treatments enhance patient care for this challenging condition.
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Affiliation(s)
- Thomas Apard
- Ultrasound Guided Hand Surgery Center, 2 Rue de Tocqueville, 78000 Versailles, France; Private Hospital Les Franciscaines, 7 Route de la Porte de Buc, 78000 Versailles, France.
| | - Vincent Martinel
- Orthopedic Group Ormeau Pyrénées, Polyclinique de l'Ormeau, Tarbes, France
| | | | | | - Jules Descamps
- Department of Orthopedics and Trauma Surgery, Lariboisière Hospital, 2 Rue Ambroise Paré, 75010 Paris, France
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Lee CH, Jung ST, Park CG, Kim J, Kang GR, Kim S. Minimally invasive surgical technique for unstable supracondylar humerus fractures in children (Gartland type III or IV). Front Pediatr 2024; 12:1352887. [PMID: 38720943 PMCID: PMC11076715 DOI: 10.3389/fped.2024.1352887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Background Achieving and maintaining anatomical reduction during the treatment of pediatric humerus fractures, classified as Gartland type III or IV, presents a clinical challenge. Herein, we present a minimally invasive surgical approach using a novel and simple K-wire push technique that aids in achieving and maintaining anatomical reduction. Methods We reviewed data of children receiving treatment for supracondylar fractures of the humerus at our hospital between January 2016 and December 2020. Patients were divided into two groups based on the method of treatment: Group 1 was treated with the K-wire push technique, and Group 2 was treated with the standard technique as described by Rockwood and Wilkins. The medical records and radiographic images were reviewed. In total, 91 patients with Gartland types III and IV fractures were included, with 37 and 54 patients in Groups 1 and 2, respectively. Results The postoperative reduction radiographic parameters and Flynn scores at final follow-up were not significantly different between the two groups. Conclusion The minimally invasive K-wire push technique for unstable supracondylar fractures in children is a safe and effective alternative for improving reduction. Using this technique, complications can be minimized, and the requirement for open reduction can be reduced.
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Affiliation(s)
- Chang-Hyun Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Sung-Taek Jung
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Chun-Gon Park
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Joonyeong Kim
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Gyo Rim Kang
- Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sungmin Kim
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
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Richards D, Levin KH. Other median neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:89-101. [PMID: 38697748 DOI: 10.1016/b978-0-323-90108-6.00011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Median mononeuropathy is common, with carpal tunnel syndrome the most frequently encountered acquired mononeuropathy in clinical practice. However, other disorders of the median nerve and many known anatomical variants can lead to misdiagnosis and unexpected surgical complications if their presence is not correctly identified. A number of inherited and acquired disorders can affect the median nerve proximal to the wrist, alone or accompanied by other affected peripheral nerves. Recognizing other disorders that can masquerade as median mononeuropathies can avoid misdiagnosis and misguided management. This chapter explores median nerve anatomical variants, disorders, and lesions, emphasizing the need for careful examination and electrodiagnostic study in the localization of median neuropathy.
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Affiliation(s)
- Danielle Richards
- Neuromuscular Center, Cleveland Clinic, Cleveland, OH, United States
| | - Kerry H Levin
- Neuromuscular Center, Cleveland Clinic, Cleveland, OH, United States.
