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Chen T, Huang D, Yang X, Yang P. The carpal tunnel syndrome secondary to epithelioid sarcoma: A case report. Asian J Surg 2024:S1015-9584(24)00731-0. [PMID: 38643054 DOI: 10.1016/j.asjsur.2024.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024] Open
Affiliation(s)
- Tao Chen
- Department of Plastic and Reconstructive Surgery, Jinhu County People's Hospital, NO. 160, Shenhua Avenue, Jinhu County, Huai'an, Jiangsu, China
| | - Desong Huang
- Department of General Surgery, Jinhu County People's Hospital, NO. 160, Shenhua Avenue, Jinhu County, Huai'an, Jiangsu, China
| | - Xiang Yang
- Department of Plastic and Reconstructive Surgery, Jinhu County People's Hospital, NO. 160, Shenhua Avenue, Jinhu County, Huai'an, Jiangsu, China
| | - Ping Yang
- Department of Plastic and Reconstructive Surgery, Jinhu County People's Hospital, NO. 160, Shenhua Avenue, Jinhu County, Huai'an, Jiangsu, China.
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Ahizoune A, Hamid M. Debilitating genitofemoral neuralgia due to nerve entrapment after appendectomy: A case report. Radiol Case Rep 2024; 19:1432-1435. [PMID: 38292791 PMCID: PMC10827544 DOI: 10.1016/j.radcr.2023.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Genitofemoral (GF) neuralgia refers to pain and sensory complaints in the region innervated by the GF nerve. It is a rarely reported condition, often due to iatrogenic causes following inguinal surgeries. In refractory forms, diagnostic reassessment is required to look for possible entrapment of the GF nerve. Here we describe a patient who underwent appendectomy and subsequently developed severe debilitating pain in the region of the right GF nerve. Our patient underwent a second laparoscopic surgery with clip removal, resulting in rapid recovery.
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Affiliation(s)
- Aziz Ahizoune
- Department of Neurology and Neurophysiology, Mohammed V Military Teaching Hospital, University of King Mohammed V-Souissi, Rabat, Morocco
| | - Mohamed Hamid
- Department of Neurology and Neurophysiology, Mohammed V Military Teaching Hospital, University of King Mohammed V-Souissi, Rabat, Morocco
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Fouasson-Chailloux A, Merle M, Duysens C, Falcone A, Daley P, Pomares G, Jager T. Nerve entrapment complicating neurogenic thoracic outlet syndrome surgery: A 10-year retrospective study. Hand Surg Rehabil 2024:101660. [PMID: 38342235 DOI: 10.1016/j.hansur.2024.101660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/13/2024]
Abstract
Neurogenic thoracic outlet syndrome results from compression of the brachial plexus. The symptoms are mainly pain, upper-limb weakness and paresthesia. Management always starts with a rehabilitation program, but failure of rehabilitation may necessitate surgery. In practice, we observed that several patients developed secondary distal nerve entrapment in the months following surgery, with no preoperative compression. We aimed to assess the occurrence of distal nerve entrapment after surgery for neurogenic thoracic outlet syndrome in a retrospective cohort study. Seventy-four patients were included; 82% females; mean age, 39.4 ± 9.4 years. There were 36.5% with high intensity and 63.5% with low to moderate intensity work. Eighteen (24.3%) developed secondary upper-limb entrapment at 10.6 ± 5.8 months after surgery. Sixteen had a single entrapment and 2 had two different entrapments. In 10 cases (50%) the ulnar nerve was involved at the elbow, in 7 (35.0%) the radial nerve at the radial tunnel, and in 3 (15.0%) the median nerve. No differences were found between patients with and without secondary nerve entrapment in gender (p = 0.51), mean age (p = 0.44), symptom duration (p = 0.92) or work intensity (p = 0.26). Further studies are needed to confirm these results and to shed light on the underlying mechanisms.
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Affiliation(s)
- Alban Fouasson-Chailloux
- Institut Européen de la Main, Luxembourg L-2540, Luxembourg; Medical Training Center, Hôpital Kirchberg, Luxembourg L-2540, Luxembourg; Service de MPR Locomotrice et Respiratoire, Nantes Université, CHU Nantes, Nantes 44093 France; Institut Régional de Médecine du Sport (IRMS), Hôpital St Jacques, Nantes 44093, France.
| | - Michel Merle
- Institut Européen de la Main, Luxembourg L-2540, Luxembourg; Medical Training Center, Hôpital Kirchberg, Luxembourg L-2540, Luxembourg
| | - Christophe Duysens
- Institut Européen de la Main, Luxembourg L-2540, Luxembourg; Medical Training Center, Hôpital Kirchberg, Luxembourg L-2540, Luxembourg
| | - Andréa Falcone
- Institut Européen de la Main, Luxembourg L-2540, Luxembourg; Medical Training Center, Hôpital Kirchberg, Luxembourg L-2540, Luxembourg
| | - Pauline Daley
- Service de MPR Locomotrice et Respiratoire, Nantes Université, CHU Nantes, Nantes 44093 France; Institut Régional de Médecine du Sport (IRMS), Hôpital St Jacques, Nantes 44093, France
| | - Germain Pomares
- Institut Européen de la Main, Luxembourg L-2540, Luxembourg; Medical Training Center, Hôpital Kirchberg, Luxembourg L-2540, Luxembourg
| | - Thomas Jager
- Institut Européen de la Main, Luxembourg L-2540, Luxembourg; Medical Training Center, Hôpital Kirchberg, Luxembourg L-2540, Luxembourg
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Cottias P, Gaujac N, Bouché PA, Anract P. Unusual entrapment symptomatology treated in 115 cases by neurolysis of the common fibular nerve at the fibular head combined with neurolysis of the posterior tibial nerve at the tarsal tunnel. Orthop Traumatol Surg Res 2023; 109:103485. [PMID: 36435376 DOI: 10.1016/j.otsr.2022.103485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/12/2022] [Accepted: 02/22/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Entrapment of the common fibular nerve (CFN) at the head of the fibula and entrapment of the posterior tibial nerve (PTN) at the tarsal tunnel are the most common nerve entrapment syndromes in the lower limb. Our aim was to study the results of combined neurolysis of the CFN and PTN for chronic lower limb pain. We hypothesized that combined neurolysis allowed a reduction of this chronic pain. MATERIAL AND METHOD This bi-centric retrospective study took place from January 2015 to November 2018, with a single senior surgeon. The inclusion criteria were all patients operated on for an idiopathic entrapment syndrome with neurolysis of the PTN at the tarsal tunnel, combined with neurolysis of the CFN at the head of the fibula. The primary endpoint was the pain evolution assessed on a numerical analogue scale (NAS) preoperatively and postoperatively on D+21, and at the last follow-up. The secondary endpoint was to determine the prognostic factors on the clinical outcome of neurolysis. RESULTS One hundred and fifteen neurolysis were included, comprising 64 women and 38 men with a mean age of 57±17.6 years. The preoperative pain (NAS0) was evaluated at 6±2.4 points. At D+21 postoperatively, there was a significant reduction in pain (NASD+21: 3±2.6 points, p<0.01). Similarly, at the last follow-up (with a mean follow-up of 37±8.4 months), there was a significant reduction in pain (NASLFU: 2±2.5, p<0.01). A history of systemic inflammatory disease was the only factor associated with a less significant decrease in pain at D+21, according to a multivariate analysis (p<0.01). There were 14 complications (12%) not requiring revision surgery. CONCLUSION This study is the first to demonstrate the efficacy of combined neurolysis of the CFN at the head of the fibula and the PTN at the tarsal tunnel, in the treatment of idiopathic nerve entrapment syndrome of the lower limb. LEVEL OF EVIDENCE IV; Retrospective comparative study.
