Symptoms Of Nerve Compression Research Articles

Persistent Sciatic Artery Aneurysm With Distal Embolization Treated Endovascular - A Case Report.

Persistent sciatic artery (PSA) is a rare embryologic remnant of the internal iliac artery variant with an estimated incidence of 0.03-0.06 %. Aneurysmatic formation can give rise to neurological sciatic nerve compression symptoms or thromboembolic and ischemic symptoms. The present is a case with recurrent thromboembolic symptoms and PSA aneurysm, successfully treated endovascularly.

Spinal endoscopic technique in the surgical treatment of thoracic ossification of the ligamentum flavum

Thoracic ossification of the ligamentum flavum (TOLF) is a pathological heterotopic ossification disease in which the fibrous tissue of the ligamentum flavum of the thoracic spine converts into bony tissue, often leading to thoracic spinal stenosis and compression of the thoracic spinal cord nerve. When TOLF patients present with symptoms of spinal cord nerve compression, surgical treatment is usually required, and traditional open surgery is more invasive and carries a higher risk of spinal cord nerve injury. In recent years, domestic and foreign researchers have tried to apply spinal endoscopic techniques such as microendoscopy, percutaneous foraminoscopy, and unilateral biportal endoscopy for the treatment of TOLF, which can maximize the preservation of normal bone while achieving adequate decompression of the spinal cord nerve, with less damage to spinal stability, and have the advantages of less surgical trauma, less bleeding, and faster postoperative recovery. Due to the special anatomical structure of the thoracic vertebra, spinal endoscopic techniques should focus on safety and it is recommended that they are performed in experienced centers, and surgical indications should be strictly controlled.

Three-dimensional finite element analysis of lumbar disc herniation under different body positions

To campare biomechanical effects of different postural compression techniques on three-dimensional model of lumbar disc herniation (LDH) by finite element analysis. Lumbar CT image of a 48-year-old female patient with LDH (heighted 163 cm, weighted 53 kg) was collected. Mimics 20.0, Geomagic Studio, Solidwords and other software were used to establish three-dimensional finite element model of LDH on L4,5 segments. Compression techniques under horizontal position, 30° forward bending and 10° backward extension were simulated respectively. After applying the pressure, the effects of compression techniques under different positions on stress, strain and displacement of various tissues of intervertebral disc and nerve root were observed. L4, 5 segment finite element model was successfully established, and the model was validated. When compression manipulation was performed on the horizontal position, 30° flexion and 10° extension, the annular stress were 0.732, 5.929, 1.286 MPa, the nucleus pulposus stress were 0.190, 1.527, 0.295 MPa, and the annular strain were 0.097, 0.922 and 0.424, the strain sizes of nucleus pulposus were 0.153, 1.222 and 0.282, respectively. The overall displacement distance of intervertebral disc on Y direction were -3.707, -18.990, -4.171 mm, and displacement distance of nerve root on Y direction were +7.836, +5.341, +3.859 mm, respectively. The relative displacement distances of nerve root and intervertebral disc on Y direction were 11.543, 24.331 and 8.030 mm, respectively. Compression manipulation could make herniated intervertebral disc produce contraction and retraction trend, by increasing the distance between herniated intervertebral disc and nerve root, to reduce symptoms of nerve compression, to achieve purpose of treatment for patients with LDH, in which the compression manipulation is more effective when the forward flexion is 30°.

SUTURE CHOICE IN CARPAL TUNNEL SURGERY: A RANDOMIZED CONTROLLED TRIAL

ObjectiveCarpal tunnel release surgery is a commonly performed procedure for alleviating symptoms of median nerve compression and restoring hand function. With pressure on theatre time these procedures are now commonly performed in a step-down out-patient facility under local anaesthetic. The choice of suture for skin closure in this procedure can impact the quality of wound healing, patient outcomes and the follow-up required however the question of the best type of suture remains unanswered. The purpose of this study was to compare the outcomes of absorbable and non-absorbable sutures using a randomised control trial design.MethodsEighty patients diagnosed with bilateral carpal tunnel syndrome were enrolled and underwent outpatient carpal tunnel release surgery under local anaesthetic in a staged fashion. Random number generation was used to assign each hand to receive interrupted nylon or Vicryl Rapide sutures. Pre-operative data collection included patient demographics, ASA, inflammatory conditions, smoking status as well as a Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. Patients were followed up at 2 and 6 weeks after each operation and the BCTQ was repeated along with the Patient and Observer Scar Assessment Scale and the VAS score for wound discomfort. This study has approval from the DHB ethics committee, Local Iwi, HDC and ANZ Clinical Trials:ACTRN12623000100695.ResultsStatistical analysis assessed patient preference and the scores between the groups. Multi-variate analysis was performed to assess the factors that may be contributing to patient choice.ConclusionInsights into patient preference and clinical outcomes associated with absorbable sutures and non-absorbable sutures in the setting of out-patient surgery are discussed.

