Complaints Of Paresthesia Research Articles

COVID-19 and Neuromuscular Involvement: A Case Series and Brief Review of Literature

Background: Tough COVID-19 predominantly affects the respiratory tract, and extra-pulmonary manifestations, including neuromuscular complaints have been associated with this disorder. It is vital to monitor COVID-19 cases for the occurrence of Neuromuscular Disorders (NMDs), which could be overshadowed by severe respiratory and cardiovascular symptoms. In this study, we reported electrophysiological findings of a series of COVID-19 patients with complaints of paresthesia and weakness. Methods: In this case series, the Electrodiagnostic studies (EDX) of 36 patients with recent complaints of weakness or paresthesia and a history of COVID-19 before symptoms were reported. Results: 12 cases (33.3%) had abnormal EDX, five males and seven females, with a mean age of 51.42±11.49 years, history of hospitalization in five cases (41.7%), and ICU admission in four (33.3%). Seven cases were concluded as having a predominantly axonal type polyneuropathy (five sensory-motor and two sensory polyneuropathies). Of these seven, one was suggestive of Critical Illness Neuropathy (CIN). Three cases demonstrated a myopathic pattern with a history of ICU admission, hence the impression of Critical Illness Myopathy (CIM). In addition, one of these three, developed both myopathy and neuropathy and thus, is considered as having CIM/N. One case was diagnosed with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). The last case demonstrated an inflammatory involvement of lumbosacral roots (COVID-19-related radiculitis). Conclusion: COVID-19 could be associated with a wide range of NMDs. In this study, the presence of axonal polyneuropathy, CIDP, and myopathy was demonstrated following SAR-COV-2 infection. Also, CIN/M was observed in COVID-19 patients with a history of ICU admission

EVALUATION OF POSTOPERATIVE PARESTHESIA FOLLOWING ORAL SURGERY IN DOCUMENTED CASES at FORENSIC MEDICINE

Objective: Surgical procedures applied in dentistry are open to different complications and one of the most important of these complications is nerve damage. Paresthesia occurs at varying rates according to the degree of damage to the affected nerve. The aim of this study is to compare the surgical procedures applied in cases where paresthesia has occurred.
 
 Methods: The study was designed retrospectively on cases referred to the Department of Dentistry of the 7th Specialization Board of the Council of Forensic Medicine between April 2019 and May 2023, with complaints of paresthesia following oral, dental and maxillofacial surgery operations. A total of 387 surgical procedures were divided into 3 groups as impacted mandibular wisdom tooth surgery, orthognathic surgery and dental implant surgery and the groups were compared with each other. The groups were also evaluated in terms of the technique, patient age and gender, and local factor variables applied within themselves.
 
 Results: Of the cases, 58.9% were female (229 people) and 41.1% (159 people) were male (p

Status of Vitamin B12 Deficiency among Lactating Mothers at Six Weeks Postpartum at a Tertiary Care Hospital, West Bengal, India

Introduction: Vitamin B12 (vit B12) deficiency is a preventable disorder and has dire consequences on the neurological development of the infant. The only source of vit B12 for exclusively breastfed newborns is their mother’s milk. So, determining the status of maternal vit B12 levels during early lactation is vital. In India, very few studies have documented vit B12 deficiency among lactating mothers, especially eastern region remains unexplored. Aim: To estimate the prevalence of vit B12 deficiency among healthy lactating mothers attending the postpartum clinic at six weeks at a Tertiary Care Hospital of West Bengal, India and also to compare the haematological values between vit B12 deficient and sufficient groups among the lactating mothers. Materials and Methods: An observational cross-sectional study was conducted in the Department of Biochemistry in collaboration with postpartum clinic of Calcutta National Medical College, West Bengal, India. The study was carried out over a period of two months, from July 2022 to August 2022. Serum vit B12, serum ferritin and haematological parameters {Haemoglobin (Hb), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin Concentration (MCHC)} were measured in 121 apparently healthy lactating women attending the postpartum clinic for a regular check-up at six weeks. Detailed socioclinical history and dietary history was taken from each participant and these variables were compared between vit B12 deficient and sufficient groups. Pearson’s Chi-square test, Fisher’s-exact test, Mann-Whitney U test were applied to analyse the data. Results: The total study population comprised of 121 mothers with an average age of 25.65±3.71 years and 75% of them consumed non vegetarian diet. A prevalence of 19 (15.7%) deficiency of vit B12 was found among the lactating mothers at six weeks postpartum. Mothers who were vegetarian, multigravida and with complaints of paraesthesia were more associated to cobalamin deficiency. The vit B12 deficient mothers had significantly higher erythrocyte indices than the sufficient group but none of the values were in the megaloblastic range. Conclusion: The vit B12 deficiency was prevalent during early lactation in 19 (15.7%) lactating mothers. The first postnatal visit at six weeks might be the most feasible period to screen and supplement these women to prevent long term sequelae in both mother and child. Haematological parameters were of limited use in identifying vit B12 deficiency during lactation.

