Nerve Compression Research Articles

Giant lipomas: A 130-year literature review, case series, and introduction of an intuitive management algorithm

Background: Lipomas are the most common benign mesenchymal tumors in adults. On the other hand, giant lipomas, defined as lipomas over >10 cm in length of over 1000 g in weight, are less frequently seen, can be clinically challenging to manage, and require careful attention. While most cases are benign, soft, asymptomatic masses, there is potential for functional limitation, nerve compression syndromes, and sarcomatous changes in such lesions. Methods: A case series is presented and an extensive review of the literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) declaration, since the first description of a giant lipoma reported in 1894, with the aim of providing an updated and comprehensive “state-of-the-art” on the management, diagnosis, and treatment of this entity. PubMed, Scopus, and Google Scholar databases were queried for relevant articles using the search terms “Giant lipoma” and “Massive lipoma” from 1894 to 2024. Results: Five consecutive clinical cases were reported. A total of 79 patients were identified from the 65 collected reports. Clinical characteristics of the lesions, surgical details, and patient characteristics are obtained and summarized. Preoperative/postoperative radiological/histological features are reported. Conclusion: Surgical excision remains the gold standard treatment for giant lipomas. According to existing literature, most recommendations are based on expert opinions and there is a paucity of guidelines or universal consensus on a treatment pathway for standardized, multidisciplinary management of such a challenging clinical condition.

Assessment of the ulnar nerve stiffness during valgus stress of the elbow using shear wave elastography: an observational cross-sectional study.

Identification of the relationship between valgus stress in the medial elbow and ulnar nerve strain during maximum external rotation of the shoulder is pivotal for the prevention and management of ulnar neuropathies. In this observational cross-sectional study, we aimed to determine the changes in ulnar nerve stiffness under valgus stress at different nerve entrapment sites. Twenty healthy baseball players participated in the study. The stiffness of the ulnar nerve on the throwing side was assessed at two sites, the arcade of Struthers and the Osborne's ligament, at 0°, 60°, and 90° flexion by shear wave elastography using a 10-MHz linear transducer. The arcade of Struthers was defined as the proximal site and the Osborne's ligament as the distal site. Valgus stress was applied to the medial elbow at 0, 30, 50, and 70 N using a Telos stress device, and the stiffness caused by valgus stress was measured. At all elbow flexion angles, the stiffness of the ulnar nerve under 70 N valgus stress was higher than that under 30 N stress. The stiffness of the ulnar nerve at the proximal site was significantly higher than that at the distal site. Valgus stress increases ulnar nerve stiffness. In addition, the stiffness of the proximal site increases.

Ultrasound acting as a guiding light in the diagnosis of posterior interosseous nerve entrapment at ligament of Frohse – A case report

Posterior interosseous nerve (PIN) entrapment syndrome is a relatively rare compression neuropathy which leads to weakness of the extensor muscles of hand. This becomes a cause of morbidity to the patient with resultant difficulty in conducting day-to-day activities. Thickening of proximal edge of the superficial head of the supinator muscle which forms the ligament of Frohse can lead to compression of the PIN as it enters the supinator canal. Although nerve conduction studies can indicate the diagnosis, they cannot identify the exact site and cause of compression which is crucial for deciding the further management. Magnetic resonance imaging can identify the cause of entrapment in some cases; however, this is extremely difficult given the small size of the PIN and arcade of Frohse. Ultrasound overcomes these limitations and provides a cost and time effective, efficient, and sensitive diagnostic tool for detecting nerve entrapment. Here, we would like to emphasize the emerging importance of ultrasound by describing a case of ligament of Frohse thickening causing PIN entrapment which was effectively diagnosed by ultrasound and confirmed on surgical exploration, treated with surgical ligament release with a full recovery.

