Tinel's Sign Research Articles

Schwannoma of median nerve: Case report and review of literature

Schwannoma of the median nerve is uncommon. It can be mistaken for other benign swellings. A 59- year- old lady presented with a slowly increasing swelling on the thenar aspect of left hand. She had pain and numbness. Tinel's sign was positive. MRI showed an intensely enhancing, ovoid swelling eccentrically to the median nerve. There was heterogeneity on T2-weighted image and on contrast enhanced sequence. Contrasting central and peripheral intensities is known as the target sign. Surgery was done with local anaesthesia under operating microscope. Dissection was done between the fascicles and the tumour wall. The tumour was excised. Histopathological examination showed spindle cells, with Antoni A and Antoni B areas, Verocay bodies and ectatic blood vessels. Immunohistochemistry showed positivity for S-100. Ki-67 index was 1–2%. The diagnosis was schwannoma. Postoperatively she was relieved of numbness.

An iatropathic tibial nerve injury in a patient following total ankle replacement

Ankle arthroplasty is an infrequent procedure, and there is a risk of injury to nearby neurovascular structures from direct injury and from traction. The risk of nerve injury is difficult to quantify due to low-procedure numbers, non-mandatory nerve injury reporting to the National Joint Registry in the UK and delayed recognition of nerve injury despite the British Orthopaedic Association Standards for Trauma 5 guidelines on the management of peripheral nerve injury. Neuropathic pain following a major joint procedure with disordered sensation, motor paralysis and alterations in autonomic function in the distal skin are suggestive of nerve injury. A Tinel's sign at the site of suspected injury is diagnostic and the nerve should be promptly explored by a surgeon familiar with the operative assessment and reconstruction options for nerve injury. Processed nerve allograft is a useful adjunct in the reconstruction algorithm in cases of non-critical nerve disruption and central sensitisation to avoid the harvest of an intact sensory autologous nerve and risking further exacerbation of neuropathic pain at another site. The case presented discusses an iatropathic tibial nerve injury in a 48-year-old man who underwent reconstruction using nerve allograft.

Evaluating of the Outcomes of Median Nerve Decompression with a Mini Incision Proximal to the Distal Wrist Crease.

To evaluate the feasibility of the mini-open incision method in patients who underwent median nerve decompression in the carpal tunnel with a mini incision made proximal to the distal wrist crease. A total of 80 patients (84 hands) operated by a single surgeon with a mini incision were included. The patients were evaluated postoperatively for the presence of pillar pain, pain on the incision scar, and scar sensitivity in addition to preoperative findings. The Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) questionnaire was used for clinical scoring. To evaluate the effectiveness of the method, the findings were recorded at and compared between at 12 and 24 months follow-ups. No complications were observed at the wound site in the early postoperative period. Ten patients reported numbness, 5 experienced weakness, and 4 revealed positive Tinel's sign. Keloid formation without pain and scar sensitivity was detected in 2 patients at 6 months. No patient reported night pain, pain on pillar or incision scar, scar sensitivity, recent sensory loss, and disease recurrence. Numbness was present in 7 patients at 12 months and in 3 at 24 months; 3 and 2 patients reported weakness at 12 and 24 months, respectively. The mean Quick DASH score was 72.7 preoperatively, 10.2 at 12 months, and 9.1 at 24 months. The median nerve decompression in the carpal tunnel may be performed with a mini incision made proximal to the distal wrist crease is effective and safe method, and provides less complications and higher patient comfort.

The late diagnosis of nerve injuries following interscalene block and shoulder surgery

Objectives: Interscalene blocks are commonly performed with the shoulder surgery, nerve injuries are reported to have the prevalence of 14% at 10 days postoperatively. While clinicians may be aware of the associated risk of nerve injury from either the surgery or the block, they may not recognize these nerve injuries. Our objectives were to determine factors contributing to injury and late referral. Methods: We searched our peripheral nerve injury database to identify a consecutive series of nerve injuries-associated with interscalene nerve block and the shoulder surgery. The identified cases were subject to clinical review and a review of the medical records including the consent form, anesthetic records, operation note, and the neurophysiology records. Results: Six cases of nerve injury were identified during a 24-month period. Half the patients experienced a delay of >6 months from injury to review, despite the documentation of persisting sensory and motor dysfunction. Regional anesthesia technique was not uniform. All patients required a specialist treatment from a regional peripheral nerve injury service. Conclusions: Clinicians should be aware that prolonged block duration is a feature of the potential nerve injury. The presence of a Tinel sign, autonomic dysfunction, and nerve pain in the distribution of the injured nerve are features suggesting nerve injury. Orthopedic surgeons should be able to recognize the nerve injury and seek early referral to the appropriate specialists. Where doubt exists, the patient should be referred for an urgent review by a peripheral nerve injury specialist.