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Affiliation(s)
- Pascal Cottias
- Service de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire Cochin, 27, rue du Faubourg Saint Jacques, 75014 Paris, France; Centre chirurgical de Rémusat, 21, rue Rémusat, 75016 Paris, France
| | - Nicolas Gaujac
- Service de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire Cochin, 27, rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Pierre-Alban Bouché
- Service de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire Cochin, 27, rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Philippe Anract
- Service de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire Cochin, 27, rue du Faubourg Saint Jacques, 75014 Paris, France
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Elwakil W. Correlation between delayed carpal tunnel syndrome and carpal malalignment after distal radial fracture. J Orthop Surg Res 2023; 18:365. [PMID: 37193988 DOI: 10.1186/s13018-023-03844-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Delayed carpal tunnel syndrome after Colles' fracture is a common complication particularly following conservative treatment. The aim of the study was to verify the correlation of different radiological parameters of carpal alignment and the development as well as the severity of DCTS in elderly female patients within 6 months of distal radial fracture (DRF). METHODS This is a retrospective case-control study that included 60 female patients with DRF within 6 months treated conservatively (30 patients with signs and symptoms suggestive of DCTS and 30 asymptomatic patients as a control group). Electrophysiological evaluation was done for all the participants, as well as radiological assessment to measure parameters of carpal alignment mainly radiocapitate distance (RCD), volar prominence height (VPH) and volar tilt (VT). RESULTS There was a statistical significant difference between both groups regarding the radiological parameters of carpal alignment (The mean values of RCD, VT and VPH were - 11.48 mm, - 20.68° angle, and 2.24 mm respectively in the symptomatic group). A strong correlation was found between decrease in the parameters of carpal alignment and the severity of DCTS. Logistic regression analysis showed that VT is strongly involved in the development of DCTS. The threshold value of the VT was - 20.2° angle (sensitivity 0.83; specificity 0.9; odds ratio 45; 95% CI 0.894-0.999; p < 0.001). CONCLUSIONS Anatomical alteration of the carpal tunnel after DRF with dorsal displacement of the carpal bones contribute to the development of DCTS. Decreasing VT and VPH and RCD are the most significant independent predictors for the development of DCTS in conservatively managed DRF. Protocol ID: 0306060.
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Grönfors H, Himanen SL, Martikkala L, Kallio M, Mäkelä K. Median nerve ultrasound cross sectional area and wrist-to-forearm ratio in relation to carpal tunnel syndrome related axonal damage and patient age. Clin Neurophysiol Pract 2023; 8:81-87. [PMID: 37215684 PMCID: PMC10196766 DOI: 10.1016/j.cnp.2023.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 05/24/2023] Open
Abstract
Objective Primary objective was to retrospectively examine the effects of patient age and carpal tunnel syndrome (CTS) related axon loss on median nerve (MN) high resolution ultrasound (HRUS) in younger and older patients. HRUS parameters evaluated in this study were MN cross sectional area at the wrist (CSA) and wrist-to-forearm ratio (WFR). Methods The material comprised 467 wrists of 329 patients. The patients were categorized into younger (<65 years) and older (≥65 years) groups. Patients with moderate to extreme CTS were included in the study. Axon loss of the MN was assessed by needle EMG and graded by the interference pattern (IP) density. The association between axon loss and CSA and WFR was studied. Results The older patients had smaller mean CSA and WFR values compared to the younger patients. CSA correlated positively to the CTS severity only in the younger group. However, WFR correlated positively to CTS severity in both groups. In both age groups, CSA and WFR correlated positively with IP reduction. Conclusions Our study complemented recent findings on the effects of patient age on the CSA of the MN. However, although the MN CSA did not correlate with the CTS severity in older patients, the CSA increased in respect to the amount of axon loss. Also, as a new result, we presented the positive association of WFR with CTS severity among older patients. Significance Our study supports the recently speculated need for different MN CSA and WFR cut-off values for younger and older patients in assessing the severity of CTS. With older patients, WFR may be a more reliable parameter to assess the CTS severity than the CSA. CTS related axonal damage of the MN is associated to additional nerve enlargement at the carpal tunnel intel site.
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Affiliation(s)
- Henri Grönfors
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - Sari-Leena Himanen
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Elämänaukio 2, 33520 Tampere, Finland
| | - Lauri Martikkala
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - Mika Kallio
- Department of Clinical Neurophysiology, Oulu University Hospital, Kajaanintie 50, 90220, PL 10, 90029 OYS, Finland
- Research Unit of Medical Imaging, Physics and Technology; University of Oulu, Kajaanintie 50, 90220; PL 10, 90029 OYS, Finland
| | - Katri Mäkelä
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Elämänaukio 2, 33520 Tampere, Finland
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Abstract
Continued advancements in magnetic resonance (MR) neurography and ultrasound have made both indispensable tools for the workup of peripheral neuropathy. Ultrasound provides high spatial resolution of superficial nerves, and techniques such as "sonopalpation" and dynamic maneuvers can improve accuracy. Superior soft tissue contrast, ability to evaluate both superficial and deep nerves with similar high resolution, and reliable characterization of denervation are strengths of MR neurography. Nevertheless, familiarity with normal anatomy, anatomic variants, and common sites of nerve entrapment is essential for radiologists to use both MR neurography and ultrasound effectively.
