Symptoms Of Nerve Compression Research Articles

Incidence, Management, and Prognosis of Early Ulnar Nerve Dysfunction in Type C Fractures of Distal Humerus

Displaced comminuted of the distal humerus in adults are among the most complex fractures to be managed effectively. The ulnar nerve is at high risk of impingement secondary to injury, operation, and postoperative rehabilitation in these fractures. In this study we focus on the incidence, management, and prognosis of early ulnar nerve dysfunction in the course of treating type C fractures of distal humerus. We examine a patient sample of 117 consecutive AO type C fractures of distal humerus, between June 1998 and October 2005. Twenty-nine patients exhibited preoperative ulnar nerve compression symptoms (incidence 24.8%) and were divided into two groups randomly, which received treatment of anterior subfascial transposition or in situ decompression of the ulnar nerve respectively, in conjunction with internal fixation with medial and lateral plates. The subgroup of 88 patients without preoperative ulnar nerve symptoms remained asymptomatic postoperatively (0% incidence of late ulnar nerve dysfunction). According to Bishop rating system, excellent and good results of ulnar nerve function were achieved in 13 of 15 patients (86.7%) in the transposition group, 8 of 14 patients (57.1%) in the in situ decompression group. The results difference is statistically significant (p < 0.05). We conclude that neurolysis and anterior subfascial transposition of vascularized ulnar nerve during open reduction and internal fixation of type C fractures of the distal humerus is beneficial in cases of early ulnat nerve dysfunction.

Unilateral Carpal Tunnel Syndrome Caused by an Occult Palmar Lipoma

Carpal tunnel syndrome usually presents bilaterally and space-occupying lesions should be suspected in patients with unilateral symptoms, especially with a long history and when the symptomatic hand shows severe neurophysiologic impairment, while the contralateral hand is neurophysiologically intact. Approximately half of patients with unilateral symptoms have positive electrodiagnostic test results in the asymptomatic, contralateral hand. Space-occupying lesions are known to cause carpal tunnel syndrome and the incidence of space-occupying lesions in unilateral carpal tunnel syndrome is higher than that of bilateral carpal tunnel syndrome. It is easy to detect a mass when it is palpable, but occult lesions may be overlooked easily. Whenever a patient presents with unilateral symptoms and unilateral neurophysiologic impairment, the possibility of a space-occupying lesion compressing the median nerve should be kept in mind in the differential diagnosis. This article presents 2 cases of patients with occult deep palmar lipomas compressing the median nerve and causing unilateral symptoms of carpal tunnel syndrome. We stress the importance of imaging studies in patients with unilateral symptoms that are usually not used in carpal tunnel syndrome. While both patients' symptomatic hands showed severe neurophysiologic impairment, the contralateral hands were totally intact, which is contradictory with a long history. The reported patients were evaluated and magnetic resonance images revealed intra-tunnel lesions. Although lipomas are the most common soft tissue tumor in the body, <5% of the benign tumors of the hand are lipomas. Since the thick palmar fascia is strong, a deep lipoma may not be recognized although nerve compression symptoms may be gross.

The Pedicle Screw Fixation With Vertebroplasty Augmentation in the Surgical Treatment of the Severe Osteoporotic Spines

Retrospective clinical study. To present the early clinical results of pedicle screw fixation augmented by vertebroplasty using polymethylmethacrylate in severely osteoporotic patients requiring spine surgery due to the neurologic deficit. It is postulated that combining a formal vertebroplasty-that is, maximum filling of the trabecular space with polymethylmethacrylate-with pedicle screw placement in osteoporotic vertebrae could result in resistance to pullout forces significantly. Between the years 2003 and 2006, pedicle screw placement with vertebroplasty augmentation was performed in 49 patients who had severe osteoporosis and who required spine surgery due to neurologic deficit. Eleven patients with less than 2 years of follow-up and 2 patients who died from unrelated illness were excluded from the study. Thirty-six of 49 patients having minimum 2 years of follow-up were included. Cement augmentation was also performed in segments proximal and distal to instrumentation to prevent junctional segment fractures. Early and late postoperative complications were recorded during follow-up. The mean postoperative follow-up was 37 (24 to 48) months. The average age of the patients was 66 (59 to 78) years. The instrumentation was performed meanly at 5 segments and vertebroplasty was performed averagely at 7 segments. All patients had the T-score value of less than -2.5 from the anteroposterior and lateral lumbar spine and hip views, so regarded as severe osteoporosis. In our study group, there were no extravasation and subsequent thermal neural injury. Four superficial wound infections have been observed and they responded well to local debridement and antibiotics. There were no proximal and distal junctional segment fractures during the follow-up course. Postoperatively, all patients with neurologic symptoms had complete relief of their nerve compression symptoms. In patients requiring spine surgery due to neurologic deficit and having no sufficient time for the medical treatment of severe osteoporosis, pedicle screw fixation with vertebroplasty augmentation and vertebroplasty in segments proximal and distal to the instrumented segments can be good alternative methods to provide well fixation and fusion while preventing proximal and distal junctional fractures. One should be careful about pulmonary cement embolism after such kind of procedures.