Validity of the Tinel Sign and Prevalence of Tibial Nerve Entrapment at the Tarsal Tunnel in Both Diabetic and Nondiabetic Subjects: A Cross-Sectional Study.

Nerve entrapments like carpal tunnel syndrome are more prevalent in patients with diabetes, especially in those with diabetic polyneuropathy. Our study aims were to investigate the validity of the Tinel sign in diagnosing tibial neuropathy and determine the prevalence of tibial nerve entrapment in both a diabetic and nondiabetic population. Two hundred forty nonneuropathic subjects with diabetes and 176 diabetic subjects with neuropathy participating in the prospective Rotterdam Diabetic Foot Study and 196 reference subjects without diabetes and without neuropathy complaints were evaluated. All subjects underwent sensory testing of the feet, and complaints were assessed using the Michigan Neuropathy Screening Instrument. The Tinel sign was defined as discriminative and valid for diagnosing tibial nerve entrapment when the nerve-related Michigan Neuropathy Screening Instrument subscore of neuropathic symptoms differed at least 5 percent between the Tinel-positive and Tinel-negative subjects. When the sign was valid, prevalence estimates of tibial nerve entrapment at the tarsal tunnel were calculated. Significantly more neuropathic symptoms (p < 0.002) and higher sensory thresholds (p < 0.0005) were observed in (compressed) tibial nerve-innervated areas, indicating that a positive Tinel sign at the tarsal tunnel is a valid measure of tibial nerve abnormality. The prevalence of tibial nerve entrapment in diabetic patients was 44.9 percent (95 percent CI, 40.1 to 49.7 percent) versus 26.5 percent (95 percent CI, 20.3 to 32.7 percent) in healthy controls (p < 0.0001). Tibial nerve entrapment is more prevalent in diabetic subjects than in controls. The significantly more frequently reported neuropathic complaints and concomitant sensory disturbances provide evidence for the role of superimposed entrapment neuropathy in diabetes-related neuropathy. Diagnostic, IV.

A study of effect of tarsal tunnel decompression on sensory improvement in diabetic foot: a prospective randomized control trial

Background: In India approximately, 45000 legs are amputated every year and almost 75% of these amputations are carried out in neuropathic feet which are potentially preventable. Diabetic peripheral nerves are at risk of entrapment neuropathies focally, where these nerves are contained in a closed space. The aim of the study was to find out the effect of decompression of compressed posterior tibial nerve and its branches at tarsal tunnel in restoration of sensation in diabetic foot.Methods: A total of 70 diabetic patients with ulcer foot in one limb (test limb) and with no ulcer on the other limb (control limb) were selected for study. The test limb was subjected to tarsal tunnel release. Sensory recovery was evaluated in the ulcer limb and compared with normal limb in same patient and results were evaluated statistically for significance.Results: Present study shows that following tarsal tunnel decompression surgery on test limb, 65 patients (93%) had sensory gain and 5 patients (7%) had documented no sensory gain on test limb, with statistical significance. After de-compressive surgery on the test limb, 69 patients (98.6%) were documented to have resolving of Tinel sign in the test limb with sensory improvement, suggesting adequate decompression and 1 patient (1.4%) was documented to have persistent Tinel sign suggesting possibility of inadequate decompression with no recovery of sensation, with statistical significance.Conclusions: Present study reveals that decompression of tarsal tunnel in diabetic ulcer foot patients leads to definite improvement in sensation of foot which will prevent further ulcer formation and resultant complications ending in amputations.