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Jung DH, Lee SE, Park D, Lee JW. A revised electrodiagnosis-based severity classification for carpal tunnel syndrome. J Back Musculoskelet Rehabil 2024; 37:1205-1212. [PMID: 38578879 DOI: 10.3233/bmr-230275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND An electrodiagnostic evaluation is conducted to diagnose carpal tunnel syndrome (CTS) and evaluate its severity. OBJECTIVE This study proposes a revised approach for classifying the severity of electrophysiological findings for patients with CTS. METHODS This retrospective cross-sectional study included patients with CTS confirmed through electrodiagnostic evaluations. Based on the Stevens' classification, the patients were divided into three groups (mild/moderate/severe). A new intermediate group was defined to identify patients with normal motor nerve conduction studies and abnormal electromyographic results. CTS pain was evaluated using a numeric rate scale. Physical examinations and sonographic evaluation were performed to detect anatomical abnormalities. RESULTS Overall, 1,069 CTS hands of 850 CTS patients were included. The mean age was 57.9 ± 10.8 years, and 336 (39.5%) were men. There were 522 (48.8%) mild cases; 281 (26.3%) moderate cases; and 266 (24.9%) severe cases. In the severe group, 49 cases were reclassified into the intermediate group. The median cross-sectional area in the intermediate group significantly differed from that in the severe group. However, the pain score significantly differed from that of the moderate group. CONCLUSION The intermediate CTS group showed clinical features that were intermediate to those of the moderate and severe CTS groups.
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Affiliation(s)
- Do Hun Jung
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Eok Lee
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang, Korea
- Department of Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang, Korea
| | - Jang Woo Lee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Silva J, Sehmbi H, Fiala KJ, Shehata P, Abd-Elsayed A. Radiofrequency ablation and pulsed radiofrequency of the upper extremities. RADIOFREQUENCY ABLATION TECHNIQUES 2024:97-139. [DOI: 10.1016/b978-0-323-87063-4.00022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Honis HR, Gruber H, Honold S, Konschake M, Moriggl B, Brenner E, Skalla-Oberherber E, Loizides A. Anatomical considerations of US-guided carpal tunnel release in daily clinical practice. J Ultrason 2023; 23:e131-e143. [PMID: 37732109 PMCID: PMC10508271 DOI: 10.15557/jou.2023.0022] [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] [Received: 02/23/2023] [Accepted: 04/28/2023] [Indexed: 09/22/2023] Open
Abstract
Carpal tunnel syndrome is the most frequent compression neuropathy with an incidence of one to three subjects per thousand. As specific anatomical variations might lead to unintended damage during surgical interventions, we present a review to elucidate the anatomical variability of the carpal tunnel region with important considerations for daily clinical practice: several variants of the median nerve branches in and around the transverse carpal ligament are typical and must - similarly to the variant courses of the median artery, which may be found eccentric ulnar to the median nerve - be taken into account in any interventional therapy at the carpal tunnel. Unintended interference in these structures might lead to heavy arterial bleeding and, in consequence, even underperfusion of segments of the median nerve or, if neural structures such as variant nerve branches are impaired or even cut, severe pain-syndromes with a profound impact on the quality of life. This knowledge is thus crucial for outcome- and safety-optimization of different surgical procedures at the volar aspect of the wrist and surgical therapy of the carpal tunnel syndrome e.g., US-guided carpal tunnel release, as injury might result in dysfunction and/or pain on wrist motion or direct impact in the region concerned. For most variations, anatomical and surgical descriptions vary, as official classifications are still lacking.
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Affiliation(s)
- Hanne-Rose Honis
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes Gruber
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Sarah Honold
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Moriggl
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | - Erich Brenner
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | | | - Alexander Loizides
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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Neumann M, Suchomlinov A. Pilot Cadaveric Study of Anatomical Variations of the Median Nerve at the Wrist in the Lithuanian Population. Cureus 2023; 15:e39282. [PMID: 37346218 PMCID: PMC10280309 DOI: 10.7759/cureus.39282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Carpal tunnel syndrome (CTS) is known as one of the most common neurological disorders in the human body. Nowadays, the prevalence in the general population ranges between 1% and 5%. Due to its high prevalence and increasing incidence of carpal tunnel surgery, the anatomical variations of the median nerve at the wrist are important to know to avoid iatrogenic injury of the nerve. PURPOSE The objective of this study was to evaluate the anatomical variation of the median nerve at the level of the wrist in the Lithuanian population with a focus on its thenar motor branch based on the classifications of Lanz. MATERIAL AND METHODS A cadaveric study was performed, and 30 wrists of 15 adult Lithuanian cadavers ranging from 70 to 89 years of age were dissected and examined. Eight female and seven male cadavers were included in the study. Any anatomical finding was documented, and the results were compared with the classification of Lanz as well as with the data found in the literature. RESULTS All hands showed different patterns in comparison to the standard anatomical variation Lanz type 0. The most common result was dedicated to Lanz group 4A. Nineteen out of 30 hands (63%, p<0.01) had an accessory branch proximal to the carpal tunnel, while one of these hands showed a third thenar motor branch. Five hands (16%) were dedicated to Lanz group 2 with an accessory branch distal to the carpal tunnel. One hand (3%) showed a variation close to Lanz group 2, but in this case, the thenar motor branch had its origin under the flexor retinaculum instead of proximal to it. Two hands each (6%) were classified by Lanz groups 1B and 3A. Additionally, one variation showed a pattern of a combination of Lanz types 3A and 3B. The bifid median nerve had a connecting branch in between which started distal to the flexor retinaculum. Two anatomical variations (6%) were not described by the classification of Lanz.