A rare cause of neonatal hypocalcemia: malignant infantile osteopetrosis

Malignant infantile osteopetrosis (MIOP) is a rare inherited bone disease characterized by reduced or dysregulated activity of osteoclasts, which results in generalized osteosclerosis. This leads to abnormal bone marrow cavity formation and to the clinical signs and symptoms of bone marrow failure and nerve compression. Symptoms related to early or late hypocalcemia may appear as the first presentation of MIOP in a newborn. We present a 14-day-old boy with neonatal hypocalcaemia due to MIOP.

Thoracic Outlet Syndrome

: Arterial and venous thoracic outlet syndrome (TOS) were recognized in the late 1800s and neurogenic TOS in the early 1900s. Diagnosis and treatment of the 2 vascular forms of TOS are generally accepted in all medical circles. On the other hand, neurogenic TOS is more difficult to diagnose because there is no standard objective test to confirm clinical impressions. : The clinical features of arterial, venous, and neurogenic TOS are described. Because neurogenic TOS is by far the most common type, the pathology, pathophysiology, diagnostic tests, differential and associate diagnoses, and treatment are detailed and discussed. The controversial area of objective and subjective diagnostic criteria is addressed. : Arterial and venous TOS are usually not difficult to recognize and the diagnosis can be confirmed by angiography. The diagnosis of neurogenic TOS is more challenging because its symptoms of nerve compression are not unique. The clinical diagnosis relies on documenting several positive findings on physical examination. To date there is still no reliable objective test to confirm the diagnosis, but measurements of the medial antebrachial cutaneous nerve appear promising.

Spontaneous Massive Hemothorax Associated with Solitary Posterior Mediastinal Neurilemmoma

Neurogenic tumors are common in posterior mediastinal tumors and neurilemmoma represents approximately 40% of neurogenic tumors arising in the mediastinum. It is usually asymptomatic, and is generally diagnosed incidentally. In some cases, they presented with symptoms of nerve or airway compression. However, a solitary neurilemmoma, particularly not associated with von Recklinghausen disease, with spontaneous hemothorax is quite rare. We report a case of spontaneous massive hemothorax associated with a solitary neurilemmoma.

Complications of Volar Locking Plates for Distal Radius Fractures: Experience of a District General Hospital

Background: The role of volar locking plates in the treatment of distal radial fractures is unsettled. The objective of this study is to evaluate the complications of this treatment method in a district general hospital setting. Methods: We retrospectively reviewed the radiological and clinical records of 52 consecutive patients who were treated using volar locking plates between November 2004 and August 2006. Results: Forty-eight patients were available for review at an average follow-up of 14 months (6-26 months). Fifteen patients had one or more complications; median nerve compression symptoms (nine patients), hard-ware related complications (four patients), superficial wound infection and stitch abscess (three patients), malunion (two patients), failure of fixation and loss of reduction (two patients) and complex regional pain syndrome (two patients). A total of seven re-operations were performed. Discussion & Conclusions: Due to the high complication rate in this study, we recommend a more reserved attitude toward the use of distal radial volar locking plates.

A PROSPECTIVE PLAN TO MINIMISE MEDIAN NERVE RELATED COMPLICATIONS ASSOCIATED WITH OPERATIVELY TREATED DISTAL RADIUS FRACTURES

Loss of median nerve function or a neuropathic pain syndrome may occur in around 20% of distal radius fractures if post-traumatic oedema in the carpal canal generates excessive pressure on the median nerve. No method currently exists to reliably distinguish which patients may benefit from a concomitant carpal tunnel release. This case series details the results of following a prospective plan designed to minimise median nerve related complications associated with distal radius fractures by measuring Semmes-Weinstein monofilament scores in 374 radius fracture patients who underwent surgical stabilisation. One hundred and sixty-nine patients with the clinical symptoms of median nerve compression, a decrement in monofilament score of grade 1 (out of 5) compared to the contralateral side or at least 4.31 g underwent concomitant carpal tunnel release. The remaining 205 patients did not have carpal tunnel release. There were no cases of neuropathic pain or loss of median nerve function.

