Median Nerve Compression Research Articles

Unusual Symptoms of Lacertus Syndrome: A Case Report

Background: Lacertus syndrome, a condition characterized by median nerve compression at the elbow due to anatomical variations, is often misdiagnosed. This case report describes a 53-year-old female patient who presented with severe lateral elbow and shoulder pain, previously diagnosed with cervicalgia and tennis elbow. Methods: Upon admission, she reported significant pain (NRS—Numerical Rating Scale 8/10) and occasional radiating paresthesia in the first three digits of her left hand. Clinical examination revealed weakness in the wrist and finger flexion, which was exacerbated by a positive Cutaneous Scratch Test (CST), while Magnetic Resonance Imaging (MRI) of the cervical spine showed no definitive abnormalities. Electroneurography (ENG) indicated reduced amplitude in the left anterior interosseous nerve. Ultrasound excluded carpal tunnel syndrome but identified nerve flattening beneath the pronator teres muscle. A surgical decompression of the median nerve was performed, resulting in immediate improvement in muscle strength and significant pain reduction (NRS 1/10) postoperatively. Follow-up evaluations confirmed substantial recovery in nerve function and morphology. Conclusions: This case illustrates the atypical presentation of Lacertus syndrome, emphasizing the need for comprehensive diagnostic approaches that include clinical, imaging, and neurophysiological assessments. Awareness of this syndrome is crucial for differential diagnosis in patients exhibiting uncharacteristic symptoms, such as shoulder or elbow pain, to ensure timely and effective treatment.

Analgesic Efficacy of Gabapentin in Patients Undergoing Carpal Tunnel Release Surgery: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials.

Carpal tunnel syndrome (CTS) results from median nerve compression and may lead to significant pain. Surgical management through release is the gold standard approach for severe CTS patients. Gabapentin is used as an analgesic drug, but data on its postoperative effects on pain assessment and safety measures are unclear. We aimed to assess the clinical effectiveness of gabapentin in patients undergoing CTS release surgery.We searched PubMed, Scopus, Web of Science (WOS), and the Cochrane Library for randomized controlled trials (RCTs) addressing the effectiveness of gabapentin in patients with CTS release until September 2024. The primary outcome was the assessment of postoperative pain at one, six, 12, and 24 hours by a visual analog scale (VAS). Other specific outcomes wereadverse events. Data were pooled as effect sizes (mean difference (MD) or odds ratio (OR)) with their 95% confidence interval (CI) in a random-effects model using Stata/MP 18. Three RCTs comprising 205 patients were included in the pooled meta-analysis. Gabapentin significantly reduced postoperative pain at six, 12, and 24 hours compared to placebo (MD = -0.6, 95% CI: -0.63 to 0.57, p < 0.001; MD = -2.14, 95% CI: -2.18 to -2.1, p < 0.001; and MD = -1.41, 95% CI: -1.82 to -0.99, p < 0.001, respectively). On the other hand, no significant differences were observed regarding other studied outcomes (i.e., safety) between the two groups. This pooled meta-analysis of 205 patients revealed that gabapentin was associated with reduced pain postoperatively at 6, 12, and 24 hours with comparable rates of adverse events compared to placebo. Further RCTs are warranted to validate the current findings.

Anterograde ultrasound guided lacertus fibrosus release at the elbow under WALANT - Technical note.

Dynamic compression of the median nerve under the lacertus fibrosus at the elbow causes pain and weakness. It is a frequently overlooked pathology and a cause of failed recovery after carpal tunnel release. The purpose was to present a technical note on minimally invasive ultrasound-guided lacertus syndrome surgical treatment under WALANT. We believe the technique is indicated in patients who present with a positive Hagert's triad of pain over the median nerve at the lacertus, weakness on testing of the flexor pollicis longus, second flexor digitorum profundus, and flexor carpi radialis, and a positive sensitive collapse test. Contraindications include static median nerve compression at the elbow and allergy to lidocaine. The technique is preceded by local anesthesia, which is completed under ultrasound guidance for deeper or more proximal structures. The entry point is calculated proximal to the lacertus and the special knife is introduced through a 0.5 cm incision. The lacertus is divided anterogradely under ultrasound guidance. Full recovery of strength is evidenced by the completion of the division. The patient returns to full activity within days to a week after surgery. Minimally invasive, ultrasound-guided release allows for rapid return of full-strength motion with minimal scarring.