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Affiliation(s)
- Markus Neumann
- Department of Anatomy, Histology, and Anthropology, Vilnius University Faculty of Medicine, Vilnius, LTU
| | - Andrej Suchomlinov
- Department of Anatomy, Histology, and Anthropology, Vilnius University Faculty of Medicine, Vilnius, LTU
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Schwabl C, Hörmann R, Strolz CJ, Drakonaki E, Zimmermann R, Klauser AS. Anatomical Variants of the Upper Limb Nerves: Clinical and Preoperative Relevance. Semin Musculoskelet Radiol 2023; 27:129-135. [PMID: 37011614 PMCID: PMC10069954 DOI: 10.1055/s-0043-1761952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Profound knowledge of nerve variations is essential for clinical practice. It is crucial for interpreting the large variability of a patient's clinical presentation and the different mechanisms of nerve injury. Awareness of nerve variations facilitates surgical safety and efficacy. Clinically significant anatomical variations can be classified into two main groups: variability in the course of the nerve and variability of structures surrounding the nerve. In this review article we focus on the most common nerve variants of the upper extremity and their clinical relevance.
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Affiliation(s)
- Christoph Schwabl
- Radiology Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Romed Hörmann
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elena Drakonaki
- Independent MSK Radiology Practice, Heraklion, Crete, Greece
| | - Robert Zimmermann
- Department of Surgery, University Hospital for Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Yarbrough B, Chan PYW, Tan V. Unusual Anatomic Location of the Median Nerve Within the Pronator Teres Muscle: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00034. [PMID: 36049029 DOI: 10.2106/jbjs.cc.22.00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 57-year-old man presented with pain and paresthesia in both hands and was diagnosed with pronator teres syndrome. Surgical decompression of the left elbow and forearm revealed the median nerve in an unusual anatomic location, specifically running within the pronator teres muscle. CONCLUSION Anatomic anomalies of the pronator teres muscle and the path of the median nerve have been described. However, there are no reports of the median nerve entering and traveling within the pronator teres. Surgeons should be aware of this anomaly to avoid potential iatrogenic injury when performing an anterior surgical approach to the elbow and proximal forearm.
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Affiliation(s)
- Ben Yarbrough
- Institute for Hand and Arm Surgery, Madison, New Jersey
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Bayram GA, Ciddi PK, Marangoz C. The effect of median nerve mobilization on two point discrimination. J Phys Ther Sci 2022; 34:422-425. [PMID: 35698552 PMCID: PMC9170487 DOI: 10.1589/jpts.34.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/06/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Two-point discrimination (TPD) is expressed as the minimum distance at which
two mechanical stimuli applied simultaneously to the skin can be perceived as two separate
points. The aim of this study was to investigate the effect of median nerve mobilization
on TPD in healthy adults. [Participants and Methods] This study included 120 healthy
adults. Participants were randomized according to their gender into the Neural
Mobilization Group (NMG) and Control Group (CG). Demographic data of the participants
(gender, age, height, weight, BMI, smoking) were recorded and TPD measurement was
performed with baseline aesthesiometer on the palm with distal phalanges of the thumb,
index and middle finger on the right-left hand. After the baseline TPD test, participants
in the NMG performed Median Nerve Mobilization for 14 days. Measurements were taken before
and after training. [Results] A statistically significant difference was found in all
other measurements in both groups, except for the right and left palm TPD measurements in
the control group. [Conclusion] It is thought that it would be beneficial to investigate
the healing effects of the neural mobilization applications, which include all parts of
the nerve line in disease conditions.