Related factors of delirium after transsphenoidal endoscopic pituitary adenoma resection-A matched retrospective cohort study

ObjectivesThe primary aim of this study is to explore the factors associated with delirium incidence in postoperative patients who have undergone endoscopic transsphenoidal approach surgery for pituitary adenoma. MethodsThe study population included patients admitted to Tianjin Huanhu Hospital's Skull Base Endoscopy Center from January to December 2022, selected through a retrospective cohort study design. The presence of perioperative delirium was evaluated using the 4 'A's Test (4AT) scale, and the final diagnosis of delirium was determined by clinicians. Statistical analysis included Propensity Score Matching (PSM), χ2 Test, and Binary Logistic Regression. ResultsA total of 213 patients were included in this study, and the incidence of delirium was found to be 29.58 % (63/213). Among them, 126 patients were selected using PSM (delirium:non-delirium = 1:1), ensuring age, gender, and pathology were matched. According to the results of univariate analysis conducted on multiple variables, The binary logistic regression indicated that a history of alcoholism (OR = 6.89, [1.60–29.68], P = 0.010), preoperative optic nerve compression symptoms (OR = 4.30, [1.46–12.65], P = 0.008), operation time ≥3 h (OR = 5.50, [2.01–15.06], P = 0.001), benzodiazepines for sedation (OR = 3.94, [1.40–11.13], P = 0.010), sleep disorder (OR = 3.86, [1.40–10.66], P = 0.009), and physical restraint (OR = 4.53, [1.64–12.53], P = 0.004) as independent risk factors for postoperative delirium following pituitary adenoma surgery. ConclusionsFor pituitary adenoma patients with a history of alcoholism and presenting symptoms of optic nerve compression, as well as an operation time ≥3 h, enhancing communication between healthcare providers and patients, improving perioperative sleep quality, and reducing physical restraint may help decrease the incidence of postoperative delirium.

Below Elbow Amputation Due to Ischemic Complications after Radial Artery Cannulation: A Case Report

The patient is a 57 year old male with peripheral vascular disease and a non-healing thumb wound. After radial artery catheterization (RAC), he developed pain and numbness in the radial-sided 3.5 fingers and pulse oximetry readings <80%. With a possible diagnosis of carpal tunnel syndrome due to increased pressure, the patient underwent a carpal tunnel release (CTR) one week after the catheterization and reported immediate pain relief. Unfortunately, his wound failed to heal, and his pain returned one week later. Another operation was performed to decompress the carpal tunnel; however, the pain worsened, and fingertip necrosis progressed, including the thumb, index, and middle fingers. An angiogram showed arterial calcifications, ruling out reperfusion of the hand. A trans-forearm amputation was performed. This case highlights overlapping symptoms of ischemia and median nerve compression as well as the risk of hand ischemia after RAC in those with circulatory compromise.

From hyperglycemia to intervertebral disc damage: exploring diabetic-induced disc degeneration.