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Pardal-Fernández JM, Diaz-Maroto I, Segura T, de Cabo C. Ulnar nerve thickness at the elbow on longitudinal ultrasound view in control subjects. Neurol Res Pract 2023; 5:4. [PMID: 36698205 PMCID: PMC9878874 DOI: 10.1186/s42466-023-00230-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Ulnar mononeuropathy at the elbow is the second most frequent neuropathy in humans. Diagnosis is based on clinical and electrophysiological criteria and, more recently, also on ultrasound. Cross-sectional ultrasound is currently the most valued, although longitudinal ultrasound allows assessment of the entire affected trajectory of the nerve in a single view, but always in a straight line with no changes in direction, as in the extended elbow. The main aim of this work is to propose normative values for longitudinal ultrasound of the ulnar nerve at the elbow. METHODS The neurological exploration of upper extremity, and electrophysiological and ultrasound parameters at the elbow of ulnar nerve were evaluated in 76 limbs from 38 asymptomatic subjects. RESULTS The diameters of the nerve as well as the distal and proximal areas were larger at the proximal region of the ulnar groove, and even more so in older individuals. In most of these elderly subjects, we found a small, non-significant slowdown in motor conduction velocity at the elbow with respect to the forearm (less than 5 m/s). CONCLUSIONS We observed a good correlation between the longitudinal and cross-sectional ultrasounds of the ulnar nerve at the elbow. Longitudinal ultrasound proved to be sensitive, reliable, simple and rapid, but its greatest contribution was allowing the visualization of the entire nerve trajectory in an integrated way, providing an image with good definition of the outline, proportions and intraneural characteristics of the nerve.
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Affiliation(s)
| | - Inmaculada Diaz-Maroto
- Unit of Neuromuscular Disorders, Department of Neurology, University General Hospital, Albacete, Spain
| | - Tomás Segura
- Department of Neurology, University General Hospital, Albacete, Spain
| | - Carlos de Cabo
- Neuropsychopharmacology Unit, University General Hospital of Albacete, Albacete, Spain
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9
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Brandt L, Albert S, Brandt KL. [Meralgia paraesthetica as complication of patient positioning : A not fully controllable risk]. Anaesthesiologie 2022; 71:858-864. [PMID: 36282281 PMCID: PMC9592874 DOI: 10.1007/s00101-022-01213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
Als Meralgia paraesthetica (MP) bezeichnet man eine zu den neurologischen Engpasssyndromen zählende Schädigung des aus dem Plexus lumbalis entspringenden sensiblen N. cutaneus femoris lateralis. Symptome sind temporäre oder bleibende Parästhesien und Schmerzen an der Vorder- und Außenseite des Oberschenkels. Die MP kann idiopathisch auftreten, sich genuin als z. B. „seat belt syndrome“ oder „Jeans-Syndrom“ verwirklichen, sie kann aber auch Folge eines operativen Eingriffs oder einer chirurgischen bzw. intensivmedizinischen Lagerung sein. Im Fokus stehen hierbei in der Literatur die Steinschnitt-, die Bauch- und die „Beach-chair“-Lagerung. Analysiert wurden 21 Beschwerden über eine postoperativ erstmals aufgetretene MP, die bei der Gutachterkommission für ärztliche Behandlungsfehler bei der Ärztekammer Nordrhein im Verlauf der letzten 10 Jahre eingereicht wurden. Unter diesen konnten 6 Fälle als Lagerungsschaden nach Steinschnittlagerung identifiziert werden; in 3 Fällen trat eine MP nach Rückenlagerung auf; die Ätiologie konnte nicht sicher geklärt werden. In 12 Fällen wurde die MP als direkte Operationskomplikation erkannt. Pathophysiologie, Inzidenz und Verlauf sowie juristische Implikationen der lagerungsbedingten MP werden beschrieben. Als hauptsächlicher Pathomechanismus wird eine Druckschädigung des Nervs an seiner Kreuzungsstelle mit dem Leistenband diskutiert. Wenngleich alle hier vorgestellten Fälle nach der Steinschnittlagerung auftraten, scheint sich die Komplikation nach Literaturdaten auch bei anderen Lagerungsarten, am häufigsten möglicherweise bei Bauchlagerungen, zu verwirklichen. Dies erklärt auch die zunehmenden Fallberichte einer MP nach Bauchlagerung bei COVID-19-Patient*innen. Eine sichere Vermeidung der lagerungsbedingten Komplikation erscheint aufgrund der anatomischen Variabilität des Nervenverlaufs und der unklaren Pathomechanismen nicht möglich.
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Affiliation(s)
- L. Brandt
- abcGbR, Ernst-Udet-Straße 9, 85764 Oberschleißheim, Deutschland
| | - S. Albert
- grid.452286.f0000 0004 0511 3514Fachbereich Neurologie, Kantonsspital Graubünden, Chur, Schweiz
| | - K. L. Brandt
- grid.6441.70000 0001 2243 2806cand.med., Faculty of Medicine, Vilnius University, Vilnius, Litauen
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Torun Bİ, Balaban M. Prevalence and clinical implications of the Gantzer's muscle. Surg Radiol Anat 2022; 44:1297-1303. [PMID: 35974186 DOI: 10.1007/s00276-022-03006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The Gantzer's muscle is considered to be the accessory head of the flexor pollicis longus. The prevalence of the Gantzer's muscle and its anatomical relations vary in the literature. So, we aimed to study its prevalence and anatomical relations on a broad population on magnetic resonance (MRI) and ultrasound (US) images. MATERIALS AND METHODS We investigated a total of 473 upper extremities of 378 people (171 women, 207 men), aged between 18 and 73 years, by MRI and US. We investigated the prevalence and length of the Gantzer's muscle and its anatomical relationship with the median (MN) and anterior interosseous nerves (AIN). RESULTS Of the 473 extremities, 96 had Gantzer's muscle (20.3%). Overall prevalence of the Gantzer's muscle was 21.9% (51 in 232) in women and 18.7% (45 in 241) in men. In the population we performed US, Gantzer's muscle was located 40.0% in only the right limb, 37.1% in only the left limb and 22.9% bilaterally. All the Gantzer's muscles originated from the coronoid process. Of the 43 Gantzer's muscles seen in US, thirty-four (79.1%) were attached to flexor pollicis longus and nine (20.9%) were attached to flexor digitorum superficialis. The mean length of the Gantzer's muscle was 29.7 (range 17.2-44.5) mm. MN was anterior to the Gantzer's muscle in all extremities except ten. In all extremities, AIN was located posterior to the Gantzer's muscle. CONCLUSION Although it is seen at a rare rate of 20.3%, Gantzer's muscle should be considered in MN and AIN compressions due to its close proximity to these nerves.
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Affiliation(s)
- Bilge İpek Torun
- Department of Anatomy, Faculty of Medicine, Ankara Yildirim Beyazit University, Bilkent, Ankara, Turkey.
| | - Mehtap Balaban
- Department of Radiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
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Yorns WR. Neurologic Disorders Affecting the Foot and Ankle. Clin Podiatr Med Surg 2022; 39:15-35. [PMID: 34809793 DOI: 10.1016/j.cpm.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The neurologic causes of foot and leg dysfunction are reviewed. Disorders causing foot and ankle pain, weakness, or other sensorimotor disturbances often cause difficulty with ambulation and prompt patients to seek medical evaluation. Physical signs and symptoms along with targeted diagnostic testing are needed to come to the correct diagnosis and treatment plan. An overview of peripheral nerve, muscle, and central nervous system disorders affecting the foot and leg are discussed.