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Affiliation(s)
- Gulay Aras Bayram
- Department of Physical Therapy and Rehabilitation, Faculty of Health Science, Istanbul Medipol University: Istanbul 34810, Turkey
| | - Pinar Kaya Ciddi
- Department of Physical Therapy and Rehabilitation, Faculty of Health Science, Istanbul Medipol University: Istanbul 34810, Turkey
| | - Cafer Marangoz
- Department of Physiology, Faculty of Medicine, Istanbul Medipol University, Turkey
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Application of shear wave elastography and median nerve cross-section area in the diagnosis and staging of carpal tunnel syndrome: a case-control study. Pol J Radiol 2021; 86:e638-e643. [PMID: 34925653 PMCID: PMC8652346 DOI: 10.5114/pjr.2021.111437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose Imaging is gaining a more prominent role in the diagnosis of carpal tunnel syndrome (CTS), especially ultrasonography. Shear wave elastography (SWE) is a novel qualitative method to study mechanical changes in tissue. In this study, we aim to assess the role of SWE in diagnosing and staining of the disease. Material and methods A total of 124 wrists were included in the study. Seventy wrists had CTS, and 54 were included as the control group. All of the wrists with CTS had staging done with nerve conduction study. All patients underwent ultrasonography by an expert radiologist and had the SWE and cross-section of the median nerve determined. These values were compared among the 2 groups and different stages of CTS. The receiver operating characteristic curve was utilized to assess the diagnostic role of each of the variables. Results Cross-section area (CSA) and SWE were significantly different between the 2 groups (p = 0.0001). CSA was also significantly different among various stages of CTS. SWE was not significantly different among moderate and severe stages of CTS. Both of the variables had a good ability to distinguish mild CTS from healthy wrists (p = 0.0001). Conclusion SWE can be used in diagnosing CTS and in the staging of the disease.
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Borges ÁVRM, Souza SAL. Anatomy of the nerves, vessels, and muscular compartments of the forearm, as revealed by high-resolution ultrasound. Part 1: overall structure and forearm compartments. Radiol Bras 2021; 54:388-397. [PMID: 34866699 PMCID: PMC8630951 DOI: 10.1590/0100-3984.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 11/22/2022] Open
Abstract
In recent decades, high-resolution ultrasound (HRUS) has revolutionized the morphological and structural evaluation of peripheral nerves and muscles, revealing details of the internal structure of the neural fascicles and muscle architecture. Applications range from diagnostics to interventional procedures. The anatomy of the forearm region is complex, with several muscles and an extensive network of vessels and nerves. To guarantee the success of the evaluation by HRUS, knowledge of the normal anatomy of the region is essential. The aim of these two companion articles is to present the normal anatomy of the nerves and compartments of the forearm, as revealed by HRUS, as well as the relationships between the main vessels and nerves of the region. Part 1 aims to review the overall structure of nerves, muscles and tendons, as seen on HRUS, and that of the forearm compartments. We present a practical approach, with general guidelines and tips on how best to perform the study. Part 2 is a pictorial essay about compartment vascularization and cutaneous innervation. Knowledge of the normal anatomy of the forearm improves the technical quality of the examinations, contributing to better diagnoses, as well as improving the performance and safety of interventional procedures.
