Peripheral Nerve Compression Syndromes Research Articles

Additional contribution of phonophoresis and low-level laser therapy to exercise in the treatment of carpal tunnel syndrome: A clinical, electrophysiological, and ultrasonographic evaluation.

Carpal Tunnel Syndrome (CTS) is the most common peripheral nerve compression syndrome. This study aims to evaluate the additive contribution of phonophoresis and low-level laser therapy (LLLT) to tendon and nerve gliding exercises electrophysiologically, ultrasonographically, and clinically in the treatment of moderate CTS. The sample consisted of 45 patients with moderate CTS, randomized into three groups. Group 1 received phonophoresis and exercise, Group 2 received LLLT and exercise, and Group 3 received exercise alone. Participants were evaluated electrophysiologically, clinically, and ultrasonographically before treatment and at the 6th and 12th weeks after the treatment. An improvement was observed in clinical parameters (Boston Functional Status Scale, Boston Symptom Severity Scale, visual analog scale at rest, and visual analog scale during activity) for all groups at the 6th and 12th weeks after the treatment (p<0.05). An improvement was also noted in the ultrasonographic parameter (cross-sectional area) for all groups at the 12th week after the treatment (p=0.017). Phonophoresis and LLLT do not provide additional effects to exercise therapy. Exercise therapy alone may positively contribute to ultrasonographic and clinical outcomes in the treatment of moderate CTS.

Diagnostik von peripheren Nerven bei Läsionen und Kompressionssyndromen: Positionspaper der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie – (DAM)

The treatment of peripheral nerve pathologies requires a rapid and precise diagnosis. However, the correct identification of nerve pathologies is often difficult and valuable time is lost in the process. In this position paper of the German-Speaking Group for Microsurgery of Peripheral Nerves and Vessels (DAM), we describe the current evidence for various perioperative diagnostics for the detection of traumatic peripheral nerve lesions or compression syndromes. In detail, we evaluated the importance of clinical examinations, electrophysiology, nerve ultrasound and magnetic resonance neurography. Additionally, we surveyed our members for their diagnostic approach in this regard. The statements are based on a consensus workshop on the 42nd meeting of the DAM in Graz, Austria.

Neuropathic pruritus-Evidence-based treatment recommendations

Neuropathic pruritus is apreviously neglected symptom of awide range of neurological diseases. Peripheral nerve or root compression syndromes, space-occupying lesions of the central nervous system, chronic inflammatory neurological diseases and polyneuropathy can cause neuropathic pruritus. Even when the identification of the underlying neurological disease is successful, adirect causal treatment is not always possible, hence an effective symptomatic treatment remains the only therapeutic option. The purpose of this review article is to present the current literature on various therapeutic agents and options in the treatment of neuropathic pruritus.

Mediyal Plantar Sinir Anormalliği: Nadir Bir Olgu Sunumu

There are not many articles about the anatomical knowledge of the variable conditions of the sole of the foot, but normally knowledge of this area is essential for surgeries such as reconstructive or peripheral nerve compression syndrome. In this region, medial plantar nerve (nervus plantaris medialis) innervates the abductor and flexor muscles of the thumb. In addition, there is a region where receives the skin sensation in the foot. When it is damaged or exposed to pressure by any muscle due to an abnormal course, it can’t stimulate the relevant muscles and the person may experience numbness and loss of muscle function on the sole of the foot. During a routine cadaver dissection, an abnormal course of nervus plantaris medialis was observed on the left side of a male cadaver. In this case, we presented the abnormal course of some branches of medial plantar nerve and discussed the clinical significance.

Acupuncture and related therapies for carpal tunnel syndrome: A protocol for systematic review and Bayesian network meta-analysis.