WED 222 Hawkes sign: a novel test for carpal tunnel syndrome

BackgroundIn carpal tunnel syndrome (CTS) patients often report symptoms when elevating the arms, as in driving or phoning.In Hawkes test both forearms are squeezed firmly about 50 mm (2 inches) proximal to the patient’s wrist while simultaneously elevating the subject’s hands just above shoulder height. When positive there is tingling in a median nerve distribution within a few seconds.MethodsFifteen patients with suspected CTS were evaluated by a) Tinel’s, Phalen’s and Hawkes’ manoeuvres b) routine nerve conduction tests (NCT) then graded positive or negative and compared with NCT.ResultsPositive signs were present for Tinel in 14/15; Phalen in 8/10 and Hawkes in 15/15. NCT supported CTS in 9/15. Where NCT were abnormal Tinel and Hawkes signs were always positive but Phalen was negative in 2/7. Where NCT was normal (6/15) the negative/positive rates were: Tinel 1/5; Phalen 3/3; Hawkes 0/6.ConclusionAll three procedures, particularly Tinel and Hawkes had a high positive rate for CTS, but confirmed by NCT in only 6/15. However, NCT may be falsely negative especially in mild cases. The proposed arm elevation/compression test permits useful initial assessment of CTS although the false positive rate is probably high.

Is there a correlation between sensory and motor axonal damage of the median nerve during carpal tunnel syndrome?

Objectives Carpal tunnel syndrome (CTS) is the most common nerve compression. The Electroneuromyography (ENMG) is the most objective test to document neurophysiological abnormalities [1] . Sensory impairment often precedes motor impairment, and demyelination precedes axonal loss. To our knowledge, no study has investigated the relationship between sensory and motor impairment. The aim of this work is to look for a correlation between sensory axonal loss and motor loss of the median nerve. Methods This is a retrospective study that regrouped 60 patients (120 hands) and for whom the diagnosis of CTS was retained following the ENMG. The statistical study was carried out with SPSS 20 software. The correlation was studied by the Pearson test. Results The mean age of the patients was 53.16 ± 11.8 years. The female sex was predominant with a sex ratio of 0.11. Diabetes was present in 40% of patients and hypothyroidism in one patient. The clinical lesion was bilateral in 75% of cases. Tinel sign was positive in 59.2% of the hands and phalen sign in 53.3% of the hands. The ENMG objectified CTS in 89.2% of hands with sensory-motor involvement in 50.8% of hands. Axonal loss was found in 36.7% of the hands. Mean sensory and motor amplitude was 63.4 ± 46.7 uV and 12.54 ± 4.9 mV respectively. The Pearson test showed a significant correlation between the amplitude of the sensory potential and that of the motor potential of the median nerve (P = 0.005). Conclusion This study shows a correlation between sensory and motor axonal loss. A multicenter study is needed to better retain this correlation relationship.

Compressive Neuropathy of the Ulnar Nerve in the Hypothenar Region by Lipoma: Case Report

AbstractLipomas are well-defined tumors of the adipose tissue that often occur in the torso or the extremities of adult patients. These tumors usually develop painlessly and insidiously, but they may compress adjacent structures. The objective of the present study is to describe the case of a 68-year-old female patient with a giant lipoma located at the hypothenar region, with manifestation of compression of the common palmar digital nerves, the ulnar nerve, and the abductor muscle of the V finger. Regarding the symptoms, the patient felt moderate pain in the hypothenar region, with no Tinel sign, and no changes in the motor function or sensibility of the digits innervated by the ulnar nerve. Lipomas may present a varied range of histological characteristics, and malignant tumors may be a differential diagnosis. An imaging exam may aid in the diagnosis, which is confirmed by a histopathological study. For the present case, as recommended in the literature, a surgical procedure was performed for the resection of the tumor, which resulted in the control of the symptoms.

Retrospective study to evaluate the treatment of digital pulp lesions using a homodigital flap

ObjectiveTo assess the homodigital flap surgical procedure, as well as the function of the finger, pain, sensation, esthetics, and patient satisfaction. MethodRetrospective analysis of records and questionnaires of patients who underwent this surgical technique between the months of May 2013 and October 2016. Eight were included in the study, with an average follow-up period of 23 months. Patients with digital pulp lesions of the thumbs and those who did not perform rehabilitation were excluded. All underwent the two-point discrimination test, the Semmes–Weinstein test, and range of motion evaluation. The age varied from 22 to 59 years (average of 32.9), six (75%) being male patients. ResultsThree patients (37.5%) had involvement of the right hand and five of the left (62.5%). Regarding the etiology, seven suffered injury and one a chemical burn. The average distance obtained from the two-point discrimination test was 7.3mm. All patients who underwent the Semmes–Weinstein test obtained response to the purple filament. The average sum of the range of motion of the affected digit was 98.9%. The flap area was on average 294.4mm2. The return to work averaged seven weeks. A positive Tinel sign was found in the donating area and two reported intolerance to cold. Partial or total necrosis of the flap was not observed. ConclusionThe homodigital flap technique presented satisfactory esthetics and functional results regarding feasibility, sensation, and digital mobility in pulp lesions.