Rehabilitation Management of a Patient with Median Nerve Entrapment from Venipuncture-associated Hematoma in Dengue Hemorrhagic Fever: A Case Report

Dengue hemorrhagic fever is a severe form of dengue presenting commonly with bleeding diathesis, but rarely with peripheral nervous system manifestations. Proximal median neuropathy comprises 1% of upper limb compression syndromes, and this case is the first to report injury to the proximal median nerve due to compression from hematoma formation. This case report presents the rehabilitation process of a 25-year-old Filipino female median nerve entrapment from venipuncture-associated hematoma presenting as burning sensation on the medial elbow, forearm and hand, weak flexion movement of her left thumb, index, and middle fingers. The patient was managed conservatively with pain medications, range of motion, gross and fine motor, and sensory re-education exercises. At 12 months, there was partial but functional recovery of median motor distribution and full recovery of median sensory distribution, as evidenced by improved sensory nerve action potential conduction velocity and amplitude, and compound motor action potential conduction velocity, with persistent decreased amplitude at 50%, and decrease in cross-sectional area of the left median nerve. This paper highlights the functional outcomes of a conservatively managed median nerve entrapment from venipuncture hematoma from dengue hemorrhagic fever. This case report also emphasizes that in the presence of severe bleeding risk of surgery in the background of severe thrombocytopenia, timely rehabilitation medicine referral with monitoring through clinical evaluation, musculoskeletal ultrasound, and electrodiagnostic study presents a viable alternative in the management of compression neuropathy.

Case Report: Periocular Steroid Injection Combined Vemurafenib Therapy in the Long-term Management of Orbital Involvement of Erdheim-Chester Disease.

Abstract Purpose: To report a rare case of vision loss from Erdheim-Chester Disease (ECD) and long term, follow up, management and results. Case Report: A 62-year-old woman presented with bilateral exophthalmos and deterioration in visual acuity of both eyes. Magnetic resonance imaging studies revealed bilateral intraconal orbital tumors. She was diagnosed optic neuropathy in both eyes. The patient was treated with pegylated interferon and systemic pulse steroid. However, recurrences were common. Subsequently, the patient underwent regular corticosteroid injection directly into the retro-orbital region of both eyes monthly, which led to intermittent improvement of vision. At the 8th month of visual impairment, Vemurafenib was initiated. Results: The visual acuity and visual field scores were stable for 6 years during the follow-up. No major complication was observed. Conclusion: Combined vemurafenib and perioculer steroid injection is a well tolerated therapy with less systemic adverse effects which may benefit patients with orbital involvement of ECD. Key words: Erdheim–Chester disease; compressive optic neuropathy; vemurafenib; Optical coherence tomography; Optical coherence tomography angiography.

James (Carrick) Moore (1763-1860): Another (Scottish) Local Anaesthetic Hero.

Modern technology has provided the author with access to a previously unobtainable publication, John Moore's 1784 work, 'A Method of Preventing or diminishing Pain in Several Operations of Surgery'. Not only did this allow direct consideration of his technique of nerve compression (which has been described briefly by many others since), but also showed that Moore had very advanced humane views on the need to try and produce pain relief for surgery. It also became possible to obtain far more information on the author, notably that although he worked in London he was born and educated in Glasgow, and did his initial medical training in Edinburgh. He thus is one of a group, all of whom were Scots, who did preliminary work on local anaesthesia before the recognition of the local action of cocaine. His technique was tried, apparently successfully, for a below-knee amputation by John Hunter, and while both the technique and his humane approach were noted by others, the method does not seem to have found wider favour. He continued working as a surgeon in London until he inherited an estate in south-west Scotland, this allowing him to give up clinical practice and focus on writing and campaigning. He wrote the definitive biography of his brother (Sir John Moore of Corunna fame) and was a leading advocate of vaccination, leading the organisation after Jenner's death. These activities meant that he was well known in his lifetime, but he deserves to be better known today as being the first person to promote the need for pain relief during surgery.

Contribution of remote Pacinian corpuscles to flutter-range frequency discrimination in humans.