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Affiliation(s)
- William R Yorns
- Department of Neurology, UCONN School of Medicine, Connecticut Children's Medical Center, 505 Farmington Avenue., 2nd Floor, Farmington, CT 06032, USA.
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12
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Stratchko L, Rosas H. Imaging of Elbow Injuries. Clin Sports Med 2021; 40:601-623. [PMID: 34509201 DOI: 10.1016/j.csm.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Familiarity with throwing mechanics during elbow range of motion allows accurate diagnosis of sports-related elbow injuries, which occur in predictable patterns. In addition, repetitive stress-related injuries are often clinically apparent; however, imaging plays an important role in determining severity as well as associated injuries that may affect clinical management. A detailed understanding of elbow imaging regarding anatomy and mechanism of injury results in prompt and precise treatment.
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Affiliation(s)
- Lindsay Stratchko
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
| | - Humberto Rosas
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
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Janovics K, Soós B, Tóth Á, Szalma J. Is it possible to filter third molar cases with panoramic radiography in which roots surround the inferior alveolar canal? A comparison using cone-beam computed tomography. J Craniomaxillofac Surg 2021:S1010-5182(21)00137-2. [PMID: 34090736 DOI: 10.1016/j.jcms.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/13/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
Inferior alveolar nerve (IAN) entrapment in third molar (M3) roots bears a significant risk for nerve injury. The aim of this study was to identify specific panoramic radiographic (PR) signs that can reliably identify IAN entrapment (IANE) root conformations. In a retrospective case-control study, 10 IANE and 218 non-IANE third molar risk cases were examined by PR and CBCT. The collected data included "classic" specific high-risk panoramic signs, number of M3 roots, extent of inferior alveolar canal (IAC)-root tip overlap, rotated position of M3 and impaction pattern. After bivariate analysis, sensitivity, specificity, positive and negative predictive values, positive likelihood ratios (LR+) and accuracy (area under the curve [AUC]) were calculated for the most significant predictive variables. Interruption of both cortical lines (LR+: 43.6; AUC: 96.0%) and upward diversion of the IAC (LR+: 36.3; AUC: 96.5%) were the most accurate single signs indicating IANE. Upward diversion combined with root darkening and interruption of the IAC (AUC: 97.4%) and the combination of darkening with interruption and with a rotated M3 (LR+:130.8; AUC: 97.8%) were the most accurate combinations predicting IANE. IANE may be correctly filtered with PR when focusing on the signs of upward diversion, darkening, interruption and rotated M3 position, especially in cases involving their multiple (≥3) presence. CBCT evaluation is highly recommended in these cases before partial and total tooth removals.
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Abstract
Entrapment neuropathy around elbow is a common cause of disability across all age groups. The major nerves that traverse the elbow are ulnar, median and radial nerves and their branches. Cubital tunnel syndrome leading to ulnar nerve compression can often present with significant pain, paresthesia or weakness. Median and Radial nerve compression around the elbow, albeit less frequent, can also lead to significant morbidity and must be kept in the differential diagnosis when dealing with patients complaining of persistent pain around the elbow and weakness of forearm/hand muscles. Electrodiagnostic studies can be a useful adjunct to clinical examination, to help localize the site and quantify the grade of compression. Management should involve a trial of conservative treatment and failing that, surgical treatment should be considered. We hereby provide an overview of nerve entrapments around the elbow including their applied anatomy, etiology, clinical assessment and overview of the current concepts in surgical treatment.
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Affiliation(s)
- Arjun Ajith Naik
- Corresponding author. Trauma and Orthopaedics, Princess Royal University hospital- KCH NHS trust, Farnborough common, Orpington, BR68ND, UK.
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Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 2 Lower limb. Eur J Radiol 2020; 135:109482. [PMID: 33360825 DOI: 10.1016/j.ejrad.2020.109482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/15/2020] [Accepted: 12/14/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE This review discusses the relevant anatomy, etiopathogenesis, current notions in clinical and imaging features as well as management outline of lower limb entrapment neuropathies. METHODS The review is based on critical analysis of the current literature as well as our experience in dealing with entrapment neuropathies of the lower limb. RESULTS The complex anatomical network of nerves supplying the lower extremities are prone to entrapment by a heterogenous group of etiologies. This leads to diverse clinical manifestations making them difficult to diagnose with traditional methods such as clinical examination and electrodiagnostic studies. Moreover, some of these may mimic other common conditions such as disc pain or fibromyalgia leading to delay in diagnosis and increasing morbidity. Addition of imaging improves the diagnostic accuracy and also help in correct treatment of these entities. Magnetic resonance imaging is very useful for deeply situated nerves in pelvis and thigh while ultrasound is well validated for superficial entrapment neuropathies. CONCLUSION The rapidly changing concepts in these conditions accompanied by the advances in imaging has made it essential for a clinical radiologist to be well-informed with the current best practices.
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Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipin Sudhakaran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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16
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Podnar S. Patterns and parameters describing nerve thickening in compression and entrapment ulnar neuropathies at the elbow. Clin Neurophysiol 2020; 132:530-535. [PMID: 33450574 DOI: 10.1016/j.clinph.2020.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare pattern and parameters describing nerve thickening in ulnar neuropathy at the elbow (UNE) due to external compression in the retrocondylar groove (RTC), and entrapment under the humeroulnar aponeurosis (HUA). METHODS In a group of our previously reported UNE patients we ultrasonographically (US) measured ulnar nerve cross-sectional areas (CSA) on 6-8 standard locations in the elbow segment. We compared CSA patterns in both groups, and determined diagnostic utility of selected CSA based parameters. RESULTS We studied 79 patients (81 arms) with UNE due to external compression, and 53 patients (55 arms) due to entrapment. Maximal ulnar nerve CSA (>16 mm2), maximal CSA change (>7 mm2/1-2 cm) and maximal/minimal CSA ratio (>2.6) were significantly larger in UNE due to entrapment. They also differentiated these arms from arms with compression with sensitivities of 78%, 87% and 80%, and specificities of 90%, 94%, and 85%, respectively. CONCLUSION Maximal difference in CSA between points separated by 1-2 cm (>7 mm2/1-2 cm) very efficiently differentiated between UNE due to external compression and entrapment. SIGNIFICANCE The proposed parameter will hopefully complement precise localization in determining underlying mechanism of UNE. This may help physicians to determine the most appropriate treatment for UNE and possibly other focal neuropathies of unknown cause; i.e., conservative treatment for external compression and surgery for entrapment.
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Affiliation(s)
- Simon Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Centre Ljubljana, Slovenia.