Clinical Outcomes of Full Endoscopic Thoracic Discectomy in Acute Disc Herniation: A Case Report from Khyber Pakhtunkhwa

Objectives: Thoracic disc herniations are rare relative to lumber and cervical spine herniations and account for 0.25% to 0.75% of cases in the general population. This case report presents a rare case of a 65-year-old male diagnosed with thoracic disc herniation and managed through full endoscopic thoracic discectomy. Clinical Presentation: A 65-year-old wheelchair-bound male presented to OPD with complaints of paresthesia and sensory symptoms along with motor weakness from the past 2 weeks. No Symptoms of bowel and bladder dysfunction were present. Diagnosis/Intervention: Sagittal and axial MRI findings revealed disc herniation at the T11 – T12 level. Full endoscopic thoracic discectomy through a transforaminal approach was performed to decompress the spinal cord. Conclusion: Acute thoracic disc herniations although rare, can present with variable clinical manifestations. Full endoscopic thoracic discectomy through a transforaminal approach is a safe and effective surgical procedure associated with improved patient outcomes, increased satisfaction scores, and decreased chances of complications. Keywords: Acute thoracic disc herniation, endoscopic discectomy, full endoscopic thoracic discectomy.

Neoadjuvant Chemotherapy as a Viable Treatment Option for Locally Advanced Adenoid Cystic Carcinoma of Salivary Gland: a Case Report

Adenoid cystic carcinoma (ACC) is a rare infiltrative tumor predominantly affecting minor salivary gland along with submandibular and parotid glands. Its biological behavior has not been clearly understood, and only few researches have been performed regarding treatment options. Patient usually presents with swelling of salivary gland region with complaints of paresthesia, numbness, and pain or muscle weakness due to nerve involvement. Diagnosis is confirmed on histopathology, and surgical excision is the treatment of choice in resectable cases. The role of neoadjuvant chemotherapy or radiotherapy remains debatable in advanced presentation. Present case depicts the role of chemotherapy and radical surgery in its management. Here, we present a case of recurrent locally advanced ACC that was down staged and underwent R0 resection after neoadjuvant chemotherapy (NACT). After two and half years of follow-up, the patient is alive and disease-free. Adenoid cystic carcinoma (ACC) is a rare and aggressive variant of salivary gland neoplasm. Perineural invasion and resistance to present chemotherapeutic drugs makes treatment more challenging. Role of chemotherapy remains controversial and in upfront technically unresectable cases neoadjuvant chemotherapy (NACT) can be used as an option to achieve R0 resection.

Demographical, Anatomical, Disease-Related, and Occupational Risk Factors for Carpal Tunnel Syndrome

Background: Carpal tunnel syndrome (CTS) is the most common focal mononeuropathy. It causes characteristic symptoms, including numbness and paresthesia in the hand due to median nerve compression at the wrist. Objectives: We aimed to investigate CTS prevalence and personal, psychosocial, biomedical, and occupational factors related to it comprehensively, according to scattered publications, without the simultaneous evaluation of all CTS risk factors. Methods: A total of 345 patients referred to a hand clinic with a complaint of paresthesia in upper extremities and suspected CTS. The patients underwent neurological assessment and electrodiagnostic (EDX) tests to confirm the diagnosis. The demographic information, past medical history, past trauma history, and occupational history of all the patients were recorded and finally analyzed with SPSS software. Results: Of the patients, 213 (67.1%) met the criteria for CTS, of whom 160 (75%) were female. Females were significantly more affected by CTS than males (P < 0.05). The mean age was higher in the CTS patients (53.80 ± 11.57 years) than in non-patients (42.39 ± 12.31 years, P < 0.001). No statistical relevance was found between CTS prevalence with occupational history, underlying medical conditions, positive Tinel’s and Phalen's tests, and muscle atrophy. Conclusions: We recognized age and gender as main determinants in developing CTS. We also found that older age was related to higher CTS intensity.