Carpal Tunnel Syndrome Incidence In Teachers and Employees at SMP Negeri 1 Pematangsiantar

Background. Median nerve compression at the wrist (carpal tunnel syndrome) is the most common disorder affecting the median nerve and is the most common nerve compression syndrome. Problems usually arise from excessive hand use and work microtrauma. Objectives. To determine the incidence, severity, characteristics of respondents detected, and risk factors that allow for CTS. Methods. The study was an analytic-descriptive study with a cross-sectional approach. Using 70 samples of data from educators and employees at SMP Negeri 1 Pematangsiantar. Data were analyzed using univariate and bivariate analysis. Results. This study involved 70 educators and employees, 59 (84.3%) were found with the majority of respondents experiencing complaints with asymptomatic symptom severity 46 people (65.7%), mild 22 people (31.4%), and moderate 2 people (22.9%). Of the 59 respondents detected, 50 people (71.4%) had mild functional symptom status. The majority of respondents detected with CTS were female (74.6%) and were in the age range of 51-60 years (44%). Respondents detected with CTS had nutritional status type I obesity (34%). Of the 59 respondents detected with CTS, 54 people (91.5%) were educators who had a working duration of ≥8 hours a day (52.5%) and experienced complaints in the left hand (69.5%). Conclusion. Most predominantly female in the age range of 51-60 years who worked as educators with a working duration of ≥8 hours and the majority experienced complaints in the left hand. Keywords: Carpal tunnel syndrome, educators, incidence

EFFECTS OF DEEP TRANSVERSE FRICTION MASSAGE ALONG WITH NERVE GLIDING EXERCISES IN THE MANAGEMENT OF CARPAL TUNNEL SYNDROME PATIENTS

Background: Carpal Tunnel Syndrome (CTS) is a prevalent condition characterized by discomfort, pain, and functional impairment due to median nerve compression. Conservative treatment approaches aim to manage symptoms and improve functionality. Among these, manual therapies such as Deep Transverse Friction Massage (DTFM) and Nerve Gliding Exercises (NGEs) have shown promise in addressing both neural and mechanical dysfunctions. This study evaluates the combined effects of DTFM and NGEs in alleviating CTS symptoms and enhancing functional outcomes. Objective: To investigate the effects of Deep Transverse Friction Massage combined with Nerve Gliding Exercises in the management of Carpal Tunnel Syndrome. Methods: This randomized clinical trial employed a non-probability purposive sampling technique to recruit 56 participants aged 20–40 years with CTS, confirmed by positive Phalen’s, Tinel’s, and Duncan’s tests, and moderate pain levels (VAS 4–7). Patients were randomly assigned to Group A (DTFM + NGEs) or Group B (NGEs alone). The intervention spanned four weeks, with two sessions per week. Outcome measures included pain (Visual Analog Scale), wrist range of motion (goniometer), grip strength (handheld dynamometer), and functional disability (Boston Scale). Statistical analyses were conducted using SPSS version 20, employing the Friedman test for intragroup analysis and the Mann-Whitney U test for intergroup comparisons. Results: Group A showed significant improvements across all variables compared to Group B. Pain reduction demonstrated a highly significant difference (p &lt; 0.000) post-intervention, with improved wrist flexion (p = 0.05) and extension (p = 0.056). Grip strength increased significantly (p &lt; 0.000), and functional disability scores were notably better in Group A (p &lt; 0.000). The findings indicate the superior efficacy of the combined intervention over nerve gliding exercises alone. Conclusion: The combination of Deep Transverse Friction Massage and Nerve Gliding Exercises proved significantly more effective than NGEs alone in managing pain, improving wrist mobility, enhancing grip strength, and reducing functional disability in patients with Carpal Tunnel Syndrome.

