Frequent Entrapment Research Articles

Efficiency of Direct Transcutaneous Electroneurostimulation of the Median Nerve in the Regression of Residual Neurological Symptoms after Carpal Tunnel Decompression Surgery.

Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy. CTS therapy includes wrist immobilization, kinesiotherapy, non-steroidal anti-inflammatory drugs, carpal tunnel steroid injection, acupuncture, and physical therapy. Carpal tunnel decompression surgery (CTDS) is recommended after failure of conservative therapy. In many cases, neurological disorders continue despite CTDS. The aim of this study was to investigate the efficiency of direct transcutaneous electroneurostimulation (TENS) of the median nerve in the regression of residual neurological symptoms after CTDS. Material and Methods: 60 patients aged 28-62 years with persisting sensory and motor disorders after CTDS were studied; 15 patients received sham stimulation with a duration 30 min.; 15 patients received high-frequency low-amplitude TENS (HF TENS) with a duration 30 min; 15 patients received low-frequency high-amplitude TENS (LF TENS) with a duration 30 min; and 15 patients received a co-administration of HF TENS (with a duration of15 min) and LF TENS (with a duration of 15 min). Results: Our research showed that TENS significantly decreased the pain syndrome, sensory disorders, and motor deficits in the patients after CTDS. Predominantly, negative and positive sensory symptoms and the pain syndrome improved after the HF TENS course. Motor deficits, reduction of fine motor skill performance, electromyography changes, and affective responses to chronic pain syndrome regressed significantly after the LF TENS course. Co-administration of HF TENS and LF TENS was significantly more effective than use of sham stimulation, HF TENS, or LF TENS in patients with residual neurological symptoms after CTDS.

Advances in Biomedical and Environmental Applications of Magnetic Hydrogels

Hydrogels have been the focus of research across disciplines or subject perspectives owing to their distinctive chemical, physical, and mechanical characteristics. Hydrogels have been leveraged for their biocompatibility and attractive adhesion or adsorption behavior. Conventional hydrogels suffer from frequent entrapment due to low controllability, limited responsiveness, and weak actuation properties. Magnetic hydrogels address many of these concerns and offer a rapid magnetic response and precise temporal and spatial control. The structural and functional features of magnetic hydrogels can address overlapping requirements in biomedical and environmental applications. The focus of this review is on the progress made in the use of magnetic hydrogels. Specifically, their applications in controlled drug delivery as contrast agents in magnetic resonance imaging and in the treatment and remediation of wastewater are discussed. The first part of the review delineates strategies for preparing magnetic hydrogels and the advantages of each approach. The second part of the review describes a variety of biomedical and environmental applications for highlighting the convergent functionalities of magnetic hydrogels that are relevant to each domain. The challenges in the use of magnetic hydrogels and prospective applications are also included in the review.

Ulnar Nerve Entrapment at Elbow, a Retrospective Clinical Observational Study.

Importance: Ulnar neuropathy at the elbow is the second most frequent entrapment neuropathy, affecting 6% of the population. Surgical criteria are based on a general agreement but remain controversial about which procedure is associated with the best results and the fewest complications. This data can help evaluate the effectiveness of operative techniques in symptomatic cure.
 Material and Methods: The study analysis included 26 out of 35 patients with 'Ulnar neuropathy at elbow' diagnosis, treated between January 2017- March 2022 at the Department of Neurosciences, University Service of Neurosurgery, University Hospital Center “Mother Theresa”, Tirana, Albania.
 9 patients from the time period January-June 2018 were excluded from this study analysis due to lack of access to data. Data sources such as medical records and documentation copies of instrumental examinations were extracted from archives of Statistics Service and Hospital Registers, University Hospital Center “Mother Theresa”, Tirana, Albania. Phone follow-up was applied as well.
 Results: We report 26 patients analyzed retrospectively (female: male ratio 1:2.71). 29 operated extremities were studied: 26 with Cubital Tunnel Syndrome, of which 2 presented with ipsilateral Carpal Tunnel Syndrome and 1 bilateral; 2 with contralateral Carpal Tunnel Syndrome. There were 11 patients gr. II McGowan and 15 patients gr. III McGowan.
 There are no positive elbow flexion-extension test cases, indicative of the transposition technique. All patients were clinically evaluated at a distance of 1-3 years post-operatively and 19% presented objective symptoms. Long-term follow-up shows the motor and sensory improvement for gr. II McGowan patients, while gr. III McGowan patients show only sensory and grip improvement, with the persistence of muscular atrophy.
 The most frequent cause of compression was determined fibrosis and hypertrophy around the Osborne ligament (13/26).
 Conclusions: Clinical stage of neuropathy is the decisive factor influencing prognosis. Simple decompression in situ is sufficient in most cases. Dynamic intraoperative testing of sulcus competence, to assess (sub)luxation of the ulnar after decompression, determines the final operative technique.