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17
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Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 1 upper limb. Eur J Radiol 2020; 131:109234. [PMID: 32949858 DOI: 10.1016/j.ejrad.2020.109234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/21/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This article aims to review the pertinent anatomy, etiopathogenesis, current clinical and radiological concepts and principles of management in case of upper limb entrapment neuropathies. METHODS The review is based on critical analysis of the existing literature as well as our experience in dealing with entrapment neuropathies. RESULTS Entrapment neuropathies of the upper limb peripheral nerves are common conditions that are often misdiagnosed because of their varying clinical presentations and lack of standardized diagnostic methods. Clinical assessment and electrodiagnostic studies have been the mainstay; however, imaging techniques have provided newer insights into the pathophysiology of these entities, leading to a paradigm shift in their diagnosis and management. The current best practice protocols for entrapment syndromes are constantly evolving with increasing emphasis on the role high-resolution ultrasound and magnetic resonance imaging. Many imaging criteria are described and we have tried to present the most validated measurements for diagnosing entrapment neuropathies. CONCLUSION It is imperative for a clinical radiologist to be familiar with the etiopathogenesis and clinical features of these conditions, in addition to being thorough with the anatomy and the latest imaging strategies.
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Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipin Sudhakaran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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18
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Ayache A, Unglaub F, Tsolakidis S, Schmidhammer R, Löw S, Langer MF, Spies CK. [Revision surgery for carpal and cubital tunnel syndrome]. Orthopade 2020; 49:751-761. [PMID: 32857166 DOI: 10.1007/s00132-020-03969-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Carpal tunnel syndrome, a compressive neuropathy of the median nerve at the wrist and cubital tunnel syndrome, a compressive neuropathy of the ulnar nerve at the elbow, are the two most common peripheral nerve compression syndromes. Chronic compressive neuropathy of peripheral nerves causes pain, paraesthesia and paresis. Treatment strategies include conservative options, but only surgical decompression can resolve the mechanical entrapment of the nerve with proven good clinical results. However, revision rates for persistent or recurrent carpal tunnel syndrome is estimated at around 5% and for refractory cubital tunnel syndrome at around 19%. Common causes for failure include incomplete release of the entrapment and postoperative perineural scarring. THERAPY Precise diagnostic work-up is obligatory before revision surgery. The strategy of revision surgery is first complete decompression of the affected nerve and then providing a healthy, vascularized perineural environment to allow nerve gliding and nerve healing and to avoid recurrent scarring. Various surgical options may be considered in revision surgery, including neurolysis, nerve wrapping and nerve repair. In addition, flaps may provide a well vascularized nerve coverage in the case of recurrent carpal tunnel syndrome. In the case of recurrent cubital tunnel syndrome, anterior transposition of the ulnar nerve is mostly performed for this purpose. RESULTS In general, revision surgery leads to improvement of symptoms, although the outcome of revision surgery is less favourable than after primary surgery and complete resolution of symptoms is unlikely.
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Affiliation(s)
- A Ayache
- Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - S Tsolakidis
- Millesi Center, Nervenchirurgie und Rekonstruktive Chirurgie, Wien, Österreich
| | - R Schmidhammer
- Millesi Center, Nervenchirurgie und Rekonstruktive Chirurgie, Wien, Österreich
| | - S Löw
- Praxis für Handchirurgie und Unfallchirurgie, Bad Mergentheim, Deutschland
| | - M F Langer
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.
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19
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Kim YJ, Kim DH. Pudendal nerve entrapment syndrome caused by ganglion cysts along the pudendal nerve. Yeungnam Univ J Med 2020; 38:148-151. [PMID: 32688459 PMCID: PMC8016628 DOI: 10.12701/yujm.2020.00437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/23/2020] [Indexed: 12/26/2022] Open
Abstract
Pudendal nerve entrapment (PNE) syndrome refers to the condition in which the pudendal nerve is entrapped or compressed. Reported cases of PNE associated with ganglion cysts are rare. Deep gluteal syndrome (DGS) is defined as compression of the sciatic or pudendal nerve due to a non-discogenic pelvic lesion. We report a case of PNE caused by compression from ganglion cysts and treated with steroid injection; we discuss this case in the context of DGS. A 77-year-old woman presented with a 3-month history of tingling and burning sensations in the left buttock and perineal area. Ultrasonography showed ganglion cystic lesions at the subgluteal space. Magnetic resonance imaging revealed cystic lesions along the pudendal nerve from below the piriformis to the Alcock’s canal and a full-thickness tear of the proximal hamstring tendon. Aspiration of the cysts did not yield any material. We then injected steroid into the cysts, which resolved her symptoms. Steroid injection into a ganglion cyst should be considered as a treatment option for PNE caused by ganglion cysts.
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Affiliation(s)
- Young Je Kim
- Department of Rehabilitation Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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20
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Ayache A, Unglaub F, Langer MF, Müller LP, Oppermann J, Löw S, Spies CK. [Surgical treatment of carpal tunnel syndrome: open release of the flexor retinaculum and hypothenar fat flap for revision surgery]. Oper Orthop Traumatol 2020; 32:219-35. [PMID: 32524170 DOI: 10.1007/s00064-020-00662-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/09/2020] [Accepted: 03/26/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Decompression of the median nerve by complete release of the flexor retinaculum and the distal antebrachial fascia. In the case of revision surgery providing of a scar-free covering of the median nerve, if necessary. INDICATIONS Carpal tunnel release is indicated for symptomatic patients with painful paraesthesia or neurological deficits after adequate diagnostic evaluation. The hypothenar fat flap is indicated in revision surgery if a sufficient nerve bed of the median nerve is needed and to restore nerve gliding. CONTRAINDICATIONS General operative limitations. The hypothenar fat flap is not indicated in revision surgery if median nerve irritation is not caused by surrounding scaring but other reasons like tendonitis. SURGICAL TECHNIQUE Proximal longitudinal incision of the palm. Subcutaneous dissection and incision of the palmar aponeurosis. Careful ulnar incision of the transverse carpal ligament. Considerate release of the distal and proximal parts of the retinaculum as well as the distal part of the antebrachial fascia. Exploration of the median nerve and palpation of the carpal tunnel and resection of compressive structures, if necessary. In case of revision surgery, if required, the hypothenar fat flap is raised. The fat flap is transposed without tension palmar to the median nerve and fixed to the radial side of the carpal tunnel. POSTOPERATIVE MANAGEMENT Early functional mobilization. Immobilization for a short period is optional. After revision surgery and hypothenar fat flap, splinting for one week is recommended.