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Affiliation(s)
- Áurea V R Mohana Borges
- Department of Radiology, School of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Sergio A L Souza
- Department of Radiology, School of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Nulle K, Jaudzema A. Ultrasonographic evaluation of the median nerve: normal and variant anatomy and appearance. J Ultrason 2021; 21:e318-e325. [PMID: 34970443 PMCID: PMC8678701 DOI: 10.15557/jou.2021.0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022] Open
Abstract
The median nerve is a mixed sensory and motor nerve that innervates part of the flexor muscles in the anterior compartment of the forearm and muscles in the lateral part of the hand; palmar cutaneous and digital cutaneous nerves branch from the median nerve, which provides sensory innervation to the skin on the radial side of the palm. Also, the median nerve is an object of interest because neuropathy of the median nerve at the level of the carpal tunnel is the most common entrapment neuropathy which increases dramatically in patients with diabetes. Neuromuscular ultrasound provides extensive diagnostic information and has proved itself as a useful complementary test to electrodiagnostic examinations in cases involving median nerve neuropathy. It often happens that the cause of nerve entrapment and neuropathy are variants of several anatomical structures along the course of the median nerve. It is important to be aware and report such anatomical variations of the median nerve in order to avoid damaging the nerve during surgical treatment. Despite the frequently documented abnormalities in the pathway of the brachial plexus and the median nerve, the anatomical variations are unusual to see and are rarely reported. Moreover, there are variations that do not fit under any of the classifications described in the literature.
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Affiliation(s)
- Kitija Nulle
- Department of Radiology, Rīga Stradiņš University, Latvia
| | - Aija Jaudzema
- Department of Radiology, Rīga Stradiņš University, Latvia
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Abdalbary SA, Abdel-Wahed M, Amr S, Mahmoud M, El-Shaarawy EAA, Salaheldin S, Fares A. The Myth of Median Nerve in Forearm and Its Role in Double Crush Syndrome: A Cadaveric Study. Front Surg 2021; 8:648779. [PMID: 34621777 PMCID: PMC8490666 DOI: 10.3389/fsurg.2021.648779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/19/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose: This study aims to histologically compare the median nerve in the arm, forearm, and wrist, to help understand how cervical radiculopathy in a double crush phenomenon causes distal nerve dysfunction at the carpal tunnel and median nerve with concurrent absence of symptoms at the forearm. Methods: The study was performed on 12 fresh cadaveric upper limbs free from any injury or operation. Male cadavers in the age range of 35–40 years were used. The dissection of the median nerve and the histological examination of the specimens from the arm, forearm, and wrist were conducted to evaluate variations in the epineurium thickness (μm), perineurium thickness (μm), number of fascicles per nerve trunk, area percent of myelin covering, and area percent of neurolemmal sheath. Results: Morphometric and statistical results of the cadaveric median nerve trunk revealed that the mean epineurium and perineurium thickness measured in H&E-stained sections in the forearm were significantly greater than those in the arm and wrist specimens. Further, the mean percent area of the myelin covering in the forearm was significantly lower than that in the arm and wrist specimens in the sections stained with osmium oxide (p < 0.001). There were, however, no significant differences in the neurolemmal sheath among the arm, forearm, and wrist specimens in the silver-stained sections. Conclusion: The histological differences explained the high concomitant occurrence of carpal tunnel syndrome (CTS) and cervical radiculopathy and the concurrent absence of symptoms at the forearm. Hence, we suggest cautious evaluation of patients with upper limb symptoms, since the management of these conditions requires a different approach.
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Affiliation(s)
- Sahar A Abdalbary
- Department of Orthopaedic Physical Therapy, Faculty of Physical Therapy, Nahda University in Beni Suef, Beni Suef, Egypt
| | - Mohamed Abdel-Wahed
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Sherif Amr
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mostafa Mahmoud
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ehab A A El-Shaarawy
- Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Safinaz Salaheldin
- Department of Histology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Amal Fares
- Department of Histology, Faculty of Medicine, Cairo University, Giza, Egypt
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Gaisne E, Bellemère P, Kerjean Y, Loubersac T, Chaves C. Restoration of thumb opposition (opponensplasty). HAND SURGERY & REHABILITATION 2021; 41S:S105-S111. [PMID: 34537401 DOI: 10.1016/j.hansur.2020.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
The authors review the therapeutic principles that must be applied when restoring the thumb opposition surgically. Among the many surgical techniques, five are featured: transfer of the flexor digitorum superficialis of the third or fourth finger, transfer of the extensor indicis proprius, transfer of the palmaris longus, translocation of the flexor palmaris longus tendon, transfer of the extensor pollicis longus. After summarizing the procedures, they emphasize the practical points that must be respected. This surgery, which cannot restore sensitivity, requires a precise assessment of the patient's wishes and information on what can be really expected.