Background:Carpal tunnel syndrome (CTS) is the most common peripheral nerve compression syndrome of the upper limb. Plenty of studies showed the effects of acupuncture therapy on relieving pain and improving functional status for CTS patients. Diverse types of acupuncture therapies have been used in the treatment for CTS, but their relative treatment effects are poorly understood. This study will evaluate the effects of different acupuncture and related therapies for CTS by conducting a systematic review and Bayesian network meta-analysis (NMA).Methods:We will search randomized controlled trials (RCTs) of acupuncture and related therapies for CTS in MEDLINE (via PubMed), EMBASE, Web of Science, Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, VIP Database, Wanfang Database, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Chinese Clinical Trial Register, and OpenGrey from inception to November 2021. Then, we will select eligible studies, extract data, and conduct risk of bias assessment using the Cochrane tool. Pairwise meta-analysis and Bayesian NMA will be performed in Stata 15.1 software and Aggregate Data Drug Information System 1.16.8 software. We will assess the quality of the evidence using the Confidence in Network Meta-Analysis application.Results:In this study, the treatment effects and safety of different acupuncture and related therapies for CTS will be evaluated.Conclusion:This study will provide evidence for choosing the optimal acupuncture and related therapies in the treatment for CTS.

Ergonomics in Spine Surgery.

As physician burnout and wellness become increasingly recognized as vital themes for the medical community to address, the topic of chronic work-related conditions in surgeons must be further evaluated. While improving ergonomics and occupational health have been long emphasized in the executive and business worlds, particularly in relation to company morale and productivity, information within the surgical community remains relatively scarce. Chronic peripheral nerve compression syndromes, hand osteoarthritis, cervicalgia and back pain, as well as other repetitive musculoskeletal ailments affect many spinal surgeons. The use of ergonomic training programs, an operating microscope or exoscope, powered instruments for pedicle screw placement, pneumatic Kerrison punches and ultrasonic osteotomes, as well as utilizing multiple surgeons or microbreaks for larger cases comprise several methods by which spinal surgeons can potentially improve workspace health. As such, it is worthwhile exploring these areas to potentially improve operating room ergonomics and overall surgeon longevity.

A novel local adipofascial flap for the management of recalcitrant ulnar tunnel syndrome

Ulnar tunnel syndrome is the second most common upper-limb peripheral nerve compression syndrome. Recurrence or persistence of symptoms after primary surgery is found in 9.9%–21% of cases. The main cause of failure is peri- and endo-neural fibrosis, and management is difficult and controversial. Revision of nerve neurolysis combined with freestyle adipofascial flap provides nerve decompression and coverage with vascularized tissue, which prevents scar tissue formation around the nerve and restores glide. We performed a preliminary vessel-injected cadaver study. The perforating vessels from the posterior recurrent ulnar artery vascularize the medial adipose and fascial tissues of the elbow, allowing elevation of an adipofascial flap which is able to reach the ulnar nerve. Eight patients with neuropathic ulnar nerve pain in recalcitrant ulnar tunnel syndrome due to peri- and/or endo-neural fibrosis were treated by neurolysis, and the nerve was covered with an ulnar adipofascial flap. All patients were evaluated by percussion test, visual analog scale for pain, electromyography, electroneurography and ultrasound, and were classified according to the McGowan classification as modified by Goldberg. The study was approved by the review board. All patients had good 4-year outcome, with complete return to daily activity, work and sports 4 months after surgery. The results of this novel surgical technique were encouraging, without complications or donor site morbidity. Adipofascial flap combined with neurolysis could be a valid solution in the treatment of recalcitrant ulnar tunnel syndrome.

Revision surgery for carpal and cubital tunnel syndrome

Carpal tunnel syndrome, acompressive neuropathy of the median nerve at the wrist and cubital tunnel syndrome, acompressive neuropathy of the ulnar nerve at the elbow, are the two most common peripheral nerve compression syndromes. Chronic compressive neuropathy of peripheral nerves causes pain, paraesthesia and paresis. Treatment strategies include conservative options, but only surgical decompression can resolve the mechanical entrapment of the nerve with proven good clinical results. However, revision rates for persistent or recurrent carpal tunnel syndrome is estimated at around 5% and for refractory cubital tunnel syndrome at around 19%. Common causes for failure include incomplete release of the entrapment and postoperative perineural scarring. Precise diagnostic work-up is obligatory before revision surgery. The strategy of revision surgery is first complete decompression of the affected nerve and then providing ahealthy, vascularized perineural environment to allow nerve gliding and nerve healing and to avoid recurrent scarring. Various surgical options may be considered in revision surgery, including neurolysis, nerve wrapping and nerve repair. In addition, flaps may provide awell vascularized nerve coverage in the case of recurrent carpal tunnel syndrome. In the case of recurrent cubital tunnel syndrome, anterior transposition of the ulnar nerve is mostly performed for this purpose. In general, revision surgery leads to improvement of symptoms, although the outcome of revision surgery is less favourable than after primary surgery and complete resolution of symptoms is unlikely.

