Nerve Compression Lesions Research Articles

INCISURA SCAPULAE MORFOMETRİSİ VE TİPLENDİRİLMESİ

Giriş: Incisura scapulae, scapula’nın margo superior’unun processus coracoideus’un tabanıyla birleştiği yerde bulunan çentiktir. Incisura scapulae, lig.transversum scapulae superius ile kapatılarak bir foramene dönüşür. Bu foramenden n.suprascapularis geçer. Çentiğin şeklindeki ve boyutundaki farklılıklar suprascapular sinir sıkışmasına sebep olabilir.Bu çalışmanın amacı incisura scapulae’nın şekil değişikliklerini, derinliğini ve genişliğini incelemek ve sağ-sol taraflar arasında farklılık olup olmadığını belirlemektir. Gereç ve Yöntem: Çalışmamızda Süleyman Demirel Üniversitesi Tıp Fakültesi Anatomi Anabilim Laboratuvarı’nda bulunan 18 adet scapula incelendi. Incisura scapulae milimetrik cetvel ile fotoğraflandı ve ölçümler Image J programı ile hesaplandı. Veriler SPSS 20 programı ile analiz edildi. Incisura scapulae’nin derinliği ve genişliği ölçüldü. Incisura scapulae’lar şekline ve derinliğine göre 5 gruba ayrıldı. Tip I - derin ve U şeklinde; tip II - sığ ve U şeklinde; tip III - derin ve V şeklinde; tip IV - sığ ve V şeklinde ve tip V - çentiği delik şeklinde olarak gruplandırıldı. Bulgular: Tip I, Tip II, Tip III, Tip IV ve Tip V sırasıyla%27,7, %16,6, %11,1, %33.3ve%11,1oranlarında bulundu. Sağ ve sol taraf incisura scapulae derinliği ve genişliği karşılaştırıldığında ise taraflar arasında anlamlı fark bulunmadı (p>0.05). Sonuç: Çalışmamızda incelenen incisura scapulae tiplerinin bulunma oranları mevcut çalışmalarla benzer olmakla beraber incisura scapulae tiplerini gruplandırırken daha fazla parametre kullanılmıştır. Incisura scapulae’nin morfolojik değişikliklerinin bilinmesi bu bölgeye yapılacak cerrahi girişimlerde ve sinir sıkışma lezyonlarının tanılanmasında önem taşımaktadır. Anahtar Sözcükler: Incisura scapulae, Tiplendirme, Morfometri

Patient Characteristics in Ulnar Nerve Compression at the Elbow at a Tertiary Referral Hospital and Predictive Factors for Outcomes of Simple Decompression versus Subcutaneous Transposition of the Ulnar Nerve.

Patient characteristics and predictive factors for outcomes were analysed in 202 cases undergoing simple decompression, primary subcutaneous transposition, or secondary subcutaneous transposition for ulnar nerve compression at the elbow at a tertiary referral hospital. Data from medical charts and a survey were evaluated. The mean patient age was 49 years with revision surgery cases being significantly younger. Sixty-one percent of cases were female, and 31% were smokers. The comorbidity was extensive, including other nerve compression lesions as well as neck and shoulder problems. Overall, 53% reported being pleased with the result of surgery and 57% of the cases rated function as better or completely recovered after surgery. The median postoperative DASH (Disabilities of the Arm, Shoulder and Hand) score was 26 (IQR 11–49), which is in accordance with unpublished national data. No significant differences in DASH scores were found between surgical groups, but a higher preoperative McGowan grade was significantly associated with a poorer postoperative DASH score. Women scored greater disability postoperatively than men. There was a significantly increased risk of complications, which was doubled for smokers, following primary and secondary transposition compared to simple decompression. Surgical cases with ulnar nerve compression treated at a tertiary referral hospital constitute a heterogeneous group with great comorbidity and frequent concomitant nerve compression lesions. We suggest simple decompression as the procedure of first choice. Transposition can be used in selected cases or when simple decompression fails. All patients should be strongly recommended to stop smoking considering the remarkably increased risk for complications among smokers.

Theory of Bowstring Disease: Diagnosis and Treatment Bowstring Disease.

Bowstring disease (BSD) is a new classification of spine disease caused by axial stretched lesion on nerve roots and the spinal cord, which is differentiated from disc herniation and canal stenosis in that it is caused by nerve compression lesions. BSD could be caused by mismatched growth rates between the spine and nerve roots (the juvenile type), or by imbalanced degenerative rates between the spine column and nerve roots (degenerative type). Here, we propose that there are several self‐adjust mechanisms to relieve axial nerve tension: (i) nerve growth; (ii) posture adjustment and low back pain; (iii) autogenous degeneration of intervertebral disc; and (iv) idiopathic and degenerative scoliosis. Iatrogenic lesions could also result in BSD, which could be presented as adjacent segment degeneration, leading to adding‐on effects and other neurological symptoms. The diagnosis criteria are proposed based on symptoms, physical examination, and radiological presentations. To remove axial tension on nerve roots, lumbar surgery should aim to restore the coordination of spine and cord units. Capsule surgery, shortening the spine column, could decompress cord and nerve roots 3‐dimensionally.