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Affiliation(s)
- E Gaisne
- IMA Sante Atlantique, Boulevard Charles Gautier, BP 40419, 44819 Saint Herblain, France.
| | - P Bellemère
- IMA Sante Atlantique, Boulevard Charles Gautier, BP 40419, 44819 Saint Herblain, France
| | - Y Kerjean
- IMA Sante Atlantique, Boulevard Charles Gautier, BP 40419, 44819 Saint Herblain, France
| | - T Loubersac
- IMA Sante Atlantique, Boulevard Charles Gautier, BP 40419, 44819 Saint Herblain, France
| | - C Chaves
- IMA Sante Atlantique, Boulevard Charles Gautier, BP 40419, 44819 Saint Herblain, France
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Fernández-de-Las-Peñas C, López-de-Celis C, Rodríguez-Sanz J, Hidalgo-García C, Donelly JM, Cedeño-Bermúdez SA, Pérez-Bellmunt A. Safety of Dry Needling of the Pronator Teres Muscle in Cadavers: A Potential Treatment for Pronator Syndrome. PAIN MEDICINE 2021; 23:1158-1161. [PMID: 34519825 DOI: 10.1093/pm/pnab274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Entrapment of the median nerve at the pronator teres muscle can contribute to symptoms in the forearm and wrist. The pronator teres is also involved in patterns of spasticity observed in people who had suffered a stroke. Research on treatment efficacy with dry needling is scarce. OBJECTIVE To determine if a solid filiform needle safely penetrates the pronator teres muscle during the clinical application of dry needling. DESIGN A cadaveric descriptive study. METHODS Needle insertion of the pronator teres was conducted in ten cryopreserved forearms with a 30*0.32 mm filiform needle. With the forearm supinated, the needle was inserted 3 cm distal to the mid-point between the biceps tendon insertion and the medial epicondyle. The needle was advanced in a cranial and medial direction to a depth clinically judged to be in the pronator teres muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles. RESULTS Accurate needle penetration of the pronator teres was observed in 100% of the specimens (mean needle penetration: 16.7 ± 4.3 mm, 95%CI 13.6 to 19.7 mm). No neurovascular bundles were pierced in any of the specimen's forearms. The distances from the tip of the needle to the surrounding neurovascular bundles were 16.4 ± 3.9 mm (95%CI 13.6 to 19.2 mm) to the ulnar nerve (A), 9.0 ± 2.2 mm (95%CI 7.3 to 19.5 mm) to the median nerve (B), and 12.8 ± 4.0 mm (95%CI 10.0 to 15.7 mm) to brachial artery (C). CONCLUSION The results from this cadaveric study support the assumption that needling of the pronator teres using described anatomical landmarks can be accurately and safely conducted by an experienced clinician.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, . Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences. Universitat Internacional de Catalunya (UIC-Barcelona). C/Josep Trueta s/n. Sant Cugat del Vallès, Barcelona. Spain.,ACTIUM Functional Anatomy Group. Barcelona, Spain
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences. Universitat Internacional de Catalunya (UIC-Barcelona). C/Josep Trueta s/n. Sant Cugat del Vallès, Barcelona. Spain.,ACTIUM Functional Anatomy Group. Barcelona, Spain
| | - César Hidalgo-García
- Unidad de Investigación en Fisioterapia., Universidad de Zaragoza, Zaragoza, Spain
| | - Joseph M Donelly
- Department of Physical Therapy. University of Saint Augustine for Health Sciences-Miami Campus, Coral Gables, FL, USA
| | - Simón A Cedeño-Bermúdez
- Faculty of Medicine and Health Sciences. Universitat Internacional de Catalunya (UIC-Barcelona). C/Josep Trueta s/n. Sant Cugat del Vallès, Barcelona. Spain.,ACTIUM Functional Anatomy Group. Barcelona, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences. Universitat Internacional de Catalunya (UIC-Barcelona). C/Josep Trueta s/n. Sant Cugat del Vallès, Barcelona. Spain.,ACTIUM Functional Anatomy Group. Barcelona, Spain