Tarans-Scaphoid Lunate Fracture Dislocation: A Case Report of a Rare Injury

Trans-scaphoid lunate dislocation is an uncommon injury but can be devastating, causing loss of wrist joint movement and function, and compromising grip strength. In this report, we present a case of a 48-year-old man with a history of psychiatric disorder who attempted suicide by jumping from the second floor. He sustained a volar lunate dislocation and scaphoid fracture, with migration of the proximal part of the scaphoid to the volar aspect of the forearm. Open surgical reduction was planned through a dorsal approach: first, the lunate was reduced, then the proximal part of the scaphoid was retrieved from the volar aspect of the forearm and anatomically fixed with a 2.5 mm headless screw. The scapholunate relationship was reduced and fixed with two wires through the scapholunate and scaphocapitate joints. The wound was closed in layers, and the wrist joint was immobilized with a dorsal splint for six weeks. Six weeks postoperatively, the K wires were removed, and the patient started physiotherapy. At three months postoperative follow-up, the wrist joint function was good, with good grip strength and a good range of motion. The gold standard treatment option is open reduction and fixation of the fractured bone and stabilization of the carpal bones in anatomical alignment to reduce possible complications such as median nerve compression, chronic carpal instability, chronic wrist pain, loss of grip strength, wrist arthritis, and carpal collapse.

Nerve compression after opponensplasty: a cadaveric study

Background: We describe the differences in thumb opposition between different opponensplasty tendon transfers and determine the immediate pressure on the median and ulnar nerves incurred by each transfer. Methods: Using fresh frozen cadavers (8 specimens), opponensplasties were performed using extensor indicis proprius (EIP), flexor digitorum superficialis (FDS) with flexor carpi ulnaris (FCU) pulley, palmaris longus (PL, Camitz procedure), and PL utilizing the thenar fascia as a pulley (PLwP). Each tendon transfer was tensioned, and the thumb flexion, abduction and pronation were measured. The pressure on the median and ulnar nerves were measured for each tendon transfer at varying tensions. Results: There were no differences seen in flexion or pronation between any of the four tendon transfers. FDS, PL and PLwP demonstrated more abduction than the EIP transfer, however differences were less than 10°. EIP and FDS transfers caused significantly more pressure on the median nerve than PL or PLwP at high tendon tensions. Both EIP and FDS tendon transfers caused significantly more pressure on the ulnar nerve than PL or PLwP, and the pressure increased as tension on the transfer increased. No pressure differences were seen between PL and PLwP. Conclusions: No significant differences were seen in thumb flexion or pronation between the four tendon transfers. Differences were seen for abduction with EIP showing the least amount of abduction. EIP and FDS caused more median nerve compression than PL transfers at high tension. Both EIP and FDS tendon transfers cause more ulnar nerve compression than PL transfers at all tensions. Level of Evidence Level: V

The role of the exhaustion test in lacertus syndrome

BackgroundLacertus syndrome involves dynamic median nerve compression by the lacertus fibrosus, leading to sensory symptoms and loss of strength. Prevalence in the general population is unclear. ObjectiveThis study aimed to determine the prevalence of lacertus syndrome in the Belgian population and to evaluate the effectiveness of the exhaustion test combined with the scratch collapse test. MethodsIn a cross-sectional study from May 2023 to February 2024, 362 healthy individuals, aged 18 to 86 years underwent clinical examinations, including the scratch-collapse test and exhaustion test, to assess signs of lacertus syndrome. Results11.3% of participants (95% CI: 8.2–15.1%) reported discomfort on lacertus fibrosus palpation.The scratch-collapse test at the lacertus fibrosus was positive in 7.2% of cases (95% CI: 4.8–10.4%), increasing to 25.7% (95% CI: 21.3–30.5%, p < 0.001) following the exhaustion test. There were no significant differences in gender, occupation, or hand dominance (all p > 0.05). Hagert’s clinical triad and positive scratch-collapse test over the lacertus fibrosus were found in 2.21% (95% CI: 1.0–4.2%) of this general population after the exhaustion test. ConclusionThe prevalence of lacertus syndrome was 2.21% after the exhaustion test, and 0.83% before. The exhaustion test led to significant conversion of negative to positive scratch-collapse test from 7.2% to 25.7%.The exhaustion test enhanced the scratch-collapse test’s diagnostic accuracy, revealing a spectrum of lacertus syndrome symptoms, from unnoticed mild cases to severe manifestations, and confirmed the importance of Hagert's clinical triad in diagnosing lacertus syndrome.