Effort-related compression of median and ulnar nerves as a result of reversed three-headed and hypertrophied palmaris longus muscle with extension of Guyon's canal

We explored a swelling on the anterior surface of the right distal forearm of a 21-year-old right-handed male soldier and effort-induced symptoms of median and ulnar nerve compression that showed a reversed, three-headed and hypertrophied palmaris longus muscle with extension of Guyon's canal.

A Rare Variant Formation Of The Median Nerve: A Case Report

Variations in the formation of median nerve are common but this case report is the rare variation of formation of the median nerve posterior to the third part of axillary artery. During educational dissection of undergraduate students of the academic year 2007-2008 in our department of anatomy, the two roots of the median nerve joined behind the axillary artery to form the median nerve, which coursed behind the brachial artery and then crossed to the medial part of cubital fossa. The lateral root passed between the axillary artery and anterior circumflex humeral artery to course to the back to join the medial root of median nerve. This variation may be clinically important because symptoms of median nerve compression arising from similar variations are often confused with more common causes such as radiculopathy and carpal tunnel syndrome.

A Novel Endoscopic Technique in Treating Single Nerve Entrapment Syndromes with Special Attention to Ulnar Nerve Transposition and Tarsal Tunnel Release: Clinical Application

To describe a simple retractor integrated endoscopic technique for treating idiopathic solitary compression neuropathies with special attention to the anterior transposition of the ulnar nerve and tarsal tunnel release, and to present the clinical results. Eleven patients with ulnar sulcus syndrome, eight with tarsal tunnel syndrome, and one with meralgia paraesthetica (seven females and 13 males; age range, 12-64 yr) were treated with endoscopic anterior ulnar nerve transposition and in situ decompression of the tibial (eight patients) and lateral femoral cutaneous nerves (one patient), respectively. The selection criteria were: classical nerve compression symptoms, failed conservative treatment, abnormal electrophysiology, and a nonviolated anatomic region. The degree of nerve compression (after Dellon) was rated as moderate in five out of 20 patients and as severe in 15 out of 20 patients. Electrophysiological studies were conducted independently by physicians specializing in these techniques. Postoperative recovery was evaluated according to the nine-point Bishop rating system. Of the 11 patients with anterior ulnar nerve transposition, seven scored excellent, three scored good, and one scored fair (mean follow-up, 15.5 mo; range, 6-27 mo). Five patients with tarsal tunnel release scored excellent and three scored good (mean follow-up, 10.1 mo; range, 3-24 mo). The patient with meralgia paraesthetica showed an excellent score at 28 months after surgery. There were no technical or postoperative complications. None of the operations had to be converted to open surgery. We describe a new endoscopic technique for transposing the ulnar nerve and decompressing the tibial nerve. This technique could be extrapolated to release other single nerve entrapments. The simplicity of the technique, and our preliminary clinical results, may encourage other groups to adapt this method.

The psoas quartus muscle

We report an unusual finding in an adult male cadaver. During the routine dissection of the posterior abdominal wall as part of an anatomy course at our institution, an anomalous muscle was noted. This muscle originated from the transverse process of the left L3 vertebrae and the medial aspect of the quadratus lumborum. We believe this muscle to represent a variety of the psoas quartus that, to our knowledge, has only been described once before in the extant medical literature. The presence of a psoas quartus muscle may contribute to femoral nerve compression. The clinician may wish to consider this rare muscular anomaly in patients with symptoms of femoral nerve compression in which no other clear etiology is found. Furthermore, clinicians who image the posterior abdominal wall should be aware of this potential anomaly when interpreting the anatomy of this region.

Open repair versus endovascular treatment for asymptomatic popliteal artery aneurysm: Results of a prospective randomized study