Conservative therapy in ulnar neuropathy at the elbow (Review).

Ulnar neuropathy at the elbow (UNE) is the second most frequent entrapment syndrome in the upper limb after carpal tunnel syndrome. Clinical features are validated through electromyographic and sonographic examination. Although the two aforementioned entrapment syndromes share common pathophysiological traits, the conservative treatment approach for mild and moderate cases of UNE differs from that for median nerve entrapment. The present study identified 23 different types of scientific articles aimed to address this issue. The research stressed the importance of patient education and activity modification. Night splinting offers clinical and functional improvement. Although corticosteroid injections play a role in selected cases, their utility remains to be validated. Physiotherapy trials evaluated ultrasound, low-level laser therapy, diathermy, extracorporeal shock wave therapy and dry cupping. Neurodynamic mobilization may add value to therapeutic approaches and should be a part of it.

Effectiveness of ultrasound-guided local steroid injection to the wrist for the treatment of carpal tunnel syndrome: Is it worth it?

BackgroundCarpal tunnel syndrome (CTS) is caused by compression of the median nerve at the wrist level and the most frequent entrapment neuropathy in the upper limb. It can be treated with surgical or non-surgical methods. When nonsurgical treatment is indicated, a local corticosteroid injection into the carpal tunnel can be used to reduce pain and tingling sensation. To assess the clinical outcomes and effectiveness of patient satisfaction following ultrasound-guided steroid injection for the treatment of carpal tunnel syndrome.ResultsThe study comprises 44 female (73%) and 16 (27%) male patients, with a mean age of 57 (27–84) years. Thirty-one patients were left-handed and 29 right-handed. Twenty-six (43%) injections were performed on the right side, 8 (13%) on the left, and 26 were bilateral. Fifty-six hands of thirty-seven (70%) patients reported significant improvement symptoms, five (8%) had temporary improvement with recurrence, seventeen patients (28%) failed to improve, and one patient’s symptoms have resolved before intervention. Among temporary responders and nonresponders, two were referred to the neurologist for further evaluation. Out of twenty patients, fourteen patients (23%) had surgical decompression of carpal tunnel with complete resolution of symptoms, four patients had opted for repeat injections, and two patients refused any further intervention.ConclusionsThe use of ultrasound-guided injection for the treatment of mild to moderate carpal tunnel syndrome is a practical procedure before offering surgical treatment. It is also appropriate for the patient with significant medical problems or not willing to undergo surgical intervention. Its ultrasound guide reduces injection-related complications, improves patient satisfaction, is cost-effective, and improves patient compliance.

P-NE003. Frequency of carpal tunnel syndrome in patients having diabetes mellitus with neuropathy in a tertiary care hospital

Introduction. Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. Carpal tunnel syndrome (CTS) and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy. Methods. This study was a hospital based descriptive cross sectional study done in BIRDEM general hospital between July, 2015 and June, 2016, for a period of twelve months. The initial clinical diagnosis of DPN was made and was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Results. A total of 354 cases were finally analyzed with 153 (43.2%) patients being symptomatic and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. Majority (38.4%) of patients belonged to the age group of 51-60 years. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). Study subjects with CTS had significantly higher BMI, higher fasting blood sugar and higher HbA1c in comparison to patients without CTS. The mean compound motor action potential was not significantly different between patients with and without CTS. Conclusion. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions should be made carefully after nerve conduction study and proper diagnosis.