Among the various classes of fast-adapting (FA) tactile afferents found in hairy and glabrous skin, FA2 afferents, associated with Pacinian corpuscles (PC), preferentially signal high-frequency sinusoidal events corresponding with vibration percepts, in contrast to other classes associated with lower frequency flutter percepts. The FA2-PC complex is also uniquely sensitive to distant sources of vibration mechanically transmitted through anatomical structures. In the present study, we used a pulsatile waveform to assess the contribution of FA2 afferents to the perception of flutter-range frequency stimuli (~ 20Hz) in combination with two methods to abolish local FA inputs and force a dependence on FA2 via transmission from adjacent structures. Firstly, we examined frequency discrimination and perception of vibration applied to the hairy skin overlying the ulnar styloid before and during the blockade of intradermal receptors by local anaesthesia. Secondly, we tested frequency discrimination on the digital glabrous skin before and during the blockade of myelinated fibres by ulnar nerve compression. Despite reliance on vibration transmission to activate remote PCs, we found that flutter-range frequency discrimination was unimpeded across both skin types. Comparisons with stimuli applied to the contralateral side also indicated that perceived frequency was unaffected. This confirms that flutter-range frequency perception can be encoded by the FA2-PC system. Our results demonstrate that input from receptors specialised for low-frequency signalling is not mandatory for flutter-range frequency perception. This explains how the constancy of frequency perception might be achieved across different skin regions, irrespective of the afferent type activated for transmitting these signals.

Common sports-related nerve injuries seen by the electrodiagnostic medical consultant.

The high physiologic demands of sports create dynamic stress on joints, soft tissues, and nerves which may lead to injuries in the athlete. Electrodiagnostic (EDx) assessment is essential to identify the correct diagnosis, localization, and prognosis, to guide management of sports-related neuropathies. A comprehensive review was performed to provide the EDx medical consultant with a practical approach to the common peripheral nerve disorders seen in athletes. Sports-related neuropathies reviewed include transient traumatic irritation of the brachial plexus and/or cervical nerve roots ("Burners and stingers,") suprascapular and axillary neuropathies, ulnar neuropathy at the elbow (UNE) in throwers, ulnar neuropathy at the hand/wrist in cyclists, multi-ligamentous knee injury, and foot/ankle neuropathies including tarsal tunnel syndrome. A thorough understanding of peripheral anatomy, possible entrapment sites, mechanisms of injury, and key physical examination findings is essential for correct diagnosis. EDx assessments beyond routine studies are generally required for sports-related neuropathy, which may not necessarily follow typical entrapment patterns. Adjunct diagnostic imaging, such as point-of-care ultrasound and magnetic resonance imaging, are helpful tools to identify associated musculoskeletal pathology such as compressive cysts or nerve entrapment, which may be amenable to interventional or surgical treatment. When no clear reversible structural pathology exists, management of sports-related neuropathy is athlete-specific and generally multi-modal, involving a combination of physical rehabilitation techniques to address muscle imbalances, load management, protective equipment, and interventional pain procedures.

USO DE TERAPIAS MANUAIS NA REABILITAÇÃO DA FASCITE PLANTAR: UMA REVISÃO SISTEMÁTICA.

Fasciitis is an inflammation of the plantar fascia, a structure that helps support the medial arch of the foot and is designed to absorb much of the impact. Plantar fasciitis can result from a number of factors, including excessive stress and overload, which can result in inflammation, stress fractures of the calcaneus, compressive neuropathy of the plantar nerves, and more. The aim of this study is to to elucidate how manual therapies can be effective in the treatment of plantar fasciitis. In its preparation, a literature review was carried out to evaluate the effectiveness or not of manual therapies in the treatment of plantar fasciitis, the databases used were: Pubmed, SciElo and PEDro , in Portuguese and English, in the period from January 2019 to December 2024. Ten studies were included to be analyzed in this systematic review, and it showed that manual therapy provides significant benefits, such as reducing pain and improving the function of patients with plantar fasciitis. In conclusion, this study offers valuable insight into how an integrated approach can benefit patients with plantar fasciitis . The findings reinforce the need for personalized treatments, emphasizing that combining different modalities may be key to successful recovery. However, there have been few scientific articles on these manual techniques, so it is worth highlighting the importance of encouraging further studies.

Early and Late Intrinsic Hand Muscle Reinnervation After End-to-Side AIN to Ulnar Motor Nerve Transfer.

