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Biomedical subjects

O C Aszmann

Publications and source records attributed to O C Aszmann.

13 recordsLinked to original sources
PubMed2006

[Is a differentiated treatment depending on the degree of severity justified in cubital tunnel syndrome?].

BACKGROUND: Cubital tunnel syndrome is the second most common chronic nerve entrapment of the upper extremity, yet both diagnosis and staging of the severity of the progression of the disease rely mostly on the keen observation and interpretation of clinical signs and symptoms. To be valid, a staging system must correlate well with the known pathophysiological mechanisms of chronic nerve compression, have objective parameters available to quantify differing degrees of sensory and motor dysfunction, and finally must allow different therapeutic consequences. PATIENTS AND METHODS: In this study we have prospectively evaluated 44 patients who presented with the clinical diagnosis of cubital tunnel syndrome. Quantitative Sensory Testing was performed using a computer-assisted testing system (Sensory-Management Services L. L. C., Baltimore). Classic two-point discrimination, one point pressure threshold, pinch and grip strength were measured. Progression of disease was staged according to the gradual loss of sensory and motor function. After an average of 15 months postoperatively, ulnar nerve function was re-evaluated using the same parameters and outcome measured with the modified Bishop rating scale. RESULTS: The results of this study indicate that 100 % of patients in the moderate group had a good and excellent outcome, whereas only 74 % of the severe group were rated as good and excellent with 17 % moderate and 9 % poor outcome.

Adult↗
PubMed2005

[Significance of electroneurographic parameters in the diagnosis of chronic neuropathy of the ulnar nerve at the elbow].

PURPOSE: Ulnar neuropathy at the elbow (UNE) is the second most common compressive neuropathy of the upper limb. Besides clinical evaluation, electrodiagnostic studies are usually applied to confirm the diagnosis. However, there are certain limitations to the diagnosis of UNE by electrodiagnostic studies. In a prospectively performed study we compared the diagnostic value of the electrodiagnostic parameters to the symptoms and the clinical parameters for different degrees of sensory and motor dysfunctions. METHODS AND MATERIALS: Between 2001 and 2003, 38 patients (mean age 53.9 +/- 8.8 years, 19 men and 19 women) were treated at our institution for UNE. For 34 (89%) patients complete electrodiagnostic studies were performed and for 25 patients there was also an electrodiagnostic evaluation of the asymptomatic contralateral arm. According to the symptoms and clinical parameters (grip and pinch grip, two-point discrimination), the patients were assigned to three stages (mild, moderate, and severe). Electrophysiological measurements for each stage were compared with one another. The diagnostic value for each electrophysiological parameter was evaluated in comparison to the normal limits of the "Deutsche Gesellschaft für Neurologie (DGN)" and the "American Association of Electrodiagnostic Medicine (AAEM)". RESULTS: In the 34 symptomatic arms the mean values for motor nerve conduction were: conduction velocity (MNCV) = 41.2 +/- 11.6 m/s; velocity change above-to-below-elbow segment = 12.8 +/- 7.7 m/s; CMAP = 9224 +/- 5514 microV; dL = 3.24 +/- 0.82 mg. For the moderate stages of nerve compression (n = 11) the mean values are: MNCV = 42.5 +/- 12.7; velocity change MNCV = 13.2 +/- 6.8; CMAP = 11 890 +/- 4750; dL = 2.97 +/- 0.57; for severe nerve compression (n = 23): MNCV = 40.6 +/- 11.0; change MNCV = 12.7 +/- 8.3; CMAP = 7948 +/- 5358; dL = 3.37 +/- 0.8. The difference for each parameter between the symptomatic and asymptomatic contralateral arm was statistically significant (p < 0.05) as it was for the difference of the parameters of the group with severe nerve compression in comparison to the asymptomatic arm. In the comparison of the moderate stage group with the asymptomatic arm there was only a significant difference for MNCV and there was no significant difference between the moderate and the severe group. In our study the calculated sensitivities for the electrodiagnostic studies were 76% for all symptomatic arms, 64% for the moderate group, and 83% for the severe nerve compression group. In all patients the MNCV was the most sensitive parameter. CONCLUSION: Electrodiagnostic studies were only able to reveal 3/4 of all patients with an affection of the ulnar nerve and only 2/3 of the patients with a moderate stage of ulnar nerve compression. Although important for the further therapy, a differentiation between a moderate and severe degree of nerve compression was not possible.