An unusual acute onset hard and small volume epidural blood clotting after anterior cervical discectomy with tetraparetic neurological findings

Anterior cervical discectomy and fusion (ACDF) is one of the most commonly used surgical method to treat a variety of disordersin the cervical spine. Although, the incidence of complication related to ACDF is low, hematomas can be confronted after surgery.We report a 52-year-old male patient presented with complaints of paraesthesia and sensory loss in the upper extremities. Magneticresonance imaging (MRI) showed a large central-right paracentral protrusion resulting in narrowing of the spinal channel at thelevel of C5-C6 accompanied by spinal cord compression and bilateral foraminal stenosis. ACDF was performed at this level. Fivehours after surgery, sudden onset paraesthesia and tetraparesis developed. Urgent cervical MRI depicted acute filling half of thediscectomy cavity, compressing the dural sac and spinal cord. The patient underwent revision surgery and the symptoms improvedpostoperatively. The patient received conservative therapy and was discharged without any nerological problem. Despite being a rarecondition, sudden onset of neurological symptoms such as tetraparesis after ACDF surgery should remind the presence of hematomaat the surgical site.

A Case of Synovial Cyst of the Temporomandibular Joint with Complaint of Paresthesia of the Lower Lip

A Case of Synovial Cyst of the Temporomandibular Joint with Complaint of Paresthesia of the Lower Lip

The Frequency of Fibromyalgia in Patients Presenting with Symptoms of Carpal Tunnel Syndrome

Karpal tünel sendromu (KTS), en sık görülen tuzak nöropatisidir. Ellerde ağrı, uyuşma ve kuvvetsizlik gibi yakınmalarla karakterizedir. Fibromiyalji (FM) ise yaygın ağrının eşlik ettiği kronik kas iskelet sistemi hastalığıdır. Geniş semptom yelpazesi içinde parestezi yakınması sık görülmekte olup KTS ile karışabilmektedir. FM’li hastalarda KTS sıklığını araştıran az sayıda çalışma olup sonuçlar çelişkili bulunmuş-tur. Bu çalışmada amaç, klinik olarak KTS ile uyumlu yakınmaları olup sinir ileti çalışmalarında KTS saptanan ve saptanmayan iki grup arasında FM açısından farlılık olup olmadığını araştırmaktır. Fiziksel Tıp ve Rehabilitasyon Polikliniği’ne başvuran ve KTS ön tanısı ile elektrofizyoloji laboratuvarına yönlendirilen kadın hastalar çalışmaya dahil edilmiştir. Tüm hastalara FM 2016 ACR tanı kriterleri uygulan-mış ve Yaygın Ağrı İndeksi (YAİ), Semptom Şiddet Skalası (SSS), Fibromiyalji Şiddet Skoru (FŞS) kaydedilmiştir. Hastalar elektrofizyolo-jik olarak KTS saptanan ve saptanmayan iki gruba ayrılarak sonuçlar karşılaştırılmıştır. Çalışmaya ellerde uyuşma yakınması olan ve sinir ileti çalışması sonucunda 30 KTS pozitif, 25 KTS negatif hasta alındı. İki grup arasında yaşa ve beden kitle indeksine göre farklılık saptan-madı. KTS saptananların %26,7’sinde, saptanmayanların %24’ünde ACR 2016 kriterlerine göre FM saptanmış olup, iki grup arasında istatis-tiksel olarak anlamlı fark bulunmamıştır. YAİ, SSS ve FŞS incelendiğinde de gruplar arasında istatistiksel fark saptanmamıştır. Diğer yandan FM saptanan ve saptanmayan iki grup karşılaştırıldığında FM saptanmayan grupta median sinir ileti hızları anlamlı olarak daha yavaş bulun-du. Sonuç olarak, KTS hastalarında FM prevalansı yüksek bulunmuştur. FM olan ve olmayan KTS hastalarının median sinir iletim hızların-da anlamlı farklılıklar olduğundan, FM hastalarında KTS tanısı için elektrofizyolojik doğrulama önerilebilir.