Bilateral Variations of Pronator Teres in the Upper Limb.

During clinical practice, physicians need to have a sound knowledge of vascular and nerve variations in the body. Patients presenting with various clinical signs and symptoms need to be thoroughly investigated with anatomic variations in mind to prevent misdiagnosis. Most nerve variations are related to their formation or their course and are frequently associated with the variability of structures that surround them. These structures most commonly include blood vessels, ligaments, and muscles. Such variations should be foremost in a physician's mind when analyzing clinical symptoms. This will aid in accurate diagnosis, and if surgical intervention is warranted, such awareness would minimize intraoperative errors. This article discusses a variation in the pronator teres muscle, the branching pattern of the brachial artery, and the median nerve. During the dissection of 11 cadaveric specimens within the Geisinger Commonwealth School of Medicine, an elderly female cadaver exhibited bilateral variations in the pronator teres muscle, which originated from the mid-humerus, instead of the medial epicondyle. Careful dissection revealed associated neurovascular variations in the arm, elbow, and forearm in relation to the muscle. The pronator teres muscles in the remaining 10 cadavers in the lab were examined for variations and their lengths were measured and compared with the cadaver under study. Unlike the normal origin at the medial epicondyle as described in textbooks, it was observed that the humeral heads of the pronator teres muscle originated at mid-humerus level bilaterally,associated with the passage of the median nerve and ulnar artery posterior to it. This muscle was 19 cm in length bilaterally, approximately 5.5 cm longer than the average lengths of pronator teres measured bilaterally in the other cadavers. The abnormally high origin of this muscle was associated with the finding of a median nerve coursing posterior to it to the forearm, failing to appear in the antecubital fossa. Although the ulnar head appeared normal, there were bilateral variations in the median nerve during its passage between the two heads of the pronator teres at the proximal forearmas it proceeded to the deeper compartment of the forearm. The brachial artery was observed to divide into radial and ulnar arteries at the mid-humerus level. The radial artery replaced the brachial artery in the antecubital fossa and the ulnar artery accompanied the median nerve posterior to pronator teres into the forearm. Such variations observed bilaterally have not yet been reported in the literature. Knowledge of these variations in the origin of pronator teres muscle, the absence of specific neurovascular structures as expected within the cubital fossa, and the awareness of early bifurcation and variation in their course can be very profound for physicians, as this region is often involved in the creation of arterio-venous fistulas for medical procedures, surgical treatment options for supracondylar and radial head fractures, and to differentiate median nerve compression in pronator teres syndrome versus carpal tunnel syndrome.

P.059 Weill-Marchesani Syndrome – a rare etiology for bilateral carpal tunnel syndrome in children