The "supercharge" end-to-side (SETS) anterior-interosseous-nerve (AIN) to ulnar-motor nerve transfer is used to improve intrinsic muscle recovery in cases of severe ulnar nerve compression or proximal axonotmetic injuries. Previous work has found differing intrinsic muscle recovery after this transfer. The objectives of this study were to examine the patterns of recovery in first dorsal interossei (FDI) and abductor digiti minimi (ADM) and the impact of AIN transfer to a specific fascicular location on the ulnar-motor nerve. A retrospective review of one fellowship-trained surgeon's consecutive patients at a single center from December 2019 to September 2021 was conducted. Patients who had an AIN to ulnar-motor nerve transfer for any indication were included and were excluded if they had less than 9 months follow-up. Seventeen patients were included (88% male, mean age 55 ± 14 years). At early follow-up, compound muscle action potential amplitudes for ADM and FDI did not increase. Compound muscle action potential amplitude for ADM significantly increased at late follow-up (P < .01). Average British Medical Research Council (BMRC) strength increased at early follow-up for FDI (P < .05), but not ADM. The proportion of patients with BMRC ≥ 3 increased for FDI (P < .01) and ADM (P < .05) at late follow-up. Volar-ulnar AIN insertion position did not have a clear effect on outcomes. The SETS AIN to ulnar-motor nerve transfer demonstrates clinical and electrophysiologic evidence of intrinsic muscle recovery and reinnervation, with differing recovery of outcomes. The role of specific fascicular targeting is still unclear and required further examination as does the mechanism behind differing intrinsic recovering.

Efficacy of Integrative Korean Medicine Treatment Including Ultrasound-Guided Pharmacopuncture in Patients with Lumbar Stenosis Accompanied by Peripheral Nerve Entrapments: Considering Double Crush Syndrome in This Report of Three Cases

Efficacy of Integrative Korean Medicine Treatment Including Ultrasound-Guided Pharmacopuncture in Patients with Lumbar Stenosis Accompanied by Peripheral Nerve Entrapments: Considering Double Crush Syndrome in This Report of Three Cases

Comparative Analysis of Comorbidities and Outcomes in Endoscopic versus Open Treatment of Carpal Tunnel Release in Patients with Rheumatoid Arthritis

Abstract Background: Rheumatoid arthritis (RA) is a known risk factor for carpal tunnel syndrome, possibly because the inflammation causes compression of the median nerve. Endoscopic and open carpal tunnel release (ECTR and OCTR) have been studied extensively in the general population but less so in patients with RA. The purpose of our study was to analyze outcomes and patient-specific comorbidities associated with ECTR and OCTR in patients with RA. Methods: We conducted a retrospective cohort study using the PearlDiver database to identify patients with RA who underwent either ECTR or OCTR between 2010 and 2014. Demographic data, comorbidities, and complication rates were analyzed. We used univariate and multivariable analysis to assess differences between the treatment methods. Results: Comparing 4,234 patients who underwent OCTR to 683 patients who underwent ECTR, we found no significant differences in medical comorbidities such as hypertension, obesity, chronic kidney disease, hypothyroidism, and diabetes mellitus. Patients who underwent ECTR were significantly more likely to require a repeat procedure within 90 days of the initial procedure. However, this difference was not consistent in multivariate analysis controlling for comorbidities. Conclusion: Our study found that RA and ECTR were identified as independent risk factors for revision release, with ECTR showing a higher likelihood of repeat procedures within 90 days compared with OCTR. Despite similar demographics and comorbidities in the two study cohorts, use of OCTR outpaced ECTR use in the study period. Future research should explore further characterization of repeat procedures in this higher risk patient subset.

Prevalence and Risk Factors Associated With Carpal Tunnel Syndrome Among Sudanese Females: A Cross-Sectional Study.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy resulting from compression of the median nerve. This condition is more common in females than in males. The earlier the diagnosis, the better the prognosis and treatment outcomes. This is a cross-sectional hospital-based study conducted at Soba Teaching Hospital in obstetrics and gynecology outpatient clinic in Khartoum in the period from February 2022 to March 2022. A simple random sampling was applied, and an interview was conducted using a four-partquestionnaire. The first part was based on socio-demographic data, the second was lifestyle, and the third and fourth were based on the Boston Carpal Tunnel Questionnaire (BCTQ). The data were analyzed using the statistical package for social sciences (SPSS) software, version 23 (IBM Corp., Armonk, NY) to find the correlation between the various variables. A total of 113 women participated in the study (response rate=100%). The prevalence of CTS was found to be 5%. No significant association was found between lifestyle and medical history, e.g., obesity and oral contraceptives and CTS were p=0.167, 0.841 respectively. Conversely, there was a significant association between age and residency, with p=0.005 and 0.049, respectively. The prevalence of CTS is increasing in Sudan. Therefore, it is essential to thoroughly assess patients for any symptoms related to hand pain by asking detailed questions during consultations. In addition, further studies covering more states are neededto better understand the regional variation in CTS prevalence.