The incidence of lumbar disc herniation has gradually increased in recent years, and most patients have symptoms of low back pain and nerve compression, which brings a heavy burden to patients and society alike. Although the causes of disc herniation are complex, intervertebral disc degeneration (IDD) is considered to be the most common factor. The intervertebral disc (IVD) is composed of the upper and lower cartilage endplates, nucleus pulposus, and annulus fibrosus. Aging, abnormal mechanical stress load, and metabolic disorders can exacerbate the progression of IDD. Among them, high glucose and high-fat diets (HFD) can lead to fat accumulation, abnormal glucose metabolism, and inflammation, which are considered important factors affecting the homeostasis of IDD. Diabetes and advanced glycation end products (AGEs) accumulation- can lead to various adverse effects on the IVD, including cell senescence, apoptosis, pyroptosis, proliferation, and Extracellular matrix (ECM) degradation. While current research provides a fundamental basis for the treatment of high glucose-induced IDD patients. further exploration into the mechanisms of abnormal glucose metabolism affecting IDD and in the development of targeted drugs will provide the foundation for the effective treatment of these patients. We aimed to systematically review studies regarding the effects of hyperglycemia on the progress of IDD.

A meta-analysis of the efficacy of two-wall orbital decompression operations for thyroid-associated ophthalmopathy.

The main treatment for the symptoms of proptosis and optic nerve compression caused by thyroid-associated ophthalmopathy is orbital decompression surgery. Medial inferior wall decompression and balanced decompression are two frequently used surgical procedures. However, there is no unified consensus on how to choose different surgical options for orbital decompression in clinical practice. To compare the effects of medial inferior wall decompression and balanced decompression surgery through meta-analysis and to provide reference for clinical optimal decision making. Databases, including PubMed, Web of Science, Ovid, Cochrane Library, and ClinicalTrials.gov, were searched for randomized controlled trials and cohort studies on decompression surgery for thyroid-associated ophthalmopathy published from inception to March 21, 2023. Using RevMan 5.3 software, a meta-analysis was conducted based on the following outcome indicators: proptosis, diplopia rate, intraocular pressure, visual acuity, and complication rate. Two randomized controlled trials and five cohort studies with a total of 377 patients were included in this analysis. After balanced decompression surgery, patients with thyroid-associated ophthalmopathy experienced a significant decrease in proptosis [MD = 4.92, 95% CI (4.26, 5.58), P < 0.0001]. Balanced decompression can improve postoperative visual acuity [MD = - 0.35, 95% CI (- 0.56, - 0.13), P = 0.001] and intraocular pressure [MD = 5.33, 95% CI (3.34, 7.32), P < 0.0001]. The rates of proptosis [MD = 0.33, 95% CI (- 1.80, 2.46), P = 0.76] and diplopia [OR = 1.20, 95% CI (0.38, 3.76), P = 0.76] did not differ between patients who underwent medial inferior wall decompression and those who underwent balanced decompression. Balanced decompression and medial inferior wall decompression are both effective options for surgical treatment of thyroid-associated ophthalmopathy in clinical practice.

Endoscopic Release of the Ulnar Nerve at the Elbow: Technique Description and Case Series.

Objective The endoscopic release of the ulnar nerve reproduces a simple ( in situ ) procedure with smaller incisions, less soft tissue damage, and higher preservation of nerve vascularization. Endoscopy allows the clear visualization of the entire path of the nerve and surrounding noble structures. Moreover, it reveals any signs of compression and allows a safe release of 10 cm distally or proximally to the medial epicondyle. Methods A retrospective survey revealed that 15 subjects (1 with a bilateral injury) underwent an ulnar nerve compression release at the elbow using the endoscopic technique with Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA) equipment from January 2016 to January 2020. Results Symptoms of ulnar nerve compression improved in all patients; on average, they resumed their work activities in 26.5 days. There was no recurrence or need for another procedure. In addition, there were no severe procedure-related complications, such as infection and nerve or vascular injury. One patient had transient paresthesia of the sensory branches to the forearm, with complete functional recovery in 8 weeks. Conclusion Our study shows that the endoscopic release of the ulnar nerve at the elbow with the Agee equipment is a safe, reliable technique with good outcomes.