Diagnosis of Carpal Tunnel Syndrome: The Role of RANTES

Carpal tunnel syndrome (CTS) is regarded as most frequent entrapment neuropathy in upper extremities with high prevalence in females. It is a multi-factorial disease that had signs and symptoms due to compression of median nerve at the carpal tunnel in wrist, although may be asymptomatic. Immune system has been recognized as the main factor of neuropathic pain. Regulated on Activation, Normal T cell Expressed and Secreted (RANTES) is among the cytokines that revealed a dysregulated pattern of neuropathy specific cytokine profile in CTS and, in human, it is encoded by CCL5 gene. Sixty-four patients suffering from CTS were enrolled in this controlled cross sectional study. For all, nerve conduction study was performed to prove the diagnosis of CTS and to classify its severity. The mean age of all patients was 44.9±7.8 years, 89.1 % were female, 40.7% had mild type CTS and 40.7 % had right side CTS. 5 ml blood was obtained from each participant to measure the level of serum RANTES using specific ELISA kit. There was significant high RANTES levels in CTS patients when compared with its reference value. We conclude that RANTES level increases in patients with carpal tunnel syndrome and can be used as a predictor for its diagnosis despite its proposed neuroprotective role.

Carpal tunnel sonography.

Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy of peripheral nerves, with an incidence of 1-3 patients in 1000. CTS typically occurs between 45 and 60years of age, and it is more frequent in women than in men. The main cause of CTS is chronic compression of the median nerve and ischemic suffering secondary to increased pressure in the carpal tunnel. There are many possible causes of CTS, which can be differentiated into idiopathic causes, which include most cases, and secondary causes. Classical CTS diagnosis is based on the patient's clinical examination and electrophysiological tests, such as electromyography and nerve conduction studies. The latter are helpful for determining the site of nerve compression, assessing its severity, monitoring the course of the disease after therapy, and excluding other causes of median nerve pain, such as cervical radiculopathies, brachial plexopathies, polyneuropathy, or other forms of mononeuropathies. However, clinical examination and electrophysiological tests are not able to differentiate idiopathic forms from secondary forms of CTS, and discrepancies are possible between clinical examination and electrophysiological tests (false negatives). Ultrasound examination is able to recognize most of the secondary forms of CTS. It can evaluate the morphological alterations of the nerve and correlate them with the severity of nerve suffering in all cases, even idiopathic ones, with a sensitivity and specificity equal to those of electrophysiological tests. It can also highlight some anatomical predisposing variants or conditions that may represent contraindications to minimally invasive treatments. Ultrasound examination also plays a fundamental role in evaluating patients with an unfavorable outcome after surgical treatment.

Prominent entrapment of respiratory epithelium in primary and metastatic intrapulmonary non-epithelial neoplasms: a frequent morphological pattern closely mimicking adenofibroma and other biphasic pulmonary lesions

As one of the most common target organs for hematogenous spread from diverse cancers, biopsy interpretation of lung tumors is complicated by the challenging question of primary versus metastatic and by frequent entrapment of native respiratory glands. Nevertheless, the literature dealing with this issue is surprisingly sparse and no single study has been devoted to this topic. We reviewed 47 surgical lung specimens of non-epithelial neoplasms (38 metastases, mainly from sarcomas and 9 primary lesions) for frequency and pattern of intralesional epithelial entrapment. Respiratory epithelium entrapment was noted in 23/47 (49%) cases (diffuse in 15 and peripheral in 8). Entrapped glands frequently showed prominent regenerative and reactive changes mimicking neoplastic glands. Based on cellularity of the mesenchymal component and the extent, distribution and shape of entrapped respiratory glands, four morphological patterns were recognized: paucicellular sclerosing low-grade neoplasms containing leaflet-like glands indistinguishable from adenofibroma and fibroepithelial hamartomas (n = 11), and biphasic cellular lesions mimicking adenomyoepithelioma (n = 1), biphasic synovial sarcoma (n = 2), and pleuropulmonary blastoma (n = 1). Only a single genuine pulmonary adenofibroma was identified. This study highlights frequent respiratory epithelium entrapment in diverse non-epithelial lung tumors, both primary and metastatic. Recognition of this finding and use of adjunct IHC combined with clinical history should help to avoid misinterpretation as primary pulmonary biphasic neoplasm or as harmless adenofibroma. The vast majority of morphologically defined lung adenofibromas represent adenofibroma-like variants of histogenetically diverse entities so that a diagnosis of adenofibroma should be rendered only very restrictively and then as a diagnosis by exclusion.