Background: Carpal tunnel syndrome (CTS) is less common in children but can be associated with significant disability. Pediatric CTS can be associated with an underlying disorder most commonly storage disorders including mucopolysaccharidoses (MPS). We report a patient with bilateral severe CTS secondary to Weill-Marchesani Syndrome (WMS). Methods: A retrospective chart review was completed. Results: A five-year-old female presented with a three-year history of bilateral thumb weakness and insensate digits two and three. Nerve conduction studies (NCS) revealed severe bilateral CTS. She underwent bilateral carpal tunnel release (CTR). Unfortunately, post-operative NCS was unchanged. Ultrasound showed significant median nerve compression with flexor tendon thickening. Metabolic investigations showed no evidence of a storage disorder. Trio whole exome sequencing showed two de novo likely pathogenic variants in ADAMTS10: c.1174delC, p.H392TfsX9 and a deletion of exons 3-8. Her exam was also noted to show bilateral camptodactyly and brachydactyly, and bilateral cataracts characteristic of WMS. Conclusions: Identifying the etiology of CTS is important for management and prognosis. WMS is a genetic connective tissue disorder that can cause brachydactyly and abnormal tendon thickening, which can have implications on surgical outcomes. Awareness of this diagnosis prior to surgery would allow for better patient counseling and management decisions.

Iatrogenic brachial artery pseudoaneurysm causing median nerve compression neuropraxia diagnosed and compression therapy ultrasonography: A rarest case image

Iatrogenic brachial artery pseudoaneurysm causing median nerve compression neuropraxia diagnosed and compression therapy ultrasonography: A rarest case image

SUTURE CHOICE IN CARPAL TUNNEL SURGERY: A RANDOMIZED CONTROLLED TRIAL

ObjectiveCarpal tunnel release surgery is a commonly performed procedure for alleviating symptoms of median nerve compression and restoring hand function. With pressure on theatre time these procedures are now commonly performed in a step-down out-patient facility under local anaesthetic. The choice of suture for skin closure in this procedure can impact the quality of wound healing, patient outcomes and the follow-up required however the question of the best type of suture remains unanswered. The purpose of this study was to compare the outcomes of absorbable and non-absorbable sutures using a randomised control trial design.MethodsEighty patients diagnosed with bilateral carpal tunnel syndrome were enrolled and underwent outpatient carpal tunnel release surgery under local anaesthetic in a staged fashion. Random number generation was used to assign each hand to receive interrupted nylon or Vicryl Rapide sutures. Pre-operative data collection included patient demographics, ASA, inflammatory conditions, smoking status as well as a Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. Patients were followed up at 2 and 6 weeks after each operation and the BCTQ was repeated along with the Patient and Observer Scar Assessment Scale and the VAS score for wound discomfort. This study has approval from the DHB ethics committee, Local Iwi, HDC and ANZ Clinical Trials:ACTRN12623000100695.ResultsStatistical analysis assessed patient preference and the scores between the groups. Multi-variate analysis was performed to assess the factors that may be contributing to patient choice.ConclusionInsights into patient preference and clinical outcomes associated with absorbable sutures and non-absorbable sutures in the setting of out-patient surgery are discussed.

Relationship of obesity indices with clinical severity and nerve conduction studies in females presenting with median nerve compression neuropathy at the wrist.

Carpal tunnel syndrome (CTS) is considered to be one of the most common peripheral nerve disorders with female preponderance which significantly reduces work efficacy and needs further research on its preventable factors, especially obesity. We studied the effects of obesity indices on Phalen's test duration and median nerve conduction study (NCS) parameters in patients presenting with CTS. We examined 229 female patients presenting with clinical features of CTS. Clinical examinations including Phalen's test, median NCSs, and body composition were evaluated. Obesity indices and electrophysiological parameters were compared. There were significant associations of both body mass index (BMI) degrees and body fat percent (BF%) with clinical and NCS parameters with a linear relationship. BF% and BMI were strongly negatively correlated with Phalen's test duration (BF%; r = -0.334, BMI; r = -0.270 P = 0.001). On the other hand, BF% and BMI were positively correlated with median distal latency (BF%; r = 0.338, BMI; r = 0.372, P value = 0.001), M-latency (BF%; r = 0.264, BMI; r = 0.285, P = 0.001), median motor conduction velocity (MMCV) (BF%; r = 0.119, P = 0.072, BMI; r = 0.173, P = 0.009), median sensory conduction velocity (MSCV) (BF%; r = -0.195, P = 0.003, BMI; r = 0.327, P = 0.001), and sensory nerve action potential (SNAP amplitude) (BF%; r = -.239, BMI; r = -0.350, P = 0.001). Nerve conduction parameters are significantly affected by obesity degree defined by BMI and BF%. Therefore, combining BMI and BF% assessments gives more clinical information regarding CTS severity and management. The true predictive value of these indices needs to be elucidated further.