Abstract #45: Ultrasound Neuromodulation for the Treatment of Peripheral Nerve Compression Syndromes

Abstract #45: Ultrasound Neuromodulation for the Treatment of Peripheral Nerve Compression Syndromes

Microneurosurgical treatment options in peripheral nerve compression syndromes after chemotherapy and radiation treatment.

Chemotherapy-induced peripheral neuropathy and radiation-induced brachial plexopathy are extremely debilitating conditions which can occur after treatment of malignancy. Unfortunately, the diagnosis can be elusive, and this dilemma is further compounded by the lack of efficacious therapeutics to prevent the onset of neurotoxicity before initiating chemotherapy or radiation or to treat these sequelae after treatment. However, microsurgical nerve decompression can provide these patients with a viable option to treat this complication.

Endoscopic decompression of the ulnar nerve in the cubital tunnel yields similar outcomes but a lower complication rate than open decompression: a systematic review and meta-analysis

ImportanceCubital tunnel syndrome is the second most common peripheral nerve compression syndrome in the USA. There is controversy in the literature regarding the best surgical option.ObjectiveThe purpose of this investigation was to perform a systematic review to determine if there is a difference in clinical outcomes or complications between open and endoscopic cubital tunnel release in patients with compression of the ulnar nerve in the cubital tunnel.Evidence reviewA systematic review was registered with PROSPERO and performed using PRISMA guidelines. PubMed, SCOPUS and Cochrane Central Register of Controlled Trials databases were searched for level I–IV therapeutic comparative studies of open versus endoscopic cubital tunnel decompression in adult human patients. The levels of evidence were then assigned based on the Oxford Centre for Evidence-Based Medicine. Study methodological quality was analysed using the Modified Coleman Methodology Score. Only the outcome measurements that 3 or more studies used were included in our data synthesis. Postoperative patient satisfaction, Bishop score, recurrence and complication rates were compared between the endoscopic and open groups using the χ2 test using p<0.05.FindingsSix articles (507 patients, mean age of 48.2 years, with 28.8 months average follow-up) were analysed. 76.1% of patients were satisfied in the endoscopic group, and 73.8% were satisfied in the open group (p=0.7023). 87.4% of endoscopic patients and 81.2% of open patients had a Bishop score of excellent or good (p=0.236). The endoscopic group had a recurrence rate of 1.1%, and the open group had a 3.5% recurrence rate (p=0.0872). There were significantly fewer complications in the endoscopic group (7.9%) compared to the open group (12.9%) (p<0.01).Conclusions and relevanceEquivalent clinical outcomes, patient satisfaction and recurrence rates were observed between open and endoscopic techniques. However, a significantly lower complication rate was observed with the endoscopic technique.Level of evidenceLevel IV, systematic review of level I–IV studies.

Carpal and cubital tunnel and other, rarer nerve compression syndromes.