Surgical Results of Common Peroneal Nerve Neuroplasty at Lateral Fibular Neck.

Common peroneal nerve (CPN) compressive neuropathy is the most common lower-extremity entrapment neuropathy. A retrospective review of a prospectively maintained single-institution database of all patients with CPN palsy who underwent decompression and neuroplasty over a 5-year period was performed. Thirty patients underwent a neuroplasty of the CPN over a 5-year period (2010-2015) at our institution. The median age was 45 years, and there was a male preponderance. The average time between first onset of symptoms to surgery was 122.9 weeks and between first clinic visit and surgery was 21 weeks. The etiology of the CPN neuropathy was as follows: in 12 patients, it followed a surgical procedure and in 14 patients, it occurred after a trauma to the lower extremity. In 2 patients, it occurred as a result of a mass lesion compromising the nerve and in 1 patient, a local infection predisposed to CPN palsy. Right and left lower extremities were equally involved. The median body mass index was 28.6. The most common presentation was weakness of the tibialis anterior (TA) and extensor hallucis longus (EHL) and loss of sensation in the distribution of the CPN or one of its major branches. Pain was a presenting symptom in 16 patients. Only 12 of the 30 patients had a positive Tinel's sign at the site of compression over the lateral fibular neck. Preoperative electrophysiologic confirmation of CPN neuropathy was available in all patients. Mean follow-up was 52 weeks. Prone positioning and selective use of the operating microscope provided excellent visualization and surgical exposure of the CPN from the lower popliteal region to the peroneal tunnel. Average operating room time was 170 minutes and average skin-to-skin time 91 minutes. Clinical improvement after surgery in terms of motor function was noted in 24 of the 26 patients who presented with a motor deficit. The most consistent improvement was noted in the TA and EHL; a trend toward greater improvement with shorter time to surgery was noted. No complications related to the surgical site or CPN were encountered, and no patient had a decline in their neurologic examination as a consequence of the surgery. One patient developed a positioning-related right upper-extremity brachial plexus neuropraxic injury after surgery that recovered completely. Common peroneal neuropathy usually presents with weakness of the TA and EHL and decreased sensation or pain in the distribution of the CPN. Microscope-assisted surgical neuroplasty of the CPN at the lateral fibular neck with the patient in a prone position allows decompression of the nerve from the lower popliteal region to the peroneal tunnel. Significant improvement in motor strength after surgery, particularly of the TA and EHL, was observed in this series.

Effect of Alpha-Lipoic Acid on Clinical and Neurophysiologic Recovery of Carpal Tunnel Syndrome: A Double-Blind, Randomized Clinical Trial.

The objective of our study was to examine the effect of alpha-lipoic acid (ALA) on clinical and neurophysiologic outcomes after surgery for idiopathic carpal tunnel syndrome (CTS). We conducted a randomized, double-blind, placebo-controlled clinical trial in 20 adults diagnosed with idiopathic CTS after clinical and neurophysiologic assessment. Eligible participants took 600 mg ALA or placebo per day for 1 month before surgery, and for 2 months afterward. Further clinical and neurophysiologic assessments were undertaken immediately before surgical decompression, and at 12 weeks postoperatively with additional clinical assessments at the 4th and 8th week after surgery. Clinical outcome measures were taken by Boston Questionnaire score, the presence or absence of Tinel's sign, and Phalen's test findings. Median nerve conduction studies were also undertaken and interpreted according to Dumitru's reference values. Nineteen patients completed the study; one member of the placebo group was lost during follow-up. There were significant improvements in clinical and neurophysiologic variables in the ALA treatment group, present even before surgery. Boston Questionnaire scores had improved significantly in both groups. In the ALA group, none of the participants had positive Phalen's or Tinel's signs at 12 weeks, and motor and sensory fiber latency and amplitude had significantly improved; in the placebo group, only the sensory distal latency had improved significantly. In conclusion, ALA administered 1 month before open decompression and for 2 months afterward improves the clinical and neurophysiologic outcomes after surgery.

Modified simple decompression of ulnar nerve in the treatment of cubital tunnel syndrome: Report of a series of cases.

