Punched nerve syndrome: ultrasonographic appearance of functional vascular nerve impairment

Radial nerve compression: anatomical perspective and clinical consequences

The radial nerve is the biggest branch of the posterior cord of the brachial plexus and one of its five terminal branches. Entrapment of the radial nerve at the elbow is the third most common compressive neuropathy of the upper limb after carpal tunnel and cubital tunnel syndromes. Because the incidence is relatively low and many agents can compress it along its whole course, entrapment of the radial nerve or its branches can pose a considerable clinical challenge. Several of these agents are related to normal or variant anatomy. The most common of the compressive neuropathies related to the radial nerve is the posterior interosseus nerve syndrome. Appropriate treatment requires familiarity with the anatomical traits influencing the presenting symptoms and the related prognoses. The aim of this study is to describe the compressive neuropathies of the radial nerve, emphasizing the anatomical perspective and highlighting the traps awaiting physicians evaluating these entrapments.

Vascular entrapment neuropathy of the tibial nerve within the gastrocnemius muscle

Background:

Vascular compression is an extremely rare cause of mononeuropathy and compression of selective tibial nerve branches is an additionally a rare finding and makes diagnosis difficult.

Case Description:

Here within, we describe the case of a 41-year-old male who presented with isolated mononeuropathy of the medial gastrocnemius (MG) branch of the tibial nerve presented as persistent fasciculations and atrophy. After electromyography and clinical evaluation, surgical exploration was recommended. A vascular bundle was found to be compressing the MG branch of the tibial nerve and thus was ligated to decompress the nerve. Postoperatively, all fasciculations improved and muscle atrophied improved.

Conclusion:

Vascular compression resulting in mononeuropathy of the peripheral nerves is a rare clinical entity. Clinicians should include these etiologies on their differential when considering surgical exploration of mononeuropathies.

Cycling-Related Compressive Neuropathy of the Deep Ulnar Motor Branch in the Hand: Is Sonography a Valid Tool?

Repetitive vibratory trauma in cyclists is one of the most common causes of ulnar nerve compression at the wrist. This study describes five cases of clinically suspected compression syndrome of the deep terminal branch of the ulnar nerve (DBUN) defined by high-resolution ultrasound (HRUS) with a 18-MHz linear transducer. Reliable HRUS visualization of the DBUN was feasible in all patients. The affected nerves had focally swollen and hypo-echoic changed segments. HRUS is a good imaging tool for the evaluation of a suspicious DBUN neuropathy if no electrodiagnostic testing is available or in patients with mild to moderate clinical symptoms with inconclusive electrodiagnostic results.

A rare case of a punched nerve syndrome of the deep motor branch of the ulnar nerve

INTRODUCTION

Peripheral compression neuropathy of the ulnar nerve is a frequent condition, most likely encountered at the ulnar sulcus or the Guyon's canal. High-resolution ultrasound (HRUS) can often identify the site of injury. Primarily idiopathic, compression neuropathy can stem from a punched nerve syndrome, in which direct contact between an arterial branch and the nerve leads to compression.

MATERIALS AND METHODS

A 42-year-old male patient was examined by means of HRUS using a 17-5 MHz linear transducer on a Philips iU22(®) (Philips, Bothell, Washington, USA).

RESULTS

After reporting a punched nerve syndrome of the deep motor branch of the ulnar nerve distal to the Guyon's canal, the patient underwent surgery and showed electrophysiological and clinical improvement 6 months after decompression.

CONCLUSION

HRUS is a viable method to demonstrate a punched nerve syndrome. In conjunction with clinical presentation, even unlikely sites of compression such as the deep motor branch of the ulnar nerve can be identified.

Carpal tunnel syndrome caused by vascular nerve impairment treated with open release of the carpal tunnel

We present a patient suffering from classical unilateral symptoms of carpal tunnel syndrome, where the results of electrophysiological examinations were negative. Ultrasound showed at pulsatile median artery that led to direct mechanical impact on the median nerve. The patient was successfully treated with open release of the carpal tunnel.