Carpal tunnel syndrome is by far the most common peripheral nerve compression syndrome, affecting approximately one in every six adults to a greater or lesser extent. Splitting the flexor retinaculum to treat carpal tunnel syndrome is the second most common specialized surgical procedure in Germany. Cubital tunnel syndrome is rarer by a factor of 13, and the other compression syndromes are rarer still. This review is based on publications retrieved by a selective literature search of PubMed and the Cochrane Library, along with current guidelines and the authors' clinical and scientific experience. Randomized controlled trials have shown, with a high level of evidence, that the surgical treatment of carpal tunnel syndrome yields very good results regardless of the particular technique used, as long as the diagnosis and the indication for surgery are well established by the electrophysiologic and radiological findings and the operation is properly performed. The success rates of open surgery, and the single-portal and dual-portal endoscopic methods are 91.6%, 93.4% and 92.5%, respectively. When performed by experienced hands, all these procedures have complication rates below 1%. The surgical treatment of cubital tunnel syndrome has a comparably low complication rate, but worse results overall. Neuro-ultrasonography and magnetic resonance imaging (neuro-MRI) are increasingly being used to complement the diagnostic findings of electrophysiologic studies. Evidence-based diagnostic methods and treatment recommendations are now available for the two most common peripheral nerve compression syndromes. Further controlled trials are needed for most of the rarer syndromes, especially the controversial ones.

Surgical treatment results of carpal tunnel syndrome in patients with and without type 2 diabetes mellitus.

Carpal tunnel syndrome (CTS) is the most commonly seen peripheral nerve compression syndrome and CTS surgery is the most common surgery done for peripheral nerve compression syndromes. Type 2 diabetes mellitus (DM) is a systemic disease with a component of peripheral neuropathy. We aimed to investigate the effects of type 2 DM on functional results in type 2 DM patients who underwent carpal tunnel surgery. The study included 39 patients with carpal tunnel syndrome which was confirmed by electromyography. Twenty-one patients did not have DM, 18 patients had type 2 DM that were treated for DM and had regulated blood glucose levels. Assessments were done with the Boston scale. All operations were done by the same surgical team using the same surgical technique. Functional and symptomatic scores between the two groups were compared with the Mann-Whitney U test which is the non-parametric version of the Student's t test, and 95% confidence interval p<0.05, which is considered as statistically significant. In patients with type 2 DM, preoperative mean Symptom Severity Score was 3.6±0.35 (2.9 to 4.2) in the last control mean Symptom Severity Score was 1.2±0.16 (1.0-1.7), and preoperative mean functional status score was 3.3±0.56 (2.3 to 4.5) and in the last control mean functional status score was 1.3±0.36 (1.0 to 2.4).The patients without DM, preoperative mean Symptom Severity Score was 3.5±0.45 (2.8 to 4.2) in the last control mean Symptom Severity Score was 1.2±0.19 (1.0 to 1.6), and preoperative functional status score was 3.2±0.47 (2.4 to 4.6) in the last control mean functional status score was 1.3±0.35 (1.0 to 2.5). There was no statistically significant difference between the two groups. Type 2 DM patients with regulated blood glucose levels can be operated without additional procedure during and after surgery for carpal tunnel syndrome like in carpal tunnel syndrome patients without DM.

Effectiveness of Pregabalin as Monotherapy or Combination Therapy for Neuropathic Pain in Patients Unresponsive to Previous Treatments in a Spanish Primary Care Setting

Background and ObjectivePatients from a previous study of neuropathic pain (NP) in the Spanish primary care setting still had symptoms despite treatment. Subsequently, patients were treated as prescribed by their physician and followed up for 3 months. Since pregabalin has been shown to be effective in NP, including refractory cases, the objective of this study was to assess the effectiveness of pregabalin therapy in patients with NP refractory to previous treatments.MethodsThis was a post hoc analysis of pregabalin-naïve NP patients treated with pregabalin in a 3-month follow-up observational multicenter study to assess symptoms and satisfaction with treatment. Patients were evaluated with the Douleur Neuropathique en 4 questions (DN4), the Brief Pain Inventory (BPI) and the Treatment Satisfaction for Medication Questionnaire (SATMED-Q) overall satisfaction domain.Results1,670 patients (mean age 58 years, 59 % women), previously untreated or treated with ≥1 drug other than pregabalin, were treated with pregabalin (37 % on monotherapy). At 3 months, pain intensity and its interference with activities decreased by half (p < 0.0001), while the number of days with no or mild pain increased by a mean of 4.5 days (p < 0.0001). Treatment satisfaction increased twofold (p < 0.0001). Patients with a shorter history of pain and those with neuralgia and peripheral nerve compression syndrome (PCS) as etiologies had the highest proportion on monotherapy and showed the greatest improvements in pain-related parameters in their respective group categories.ConclusionTreatment with pregabalin (as monotherapy or combination therapy) provides benefits in pain and treatment satisfaction in patients with NP, including refractory cases. Shorter disease progression and neuralgia and PCS etiologies are favorable factors for pregabalin treatment response.