Brachioradial pruritus as a result of cervical spine pathology: The results of a magnetic resonance tomography study

Brachioradial pruritus (BRP) describes a rare form of itching occurring at the dorsolateral part of the forearms. Recent case reports suggest that BRP may be attributed to cervical lesions or spine neoplasms. We sought to determine the incidence of cervical spine changes in BRP and to correlate the localization of spinal lesions with the dermatomal presence of pruritus. Magnetic resonance tomography (MRT) of the cervical spinal cord, a chest x-ray, and a skin biopsy were performed in 41 patients (28 female, 13 male; 59.0 ± 10.6 years) with BRP. Patients completed an itch questionnaire (NeuroDerm Questionnaire) that included a dermatome chart and the Northwick Park Neck Pain Questionnaire. The patients marked the locations C5 (90.2%) and C6 (100%) on the dermatome chart. All patients had detectable MRT changes. In 80.5% of the patients, stenosis of the intervertebral foramen or protrusions of the cervical disk led to nerve compression. The location of the nerve compression lesions correlated significantly with the dermatomal localization of the pruritus (Spearman correlation coefficient 0.893; P < .01). No spinal neoplasm was observed, and 19.5% of the patients had degenerative changes without significant correlation to the dermatomal localization of pruritus. No healthy control group without pruritus was investigated. BRP may result from cervical nerve compression, and rarely, it may also stem from degenerative changes. Our findings suggest that even slight cervical changes detected on MRT may alter itch afferents and lead to BRP. Spinal cord tumors are rare and should be ruled out by a cervical spine MRT.

MR Imaging Mapping of Skeletal Muscle Denervation in Entrapment and Compressive Neuropathies

The diagnoses of entrapment and compressive neuropathies have been based on the findings from clinical examinations and electrophysiologic tests, such as electromyography and nerve conduction studies. The use of magnetic resonance (MR) imaging for the diagnosis of entrapment or compressive neuropathies is increasing because MR imaging is particularly useful for discerning potential causes and for identifying associated muscle denervation. However, it is sometimes difficult to localize nerve entrapment or demonstrate nerve compression lesions with MR imaging. Nevertheless, even in these cases, MR imaging may show denervation-associated changes in specific muscles innervated by the affected nerves. The analysis of denervated muscle distributions by using MR imaging, with a knowledge of nerve innervation patterns, would be helpful for determining the nerves involved and the levels of nerve entrapment or compression. In this context, the mapping of skeletal muscle denervation with MR imaging has a supplementary or even a primary role in the diagnosis of entrapment and compressive neuropathies.

Brachioradial pruritus in a young man presenting with transverse myelitis

Pruritus with unknown origin is a common complaint and secondary causes should be investigated. We report a 22-year-old man with intractable localized pruritus and painful burning, stinging sensations in the bilateral arms, shoulders, neck and upper back for 3 weeks. A dermatologist was consulted in the emergency department. On physical examination, there were multiple excoriated erythematous macules and depigmented scars in a linear distribution over the dermatome from C4 to C6. Decreased muscle power in bilateral upper limbs was also noted. A consultant dermatologist strongly suggested that an image survey on the cervical spine was necessary. Surprisingly, a magnetic resonance image (MRI) of the cervical spine revealed a lesion with T1 hypointensity and T2 hyperintensity occupying two-thirds of the intramedullary region at the C2-C5 levels, consistent with transverse myelitis. Brachioradial pruritus with transverse myelitis was diagnosed. It is important for clinicians to be aware that bra-chioradial pruritus should be a differential diagnosis of pruritus of unknown origin and that the disease entity is not responsive to systemic corticosteroids and antihistamines; however, it is dependent on treatment of the underlying process. Once the diagnosis of brachioradial pruritus is made, plain film or MRI of the cervical spine should be arranged to determine the presence of possible nerve compression lesions.