Vestibulo-Cochlear Symptoms Revealing Vertebro-Basilar Dolicho-Ectasia

Introduction: Vertebrobasilar dolichoectasia (VBD) are uncommon arteriopathies defined by increased length and caliber of one or more intracranial arteries. The clinical picture is polymorphic. They are most often associated with ischemic or hemorrhagic stroke, but this pathology can also cause symptoms of cranial nerve compression. Objective: We report the case of a vertebro-basilar dolichoectasia collected in the radiology department of Ibn Tofail Hospital in Marrakech, revealed by vestibulo-cochlear symptoms and diagnosed by brain MRI. In the light of this observation, we review this uncommon pathology and the contribution of magnetic resonance imaging in its diagnosis. Case report: The patient was 68 years old and had a history of severe sleep apnea syndrome. He presented with rotatory vertigo, tinnitus and hypoacusis on the left side of the head for 3 months. The neurological examination was normal and the examination of the ENT sphere revealed bilateral sensorineural hearing loss and left hyporeflexia. A cerebral MRI was performed as part of the etiological workup, which revealed elongation and dilation of the vertebral arteries measuring 3.9 mm on the left and 5.2 mm on the right, with loops of which the left crossed the homolateral cochleovestibular nerve 7 mm from its emergence, responsible for a deviation of its path, and the glossopharyngeal nerve 4 mm from its emergence. It also showed an elongation and dilatation of the basilar trunk measuring 6.8 mm, presenting a loop lateralized to the left at the level of its origin (Smoker's Grade 2) with a bifurcation opposite the floor of the V3 (Smoker's Grade 2).Thus, the diagnosis of a DEVB responsible for a vascular-nervous conflict was retained. The indication for surgical management was given but was refused by the patient due to the deep location of the arteriopathy. Discussion and conclusion: DEVB is a rare and progressive condition with cranial nerve compression as a possible complication. Brain MRI is...

Online Information Related to Symptoms of Carpal Tunnel Syndrome: A Google Search Analysis.

Introduction While Google is frequently used to access internet-based health resources, the quality of online health information remains variable. Our purpose was to assess suggested resources identified through Google search features for common symptoms related to carpal tunnel syndrome (CTS). Methods Two searches were performed. The first, labeled "symptom-related," included the terms "hand numbness," "hand tingling," and "hand falling asleep." The second, labeled "CTS-specific," included "carpal tunnel syndrome," "carpal tunnel surgery," and "carpal tunnel release." A novel feature of Google's search engine is to display similar searches made by other users ("People Also Ask" snippet). For each search, the first 100 results snippets and the associated website links were recorded. A list of unique questions was compiled and classified into 1 of 3 categories using the Rothwell classification: fact, policy, or value. Questions were also classified based on the diagnoses suggested by the query. Website authorship was determined, and the corresponding links were categorized by two independent reviewers. Results The "symptom-related" searches yielded 175 unique questions and 130 unique website links, and the "CTS-specific" searches yielded a total of 243 questions and 179 unique links. For "symptom-related" searches, 65% of questions suggested a diagnosis, with CTS being suggested as a diagnosis for only 3% of questions. In contrast, CTS was suggested by 92% of questions in "CTS-specific" searches. In both searches, nearly 75% of questions were classified as "facts." Commercial websites were the most common in both searches. Conclusion Google searches for common symptoms of median nerve compression rarely yield information related to CTS.

Rare Tumors Causing Median Nerve Compression in Adults-A Narrative Review.

The median nerve can be compressed due to a tumor along the course of the median nerve, causing typical compression symptoms or even persistence or recurrence after an operation. The aim of this review is to provide a comprehensive overview of rare tumors described in recent publications that cause median nerve compression and to evaluate treatment options.The PubMed, Embase, and Web of Science databases were searched for studies describing median nerve compression due to a tumor in adults, published from the year 2000 and written in English. From 94 studies, information of approximately 100 patients have been obtained.Results The rare tumors causing compression were in 32 patients located at the carpal tunnel, in 21 cases in the palm of the hand, and 28 proximal from the carpal tunnel. In the other cases the compression site extended over a longer trajectory. There were 37 different histological types of lesions. Complete resection of the tumor was possible in 58 cases. A total of 8 patients presented for the second time after receiving initial therapy. During follow-up, three cases of recurrence were reported with a mean follow-up period of 11 months. The most common published cause of median nerve compression is the lipofibromatous hamartoma. Besides the typical sensory and motor symptoms of median nerve compression, a thorough physical examination of the complete upper extremity is necessary to find any swelling or triggering that might raise suspicion of the presence of a tumor.

