Medial Antebrachial Nerve Research Articles

Neuropathy as the Initial Manifestation of Leprosy in an Older Patient (P3-10.004)

<h3>Objective:</h3> To consider Leprosy in the differential diagnosis of an older patient who presents with demyelinating polyneuropathy. <h3>Background:</h3> 70-year-old Bangladeshi Man with Diabetes Mellitus presents with two years of distal right arm numbness, right hand weakness, intermittent bilateral feet numbness, and prior blisters on the dorsolateral fingers. Neurologic exam revealed right arm distal&gt;proximal weakness, absent vibration in toes, decreased sensation to pinprick below the right elbow and bilateral ankles, and loss of proprioception of bilateral hallux. During initial skin evaluation no lesions were noted. <h3>Design/Methods:</h3> NA <h3>Results:</h3> Serology was unremarkable including ESR/CRP. EMG/NCS consistent with moderate sensorimotor demyelinating polyneuropathy and possible superimposed right lower trunk brachial plexopathy. MRI C-spine and brachial plexus were unrevealing. Due to EMG results and persistent symptoms Lewis Sumner Syndrome was considered. Ganglioside panel, celiac panel, and CSF studies were normal. On 3-year follow up, the patient developed worsening weakness and blisters of the left hand, and atrophy of the right hand. Dermatologic exam showed left hand hyperkeratotic plaques, right arm subcutaneous nodules, and hypopigmented patches on the trunk. Biopsy of a hypopigmented patch was negative for AFB. Repeat EMG/NCS showed decreased CMAP and SNAP amplitudes compared to the prior study in bilateral arms with continued ongoing denervation. Left medial antebrachial nerve biopsy confirmed Mycobacterium leprae. <h3>Conclusions:</h3> Leprosy is an infectious disease involving the skin, peripheral nerves, mucosal surface of the respiratory tract and eyes. Early diagnosis and treatment are essential to reduce the likelihood of disability as it is often irreversible and requires lifelong care. When leprosy occurs exclusively in neuropathic syndromes and at an older age, diagnosis can be difficult. Current classification systems rely heavily on skin manifestations, and diagnosis at the time of only peripheral nerve involvement can become challenging. As information accumulates on various neurological disorders in leprosy, it becomes increasingly clear that treatment paradigms should evolve. <b>Disclosure:</b> Dr. Sharma has nothing to disclose. Dr. Monohan has nothing to disclose. Dr. Anziska has nothing to disclose. Dr. Jacoby has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Jacoby has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Jacoby has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for N/A. The institution of Dr. Jacoby has received research support from ABPN.

Case Scenario: Postoperative Brachial Plexopathy Associated with Infraclavicular Brachial Plexus Blockade

Case Scenario: Postoperative Brachial Plexopathy Associated with Infraclavicular Brachial Plexus Blockade

Medial and lateral antebrachial nerve conductions: Orthodromic or antidromic?

Introduction: Antidromic stimulation is usually used in the evaluation of lateral antebrachial cutaneous nerve (LABCN) and medial antebrachial cutaneous nerve (MABCN). This study was conducted to evaluate the relationship between orthodromic and antidromic stimulations of these nerves. Materials and Methods: Medial and lateral antebrachial conduction studies by antidromic and orthodromic stimulation. Results: Sensory nerve action potential (SNAP) amplitudes were larger with antidromic stimulation in the majority of subjects. The lateral antebrachial SNAP amplitude was 20.5 ± 9.29 μV with antidromic stimulation and 14.6 ± 6.13 μV with orthodromic stimulation (P < 0.001). Medial antebrachial SNAP amplitudes were 12.8 ± 4.93 μV using antidromic stimulation and 6.5 ± 3.84 μV with orthodromic stimulation (P < 0.001). Sensory conduction velocities were faster with orthodromic lateral antebrachial stimulation (P = 0.002) whereas velocities were similar in medial antebrachial nerve. Supramaximal stimulation of MABCN was not possible in half of the nerves sampled to avoid the muscle artifact. Conclusion: Orthodromic stimulation of LABCN and MABCN are easy to perform and can be supplanted for antidromic stimulation in which Supramaximal stimulation may not be possible in some individuals.