Evaluation of Splint and Exercise Interventions for Carpal Tunnel Syndrome: Insights from Ultrasonographic Measurements.

BACKGROUND Carpal tunnel syndrome (CTS) is a neuropathy caused by the entrapment of the median nerve, which requires effective management strategies. The median nerve is subjected to pressure within the carpal tunnel, resulting in tingling, numbness, and pain in the median side of the hand. We compared the efficacy of splint use with an exercise program vs exercise alone in patients with mild and moderate CTS. MATERIAL AND METHODS Forty-four patients with CTS were enrolled. The patients were randomly divided into 2 groups: splint+exercise and exercise only. A range of assessment tools were used, including ultrasonography, dynamometer, the Leeds Assessment of Neuropathic Symptoms &amp; Signs Pain Score (LANSS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and 36-Item Short Form Quality of Life Scale (SF-36) score, to provide comprehensive evaluation. RESULTS The 2 groups had comparable outcomes at the end of treatment. There were no statistically significant differences in Q-DASH (P=0.326, Cohen's d=0.067), SF-36 (P=0.329, Cohen's d=0.218), VAS (P=0.521, Cohen's d=-0.299), or LANSS scores (P=0.627, Cohen's d=0.039) between the groups (P>0.05). The results demonstrate that a targeted exercise regimen, when used in isolation, can elicit outcomes that are comparable to those achieved through the integration of splinting techniques. CONCLUSIONS The study findings align with conflicting existing data on the effectiveness of splint immobilization in conjunction with exercises for CTS. The results support the significance of regular exercises, which can be applied in the home-based setting in CTS management, and offer alternative online management strategies.

Technique and Expected Benefit of Intraoperative Perfusion Imaging of Peripheral Nerves.

Peripheral nerve surgery, particularly in cases of nerve compression syndrome (NCS), necessitates a comprehensive evaluation of intraneural blood flow, as localized reductions in nerve perfusion are integral to the etiopathogenesis of such conditions. Although nerve perfusion is currently guided by morphologic characteristics, this assessment is subjective and prone to bias. Intraoperative fluorescence-assisted perfusion imaging with indocyanine green (ICG) is an established tool in flap and lymphatic surgery to objectively assess perfusion intraoperatively. However, only a few unspecific applications of ICG in peripheral nerve surgery have been published so far. In this study, we performed intraoperative perfusion imaging using ICG in 16 consecutive operations within the peripheral nervous system, including microsurgical reconstructions after obstetric brachial plexus injury, decompression for NCS, and vascularized ulnar nerve interposition transfers. Our findings show the utility of ICG in delineating healthy perfusion borders at proximal and distal stump levels after neuroma resection, and we demonstrate a correlation between histological findings and these clinically observed perfusion patterns. In NCS cases, we demonstrate that ICG imaging is effective in highlighting reduced perfusion predecompression and improved perfusion postdecompression. Additionally, ICG proved valuable for assessing perfusion of free vascularized nerve grafts. Intraoperative ICG perfusion imaging is a valuable tool during surgery of the peripheral nervous system, providing insights into the etiopathogenesis of NCS and aiding in the visualization of perfusion. This study underscores the potential of ICG in nerve surgery and its applicability for improving surgical outcomes and advancing our understanding of peripheral nerve pathologies.