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21
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van Zantvoort A, Setz M, Hoogeveen A, van Eerten P, Scheltinga M. [Chronic lower leg pain: entrapment of common peroneal nerve or tibial nerve-German version]. Unfallchirurg 2019; 122:854-9. [PMID: 31712850 DOI: 10.1007/s00113-019-0644-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Young individuals with chronic exercise-induced lower leg pain (ELP) who have normal compartmental muscle pressures and normal imaging occasionally suffer from a nerve entrapment syndrome. These patients have consistently undergone a variety of diagnostic tests and often futile therapies prior to arriving at the correct diagnosis. Awareness among traumatologists regarding these nerve entities is low. A lower leg discomfort that is frequently present at night but worsens during exercise combined with altered foot skin sensations suggests an entrapment of the common peroneal or tibial nerve. If conservative therapies fail, neurolysis is advised.
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22
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Rhodes NG, Howe BM, Frick MA, Moran SL. MR imaging of the postsurgical cubital tunnel: an imaging review of the cubital tunnel, cubital tunnel syndrome, and associated surgical techniques. Skeletal Radiol 2019; 48:1541-1554. [PMID: 30919024 DOI: 10.1007/s00256-019-03203-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/15/2019] [Accepted: 03/05/2019] [Indexed: 02/02/2023]
Abstract
Ulnar nerve compression at the elbow, specifically the cubital tunnel, is the second most common upper extremity compression neuropathy. Many patients presenting with compression symptoms will subsequently undergo surgical intervention. We review the open surgical treatment of cubital tunnel syndrome and review the expected postoperative imaging appearance of those treatments on magnetic resonance imaging (MR), including: simple or in situ decompression, medial epicondylectomy, and anterior transposition, including subcutaneous, intramuscular, and submuscular variants. We discuss the relevant anatomy of the presurgical cubital tunnel and common sites and causes of ulnar nerve compression at and about the cubital tunnel. The imaging appearance of the preoperative and postoperative ulnar nerve and postoperative complications are reviewed.
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Affiliation(s)
- Nicholas G Rhodes
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Benjamin M Howe
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Matthew A Frick
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Steven L Moran
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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23
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Williams AA, Smith HF. Anatomical entrapment of the dorsal scapular and long thoracic nerves, secondary to brachial plexus piercing variation. Anat Sci Int 2019; 95:67-75. [PMID: 31338726 DOI: 10.1007/s12565-019-00495-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/13/2019] [Indexed: 12/22/2022]
Abstract
Circumscapular pain is a frequent complaint in clinical practice. The dorsal scapular and long thoracic nerves course through the neck, where they may become entrapped between or within adjacent scalene muscles. Additionally, a high frequency of brachial plexus "piercing" variants have recently been documented, and it is unclear how they influence branching patterns distally along the brachial plexus. In the project reported here we strived to identify and quantify variations in dorsal scapular nerve and long thoracic nerve secondary to brachial plexus piercing variation. Ninety brachial plexuses from human cadavers (45 female/45 male) were evaluated to identify nerve branching patterns, specifically piercing versus non-piercing variants in the brachial plexus roots and nerves. Anatomical entrapment of the dorsal scapular nerve and long thoracic nerve was found in high frequencies (60.8% and 44.6%, respectively). Anomalous brachial plexus piercing variants were associated with higher frequencies of distal nerve branches also coursing through the scalene musculature, and there was a statistically significant correlation between brachial plexus and long thoracic nerve piercings (p = 0.027). Anatomical entrapment of nerves within scalene musculature is common and may be causative factors for idiopathic circumscapular pain, dorsalgia, and dysfunction of scapulohumeral rhythm. This study revealed a link between anatomical arrangement of the brachial plexus and occurrence of long thoracic nerve entrapment, which may lead to a series of cascading neurologic effects in which affected individuals may suffer from increased incidence of thoracic outlet syndrome and long thoracic nerve entrapment resulting in additional symptoms of interscapular pain and compromised shoulder mobility.
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Affiliation(s)
- Avery A Williams
- Department of Anatomy, Midwestern University, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA
| | - Heather F Smith
- Department of Anatomy, Midwestern University, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA.
- School of Human Evolution and Social Change, Arizona State University, P.O. Box 2402, Tempe, AZ, 85287, USA.
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24
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van Zantvoort A, Setz M, Hoogeveen A, van Eerten P, Scheltinga M. Chronic lower leg pain: entrapment of common peroneal nerve or tibial nerve. Unfallchirurg 2019; 123:20-24. [PMID: 30993359 DOI: 10.1007/s00113-019-0645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Young individuals with chronic exercise-induced lower leg pain (ELP) who have normal compartmental muscle pressures and normal imaging occasionally suffer from a nerve entrapment syndrome. These patients have consistently undergone a variety of diagnostic tests and often futile therapies prior to arriving at the correct diagnosis. Awareness among traumatologists regarding these nerve entities is low. A lower leg discomfort that is frequently present at night but worsens during exercise combined with altered foot skin sensations suggests an entrapment of the common peroneal or tibial nerve. If conservative therapies fail, neurolysis is advised.
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Affiliation(s)
- Aniek van Zantvoort
- Departments of Surgery, Neurology and Sports Medicine, Maxima Medical Center, De Run 4600, 7777, 5500 MB, Veldhoven, The Netherlands
| | - Maikel Setz
- Departments of Surgery, Neurology and Sports Medicine, Maxima Medical Center, De Run 4600, 7777, 5500 MB, Veldhoven, The Netherlands
| | - Adwin Hoogeveen
- Departments of Surgery, Neurology and Sports Medicine, Maxima Medical Center, De Run 4600, 7777, 5500 MB, Veldhoven, The Netherlands
| | - Percy van Eerten
- Departments of Surgery, Neurology and Sports Medicine, Maxima Medical Center, De Run 4600, 7777, 5500 MB, Veldhoven, The Netherlands
| | - Marc Scheltinga
- Departments of Surgery, Neurology and Sports Medicine, Maxima Medical Center, De Run 4600, 7777, 5500 MB, Veldhoven, The Netherlands.
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25
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Moroni S, Gibello AF, Zwierzina M, Nieves GC, Montes R, Sañudo J, Vazquez T, Konschake M. Ultrasound-guided decompression surgery of the distal tarsal tunnel: a novel technique for the distal tarsal tunnel syndrome-part III. Surg Radiol Anat 2019; 41:313-321. [PMID: 30798383 PMCID: PMC6420489 DOI: 10.1007/s00276-019-02196-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 01/20/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study was to provide a safe ultrasound-guided minimally invasive surgical approach for a distal tarsal tunnel release concerning nerve entrapments. METHODS AND RESULTS The study was carried out on ten fresh-frozen feet. All of them have been examined by high-resolution ultrasound at the distal tarsal tunnel. The surgical approach has been marked throughout the course of the medial intermuscular septum (MIS, the lateral fascia of the abductor hallucis muscle). After the previous steps, nerve decompression was carried out through a MIS release through a 2.5 mm (± 0.5 mm) surgical portal. As a result, an effective release of the MIS has been obtained in all fresh-frozen feet. CONCLUSION The results of our anatomic study indicate that this novel ultrasound-guided minimally invasive surgical approach for the release of the MIS might be an effective, safe and quick decompression technique treating selected patients with a distal tarsal tunnel syndrome.