Below Elbow Amputation Due to Ischemic Complications after Radial Artery Cannulation: A Case Report

The patient is a 57 year old male with peripheral vascular disease and a non-healing thumb wound. After radial artery catheterization (RAC), he developed pain and numbness in the radial-sided 3.5 fingers and pulse oximetry readings &lt;80%. With a possible diagnosis of carpal tunnel syndrome due to increased pressure, the patient underwent a carpal tunnel release (CTR) one week after the catheterization and reported immediate pain relief. Unfortunately, his wound failed to heal, and his pain returned one week later. Another operation was performed to decompress the carpal tunnel; however, the pain worsened, and fingertip necrosis progressed, including the thumb, index, and middle fingers. An angiogram showed arterial calcifications, ruling out reperfusion of the hand. A trans-forearm amputation was performed. This case highlights overlapping symptoms of ischemia and median nerve compression as well as the risk of hand ischemia after RAC in those with circulatory compromise.

A Comparison of Mini Open Transverse Incision and Longitudinal Incision for the Release of Moderate and Severe Carpal Tunnel Syndrome.

Carpal tunnel syndrome is a common condition seen in daily clinical practice. Multiple minimally invasive techniques have emerged in the last decades for median nerve decompression. However, many research are needed to study the outcome on the patients and their safety profile. We will compare group A that includes patients operated on using the minimally invasive transverse incision (number of patients = n = 221, females 76.7% and males 22.8%) versus group B that includes patients operated on using the longitudinal incision (n = 194, female 70.1% and male 29.9%) in term of clinical satisfactionand safety. The mean age of group A is 58.1±5.1 and that of group B is 58.8±4.8. The male and female distribution in both groups and the mean age were both similar with no statistically significant difference for the age (p = 0.79) or the gender distribution (p = 0.1). Data collected prospectively at regular intervals in time (preoperatively and at one month, three months, and six months post-carpal tunnel release (CTR)) between January 2006 and December 2021 were reviewed retrospectively. Patients' clinical findings, grip strength measurement using a hand dynamometer, and postoperative satisfaction measured using the BCTQ (Boston Carpal Tunnel Syndrome Questionnaire) scoring system were recorded and analyzed for each technique. A total of 415 patients were included in our study. All patients included had moderate to severe median nerve compression documented by nerve-conducted studies with positive Tinel's and Phalen's signs. Baseline demographics between group A (CTR through a longitudinal palmar mini-incision) and group B (CTR with a mini-transverse incision at the palmar crease) didn't show a statistically significant difference.Both groups showed improved grip strength and BCTQ scores at the post-operative follow-up. Median nerve decompression using both types of incisions has resulted in the same functional outcomes and patient satisfaction.

Concurrent Carpal Tunnel Syndrome and Recurrent Motor Branch of the Median Nerve Compression: A Diagnostic Complexity.

Concurrent Carpal Tunnel Syndrome and Recurrent Motor Branch of the Median Nerve Compression: A Diagnostic Complexity.