The aim of this prospective randomized study was to evaluate the relative risks and advantages of using the Hemobahn graft for popliteal artery aneurysm (PAA) treatment compared with open repair (OR). The primary end point was patency rate; secondary end points were hospital stay and length of surgical procedure. The study was a prospective, randomized clinical trial carried out at a single center from January 1999 to December 2003. Inclusion criteria were an aneurysmal lesion in the popliteal artery with a diameter > or = 2 cm at the angio-computed tomography (CT) scan, and proximal and distal neck of the aneurysm with a length of > 1 cm to offer a secure site of fixation of the stent graft. Exclusion criteria were age < 50 years old, poor distal runoff, contraindication to antiplatelet, anticoagulant, or thrombolytic therapy, and symptoms of nerve and vein compression. The enrolled patients were thereafter prospectively randomized in a 1-to-1 ratio between OR (group A) or endovascular therapy (ET) (group B). The follow-up protocol consisted of duplex ultrasound scan and ankle-brachial index (ABI) measured during a force leg flexion at 1, 3, and 6 months. Group B patients underwent an angio-CT scan and plain radiography of the knee with leg flexion (> 120 degrees) at 6 and 12 months, and then yearly. Between January 1999 and December 2003, 30 PAAs were performed: 15 OR (group A) and 15 ET (group B). Bypass and exclusion of the PAA was the preferred method of OR; no perioperative graft failure was observed. Twenty stent grafts were placed in 15 PAAs. Endograft thrombosis occurred in one patient (6.7%) in the postoperative period. The mean follow-up period was 46.1 months (range, 12 to 72 months) for group A and 45.9 months (range, 12 to 65 months) for group B. Kaplan-Meier analysis showed a primary patency rate of 100% at 12 months for OR and 86.7% at 12 months with a secondary patency rate of 100% at 12 and 36 months for ET. No statistical differences were observed at the log-rank test. The mean operation time (OR, 155.3 minutes; ET, 75.4 minutes) and hospital stay (OR, 7.7 days; ET, 4.3 days) were statistically longer for OR compared with ET (P < .01). We can conclude, with the power limitation of the study, that PAA treatment can be safely performed by using either OR or ET. ET has several advantages, such as quicker recovery and shorter hospital stay.

Persistent Sciatic Artery Aneurysm Treated by Exclusion and Obturator Bypass

Persistent sciatic artery (PSA) aneurysms occur infrequently and present a diagnostic and therapeutic challenge. The PSA is often associated with a hypoplastic femoral system meaning revascularisation is necessary in addition to exclusion of the aneurysm. We present a case of a PSA aneurysm presenting with symptoms of sciatic nerve compression, successfully treated with exclusion and revascularisation with an obturator bypass. Obturator bypass of a PSA aneurysm has been reported once, in that case to treat distal ischaemic symptoms. The aetiology, presentation and management of PSA aneurysms are discussed, concluding that obturator bypass is a satisfactory option for PSA aneurysm associated with a hypoplastic femoral system.

Persistent Sciatic Artery Aneurysm Treated by Exclusion and Obturator Bypass

Persistent sciatic artery (PSA) aneurysms occur infrequently and present a diagnostic and therapeutic challenge. The PSA is often associated with a hypoplastic femoral system meaning revascularisation is necessary in addition to exclusion of the aneurysm. We present a case of a PSA aneurysm presenting with symptoms of sciatic nerve compression, successfully treated with exclusion and revascularisation with an obturator bypass. Obturator bypass of a PSA aneurysm has been reported once, in that case to treat distal ischaemic symptoms. The aetiology, presentation and management of PSA aneurysms are discussed, concluding that obturator bypass is a satisfactory option for PSA aneursym associated with a hypoplastic femoral system.

Diagnostik von Hypophysenadenomen / Diagnostics of pituitary adenomas

Abstract Pituitary adenomas are rare benign tumors with delayed manifestation which can include headaches and symptoms of nerve compression, such as visual field disturbances or endocrine dysfunction. Endocrine abnormalities can be the result of overproduction of pituitary hormones, pituitary insufficiency, or a combination of both. The evaluation of suspected pituitary tumors should include the determination of the presence and type of hormone hypersecretion as well as hyposecretion, combined with pituitary imaging. Screening for pituitary dysfunction is achieved by assessing the pituitary and target hormone concentrations in blood, maybe followed by dynamic tests of the pituitary function.

Wrist joint ganglion presenting as a painless mass in the palm: report of 2 cases

Ganglions occur commonly in the wrist and arise from the radiocarpal and intercarpal joints. Although ganglions present commonly as masses on the dorsal or volar surface of the wrist, ganglions from wrist joints appear rarely at other locations in the hand. We report 2 cases of ganglions arising from wrist joints that presented as painless masses in the center of the palm without signs or symptoms of median or ulnar nerve compression. Surgical treatment required extensile exposure to trace the proximal stalks to their joints of origin. Knowledge of the possibility that a painless mass in the palm could be a ganglion arising from a joint in the wrist allows proper presurgical planning and informed consent.

Fibroma of a tendon sheath at the wrist: a rare cause of compression of the median nerve

We report a case of fibroma of a tendon sheath, a rare benign tumour, which presented as a painless swelling at the wrist and caused symptoms of median nerve compression. We have also reviewed similar cases.

Surgery of popliteal artery aneurysms: a 12-year experience.