Ulnar compressive neuropathy is the second most common nerve compression in the upper extremity. Although numerous operative procedures have been defined for the treatment of cubital tunnel syndrome (CuTS), the best operative intervention remains controversial. The aim of this study is to discuss the efficacy of a modified simple decompression (MSD) of the ulnar nerve in the treatment of CuTS. Each patient was preoperatively examined, and the following data were recorded: initial complaint, duration of symptoms, and presence of Tinel's sign around the elbow, results of provocation by the elbow flexion test, and results of electrodiagnostic studies. Patients' preoperative clinical manifestations were determined based on Dellon's staging system and Bishop scores. Pre- and post-operative motor conduction velocity (MCV) of the ulnar nerve were also recorded. Under the regional anesthesia, 4 cm long curved skin incision, above and below the elbow, was made posterior to the medial epicondyle of the humerus and the ulnar nerve was seen. The nerve was released proximally as it passed through the medial intermuscular septum. The cubital tunnel retinaculum and flexor carpi ulnaris aponeurosis were then cut distally. Only the compressive fascial bands are released. Then, the cubital tunnel reticulum was sutured to subcutaneous tissue loosely to prevent subluxation of the ulnar nerve. A total of 15 patients were operated. Postoperative electrophysiological study assessed at 3 months following surgery in 8 patients. In 7 of these patients (86%), the mean value of MCV had improved from 38.9 ± 12.0 m/s to 48.1 ± 11.9 m/s (P < 0.05). According to Bishop scoring system, 13 patients (86.7%) were clinically graded as excellent, 1 patient (6.7%) was graded as good, and only 1 patient (6.7%) was graded as fair. MSD is a technically simple, safe, and effective method without annoying complications.

Problems of the diagnosis and treatment of compression neuropathy of the median nerve: an analysis of typical medical practice

An analysis of typical medical errors in the diagnosis and treatment of compression neuropathy of the median nerve at the level of the wrist (carpal tunnel syndrome - CTS). Previous diagnoses and treatment of 85 patients with CTS (14 men and 71 women), aged from 36 to 84 years (middle age 62±10.6 years), who underwent surgery in our clinics were evaluated. The wrong diagnosis was made in most of patients (60%). The osteochondrosis of cervical spine (45.8%) and diabetic polyneuropathy (5.8%) were the most common mistaken diagnoses. Proper neurophysiological measurements using the Phalen's test and Tinel's sign were not performed in the majority of patients. Magnetic resonance imaging (MRI) of the cervical spine was often unreasonably made, the electroneuromyography was not used. Nonsteroidal anti-inflammatory drugs (NSAIDs), vitamin B group were improperly prescribed to the patients diagnosed with CTS. Local corticosteroids injections were not prescribed to most of patients, immobilization of the wrist was not recommended at the early stage of disease and decompressive surgery at the advanced stage of disease. Clinical observation of the patient with long period of misdiagnosing is presented. Despite the long-standing history of CTS, surgical decompression led to regression of symptoms and complete professional rehabilitation. It is necessary to inform physicians about manifestations, diagnostic criteria and effective methods of treatment of CTS.

Value of Motor Nerve Conduction Studies in the Diagnosis of Idiopathic Tarsal Tunnel Syndrome: A Single-center Prospective Observational Study from India.

Background:Nerve conduction studies are considered to be the gold standard for diagnosing secondary tarsal tunnel syndrome (s TTS), but their utility in the diagnosis of idiopathic tarsal tunnel syndrome (i TTS) is largely unknown.Objective:We sought to investigate the value of motor nerve conductions studies (MNCS) in the diagnosis of clinically suspected iTTS.Materials and Methods:Twenty-six (52 limbs) adult patients of clinically suspected iTTS were subjected to motor nerve conductions of posterior tibial nerve, and its branches and motor conduction parameters were compared with those of 45 healthy controls.Results:Symptoms were bilateral in 70% (P = 0.02), with heel pain in 95% of symptomatic limbs. MNCS was abnormal in 32 (80%) of symptomatic limbs and 8 (66.6%) of asymptomatic limbs (P = 0.004). Out of electrophysiologically abnormal nerves (n = 67), the pathological process could be identified in all the nerves with abnormal MNCS (P = 0.02). Probable demyelination was seen in 58.2% of the electrophysiologically abnormal nerves.Discussion:The present study shows that iTTS are gender and Body Mass Index neutral with bilateral symptoms being common. Tinel's sign was inconsistent. Heel pain did not correlate with abnormal inferior calcaneal nerve conductions. Motor nerve conduction study was abnormal in a significant number of symptomatic limbs. “Probable demyelination” was more frequent in symptomatic limbs.Conclusion:MNCS is significantly abnormal in symptomatic limbs of subjects with iTTS. Demyelination is slightly more common than axonopathy in iTTS. With a sensitivity of 80% and specificity of 33.3%, MNCS seems to be useful as a screening tool in clinically suspected iTTS. This study is Level II: Lesser quality randomized controlled trial or prospective comparative study.