Successful Reconstruction of a Ruptured Brachial Artery Aneurysm With Superficial Femoral Vein

A 50 year old male on chronic haemodialysis through a brachiocephalic arteriovenous fistula was transferred because of pain and symptoms of median nerve compression (A and B, asterisk). Duplex scanning noted a ruptured brachial artery (A, arrow) with a maximum diameter of 30 mm. After achieving haemostatic control the median nerve was separated from the aneurysmal wall and the aneurysm was resected. (B) A 4–5 cm length of reversed superficial femoral vein (arrow) was used for brachial artery reconstruction to prevent infection. The great saphenous vein was not used because of diameter mismatch with the dilated brachial artery.Image 1

Two Cases of Use of Cement Augmented Screws for Osteosynthesis of the Spine

With this report we decided to present the initial experience with the use of cement augmented screws in Cotrel-Dubousset fixation in cases of patients with degenerative spines in combination with severe osteoporosis.&#x0D; We present two patients who underwent treatment at UMHAT "Sv. Georgi ”, Plovdiv. The first is a 75-year-old woman who underwent right hip arthroplasty in 2002 with a Muller prosthesis. 14 years later (in 2016) due to implant ablation, a revision of the joint with a cementless, revision modular endoprosthesis of Metrimed was performed. In 2022, due to secondary degenerative scoliosis, the patient began to complain of pain in the lumbar spine, which required decompression and posterior fixation with cement augmented screws.&#x0D; The second patient was a 72 years old female and in September 2021 suffered an osteoporotic fracture at L4 level. Balloon kyphoplasty was performed at the same level. However, due to leakage of cement into the vertebral canal, it was necessary to decompress the canal and apply again the mentioned fixation system.&#x0D; The visual analog scale (VAS) was used to assess the effect of response to therapy. Both patients had no symptoms of nerve compression.&#x0D; Fenestrated screws were used in both cases.&#x0D;

Hypertrophy of the sublime tubercle in elbow ulnar collateral ligament injuries: a case series of baseball pitchers undergoing ulnar collateral ligament reconstruction with short-term follow-up

The ulnar collateral ligament (UCL) of the elbow is subject to repetitive stress in overhead throwing athletes. This can lead to morphologic changes at the bony attachments of the UCL and hypertrophy of the sublime tubercle. The purpose of this case series is to describe the surgical details and clinical outcomes of a series of competitive baseball pitchers with hypertrophic sublime tubercles who underwent UCL reconstruction (UCLR). All baseball pitchers who were treated for UCL injuries with significant hypertrophy of the sublime tubercle on preoperative imaging were included in the series. Clinical history, preoperative imaging, intraoperative findings during UCLR, and postoperative outcomes measured with the Conway scale were described. Ten players (average age of 22.9 years [range 13-39]) were included (average follow-up 20.4 months [range 3-38 months]). Five patients also had symptoms of ulnar nerve compression, with 4 requiring transposition at the time of ULCR and 1 at 3 months postoperatively. Bony hypertrophy of the sublime tubercle was confirmed intraoperatively in all cases and excised before UCLR with the docking technique. Of the 7 patients with at least 12-month follow-up postoperatively, 6 had excellent outcomes, and 1 had a fair outcome. Although UCLR in the setting of hypertrophic sublime tubercle can be more complex than typical UCLR, excellent outcomes are achievable with preoperative recognition and surgical planning.

Guyon's canal resulting from lipoma: A case report and review of the literature.

IntroductionCompression of the ulnar nerve at the wrist is a rare condition. Clinical presentations of ulnar nerve compression at the wrist and hand can vary widely due to the complex anatomic course of ulnar nerve at the wrist. Lipoma is a common benign soft tissue tumor and rarely causes neuropathy. We present a rare case of Guyon's canal syndrome caused by lipoma.Case reportsWe describe a case with acute ulnar nerve deficit. Clinical examination, EMG and MRI suggested Guyon's canal syndrome. Surgical exploration revealed a well-encapsulated fatty tumor within Guyon's canal. Histopathology demonstrated mature adipose tissue consistent with lipoma. Post-operative course was uneventful and the sensory symptom had subsided at the three month follow up.Discussion and conclusionThere are many etiologies of Guyon's canal syndrome which can be classified into groups. Symptoms of ulnar nerve compression at the wrist can vary depend on the location of the lesion. Treatment options depend on severity and duration of symptoms, previous treatment attempts, and underlying etiology. Lipoma is not a common cause of Guyon's canal with few case reports in the literature. Surgery to open and release the roof of Guyon's canal and excision of the lipoma can yield good outcome in most reports.