S2888 Tetany and Carpopedal Spasm as the Initial Presentation of Celiac Disease

INTRODUCTION: Celiac disease (CD) presents with a wide variety of symptoms, with gastrointestinal manifestations being the most common. We discuss a rare case of celiac disease diagnosed by severe hypocalcemia and carpopedal spasm. CASE DESCRIPTION/METHODS: A 25 year old male with no significant medical history presented with complaints of paresthesias in his hands and arms and a few weeks of diarrhea. Physical exam revealed carpopedal spasm. Initial lab work was significant for severe hypocalcemia (ionized calcium level of 0.66), hypomagnesemia and undetectable vitamin D 25-hydroxy level, along with elevated PTH (583.2). His electrolytes were aggressively replaced intravenously, and after stabilization, transitioned to oral supplementation. Vitamin D supplementation was also initiated. Patient was found to have elevated tissue transglutaminase IgA antibodies and gliadin peptide levels. EGD demonstrated scalloped mucosa with complete flattening of villi in the duodenum consistent with celiac disease, which was also confirmed on biopsy. Patient was initiated on calcium and vitamin D replacement and a gluten-free diet on discharge. DISCUSSION: CD usually presents with diarrhea and weight loss. However, >40% of patients present with atypical manifestations, many of which are secondary to malabsorption from a loss of absorptive area and the presence of immature surface epithelial cells whose have impaired absorptive and secretory functions. Hypocalcemia in CD occurs due to intestinal malabsorption of calcium, both from loss of villous surface area and depletion of calbindin from enterocytes leading to decreased active intestinal calcium transport mechanisms. Concurrent malabsorption of vitamin D may also play a role, although there have been reported cases with hypocalcemia despite a normal vitamin D. Hypocalcemia in CD is common, with studies demonstrating that average serum calcium is 0.02 mmol/l lower in asymptomatic CD patients that the general population. However, there are few reports, especially in the developed world, of severe hypocalcemia and neurological symptoms being the initial presentation of CD. Management includes intravenous or oral calcium replacement, with replacement of other electrolytes (magnesium, phosphorous and potassium) and vitamin D as well. These levels should be monitored at follow up visits, but it is expected that they will normalize after management of CD. It is important for a clinician to recognize atypical presentations of CD, especially in countries with high prevalence.Figure 1.: Endoscopic view of duodenal bulb showing scalloped mucosa and complete flattening of villi.Figure 2.: Microscopic view showing villous blunting and increased intraepithelial lymphocytes, H&E staining.

GIANT SIALOLITH OF THE SUBMANDIBULAR SALIVAR GLAND: CASE REPORT WITH AN EXTRAORAL APPROACH

Stone formation or sialolithiasis is a disease of the salivary glands that causes obstruction of the gland or the excretory duct due to a calcified formation that results in specific signs and symptoms in the cervico-facial region. We report a case of large salivary calculi in a 47-year-old woman with complaints of increased volume and pain at recurrent palpation in the left submandibular region radiating to the oral floor, dysphagia. The imaging exams (computed tomography cone beam and ultrasonography) evidenced the presence of large, hyperdense, and calcified mass. After the exams, surgical intervention consisted of excision of the left submandibular gland (including extensive calculus in the glandular parenchyma) through the surgical extraoral access of Hisdon under general anesthesia. There was complaint of paresthesia in the lingual floor that gradually decreased with the postoperative and preservation of the nerve of the marginal mandibular branch. No recurrence was observed. Stone formation or sialolithiasis is a disease of the salivary glands that causes obstruction of the gland or the excretory duct due to a calcified formation that results in specific signs and symptoms in the cervico-facial region. We report a case of large salivary calculi in a 47-year-old woman with complaints of increased volume and pain at recurrent palpation in the left submandibular region radiating to the oral floor, dysphagia. The imaging exams (computed tomography cone beam and ultrasonography) evidenced the presence of large, hyperdense, and calcified mass. After the exams, surgical intervention consisted of excision of the left submandibular gland (including extensive calculus in the glandular parenchyma) through the surgical extraoral access of Hisdon under general anesthesia. There was complaint of paresthesia in the lingual floor that gradually decreased with the postoperative and preservation of the nerve of the marginal mandibular branch. No recurrence was observed.