Techniques of Peripheral Nerve Repair

Nerve injuries extend from simple nerve compression lesions to complete nerve injuries and severe lacerations of the nerve trunks. A specific problem is brachial plexus injuries where nerve roots can be ruptured, or even avulsed from the spinal cord, by traction. An early and correct diagnosis of a nerve injury is important. A thorough knowledge of the anatomy of the peripheral nerve trunk as well as of basic neurobiological alterations in neurons and Schwann cells induced by the injury are crucial for the surgeon in making adequate decisions on how to repair and reconstruct nerves. The technique of peripheral nerve repair includes four important steps (preparation of nerve end, approximation, coaptation and maintenance). Nerves are usually repaired primarily with sutures applied in the different tissue components, but various tubes are available. Nerve grafts and nerve transfers are alternatives when the injury induces a nerve defect. Timing of nerve repair is essential. An early repair is preferable since it is advantageous for neurobiological reasons. Postoperative rehabilitation, utilising the patients' own coping strategies, with evaluation of outcome are additional important steps in treatment of peripheral nerve injuries. in the rehabilitation phase adequate handling of pain, allodynia and cold intolerance are emphasised.

Nerve compression syndromes of the upper extremity exemplified by rare lesions

By means of three not so common nerve compression lesions the authors comment diagnostics, indication and timing of operation. The indication for operation is given by clinical features and the course of disease. The technical findings, e.g. electromyography and electroneurography are just of supporting value. One should remember that there are not always pathologic findings in nerve compressions. By means of several own cases of suprascapular nerve entrapment, interosseous-anterior-syndrome and entrapment of the posterior interosseous nerve in the arcade of Frohse anatomical findings, clinical items, differentialdiagnosis and operative treatment are demonstrated.

ANATOMY, FUNCTION, AND PATHOPHYSIOLOGY OF PERIPHERAL NERVES AND NERVE COMPRESSION

The basic pathophysiology of nerve compression injuries is complex and it is important to consider the microanatomy of the neuron and the peripheral nerve. The clinical stages of nerve compression lesions can be related to changes in intraneural microcirculation and nerve fiber structure; alterations in vascular permeability, with subsequent formation of edema; and deterioration of nerve function observed in experimental studies. The double-crush and reversed double-crush syndromes are related to disturbances in axonal transport induced by compression, followed by morphologic and functional changes in the nerve cell bodies. An underlying neuropathy in subjects can make the peripheral nerves more susceptible to compression injuries.

Ulnar Nerve Anatomy and Compression

Compression of the ulnar nerve can be understood in terms of the anatomic and dynamic factors. Although the ulnar nerve may be compressed at any point along its course, it is particularly susceptible at the elbow and the wrist. Clinically relevant anatomy will be reviewed in an attempt to provide the reader with a logical framework for successfully diagnosing and managing typical and atypical ulnar nerve compression lesions.

The anatomy of the distal ulnar tunnel.

The distal ulnar tunnel is a region of the wrist 4-4.5 cm in length in which the ulnar nerve is particularly vulnerable to external compression. The relation of the internal topography of the nerve to the structures comprising the tunnel provides a basis for dividing the tunnel into three zones. Zone 1 is that portion of the tunnel proximal to the bifurcation of the ulnar nerve. Zone 2 encompasses the deep motor branch of the nerve, and Zone 3 surrounds the superficial branch. A review of the literature of ulnar nerve compression lesions confirmed expectations based on the regional anatomy. Zone 1 lesions included all (39) cases of combined motor and sensory deficits, one case of pure motor paralysis, and seven cases of sensory deficits. All Zone 2 lesions (36 cases) resulted in paralysis of the intrinsic muscles. Whether or not the hypothenar muscles were affected was dependent upon the location of the lesions within Zone 2. Zone 3 lesions caused sensory deficits only. Combined motor and sensory loss was most often caused by compression from deep to the nerve, while pure sensory deficits were a result of compression lesions lying superficial to the nerve.

Changes in fast axonal transport during experimental nerve compression at low pressures

The minimal pressure for impairment of fast anterograde axonal transport was determined in rabbit vagus nerve. Proteins, transported by fast anterograde axonal transport, were labeled by a microinjection of [ 3H]leucine into the nodose ganglion, and a small compression chamber was applied around the cervical vagus nerve. In this way the nerve was subjected to acute, graded compression. Compression at 20 mm Hg for 2 h as well as sham compression did not induce accumulation of axonally transported proteins at the level of compression. However, a pressure of 30 mm Hg for 2 h induced a block of axonal transport at the site of compression. The causes of the axonal transport block are discussed as well as the minimal pressure level in relation to pressures found in clinical nerve compression lesions.

Nerve compression lesions of the upper extremity

Nerve compression lesions of the upper extremity

Nerve compression lesions of the upper extremity. A clinical and experimental review.

Nerve compression lesions of the upper extremity. A clinical and experimental review.

Ulnar nerve compression lesions at the wrist and hand

Ulnar nerve compression lesions at the wrist and hand