Common Peroneal Nerve Entrapment Masked by Acute Lumbar Disc Herniation: Integrated Korean Medicine Treatment with Ultrasound-Guided Pharmacopuncture

The symptoms of common peroneal nerve (CPN) entrapment are similar to the symptoms of lumbar herniated intervertebral disc. We present the successful treatment of CPN entrapment masked by acute lumbar disc herniation. A 49-year-old man presented with low back pain and numbness in his left leg. Following admission, patient history, physical examination, and radiology findings, the patient received integrated Korean medicine (KM) treatment (acupuncture, pharmacopuncture, ultrasound-guided pharmacopuncture, moxibustion and cupping, herbal medicine, and chuna therapy) for lumbar disc herniation. Outcome measures included the numeric rating scale, the European quality of life five dimensions, and the Oswestry disability index. Symptoms persisted, and CPN compression was consequently suspected. On Day 12 of 23, in addition to KM treatment, an ultrasound-guided Shinbaro2 pharmacopuncture (4 mL) was performed on the CPN entrapment site. Significant symptom relief resulted after CPN treatment on Day 12. Improvement was particularly evident in the lower leg and ankle, areas where the pain had previously been misattributed to symptoms of lumbar disc herniation. His low back pain and radiating pain to the back of the left femur started to improve from Day 20 and were mild at discharge. This case highlights the importance of considering peripheral nerve entrapment in patients presenting with symptoms similar to lumbar disc herniation. It also suggests that combining traditional KM with modern diagnostic techniques such as ultrasonography, may be beneficial in the precise location for pharmacopuncture treatment. Further studies are recommended to validate these findings and explore the broader applicability of this approach.

Ulnar Compression Neuropathy Secondary to Ganglion Cyst at the Elbow Joint: A Case Report

Ulnar neuropathy is a common peripheral neuropathy, with cubital tunnel compression being the second most frequent upper extremity compression syndrome. Ganglion cysts, though rare, can contribute to ulnar nerve compression in the cubital tunnel. Here, we present a case of a 62-year-old farmer with longstanding diabetes and dyslipidemia who experienced progressive pain and numbness in his medial fingers, exacerbated by elbow flexion. Initially misdiagnosed and treated for Hansen’s disease. Clinico-radiological evaluation revealed a multiloculated cystic lesion in the posteromedial aspect of his left elbow, compressing the ulnar nerve. Surgical excision of the ganglion cyst alleviated symptoms, though residual motor deficits persisted postoperatively. This case underscores the importance of considering ganglion cysts in the differential diagnosis of cubital tunnel syndrome, highlighting the diagnostic challenges and therapeutic considerations in managing this rare etiology.

The comparison of the efficacy of 3D fast spoiled gradient echo sequence and steady state free precession sequence in imaging vascular compression in patients with trigeminal neuralgia

Aims: Trigeminal neuralgia is a condition characterized by sudden and intense pain in the face, affecting the fifth cranial nerve. While it can occur for various reasons, vascular compression is a well-known cause. Additionally, conditions such as tumors, arachnoid cysts, idiopathic inflammation, damage, or demyelination can result in trigeminal neuralgia, extending to the distal branches of the trigeminal nerve from the pons. We aimed to investigate the diagnostic efectiveness of post-contrast three-dimensional fast spoiled gradient echo images (3D-FSPGR) in addition to steady-state free precession (SSFP) images in the imaging of trigeminal neuralgia. Methods: A total of 33 patients with a preliminary diagnosis of trigeminal neuralgia between May 2022 and October 2023 were investigated and five individuals were excluded. Among the remaining 28 patients, vascular compression was observed in only 14 patients. Trigeminal nerve thickness on both side, the distance between trigeminal nerve and superior cerebellar artery on both side, presence of vascular compression, level of the compression, presence or absence of displacement and atrophy were reported for each sequences. The findings and results were compared using independent sample T-test and paired T-test. Results: The mean age of the patient group was calculated to be 56.29 ± 4.5, while for the control group, it was 52.07 ± 3.09. Trigeminal nerve thickness wasn’t different between patient with or without vascular compression (p=0.874 for right side on SSFP, p=0.804 for left side on SSFP, p=0.667 for right side on 3D-FSPGR and 0.769 for left side on 3D-FSPGR). In 10 patients, unilateral compression of the trigeminal nerve was observed, while in 4 patients, it was bilateral. In the right trigeminal nerve, vascular compression was observed in SSFP images in 5 cases in the transitional zone, 2 cases in the nerve root entry zone, and 1 case distally. In 3D-FSPGR images, it was interpreted as being in the transitional zone in 4 cases, in the NR entry zone in 3 cases, and distally in 1 case. On the other hand, for the left trigeminal nerve, vascular compression was observed in both SSFP and 3D FSGPR images in 5 cases in the nerve root entry zone, 3 cases in the distal zone, and 2 cases in the transitional zone. Conclusion: Both SSFP and 3D-FSPGR images can provide comparable information regarding the spatial relationship between the trigeminal nerve and vascular structures. Contrast enhanced imaging allows us diferentiate the tumoral and infammatory demyelinating processes from vascular compression, we recommended to continue with SSFP images in cases where contrast enhanced 3D FSGPR images are inconclusive.