CHONDROBLASTIC OSTEOSARCOMA IN THE MANDIBLE: A CASE REPORT

Osteosarcoma of the jaws is uncommon and mainly occurs as a fast-growing painful swelling in the posterior mandible. The knowledge of clinicopathologic aspects of osteosarcoma is essential for early diagnosis and adequate treatment. The aim of this study is to report a clinical case of chondroblastic osteosarcoma in the posterior left mandible in a 53-year-old male patient with complaint of paresthesia in the left lower lip and a fast-growing swelling in the gingival mucosa. Radiographically, the classical sunray appearance can be observed. Microscopically, we identified atypical polygonal cells with large and hyperchromatic nuclei associated with osteoid material and chondroblastic differentiation. The diagnosis of chondroblastic osteosarcoma was made. The patient was referred to an oncologist for treatment with surgery and chemotherapy.

MULTILOCULAR RADIOGRAPHIC ASPECT IN ODONTOGENIC KERATOCYST: CASE REPORT

A 63-year-old black male patient reported intraoral drainage and palpation pain in the right mandibular body region with no complaints of paresthesia. The ipsilateral gingival margin was invaginated without any expansion of the cortical bone when a clinical examination was made. In the tomographic examination, alveolar bone resorption with a multilocular pattern was observed with hypodense interior, well-defined hyperdense margins, anteroposterior growth in mandibular body to the right up to the ascending branch on the same side, and involvement of the inferior alveolar nerve canal, suggesting an ameloblastoma diagnosis. After an incisional biopsy, the histopathologic report revealed an odontogenic keratocyst. Decompressive treatment with rigid latex device was used to allow reduction of the cystic cavity to facilitate removal, decrease the rate of recurrence, and not compromise the sensitive innervation of the affected region. However, periodic radiographic examination is necessary to follow up and define the surgical moment for enucleation.

Lead Poisoning Can Be Misdiagnosed as Guillain-barre Syndrome: A Case Report

Background: Toxic neuropathy is a global health problem affecting many people over the world, annually. Lead poisoning (LP) represents neurological complaints and neurobehavioral disorders. Therefore, its significances, especially its neurological consequences, can be misdiagnosed as other neuropathies like syndromes.Case Presentation: In this case report, we aim at describing a 45-year-old woman with Guillain-Barre-like syndrome (GBS), who was admitted to the hospital with peripheral neuropathy and complaints of paresthesia in the lower and upper limbs. Suffering from GBS-like syndrome, she incidentally showed opium consumption during the hospitalization and taking her history. Serum lead levels were precisely elevated (88.6 µg/dL). To assess the neurologic effects, the brain CT, MRI, EMG, and NCV were performed, indicating severe sensory-motor demyelinating polyradiculopathy. The patient was admitted to the hospital again after 2 years with severe radicular pain in the lower and upper limbs and with positive myoclonus and tremor. While treated with plasma exchange and pregabalin at the first stage of admission, signs were normal and again recurred after 2 years, suggesting the reversibility of the histological findings and misdiagnosis. At the second stage, intravenous immunoglobulin (IVIG) was prescribed. The patient recovered and was discharged with chelation therapy of CaNa2EDTA for LP. The most frequent neurological complication induced by LP is severe sensory-motor demyelinating polyradiculopathy and axonal polyneuropathy. But, the clinical examination and the electrophysiological findings may also suggest a GBS-like syndrome.Conclusions: Any discrepancies in this regard should be reconsidered to confirm LP diagnosis.

MON-322 Intrathoracic Meningocele Associated with Neurofibromatosis Type 1: A Case Report