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Affiliation(s)
- Simone Moroni
- Department of Podiatry, Faculty of Health Sciences at Manresa, Universitat de Vic-Universitat Central de Catalunya (UVic-Ucc), Barcelona, Spain.,Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Alejandro Fernández Gibello
- Clinic Vitruvio Biomecánica, Madrid, Spain.,Department of Podiatry, Faculty of Health Sciences, University of La Salle, Madrid, Spain
| | - Marit Zwierzina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriel Camunas Nieves
- Clinic Vitruvio Biomecánica, Madrid, Spain.,Department of Podiatry, Faculty of Health Sciences, University of La Salle, Madrid, Spain
| | - Rubén Montes
- Clinic Vitruvio Biomecánica, Madrid, Spain.,Department of Podiatry, Faculty of Health Sciences, University of La Salle, Madrid, Spain
| | - José Sañudo
- Anatomy and Embryology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Teresa Vazquez
- Anatomy and Embryology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Marko Konschake
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria.
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26
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Fernández-Gibello A, Moroni S, Camuñas G, Montes R, Zwierzina M, Tasch C, Starke V, Sañudo J, Vazquez T, Konschake M. Ultrasound-guided decompression surgery of the tarsal tunnel: a novel technique for the proximal tarsal tunnel syndrome-Part II. Surg Radiol Anat 2018; 41:43-51. [PMID: 30382330 PMCID: PMC6513797 DOI: 10.1007/s00276-018-2127-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/24/2018] [Indexed: 11/27/2022]
Abstract
Background The aim of this study is to provide a safe ultrasound-guided minimally invasive surgical approach for a proximal tarsal tunnel release concerning nerve entrapments. Methods and results The study was carried out on ten fresh-frozen feet. All of them were examined by high resolution ultrasound at the medial ankle region. The surgical approach was marked throughout the course of the flexor retinaculum (laciniate ligament). Once the previous steps were done, the flexor retinaculum release technique was carried out with a 2-mm entry only. As a result, an effective and safe release of the flexor retinaculum was obtained in all fresh-frozen feet. Conclusion The results of our anatomic study indicate that our novel ultrasound-guided minimally invasive surgical approach for the release of the flexor retinaculum might be an effective, safe and quick decompression technique treating selected patients with a proximal tarsal tunnel syndrome.
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Affiliation(s)
- Alejandro Fernández-Gibello
- Faculty of Health Sciences, Department of Podiatry, University of La Salle, Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Simone Moroni
- Faculty of Health Sciences at Manresa, Department of Podiatry, Universitat de Vic-Universitat Central de Catalunya (UVic-Ucc), Clinic Vitruvio Biomecánica, Barcelona, Madrid, Spain
| | - Gabriel Camuñas
- Faculty of Health Sciences, Department of Podiatry, University of La Salle, Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Rubén Montes
- Faculty of Health Sciences, Department of Podiatry, University of La Salle, Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Marit Zwierzina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Tasch
- Department of Plastic, Reconstructive and Aesthetic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Vasco Starke
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria
| | - José Sañudo
- Anatomy and Embryology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Teresa Vazquez
- Anatomy and Embryology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Marko Konschake
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria.
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27
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Manouvakhova OV, Macchi V, Fries FN, Loukas M, De Caro R, Oskouian RJ, Spinner RJ, Tubbs RS. Landmarks for Identifying the Suprascapular Foramen Anteriorly: Application to Anterior Neurotization and Decompressive Procedures. Oper Neurosurg (Hagerstown) 2018; 14:166-170. [PMID: 29351679 DOI: 10.1093/ons/opx096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/27/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Additional landmarks for identifying the suprascapular nerve at its entrance into the suprascapular foramen from an anterior approach would be useful to the surgeon. OBJECTIVE To identify landmarks for the identification of this hidden site within an anterior approach. METHODS In 8 adult cadavers (16 sides), lines were used to connect the superior angle of the scapula, the acromion, and the coracoid process tip thus creating an anatomic triangle. The suprascapular nerve's entrance into the suprascapular foramen was documented regarding its position within this anatomical triangle. Depths from the skin surface and specifically from the medial-most point of the clavicular attachment of the trapezius to the suprascapular nerve's entrance into the suprascapular foramen were measured using calipers and a ruler. The clavicle was then fractured and retracted superiorly to verify the position of the nerve's entrance into the suprascapular foramen. RESULTS From the trapezius, the nerve's entrance into the foramen was 3 to 4.2 cm deep (mean, 3.5 cm). The mean distance from the tip of the corocoid process to the suprascapular foramen was 3.8 cm. The angle best used to approach the suprascapular foramen from the surface was 15° to 20°. CONCLUSION Based on our study, an anterior suprascapular approach to the suprascapular nerve as it enters the suprascapular foramen can identify the most medial fibers of the trapezius attachment onto the clavicle and insert a finger at an angle of 15° to 20° laterally and advanced to an average depth of 3.5 cm.
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Affiliation(s)
| | - Veronica Macchi
- Institute of Human Anatomy, Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Fabian N Fries
- Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada
| | - Raffaele De Caro
- Institute of Human Anatomy, Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | | | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada.,Seattle Science Foundation, Seattle, Washington
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28
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Abstract
Cubital tunnel syndrome is the second most common nerve compression syndrome observed in the upper extremity. Mechanical irritation of the ulnar nerve is also found in the upper and the lower arm even though cubital tunnel syndrome is documented most of the time. Apart from clinical examination electrophysiological testing is the most important contributor to the therapy decision. Depending on the clinical manifestation conservative treatment with elbow splinting may be appropriate. In the event of persistent or advanced nerve irritation surgical decompression may be the sensible intervention. Open or endoscopically assisted in situ decompression is currently recommended as the primary intervention while anterior transposition of the ulnar nerve is recommended for revision surgery.
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Affiliation(s)
- C K Spies
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland.
| | - S Löw
- Klinik für Orthopädie und Unfallchirurgie, Caritas-Krankenhaus, Bad Mergentheim, Deutschland
| | - M F Langer
- Abteilung für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - B Hohendorff
- Abteilung für Hand‑, Ästhetische und Plastische Chirurgie, Elbe Kliniken Stade-Buxtehude GmbH, Buxtehude, Deutschland
| | - L P Müller
- Unfall‑, Hand- und Ellenbogenchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
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29
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Wichelhaus A, Emmerich J, Mittlmeier T. [Posttraumatic nerve entrapment syndromes in the upper extremities]. Unfallchirurg 2017; 120:329-343. [PMID: 28299393 DOI: 10.1007/s00113-017-0340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Nerve entrapment syndromes in the upper extremities are common clinical disease patterns, less often as direct results of accidents. The most frequent compression syndrome is the carpal tunnel syndrome followed by the cubital tunnel syndrome. If the cause of the compression cannot be eliminated by conservative treatment options, an operative therapy is necessary. As the prognosis becomes worse with the duration of the nerve compression, it is important to initiate therapy at an early stage.