The relationship between ultrasound and electrodiagnostic findings in relation of the severity of carpal tunnel syndrome

IntroductionCarpal tunnel syndrome is the most common compression neuropathy. Grading the severity of carpal tunnel syndrome is an important factor in deciding on the type of treatment. This study aims to determine the relationships between the findings of the electrodiagnosis and ultrasonography methods based on the severity of carpal tunnel syndrome.MethodsIn this prospective clinical study, 50 patients (96 wrists) who were referred to the Physical Medicine and Rehabilitation Department of the Shohada Tajrish Hospital, Tehran, Iran (from March 2021 to November 2022) were studied. All patients with a history and clinical examination related to CTS underwent electrodiagnosis studies. Based on the results of electrodiagnosis, patients were divided into three groups: mild, moderate, and severe. All eligible patients underwent ultrasound at the cross-section of the wrist (at the level of the pisiform bone, the entrance of the canal) and the middle of the forearm.ResultsIn this study, the cross-sectional area of the median nerve was measured in 96 wrists of 50 patients with a mean age of 51.78 ± 9.80 years. The mean CSA of the median nerve in the mild, moderate, and severe groups was reported as 0.12 ± 0.03, 0.14 ± 0.02, and 0.21 ± 0.06, respectively. The mean WFR in different groups of CTS was reported as 1.85 ± 0.56, 1.93 ± 0.56, and 2.45 ± 0.49, respectively. A significant relationship between ultrasound findings, including CSA-inlet and WFR, and electrodiagnosis findings was presented (P value < 0.05).ConclusionBased on our findings, there is a statistically significant relationship between the sonographic findings, including the mean CSA-inlet and WFR, and the severity of CTS based on the electrodiagnosis study. Our findings revealed that as disease severity increases, sonographic parameters also increase significantly.

Assessment of median nerve with magnetic resonance neurography in cases with carpal tunnel syndrome and controls

Background: Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disorder that is diagnosed using clinical signs and symptoms and confirmed via nerve conduction studies (NCSs). While NCS is a semi-invasive procedure, magnetic resonance imaging (MRI) is a non-invasive diagnostic tool that detects macroscopic nerve abnormalities and evaluates a patient's surgical or medication treatment options. This study assessed magnetic resonance neurography (MRN)’s diagnostic and grading value by comparing it to electrodiagnostic studies in patients with CTS and healthy individuals. Methods: This was a cross-sectional study on 27 wrists with CTS and 27 healthy wrists. After history taking and physical examination, we employed an NCS to confirm and determine the severity of CTS, then MRN and diffusion tensor imaging (DTI) were used to calculate apparent diffusion coefficient (ADC), fractional anisotropy (FA), and cross-sectional area (CSA). Results: 18 patients with CTS (27 median nerves) and 15 healthy controls (27 median nerves) were evaluated. The mean FA in the CTS group was significantly lower (0.38 ± 0.05 vs. 0.45 ± 0.06, P &lt; 0.001).The mean CSA and ADC were higher in patients with CTS but not statistically significant. FA’s diagnostic cut-off was 0.42, with a sensitivity of 70.4% and a specificity of 63%. Conclusion: MRN with DTI can be an effective and non-invasive diagnostic technique for the detection of CTS. The FA measure demonstrated adequate sensitivity and specificity for differentiating patients with CTS from healthy individuals.