Background: Intrathoracic meningocele is a relatively rare condition, with 60 to 85% of cases being associated with neurofibromatosis type 1. In most cases, meningoceles are small and asymptomatic, and regular follow-up with periodic imaging is recommended without a surgical approach. Most patients become symptomatic between 30 and 50 years of age. Surgical treatment is indicated only when there is an accelerated growth of the meningocele or when the patient presents intense symptoms due to the compression of adjacent structures. Clinical Case: CRSG, 39 years old, female, with non-consanguineous parents. Patient referred to Endocrinology at age 20 by dermatology with the diagnosis of neurofibromatosis made because of the presence of cutaneous neurofibromas and cafe au lait spots. Her father had neurofibromatosis and C-cell hyperplasia diagnosed after total thyroidectomy, and the genetic analysis of RET oncogene was negative. During follow-up, patient evolved with complaints of paresthesia in bilateral upper limbs and mechanical type cervicalgia. In cervical spine MRI, dural ectasia was observed from C4 to T2 levels, with enlargement of the vertebral canal and remodeling of the posterior wall of the vertebral bodies. In parallel, the patient had a diagnosis of primary hyperparathyroidism with serum calcium of 10.7mg/dL(8.6-10.2), vitamin D 29.8ng/dL(>20), PTH 115pg/ml(15-65) and serum phosphorus of 2.2mg/dL(2.8-4.1), and normal renal function. 99mTc-sestamibi scan showed an increased parathyroid gland posterior to the superior pole of the right lobe of the thyroid. After discussion of the case with Neurosurgery and Neuroradiology, it was then hypothesized as a cervical-thoracic meningocele and opted for conservative treatment followed by serial imaging, due to the high surgical risk and little clinical compromise of the patient at the time. Subsequently, she evolved with nausea, intermittent vomiting that made her need daily antiemetic medication. We considered the hypotheses of emesis secondary to hypercalcemia and/or secondary to cerebrospinal fluid hypotension caused by meningocele. Treatment with pamidronate was initiated and the patient and is still under evaluation for probable intracranial cerebrospinal fluid hypotension. Conclusion: Neurological complaints are common during the follow-up of patients with neurofibromatosis and their differential diagnosis is of great importance for adequate therapeutic management. Regarding the main tumor lesion, in addition to the mentioned meningocele in the case, it should be differentiated from neurofibroma, neuroblastoma, ganglioneuroma and cystic hygromas of the posterior mediastinum. Reference: Huang TW, Huang HP, Ye QY, et al. A neurofibromatosis type 1 patient with thoracic encapsulated fluid and intracranial hypotension syndrome: a case report. Neurologist 2011;17:167-171.

Удовлетворенность качеством жизни пациентов с минимальными рубцовыми деформациями лица и шеи

Satisfaction with quality of life and self-attitude in patients operated by «traditional» (conventional surgical methods) and endoscopically assisted methods are considered in the article. Differences in the quality of life in patients, self-attitude to ones appearance are described. 65 patients were surgically operated and examined. Control group – patients operated by «traditional» techniques (35 patients), the average age of patients was 38 ± 11,1 years. The comparison group – patients operated using endoscopically assisted methods (30 patients), the average age of patients was 44 ± 17,7 years. Psychodiagnostic methods: 1. N. E. Vodopyanova`s scale of life quality; 2. The Short Form-36; 3. S.R. Panteleev`s Assessment of self-relationship. Complaints of paresthesia and pain experienced by patients who underwent a “traditional” operation were revealed as a result of the examination. Operated on with an endoscopically assisted method patients did not present any complaints. Differences between the assessment of the life quality and self-relationship in examined groups were found. Operated on with an endoscopically assisted method patients evaluated life quality, satisfaction with their appearance and physical condition higher than patients operated on with a “traditional” method.

Stretch breaks in the work setting improve flexibility and grip strength and reduce musculoskeletal complaints

AbstractThis study investigated the effect of a stretch break program (SBP) on the flexibility, strength and musculoskeletal complaints of storage (SW) and administrative (AW) sector workers. Twenty-six male workers were randomly selected: 16 workers from the storage sector and ten workers from the administrative sector. We applied the Physical Activity Questionnaire and Musculoskeletal Questionnaire and evaluated flexibility and grip strength before and after 6 months of the SBP. The SPB decreased the SW group members' complaints of paresthesias and numbness in the upper body and total body. The SPB reduced the AW group members' complaints of paresthesias and numbness in the upper body. Furthermore, the SPB improved cervical, trunk and left shoulder flexibility in the SW group and improved cervical and shoulder flexibility and grip strength in the AW group. The SBP contribute to improve flexibility and musculoskeletal complaints in the regions that are affected by higher rates of work-related injuries.