Relationships Between the Posterior Interosseous Nerve and the Supinator Muscle: Application to Peripheral Nerve Compression Syndromes and Nerve Transfer Procedures

Little information can be found in the literature regarding the relationships of the posterior interosseous nerve (PIN) while it traverses the supinator muscle. Because compression syndromes may involve this nerve at this site and researchers have investigated using branches of the PIN to the supinator for neurotization procedures, the authors' aim was to elucidate information about this anatomy. Dissection was performed on 52 cadaveric limbs to investigate branching patterns of the PIN within the supinator muscle. On 29 sides, the PIN entered the supinator muscle as a single nerve and from its medial side provided two to four branches to the muscle. On 23 sides, the nerve entered the supinator muscle as two approximately equal-size branches that arose from the radial nerve on average 2.2 cm from the proximal edge of this muscle. In these cases, the medial of the two branches terminated on the supinator muscle, and the lateral branch traveled through the supinator muscle; in 13 specimens, it provided additional smaller branches to the supinator muscle. The length of PIN within the supinator muscle was 4 cm on average, and the diameter of its branches to the supinator muscle ranged from 0.8 to 1.1 mm. In 10 specimens, the PIN left the supinator muscle before the most distal aspect of the muscle. In two specimens with a single broad PIN, muscle fibers of the supinator muscle pierced the PIN as it traveled through it. This knowledge of the anatomy of the PIN as it passes through the supinator muscle may be useful to neurosurgeons during decompressive procedures or neurotization.

Cubital Tunnel Syndrome – A Review and Management Guidelines

Cubital tunnel syndrome (CuTS) is the second most common peripheral nerve compression syndrome. In German-speaking countries, cubital tunnel syndrome is often referred to as sulcus ulnaris syndrome (retrocondylar groove syndrome). This term is anatomically incorrect, since the site of compression comprises not only the retrocondylar groove but the cubital tunnel, which consists of 3 parts: the retrocondylar groove, partially covered by the cubital tunnel retinaculum (lig. arcuatum or Osborne ligament), the humeroulnar arcade, and the deep flexor/pronator aponeurosis. According to Sunderland , cubital tunnel syndrome can be differentiated into a primary form (including anterior subluxation of the ulnar nerve and compression secondary to the presence of an anconeus epitrochlearis muscle) and a secondary form caused by deformation or other processes of the elbow joint. The clinical diagnosis is usually confirmed by nerve conduction studies. Recently, the use of ultrasound and MRI have become useful diagnostic tools by showing morphological changes in the nerve within the cubital tunnel. A differential diagnosis is essential in atypical cases, and should include such conditions as C8 radiculopathy, Pancoast tumor, and pressure palsy. Conservative treatment (avoiding exposure to external noxes and applying of night splints) may be considered in the early stages of cubital tunnel syndrome. When nonoperative treatment fails, or in patients who present with more advanced clinical findings, such as motor weakness, muscle atrophy, or fixed sensory changes, surgical treatment should be recommended. According to actual randomized controlled studies, the treatment of choice in primary cubital tunnel syndrome is simple in situ decompression, which has to be extended at least 5-6 cm distal to the medial epicondyle and can be performed by an open or endoscopic technique, both under local anesthesia. Simple decompression is also the therapy of choice in uncomplicated ulnar luxation and in most post-traumatic cases and other secondary forms. When the luxation is painful, or when the ulnar nerve actually "snaps" back and forth over the medial epicondyle of the humerus, subcutaneous anterior transposition may be performed. In cases of severe bone or tissue changes of the elbow (especially with cubitus valgus), the anterior transposition of the ulnar nerve may again be indicated. In cases of scarring, submuscular transposition may be preferred as it provides a healthy vascular bed for the nerve as well as soft tissue protection. Risks resulting from transposition include compromise in blood flow to the nerve as well as kinking of the nerve caused by insufficient proximal or distal mobilization. In these cases, revision surgery is necessary. Epicondylectomy is not common, at least in Germany. Recurrence of compression on the ulnar nerve at the elbow may occur. This review is based on the German Guideline "Diagnose und Therapie des Kubitaltunnelsyndroms" ( www.leitlinien.net ).