Effectiveness of combined ultrasound and exercise therapy in the treatment of carpal tunnel syndrome - randomized, placebo-controlled investigation

Introduction/Objective. The aim of the paper was to evaluate the short-term effectiveness of ultrasound treatment procedure on defined clinical parameters and changes of electrodiagnostic parameters at the median nerve in carpal tunnel syndrome patients. Methods. Thirty-five patients (50 hands) were randomly divided into two groups: the experimental group (EG) (20 patients (29 hands)) and the control group (CG) (15 patients (21 hands)). Twenty sessions of ultrasound treatment were performed over a period of seven weeks and control examination was performed during the eighth week from the initial session. Clinical assessment parameters (pain intensity, superficial sensibility, and Tinel sign), and electrodiagnostic parameters (motor distal latency ? mDL), median sensory nerve conduction velocity (SNCV), and median sensory nerve action potential (SNAP) were assessed both at baseline (T1) and at control (T2). Results. There is significant improvement of pain intensity (T1 ? 10.4/58.6/31; T2 ? 65.5/27.6/6.9; p &lt; 0.001) and superficial sensibility (T1 ? 3.4/69/27.6; T2 ? 44.8/34.5/20.7; p &lt; 0.001) in the EG after the treatment. In the EG, there is significant reduction in frequency of positive Tinel?s sign (T1 ? 100/0; T2 ? 62.1/37.9; p &lt; 0.001), and mDL significantly decreased after the treatment (T1 ? 4.7 ? 1.3; T2 ? 4.5 ? 1.2; p = 0.007), while SNAP (T1 ? 20.2 ? 15.4; T2 ? 24.4 ? 16.5; p &lt; 0.001) and SNCV (T1 ? 36.5 ? 9.8; T2 ? 42.6 ? 9.7; p &lt; 0.001) significantly increased. Conclusion. Ultrasound treatment along with exercises have positive short-term effects and benefits on improvement of clinical and electrodiagnostic findings in individuals with carpal tunnel syndrome.

Hypothenar fat pad flap vs conventional open release in primary carpal tunnel syndrome: A randomized controlled trial.

AIMTo compared outcomes between the hypothenar fat pad flap (HTFPF) and conventional open carpal tunnel release (COR) in primary carpal tunnel syndrome (CTS).METHODSForty-five patients (49 hands) were enrolled into the study from January 2014 to March 2016, 8 patients were excluded. Randomization was conducted in 37 patients (41 hands) by computer generated (Block of four randomization) into COR and HTFPF group. Nerve conduction study (NCS) included distal sensory latency (DSL), distal motor latency (DML), sensory amplitude (S-amp), motor amplitude (M-amp) and sensory nerve conduction velocity (SCV) were examined at 6 and 12 wk after CTR. Levine score, grip and pinch strength, pain [visual analog scale (VAS)], 2-point discrimination (2-PD), Semmes-Weinstein monofilament test (SWM), Phalen test and Tinel’s sign were evaluated in order to compare treatment outcomes.RESULTSThe COR group, 19 patients (20 hands) mean age 50.4 years. The HTFPF group, 20 patients (21 hands) mean age 53.3 years. Finally 33 patients (36 hands) were analysed, 5 patients were loss follow-up, 17 hands in COR and 19 hands in HTFPF group. NCS revealed significant difference of DSL in HTFPF group at 6 wk (P < 0.05) compared with the COR group. S-amp was significant improved postoperatively in both groups (P < 0.05) but not significant difference between two groups. No significant difference of DML, M-amp and SCV postoperatively in both groups and between two groups. Levine score, pain (VAS), grip and pinch strength, 2-PD, SWM, Phalen test and Tinel’s sign were improved postoperatively in both groups, but there was no significant difference between two groups.CONCLUSIONThere is no advantage outcome in primary CTS for having additional HTFPF procedure in CTR. COR is still the standard treatment. Nevertheless, improvement of DSL and S-amp could be observed at 6 wk postoperatively.