Quantitative assessment of sural nerve donor site sensitivity: one week and one year after surgery

Background The use of autologous nerve material has become the gold standard for reconstructing peripheral nerve defects. For various applications, nerve grafting is required to restore nerve continuity, and the sural nerve may be considered the best option for such purposes. The aim of this study was to quantitatively assess the recovery of donor site sensory deficit following sural nerve harvest. Methods This descriptive study was performed on 30 patients in the first week after surgery and 23 patients 1 year after sural nerve harvest. Mapping of the affected area was performed using Semmes–Weinstein monofilaments. Then, the areas of diminished or loss of sensation were evaluated with monofilament test, static and dynamic two-point discrimination, and temperature sensitivity. Also, the complaints of paresthesia, numbness, and pain were measured. The results were compared in the two groups. Results The area of diminished or loss of sensation 1 week after surgery was significantly reduced after 1 year (p00.000). A reduction was observed in the patients' complaints, especially in numbness and paresthesia, and better results were obtained in clinical findings, significantly in dynamic two-point discrimination and temperature sensation. Conclusion In this study, donor site adverse effects of sural nerve harvest decreased over time, and improvements in sensory tests were observed; however, more studies should be performed on this topic. Level of Evidence: Level III, diagnostic study.

Evaluation of Upper Extremity Nerve Conduction Velocities and the Relationship Between Fibromyalgia and Carpal Tunnel Syndrome

We undertook this study to evaluate upper extremity nerve conduction velocities (NCVs) in fibromyalgia syndrome (FS) and the relationship of the electrophysiological findings between carpal tunnel syndrome (CTS) and FS. Sixty three right-handed female patients diagnosed with FS and 52 right-handed age- and gender-matched healthy controls were enrolled in the study. Conduction studies of the median and ulnar nerves and median nerve F-wave latencies were assessed in both upper extremities using standard methods. CTS was diagnosed electrophysiologically if the median nerve sensory NCV was decreased and/or motor distal latency (DL) was prolonged. CTS was detected electrophysiologically in 26 (20.63%) of 126 extremities of 63 patients and in three (2.82%) of 104 extremities of 52 individuals of the control group. Statistically significant differences were detected between groups with respect to rate of carpal tunnel syndrome (p <0.05). There were no differences between results of NCVs of patients in FS group and healthy controls except the prolongation of the right median nerve motor DL (p = 0.019), decrease of the sensory NCV (p = 0.003) in the right median nerve, in the left median nerve (p = 0.011) and in the left ulnar nerve (p = 0.015). We determined an increased rate of CTS and decreased NCVs in the upper extremities in patients with FS. We should consider that complaints of paresthesia and pain in hands, increasing especially at nights, observed in FS may mask that CTS can be an associated illness.

Review of Different Electrodiagnostic Studies in Mild Carpal Tunnel Syndrome

Aims The objective of this study was to evaluate different sensory electrodiagnostic tests in mild carpal tunnel syndrome (CTS). Methods Forty-seven patients (45 females and 2 males) with a total of 65 hands who attended the electrodiagnosis laboratory with the complaints of paresthesia, tingling, and pain in the median nerve distribution area for at least 1 month, at least 3 times/wk were included in the study. Patients with a history of CTS surgery, decreased ulnar sensory nerve action potential amplitude (<12 μV), increased ulnar sensory nerve onset latency (>3.7 ms), increased median motor distal latency (>4.2 ms), polyneuropathy and/or radiculopathy, pacemaker users, and pregnant women were excluded from the study. Electrodiagnostic studies including median and ulnar motor nerve conduction velocities; median sensory nerve conduction velocity (SNCV) of the first, second, and third digit to wrist (D1-W, D2-W, and D3-W) and palm to wrist; sensory median-radial latency difference (MRD) from the thumb; sensory median-ulnar latency difference (MUD) across the wrist over 8-cm segment; and sensory median-ulnar latency difference (MUDF) from the fourth digit were performed. Results Median SNCV of D1-W was found pathologic in all patients, MRD in 92.3%, MUDF in 92%, median SNCV of D2-W in 81.5%, MUD in 78.5%, and median SNCV of palm to wrist in 55.62%. In the case where a second test including median SNCV of D1-W, MUDF, or MRD is conducted with median SNCV of D3-W, 100%, 98%, and 97% of patients, respectively, having mild CTS could be diagnosed electrodiagnostically. Conclusions For the electrophysiologic diagnosis of patients with probable mild CTS, adding median SNCV of D1-W, MUDF, MRD, and median SNCV of D3-W study could be suggested to increase the accuracy of the diagnosis.