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Affiliation(s)
- A Wichelhaus
- Arbeitsbereich Handchirurgie, Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland.
| | - J Emmerich
- Arbeitsbereich Handchirurgie, Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland
| | - T Mittlmeier
- Arbeitsbereich Handchirurgie, Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland
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30
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Abstract
OBJECTIVE To determine what causes ulnar neuropathy at the elbow (UNE) by analyzing patients' clinical, electrodiagnostic (EDx) and ultrasonographic (US) findings. METHODS In prospectively recruited patients with definite UNE, four blinded examiners took a history and performed neurologic, EDx and US examinations. A multivariate logistic regression model was used to investigate the association between UNE location and patient variables. RESULTS We included 117 patients; 73% with lesions in the retroepicondylar (RTC) groove and 27% under the humeroulnar aponeurotic arcade (HUA). In our multivariate model, hard manual labor (OR=152; 95% CI 12-1847; p<0.001), dominant arm involvement (OR=4.12; 95% CI 1.01-16.72; p=0.048), and age (OR=1.10; 95% CI 1.03-1.18; p=0.004) were predictive of ulnar neuropathy at HUA. CONCLUSION Our data suggest that UNE at HUA is related to years of hard labor affecting mainly dominant hands, and is caused by work-related changes in the HUA. By contrast, UNE in the RTC groove affects mainly the non-dominant arms of younger administrative workers and is caused by external compression of the ulnar nerve. SIGNIFICANCE We believe that our findings will help to improve the diagnosis and treatment of UNE patients, hopefully leading to improved clinical outcomes.
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Affiliation(s)
- Gregor Omejec
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Slovenia.
| | - Simon Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Slovenia.
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31
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Abstract
OBJECTIVE To report the utility of short-segment nerve conduction studies (SSNCSs) and ultrasonography (US) in the precise localization of ulnar neuropathy at the elbow (UNE) and differentiation between lesions in the retroepicondylar (RTC) groove and under the humeroulnar aponeurotic arcade (HUA; i.e., cubital tunnel). METHODS In a group of prospectively recruited patients with suspected UNE, four blinded examiners took a history and performed neurologic, electrodiagnostic (EDx) and ultrasonographic (US) examinations. Precise UNE localization was determined by SSNCSs criteria (conduction slowing and conduction block), and by US criteria (changes in cross-sectional area - CSA). Localizations obtained by EDx and US studies were compared. RESULTS We included 83 patients (86 arms) with SSNCSs or US diagnosis of UNE. US confirmed the SSNCSs localization in 45%, provided localization alone in 24%, and was unable to confirm SSNCSs localization in 23% of arms. Lesions in RTC (76%) were mainly demyelinating (63%), and localized at the medial epicondyle (29%) or 2 cm proximal to it (69%). By contrast, lesions at HUA (17%) were mainly axonal (73%), and localized 2 cm (57%) or 3 cm (43%) distal to the medial epicondyle. CONCLUSION SSNCSs and US are able to precisely localize UNE in the majority (93%) of arms with pathologic SSNCSs or US. UNE in RTC are predominantly demyelinating, and approx. 5-times more common than UNE at HUA that are more commonly axonal. SIGNIFICANCE SSNCSs and US are of similar utility and complement each other in precise UNE localization.
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Affiliation(s)
- Gregor Omejec
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Slovenia.
| | - Simon Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Slovenia.
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32
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Lin D, Williams C, Zaw H. A rare case of an accessory flexor hallucis longus causing tarsal tunnel syndrome. Foot Ankle Surg 2014; 20:e37-9. [PMID: 25103714 DOI: 10.1016/j.fas.2014.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/19/2014] [Accepted: 02/14/2014] [Indexed: 02/04/2023]
Abstract
Tarsal tunnel syndrome (TTS) is a rare entrapment neuropathy of the tibial nerve within the fibro-osseous tarsal tunnel for which multiple etiologies, including trauma, congenital foot abnormalities and space occupying lesions, have been described. We present an unusual case of TTS caused by an accessory Flexor Hallucis Longus (FHL) tendon. Surgical excision led to a complete resolution of symptoms and improved the quality of life of our patient.
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Affiliation(s)
- D Lin
- Department of Trauma and Orthopaedics, Hillingdon Hospital, London, UK.
| | - C Williams
- Department of Radiology, Hillingdon Hospital, London, UK.
| | - H Zaw
- Department of Trauma and Orthopaedics, Hillingdon Hospital, London, UK.
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33
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Swamy R, Rao M, Somayaji S, Raghu J, Pamidi N. Bilateral additional slips of triceps brachii forming osseo-musculo-fibrous tunnels for ulnar nerves. Ann Med Health Sci Res 2013; 3:450-2. [PMID: 24116332 PMCID: PMC3793458 DOI: 10.4103/2141-9248.117931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Rare additional slips of triceps brachii muscle was found bilaterally in a sixty two year old South Indian male cadaver during routine dissection of upper limb for undergraduate students at Melaka-Manipal Medical College, Manipal University, Manipal, India. On left side, the variant additional muscle slip took origin from the lower part of the medial intermuscular septum about 4 cm proximal to the medial humeral epicondyle. From its origin, the muscle fibres were passing over the ulnar nerve and were joining the triceps muscle to get inserted to the upper surface of olecranon process of ulna. On right side, the additional muscle slip was larger and bulkier and was arising from the lower part of the medial border of the humerus about 4 cm proximal to the medial epicondyle in addition to its attachment to the medial intermuscular septum. On both sides, the additional slips were supplied by twigs from the radial nerve. On both sides, the ulnar nerve was passing between variant additional slip and the lower part of the shaft of the humerus in an osseo-musculo-fibrous tunnel. Such variant additional muscle slips may affect the function of triceps muscle and can lead to snapping of medial head of triceps and ulnar nerve over medial epicondyle and also can dynamically compress the ulnar nerve during the contraction of triceps leading to ulnar neuropathy around the elbow.
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Affiliation(s)
- Rs Swamy
- Department of Anatomy, Melaka Manipal Medical College, Manipal University, Manipal, Karnataka, India
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34
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Abstract
This article discusses an alternative approach to general anesthesia with the use of local anesthesia in minor operating procedure suites when performing in situ decompression of cubital tunnel syndrome for those patients who have mild to moderately severe symptoms and for those who fail to respond to conservative measures. Anterior transposition can easily be performed in the same setting if indicated all with local anesthesia.
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