Nerve Stripper-Assisted Sural Nerve Harvest

Sural nerve has the favorite length and size for nerve graft interposition. Here two techniques, that is, "stocking seam" and "stair-step" or "stepladder," have been used for harvesting sural nerve. The first technique results in an unsightly scar at the posterior calf, and the latter one takes a long time to perform and exert undue traction to the graft during harvesting. The purpose of this article is to describe our experience in harvesting the sural nerve by a nerve stripper. A nerve stripper was used for harvesting sural nerve in 35 adult patients (in 6 patients, sural harvesting was done bilaterally), 27 men and 8 women. Thirty-one sural nerve harvests were done by closed technique (i.e., harvesting of sural nerve only by two incisions, one in the posterior of the lateral malleolus and the other in popliteal fossa), in 8 others by limited open technique, and in 2 cases, there was early laceration of the sural nerve at the beginning of the study. The contralateral sural nerve was harvested in one patient and medial antebrachial nerve in another by open technique. The mean length of the retrieved sural nerve was 34.5 cm in the closed technique group and 35 cm in the limited open technique group. We detected advancing Tinel's sign in all nerve stripper-assisted sural nerve harvested group members in both the closed and limited open groups. Sural nerve harvesting by the nerve stripper is a reliable and simple technique, and it is applicable as a routine technique. Applying controlled rotatory movements of the nerve stripper instead of pushing can result in satisfactory harvesting of the sural nerve without early laceration.

Long Cervical Costae Articulating with the First Ribs: A Salient Case of Thoracic Outlet Syndrome

The complex of signs and symptoms caused by compression of brachial plexus and subclavian vessels in the cervicoaxillary region is known as thoracic outlet syndrome (TOS).1 Bones and the surrounding soft tissues may play an important role in its pathogenesis. Bony factors include the long transverse process of the seventh cervical vertebra, a cervical rib, an anomalous first rib, or fractures of the clavicle or first rib.2 The most common symptoms of TOS patients are pain and paresthesias in the supraclavicular, interscapular, subscapular, and cervical regions or in the upper limbs. Although less common, some patients also experience tachycardia, dyspnea, dysphagia, angina-like chest pain, occipital headache, Raynaud's phenomenon, or complex regional pain syndrome.2–4 The diagnosis of TOS is established clinically when relevant complaints of the patients are provoked during maneuvers such as Adson, costoclavicular, hyperabduction, or Roos tests. Radiologic evaluations may shed light on the underlying pathogenesis, and cervical radiographs are simply the initial step in this regard. More sophisticated tools such as Doppler sonography, magnetic resonance imaging/angiography, and three-dimensional computed tomography can also be used for further assessment. Herein, besides presenting a rare, interesting articulation bilaterally between the cervical costae and the first ribs in a patient with TOS, we highlight the importance of oblique cervical radiographs for better delineation of such deformities. A 44-yr-old man was seen for numbness and a tingling sensation in his hands that had persisted for 3–4 mos. Physical examination revealed ulnar hypoesthesia on the left side, and provocative maneuvers for TOS (Roos and costoclavicular) were bilaterally positive. Laboratory evaluations for neuropathies and electrodiagnostic studies including median and ulnar nerve motor/sensory conduction tests, F-wave measurements, and medial antebrachial nerve conduction tests were unremarkable. Cervical radiographs were taken as the initial step for radiologic diagnosis and evaluation. Posteroanterior views suggest an anomalous cervical rib (Fig. 1A), and oblique views clearly demonstrate bilateral long cervical costae (Fig. 1B). He was diagnosed to have TOS clinically—with regard to his symptoms and physical findings—and radiologically due to the aforementioned anomalies in the cervical region. Because he was decided to be treated conservatively, a home-based exercise regimen for strengthening the shoulder elevators was prescribed. He was found to have improved clinically on the first control visit after 3 mos.FIGURE 1: A, posteroanterior cervical radiograph depicting bilateral cervical costae articulating with the first ribs; B, right cervical radiograph (oblique view) clearly delineating the articulation

Microanatomic analysis of the medial antebrachial nerve as a potential donor nerve in maxillofacial grafting.

Microanatomic analysis of the medial antebrachial nerve as a potential donor nerve in maxillofacial grafting.

Medial antebrachial nerve studies in true neurogenic thoracic outlet syndrome

Medial antebrachial nerve studies in true neurogenic thoracic outlet syndrome

Discussion: Microanatomic Analysis of the Medial Antebrachial Nerve as a Potential Donor Nerve in Maxillofacial Grafting

Discussion: Microanatomic Analysis of the Medial Antebrachial Nerve as a Potential Donor Nerve in Maxillofacial Grafting

Microanatomic analysis of the medial antebrachial nerve as a potential donor nerve in maxillofacial grafting

Purpose : To histologically compare the anterior branch of the medial antebrachial cutaneous nerve (MACN) with the sural nerve using biometric techniques. Patients and Methods : Twenty-centimeter segments of the right and left (MACN) and sural nerves from three cadavers were analyzed. The number of fascicles within the nerves were counted and the neural to connective tissue ratio was estimated. Results : Sural nerves consistently showed greater amounts of connective tissue between the fascicles than the MACN. Fascicle diameter varied less throughout the length of the MACN. Fascicle diameter varied less throughout the length of the MACN and it showed fewer and larger fascicles, more closely approximating the anatomy of the inferior alveolar nerve. Conclusion: These preliminary data suggest that the MACN, on anatomic grounds, is theoretically more suited for grafting to the alveolar and lingual nerves than the sural nerve.