Can the First Web Space Angle Be Predictive of Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy in the upper limb. Although more objective methods for assessment have been reported in literature, there is a lack of evidence concerning the best methods for assessment of CTS. This study aimed to investigate whether there was a difference in the first web space in patients with different severities of CTS in relation to healthy controls as easy screen method. This prospective controlled trial was conducted on 126 patients at the Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Science, Ankara, Turkey, from January 2016 to January 2018. Hand grip and pinch strength of patients were determined. Also, first web angle were measured by goniometer. Patients were divided into 3 CTS groups as electrophysiologically: "mild: group 1", "moderate: group 2" and "severe: group 3". Patient and healthy groups were compared in terms of the evaluation parameters. Comparisons were also made between these groups. There was significant reduction in hand strengths and first web angle in patient groups compared to healthy groups (P<0.05). Moreover, the first web angle was significantly different between the CTS groups (P= 0.001). The cut-off value for CTS was <38.5°. The possibility of CTS can be evaluated by measuring the first web space angle with a simple goniometer as a easy and in-expensive method in outpatient clinics.

Frequency of Carpal Tunnel Syndrome in Patients Having Diabetes Mellitus with Neuropathy in a Tertiary Care Hospital of Bangladesh

Background: Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. CTS and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy.Methods: This study was a hospital based descriptive cross sectional study done in a tertiary care hospital, Dhaka between July, 2015 and June, 2016. The initial clinical diagnosis of diabetic peripheral neuropathy was made from history and examination. It was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Collected data were checked, verified for consistency and edited for final results. Data cleaning, validation and analysis were performed using Statistical Package for the Social Sciences (Version 20.0).Results: A total of 354 cases were finally analyzed with 153 (43.2) patients being symptomatic for CTS and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Majority (38.4%) of patients belonged to the age group of 51-60 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). One hundred and ninety two (54.2%) patients were housewives, 57 (16.1%) were garment workers, 45 (12.7%) patients were businessmen and 60 (16.9%) patients were service holders. Study subjects with CTS had significantly higher body mass index, higher fasting blood glucose and higher HemoglobinA1c in comparison to patients without CTS. Examination of upper limb sensory nerves showed that nerve conduction velocity was significantly decreased and distal latency was found to be significantly increased in patients with CTS on median nerve examination. The mean compound motor action potential was not significantly different between patients with and without CTS.Conclusion: Symptoms and signs of CTS are mostly masked by the symptoms of DPN and patients presenting with such symptoms in the upper limbs should be evaluated for CTS as a separate entity to DPN. The finding of a frequency of CTS of 26% in subjects with diabetes with varying degrees of DPN is remarkably high. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions be made carefully after nerve conduction study and proper diagnosis.Birdem Med J 2018; 8(3): 240-245

Emphysematous Pyelonephritis: Experience of Managing 15 Consecutive Cases in a Tertiary Care Hospital of Bangladesh

Background: Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. CTS and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy.Methods: This study was a hospital based descriptive cross sectional study done in a tertiary care hospital, Dhaka between July, 2015 and June, 2016. The initial clinical diagnosis of diabetic peripheral neuropathy was made from history and examination. It was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Collected data were checked, verified for consistency and edited for final results. Data cleaning, validation and analysis were performed using Statistical Package for the Social Sciences (Version 20.0).Results: A total of 354 cases were finally analyzed with 153 (43.2) patients being symptomatic for CTS and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Majority (38.4%) of patients belonged to the age group of 51-60 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). One hundred and ninety two (54.2%) patients were housewives, 57 (16.1%) were garment workers, 45 (12.7%) patients were businessmen and 60 (16.9%) patients were service holders. Study subjects with CTS had significantly higher body mass index, higher fasting blood glucose and higher HemoglobinA1c in comparison to patients without CTS. Examination of upper limb sensory nerves showed that nerve conduction velocity was significantly decreased and distal latency was found to be significantly increased in patients with CTS on median nerve examination. The mean compound motor action potential was not significantly different between patients with and without CTS.Conclusion: Symptoms and signs of CTS are mostly masked by the symptoms of DPN and patients presenting with such symptoms in the upper limbs should be evaluated for CTS as a separate entity to DPN. The finding of a frequency of CTS of 26% in subjects with diabetes with varying degrees of DPN is remarkably high. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions be made carefully after nerve conduction study and proper diagnosis.Birdem Med J 2018; 8(3): 246-250

Local administration of corticosteroids in treatment of carpal tunnel syndrome

Carpal tunnel syndrome is the most frequent entrapment neuropathy. We performed a literature review of application of local corticosteroid injections. The main aim of the review is to outline the issues concerning indications for the treatment, efficiency and safety of the procedure, and the effect’s duration. Different techniques and different types of corticosteroids, outcomes of the local injections in comparsion with surgical treatment are discussed.