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Clarke E, Mazurek A, Radek M, Żytkowski A, Twardokęs W, Polguj M, Wysiadecki G. Superficial brachial artery – A case report with commentaries on the classification. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Variant Median Nerve Anatomy: Ultrasound Evidence of a Pseudoconduction Block. J Clin Neuromuscul Dis 2021; 22:209-213. [PMID: 34019005 DOI: 10.1097/cnd.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A conduction block at a noncompressible site warrants further investigation. METHODS AND MATERIALS A 36-year-old woman with a history of Hodgkin lymphoma and chemotherapy-induced polyneuropathy developed bilateral hand numbness and paresthesias. Workup revealed bilateral carpal tunnel syndrome and an apparent superimposed conduction block of the median nerve in the forearm. Given the history of cancer, there was concern for an infiltrative or an immune-mediated process. RESULTS Neuromuscular ultrasound demonstrated that the median nerve descended the upper extremity along an atypical path, deep along the posteromedial aspect of the upper arm, and relatively medially in the forearm. Ultrasound-directed nerve stimulation revealed there was no conduction block. This anatomical variant has been rarely described and has not been reported previously to mimic conduction block or been documented via ultrasound. CONCLUSIONS This case demonstrates that neuromuscular ultrasound may supplement the electrodiagnostic study and limit confounding technical factors because of rare anatomic variation.
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Fernandes C, Moreira S, Miyamoto Meirelles L, Gomes dos Santos J, Faloppa F, Albertoni W. Linburg–Comstock anomaly: A comparison of the prevalence in women with and without clinical carpal tunnel syndrome. HAND SURGERY & REHABILITATION 2021; 40:64-68. [DOI: 10.1016/j.hansur.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 12/28/2022]
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Bianchi S, Hoffman DF, Tamborrini G, Poletti PA. Ultrasound Findings in Less Frequent Causes of Carpal Tunnel Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2469-2482. [PMID: 32459879 DOI: 10.1002/jum.15349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
The most common etiology of carpal tunnel syndrome (CTS) is idiopathic. However, secondary causes of CTS should be considered when symptoms are unilateral, or electrodiagnostic studies are discrepant with the clinical presentation. Imaging of the carpal tunnel should be performed when secondary causes of CTS are suspected. An ultrasound evaluation of the carpal tunnel can assess for pathologic changes of the median nerve, detect secondary causes of CTS, and aid in surgical planning.
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Affiliation(s)
- Stefano Bianchi
- Cabinet d'Imagerie Médicale SA, Geneva, Switzerland
- Division of Radiology, Hopitaux Universitaires de Genève, Geneva, Switzerland
| | - Douglas F Hoffman
- Departments of Orthopedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Giorgio Tamborrini
- Ultraschall Zentrum Rheumatologie Aeschenvorstadt, Basel, Switzerland
- Rheumatology University Hospital Basel, Basel, Switzerland
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Bilateral Proximal Median Neuropathy: An Unexpected Complication of Back Tattoo. Can J Neurol Sci 2020; 48:297-298. [PMID: 32669141 DOI: 10.1017/cjn.2020.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Helfenstein Júnior M. Uncommon compressive neuropathies of upper limbs. Best Pract Res Clin Rheumatol 2020; 34:101516. [DOI: 10.1016/j.berh.2020.101516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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