Compression Neuropathy: A Late Finding in the Postburn Population: A Four-Year Institutional Review

Nerve compression syndromes may cause postburn morbidity that can often be difficult to recognize and manage. This study reviewed patients in the authors' institution who needed nerve decompression secondary to thermal or electrical burns. The objective was to evaluate the timing of nerve decompression in the burn population. A 4-year review of the authors' institution's database found 22 patients who underwent peripheral neuroplasty. This patient population included both thermal and electrical burn patients. Two patients were excluded from the study because they underwent rapid forearm amputation, and a third patient who had his initial burn care done in Europe was also excluded. The authors reviewed the mechanism of burn: percentage of body surface area burned, which nerves underwent decompression, and time from burn to decompression. Nerve compression syndromes were diagnosed and treated in this group of patients from day 46 to 1530 post-burn. Carpal tunnel was the most common site of compression accounting for 46% of the nerve decompressions. Sixteen of the 19 (84%) patients required that synchronous nerves be decompressed. The average body surface area burn in the thermal group was 43 and 5% in the electrical burn group. Nerve compression syndromes secondary to burns can be a challenging problem to diagnose and treat. Multiple studies have shown the importance of treating nerve compressions in the acute setting; however, this study shows the importance of long-term surveillance, secondary to the late presentation of nerve compression syndromes. Late nerve compression neuropathies were present in both the electrical and thermal burn patients. The authors also found that presentation of a single nerve compression should raise the suspicion of a synchronous nerve compression. Patients with thermal burns greater than 20% body surface area and electrical burns should be routinely questioned and examined for the peripheral nerve compression syndromes during long-term follow-up.

The current situation and prospect treatment of peripheral nerve compression syndromes by endoscopic technique

内窥镜下治疗周围神经卡压综合征始于腕管综合征的治疗,现已扩展到肘管综合征及胸廓出口综合征等的治疗.由于其具有创伤小、恢复快、美观等优点,使内窥镜技术在周围神经卡压领域的应用日益受到医生的推崇和患者的欢迎,但同时随着手术病例的不断积累和应用,内窥镜在治疗周围神经卡压综合征中也存在一些争议。

MR Findings of Peripheral Nerve Entrapment and Compression Syndrome

MR Findings of Peripheral Nerve Entrapment and Compression Syndrome

Who Really First Described and Explained the Suprascapular Nerve Entrapment Syndrome?

To The Editor: In your esteemed journal, or better said, our journal, since orthopaedic physicians all around the world consider The Journal of Bone and Joint Surgery our best journal, the article “Suprascapular Nerve Entrapment” (82-A: 415-424, March 2000), by Cummins et al., was excellent, as is usual for your Current Concepts Reviews. I found it to be very useful since I have been studying the so-called tunnel syndromes (peripheral nerve compression syndromes or entrapment neuropathies) for a great number of years. There was a minor drawback in that the authors were oriented exclusively toward papers published in English, a practice that is becoming almost universal. I do not wish, however, to bemoan the unchangeable fact that nowadays a paper must be published in English for it to have any chance for recognition. Similarly, the authors failed to consult books dealing with nerve entrapment syndromes (tunnel syndromes or peripheral nerve compression syndromes), which may have been due to difficulty in getting access to these books. With your help, I would like to correct a historical injustice regarding citation of the first description of suprascapular nerve entrapment. I would also like to indicate how clinicians made their diagnoses long ago without the …