Temporal trends in US counterterrorism sting operations, 1989–2014

ABSTRACTHow has the US government’s use of counterterrorism sting operations changed over the past quarter-century? Have major terrorist attacks led to more frequent sting operations and/or more frequent entrapment – and if so, have such changes been temporary or long-lasting? Have different types of terrorism provoked different reactions? This study answers these questions using a database of US terrorism prosecutions occurring between 1989 and 2014, each coded for 20 indicators of entrapment. We analyse temporal trends, and in particular, compare the government’s responses to the 1995 Oklahoma City bombing and the 9/11 terror attacks. Results indicate that after the Oklahoma City bombing, the number of sting operations against right-wing extremists doubled, while the average number of entrapment indicators dropped. This suggests that authorities in the 1990s responded to the growing threat of right-wing terrorism appropriately: conducting more investigations while avoiding entrapment. After 9/11, sting operations against suspected jihadi terrorists rapidly increased, but in this case, they featured high numbers of entrapment indicators through the end of the study period, suggesting widespread and persistent entrapment. Reasons for this difference, and for the government’s failure to reduce entrapment in response to widespread criticism over the past decade, are analysed.

Trapeziohamate Distance in Carpal Tunnel View as a Risk Factor for Carpal Tunnel Syndrome

Background: Carpal tunnel syndrome (CTS) is the most frequent entrapment syndrome of the upper limp, which leads to compression of the median nerve at the level of the wrist. Any early diagnosis based on the radiological and clinical findings is essential to find a risk factor preventing permanent nerve damage and functional sequelae. Objectives: The main aim of this study was to evaluate and determine trapeziohamate distance as a risk factor for incident CTS. Patients and Methods: The subjects in this case-control study were patients divided into an experimental group (n = 38) and control group (n = 23). Prospective study was conducted on 33 female and 5 male patients with CTS and 21 females and 2 males in control group. Subjects were selected from patients and their relatives who referred to our hand surgery department. In total, 61 subjects were examined. Gender and age as the personal factors, dominant hand, diabetes mellitus (DM), occupation and trapeziohamate distances were evaluated in all patients and control group. Mean values of trapeziohamate distance as a risk factor for experimental and control groups were measured. Levene’s test and Student’s t test were used to analyse the collected data using Statistical Package for Social Science. Results: The risk of CTS was higher in women and housekeeper. There was a significant difference between the two groups for trapeziohamate distance. The mean of trapeziohamate distance in control group (23.39) was significantly higher than the mean of experimental group (21.02). Conclusions: Our study confirmed that the incidence of CTS is higher in women and housekeeper and trapeziohamate distance is a dependent risk factor for the carpal tunnel syndrome.

Test-retest reliability of transcarpal sensory NCV method for diagnosis of carpal tunnel syndrome.

Background:Carpal Tunnel Syndrome (CTS) is the most frequent entrapment neuropathy affecting the upper extremity. There are a variety of electrodiagnostic methods available for documenting median neuropathy in CTS. In some studies, determining the sensory NCV across the palm-wrist segment has been introduced as the most sensitive diagnostic procedure for CTS. The aim of this study was to investigate the test-retest reliability of transcarpal median sensory NCV method for the diagnosis of CTS.Materials and Methods:Twenty-three patients with clinical symptoms of CTS were tested two times by two different practitioners in one session and again by the first practitioner after one week. Stimulation of the median nerve was performed in the wrist and palm, with a conduction distance maximum of 7 cm, reliabilities of median nerves sensory nerve action potential latencies with stimulation at wrist and palm (W-SNAP, P-SNAP) and its transcarpal NCV were assessed with intraclass correlation coefficient (ICC).Results:Comparison of the obtained values, which were done by two practitioners in one session showed ICC of W-SNAP latency, P-SNAP latency and transcarpal NCV of 0.93, 0.88 and 0.87, respectively and values that were done by one practitioner in two sessions with one-week interval showed ICC of 0.60, 0.50 and 0.47, respectively.Conclusion:Our findings suggest excellent interpractitioner test-retest reliability of transcarpal median sensory NCV method for diagnosing CTS.