Posterior Interosseous Nerve Palsy Associated with Multiple Epiphyseal Dysplasia

AbstractMultiple epiphyseal dysplasia is a condition that courses with a retarded epiphyseal development and may cause joint dysmorphia. We report a case of posterior interosseous nerve palsy in a child with dysplasia. After a physical examination and complementary diagnostic tests that revealed posterior interosseous nerve compression neuropathy, surgical neurolysis og the posterior interosseous nerve was performed at level of the the arcade of Frohse. The satisfactory evolution of the patient confirmed our diagnosis. Attention must be paid to the onset of signs or symptoms of nerve compression in these patients.

Dorsalis pedis artery thrombosis in an elite rugby player: an unusual cause of pedal claudication in a high-risk ankle

Vascular thrombosis in young elite athletes is uncommon, usually affecting calf veins and arteries beyond the knee joint. Arterial thrombosis, especially in the dorsalis pedis artery, is very rare without premature atherosclerosis or trauma. Its clinical presentation with progressive claudication of insidious onset is nonspecific and overlaps with the symptoms of deep peroneal nerve compression as a part of anterior ankle impingement, a more common entity in athletes. Ultrasound can evaluate pedal claudication in athletes differentiating vascular and neural causes expediting diagnosis, management and, in turn, return to play. Furthermore, imaging-Doppler ultrasound and MR angiography in particular-plays a vital role in the evaluation of potential aetiology and evolution (i.e., collateral development and recanalization) of the occluded vessel. We present a case of dorsalis pedis artery thrombosis with both MRI and ultrasound findings in a professional rugby player who had no systemic comorbidity, but numerous previous surgical interventions around the ankle joint in both the remote and recent past, putting the adjacent DPA at increased risk for developing thrombosis. In this high-risk ankle, the dorsalis pedis thrombosis may be iatrogenic or due to sports-related, arterial wall injury with superimposed thrombosis.

Giant Posterior Inferior Cerebellar Artery Aneurysm Mimicking a Brainstem Tumor

Aneurysms from the vertebrobasilar system are rare, accounting for only 5%-10% of all intracranial aneurysms. The most common sites in which these lesions occur are the bifurcation of the basilar artery and the origin of the posterior inferior cerebellar artery (PICA). When the aneurysms present in the distal portion of the PICA, they represent from 0.5% to 6%. These aneurysms are called giant when they exceed 25 mm in diameter. We present a case of a 49-year-old male who presented with acute obstructive hydrocephalus, which required ventriculoperitoneal shunting and left hemispheric cerebellar syndrome. The magnetic resonance imaging study revealed an occupative mass located in the fourth ventricle, and diagnostic angiography showed a partially thrombosed giant saccular aneurysm in the posterior inferior cerebellar artery. He underwent surgical management via a lateral suboccipital approach. The aneurysm was remodeled and clipped successfully without complications, with an uneventful postoperative course.Although rare, PICA aneurysms should always be considered when posterior fossa syndrome occurs, including brainstem and cranial nerve compression symptoms. It can easily be misdiagnosed as a neoplastic lesion, especially when the aneurysm reaches big or giant size. Therefore, complete diagnostic studies, such as cerebral angiography, must be performed. Surgical clipping must be offered as the first line of treatment. It provides occlusion of the aneurysm and relieves compressive symptoms.

Debulking and tenolysis of an anomalous flexor digitorum superficialis muscle belly in the palm: A case report and review of the literature

Flexor digitorum superficialis (FDS) anomalies can manifest in many ways. Prior case reports have described FDS variants being found incidentally as well being associated with nerve compression and mechanical symptoms. We present a case of an 83-year-old woman complaining pain and locking of the right index finger with associated tenderness at the level of the A1 pulley. Surgical exploration revealed an anomalous FDS muscle belly originating from the FDS tendon with adhesions to the flexor digitorum profundus (FDP) tendon. Tenolysis and dubulking of the anaomalous muscle and its tendon were performed leading to resolution of her symptoms. This case highlights the importance of remaining vigilant for anatomic variants during hand surgeries.