Value of oxyneurography, based on near infrared spectroscopy, in the diagnosis of carpal tunnel syndrome in comparison to provocative clinical diagnostic tests and nerve conduction studies

ObjectiveEvaluation of the diagnostic utility of the oxyneurography (ONG) in diagnosing carpal tunnel syndrome (CTS). MethodsONG examination of the median nerve was performed in 260 patients. The results were compared with nerve conduction studies and clinical provocative tests. ResultsONG index greater than or equal to 62% was found in 95.18% of the patients with no or minimal Nerve Conduction Study (NCS) changes (1–2 according to the Padua classification) but only in 1.69% of the patients with advanced NCS changes (Padua 3–6). The sensitivity and specificity of the ONG study i.e. 95.18% and 98.31%, respectively, were compared with standard clinical tests: Tinel sign (61.45% and 14.69%), Phalen test (34.94% and 45.20%), reverse Phalen test (81.93% and 34.46%) and carpal compression test (91.57% and 72.32%). ConclusionsONG index lower than 62% was indicative of CTS. ONG has higher sensitivity and specificity then other clinical tests and it is an accurate and reliable method for the diagnosis of CTS. SignificanceOxyneurography is a non-invasive, fast and safe study which may play role in the diagnosis of carpal tunnel syndrome.

Effectiveness of wrist tube inside and outside releasing for treating median nerve double entrapment at wrist

To investigate the effectiveness of wrist tube inside and outside releasing for treating median nerve double entrapment at wrist. Thirty-one patients of median nerve double entrapment at wrist were treated between April 2011 and May 2014. There were 8 males and 23 females with an age of 33-69 years (mean, 56.4 years). In palm lateral three and a half finger, the two-point discrimination was 7-14 mm (mean, 9.5 mm), in which 24 cases were 4-10 mm and 7 cases were more than 10 mm. Carpal tunnel median nerve Tinel sign was positive; there was weak and acid swollen felling when press big thenar muscle on median nerve return branch palm surface projection points. Electromyography examination showed that median nerve endings movement incubation period was 4.5-10 ms in 22 cases, more than 10 ms in 9 cases; fibrillation potentials and positive phase voltage happened in 6 cases; the median nerve sensory conduction velocity of all patients was slow, and the motor conduction velocity also slowed down; the motor amplitude was 5-10 mV in 19 cases, less than 5 mV in 12 cases. The disease duration was 3-8 months (mean, 5.5 months). Surgical exploration of wrist median nerve in carpal tunnel and median nerve return branch outside carpal tunnel were performed in patients, especially completely released the variety entrapment factors such as thickening bow at starting point of short hallux flexor tendon, fiber bundles at ulnar side of short hallux flexor tendon, deep layer fiber of the palmar aponeurosis, and variant shallow head of short hallux flexor. All the wounds healed by first intention without wound scar pain. The patients were followed up 24-59 months (mean, 33 months). Night numbness and pain disappeared, and weak and acid swollen feeling in big thenar muscle on median nerve return branch points also disappeared. The sensation recovered to S 4 in 28 patients in palm lateral three and a half finger, the index and middle fingertip sensation recovered to S3+ in 3 cases. In the median nerve innervation area, the two points discrimination was 4-6 mm (mean, 4.8 mm). The thumb opposition function returned to normal in 29 cases and mild confinement in 2 cases. The grip strength of all the 31 cases recovered, and 1 of them increased significantly. In preoperative big thenar muscle atrophy cases, muscle strength recovered to S 5 in 4 cases, S 4 in 2 cases. At 2 years after operation, according to the functional assessment of carpal tunnel syndrome recommend by GU Yudong, the results were excellent in 29 cases and good in 2 cases, with an excellent and good rate of 100%. When treating the nerve double entrapment in wrist using wrist tube inside and outside releasing method, the variety entrapment factors of return branch of median nerve should be completely released, so the effectiveness can be improved.

Management and patients perspective regarding a common peroneal nerve schwannoma: a rare cause of lower leg pain in a young individual

The differential diagnosis of exercise-induced lower leg pain in young individuals is extensive and includes entities such as chronic exertional compartment syndrome, popliteal arterial entrapment syndrome, cystic adventitial disease, medial...