P419: Benign tumour as a rare cause of tarsal tunnel syndrome – case report

Question: Tarsal tunnel syndrome is the most frequent entrapment neuropathy of the posterior tibial nerve [1]. It may involve also its plantar and/or calcaneal branches [3]. It is a rare and frequently underdiagnosed condition leading to motor, sensory and autonomic complications affecting the sole. Early decompression in the symptomatic cases promotes good recovery [2]. Methods:We present the case of a 59-year-old female who was admitted to our Clinic with a 2-month-history of progressive weakness and burning of the right foot. The diagnosis of the symptomatic tarsal tunnel syndrome was made based on electrodiagnostic testing and magnetic resonance imaging of the right foot. Results: Electroneurography revealed a severe right tibial nerve injury in the tarsal tunnel. MRI showed a polycyclic cystic mass medially to the lower ankle joint distorting the swollen tibial nerve. The postoperative outcome was good. Conclusions: Tarsal tunnel syndrome can be easily overlooked due to the rarity and nonspecific symptoms of this pathology and a tumour in the tarsal tunnel is an exeptional cause [2]. Insightful electrodiagnostic testing can help identify the site of injury. When combined with imaging, it constitutes a proper therapeutic regimen.

Cubital tunnel syndrome: Comparative results of a multicenter study of 4 surgical techniques with a mean follow-up of 92 months

BackgroundCubital tunnel syndrome is the second most frequent entrapment syndrome. Physiopathology is mixed, and treatment options are multiple, none having yet proved superior efficacy. ObjectivesThe present retrospective multicenter study compared results and rates of complications and recurrence between the 4 main cubital tunnel syndrome treatments, to identify trends and optimize outcome. Materialand methodsPatients presenting with primary clinical cubital tunnel syndrome diagnosed on electroneuromyography were included and operated on using 1 of the following 4 techniques: open or endoscopic in situ decompression, or subcutaneous or submuscular anterior transposition. Four specialized upper-limb surgery centers participated, each systematically performing 1 of the above procedures. Subjective and objective results and rates of complications and recurrence were compared at end of follow-up. ResultsFive hundred and two patients were included and 375 followed up for a mean 92months (range, 9–144months); 103 were lost to follow-up and 24 died. Whichever the procedure, more than 90% of patients were cured or showed improvement. There was a single case of scar pain at end of follow-up, managed by endoscopic decompression; there were no other long-term complications. None of the 4 techniques aggravated symptoms. There were 6 recurrences by end of follow-up: 1 associated with open in situ decompression and 5 with submuscular transposition. ConclusionSurgery was effective in treating cubital tunnel syndrome. Submuscular anterior transposition was associated with recurrence. In contrast to literature reports, subcutaneous anterior transposition, which is a reliable and valid technique, was not associated with a higher complication rate than in situ decompression. Level of evidenceLevel IV. Multicenter retrospective.

La fistule artérioveineuse est un facteur supplémentaire de risque de développer un syndrome du canal carpien chez le patient hémodialysé

IntroductionCarpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy reported in patients with renal failure undergoing periodic haemodialysis. The role of arteriovenous fistula was discussed. The aim of this study was to investigate this relationship. MethodsSubjects for this study were hemodialysis patients who underwent systematic electroneuromyography between January 2003 and December 2010. Only patients with unilateral fistulae were included for the study. ResultsOne hundred and thirty-four out of 155 patients were examined. CTS was noted in 106 patients and was detectable only in ENMG in 42% of cases. It was more frequent (P<0.001) and more severe in the side of fistulae (P=0.08). Besides, development of CTS was only correlated with the longer duration of dialysis (P=0.005). This duration was significantly shorter in patients with CTS and diabetes. ConclusionThe positive correlation between CTS and aretriovenous fistulae confirms the pathogenic role of this latter. The risk rises in these patients with the duration of hemodialysis and the presence of diabetes.

Синдром карпального каналу: діагностика та консервативне лікування

The Carpal tunnel syndrome is the most frequent entrapment neuropaphy of human. The Article isdedicated to diagnostics and conservative treatment this pathology. The early diagnostics and in timefixed treatment prevents the progress of the disease, raises the quality of life and allows to avoid surgicalprocedure. Big attention is given acupuncture reflexotherepy and infrared latherotherepy, which useraises the quality of the therapeutic influences.