Management of asymptomatic popliteal aneurysm is controversial, and the prognosis for acutely thrombosed aneurysm is notoriously poor. We evaluated the management and outcome for popliteal aneurysm. A retrospective review of all patients with popliteal aneurysm between 1988 and 2000 was carried out. Fifty-two limbs were operated on in 41 patients. Data collected included findings at presentation, operative details, graft patency, limb salvage, complications, and 30-day mortality. Initial findings included acute ischemia (n = 14), no symptoms (n = 29), acute rupture (n = 2), chronic ischemia (n = 5), and symptoms of nerve or vein compressive (n = 2). All patients with symptomatic aneurysms and 22 patients with asymptomatic aneurysms (21 larger than 2 cm in diameter, 1 with thrombus at duplex ultrasound scanning) underwent surgery as first-line treatment. Of the 7 patients with asymptomatic aneurysm managed with surveillance with duplex ultrasound scanning, acute ischemia developed in three, 1 aneurysm ruptured, compressive symptoms developed in 1, and 2 remained asymptomatic but required surgery because of aneurysm enlargement (>2 cm). Of the 17 patients with acute ischemia, 13 had neurologic signs and underwent immediate thromboembolectomy (trifurcation alone in 8, ankle-level arteriotomy in 4) and bypass grafting (n = 12) or inlay grafting (n = 1), and the other 4 underwent intra-arterial thrombolysis initially. Of these 4 procedures, 2 were successful and had elective surgery; the other 2 required urgent surgery because of secondary distal embolism and failure of recanalization. Thirteen of the 17 grafts were to the crural vessels. Bypass grafting (medial approach) was used in 16 of the 17 patients with acute ischemia, all 5 patients with chronic ischemia, and the 8 patients with no symptoms. An inlay technique (posterior approach) was used in 16 patients with no symptoms, the 3 patients with symptoms of nerve or vein compression, and 1 patient with acute ischemia. The distal anastomoses were to the below-knee popliteal artery in 35 patients and the crural arteries in 15 patients, using autologous vein. Two of the patients with rupture underwent ligation alone, the other undergoing bypass grafting in addition. The overall 5-year primary patency rate was 69%, secondary patency rate was 87%, and limb salvage rate was 87%. Limb salvage was achieved in 14 of the 17 patients with acute ischemia. Patients with asymptomatic aneurysms had better secondary graft patency (100%) compared with symptomatic aneurysms (74%; P <.01). Acute ischemia, technique used, and crural artery grafts were not predictors of graft failure with either univariate or multivariate analysis. Symptomatic aneurysms were associated with more postoperative complications and greater 30-day mortality (4 of 28 vs 0 of 24). Thromboembolectomy followed by crural bypass grafting is an effective treatment for popliteal aneurysm with severe acute limb ischemia. Outcome is better with surgical management of asymptomatic popliteal aneurysm compared with symptomatic aneurysm.

Venous Rupture Complicating Hemodialysis Access Angioplasty: Percutaneous Treatments and Outcomes

Purpose: To evaluate the usefulness of percutaneous management and prognosis in venous rupture during angioplasty of hemodialytic arteriovenous fistulas. Materials and Methods: Among 814 patients who underwent angioplasty on account of inadequate hemodialysis, 63[39 women and 24 men aged 20-78 (mean, 55.8) years] were included in this study. All 63 had peripheral venous stenosis. Venous rupture was diagnosed when contrast leakage was seen at venography after percutaneous angioplasty (PTA). In order to manage venous rupture, the sites at which this occurred were compressed manually for 3-5 minutes or blood flow was blocked with a balloon catheter for the same period. In one case, a stent was inserted at the rupture site. Using the Kaplan-Meier method, we investigated the patency rate of arteriovenous fistula (AVF) in cases of successful PTA. We also compared PTA patency rates in cases with and without peripheral venous rupture. Results: Venous rupture occurred in 38 cephalic, 16 brachial, and 9 basilic veins. In 63 patients, bleeding stopped and in 54 (85.7%) of these, PTA was successful. Among the nine failed cases, dilatation was incomplete in five, though bleeding had stopped. In patients with brachial and cephalic vein rupture, the venous tract at the rupture site was not located. Two patients underwent surgery: one of these experienced brachial venous rupture, with incontrollable bleeding, and the other had nerve compression symptoms due to hematoma. Among 54 patients in whom PTA was successful, the primary and secondary six-month rates for angioaccess were 47.9% and 81.2%, and the mean patency period was 6.1 and 15.8 months, respectively. In cases of non-venous rupture, the mean patency period was 9.6 months, significantly longer than in cases involving venous rupture (p=0.02). Conclusion: Venous rupture occurring during the PTA of hemodialytic AVF can be managed percutaneously.