Prevalence of Carpal Tunnel Syndrome During Pregnancy

Background: Carpal Tunnel Syndrome (CTS) is a common condition during pregnancy, associated with symptoms like tingling, numbness, and pain in the hand and arm due to median nerve compression. The prevalence and severity of CTS can increase due to physiological changes during pregnancy, such as fluid retention and hormonal fluctuations. Objective: This study aimed to determine the prevalence of CTS in pregnant women, identify the trimester with the highest occurrence, and assess the effectiveness of Phalen's and Durkan compression tests in diagnosing CTS during pregnancy. Methods: A cross-sectional study was conducted over six months at Akhtar Saeed Trust Teaching Hospital and Farooq Hospital, Lahore, involving 121 pregnant women. Participants were selected using non-probability convenience sampling and were divided by trimester. The diagnosis of CTS was confirmed through Phalen's and Durkan compression tests. Data analysis was performed using SPSS version 25, with a chi-square test to evaluate the association between CTS prevalence and pregnancy trimester. Results: The prevalence of CTS among the participants was identified as 33.1% with Phalen's test and 55.4% with Durkan's compression test. The third trimester showed the highest occurrence of CTS symptoms, with a significant increase in prevalence (p=0.005 for Phalen’s test and p=0.394 for Durkan compression test). The frequency of CTS symptoms was 28.9% in the first trimester, 32.2% in the second trimester, and 38.8% in the third trimester. Conclusion: The study confirms that CTS is prevalent among pregnant women, particularly in the third trimester. The findings emphasize the need for healthcare providers to be aware of the increased risk of CTS during pregnancy and the importance of early diagnosis and management to alleviate symptoms.

Entrapment Neuropathies of the Median Nerve: An Updated Review

In this revision, we will try to address the entrapment neuropathies of the median nerve, from a clinical and practical approach, so as the family physicians or non-specialist practitioners can know more about these pathologies. Despite Carpal Tunnel Syndrome (CTS) is by far the most common entrapment neuropathy, we should know that not all the pains or paresthesias in the volar side of the hand or forearm are due to CTS. We will deliberately avoid too many anatomic data or specific treatment details, of limited utility in general practice. Nevertheless, in the references the reader can get much more information. If this paper can clarify several questions regarding the median nerve compression, signs and symptoms, the authors will feel more than happy, as this is our main objective.

Value of MUNE versus compound muscle action potential in assessing motor unit loss in patients with carpal tunnel syndrome

BackgroundThe most prevalent nerve entrapment disorder, known as carpal tunnel syndrome (CTS), is brought on by wrist-based median nerve compression. Focal demyelination progresses to axonal dysfunction as the condition worsens. In order to detect motor unit (MU) loos, this study compares two motor unit number estimation (MUNE) techniques with compound muscle action potential (CMAP) amplitude. The CMAP amplitude and MUNE of the median nerve in 137 hands of 70 neurophysiologically approved CTS patients, aged 40.27 ± 10.06 years were examined. Another 90 hands from 56 healthy volunteers who are age- and gender-matched serve the control group.ResultsIn contrast to 192.5 and 248.5 in controls, the median nerve values of incremental and adapted multipoint stimulation (aMPS) MUNE in CTS patients were, respectively, 111 and 133 (p < 0.0001). Patients with severe CTS compared to those with mild CTS using both methods had significantly lower MUNE. MUNE values are the same regardless of gender or hand dominance. In comparison to MUNE methods (cutoff values of 106.5 and 203, respectively), CMAP amplitude had a sensitivity and specificity of more than 60% in detecting MU loss (cutoff value of 6.85 mV). The CTS grading had no effect on the CMAP amplitude. MUNE values had positive with CMAP amplitude and negative with CTS grading and Phalen test positivity.ConclusionsWhen identifying motor nerve involvement in CTS patients, the MUNE technique is more accurate than a standard motor nerve conduction study (NCS). It was emphasized that MUNE evaluation in determining MU loss in the early stages of CTS may be helpful in diagnosis and treatment. There was no correlation between handedness and the number of MUs as determined by MUNE techniques. Both methods almost equally identify MU loss and have the same sensitivity and specificity.

PROXIMAL MEDIAN NERVE COMPRESSION DUE TO GIANT LIPOMA. SURGICAL TREATMENT UNDER WALANT.

Lipomas are benign mesenchymal tumors, which can be found anywhere in the body. In less than 1% of cases, they can be observed in distal extremities. The authors describe a rare case of a giant lipoma in the proximal third of the forearm associated with median nerve compression. WALANT surgical resection allows for a safe and complete excision of the tumor. The authors present a short review of the pertinent literature.