Chronic Disease↗
PubMed2000

The anatomy of the pectoral nerves and their significance in brachial plexus reconstruction.

Twenty-nine brachial plexuses from 13 embalmed and 5 fresh cadavers were examined under x3.5 loupe magnification to collect systematic and topographic anatomical data regarding the lateral and medial pectoral nerves. Additionally, nerve biopsy specimens were harvested in 5 fresh cadavers to obtain histomorphometric data. In all dissections the pectoral nerves exited at the trunk level as 3 distinct nerves. The superior pectoral nerve (from the anterior division of the superior trunk) commences just distal to the suprascapular nerve and courses laterally to innervate the lateral clavicular portion of the pectoralis major muscle (PM) with 2 to 4 branches. The middle pectoral nerve (from the anterior division of the middle trunk) courses distally and enters the infraclavicular fossa with 2 constant branches. The superficial branch terminates in the medial clavicular and upper sternal parts of the PM. The deep branch always forms a plexus with the medial pectoral or inferior pectoral nerve (from the anterior division of the inferior trunk), which courses at a right angle around the the lateral thoracic artery. From this plexus several branches terminate in the Pm. The branch to the lower aspect of the PM pierces the pectoralis minor muscle in two thirds of cases, whereas it passes its inferior border to reach the lower aspects of the PM with an average length of 15 cm in one third of cases. Knowledge of the detailed anatomy of the pectoral nerves, as outlined in this study, clarifies the obscure anatomic relationship of the lateral and medial pectoral nerves and allows easy intraoperative location of the medial pectoral nerve at the exit of the lateral thoracic artery. The length of the inferior pectoral nerve, the number of motor axons, and the anatomical proximity of this nerve make it an expendable but powerful source of reinnervation to the musculocutaneous nerve in upper brachial plexus injuries.

Adult↗
PubMed2000

Results of decompression of peripheral nerves in diabetics: a prospective, blinded study.

Diabetic neuropathy traditionally is considered progressive and irreversible and will result in lower extremity ulceration and amputation in a segment of the diabetic population, despite the best efforts to control serum glucose levels. Restoration of sensation to the diabetic may prevent these complications of neuropathy. The present study was designed to evaluate whether decompression of a peripheral nerve at a known site of anatomic narrowing can restore sensibility to that nerve in the diabetic. Twenty diabetic patients ( 14 type I, 6 type II, with a mean duration of diabetes of 14.8 years) had surgical decompression of a median nerve at the wrist and an ulnar nerve at the elbow, or a decompression of the posterior tibial nerve at the ankle (total of 31 nerves). A therapist, in a manner blind to the operative site, evaluated two-point discrimination in the pulp of the appropriate digit. The postoperative sensibility was compared with that of the nontreated, contralateral extremity. At a mean of 23.3 months, 69 percent of the lower-extremity nerves and 88 percent of the upper-extremity nerves (79 percent overall) had improvement in sensibility. In comparison, 32 percent of the control (not decompressed) contralateral nerves had measurable progression of neuropathy. The hypothesis that decompression of a peripheral nerve in the diabetic will improve sensibility was confirmed at the p < 0.001 level.

Adult↗
PubMed1998

Relationship between cutaneous pressure threshold and two-point discrimination.

The amount of pressure that should be applied when doing the two-point discrimination test has always been a matter of controversy. The Pressure-specified Sensory Devices permits recording the pressure at which two-point discrimination (2 PD) occurs. The purpose of this study was to investigate the relationship between the cutaneous pressure threshold and 2PD in people with normal and abnormal peripheral nerve functions. The Pressure-specified Sensory Devices was used to quantify the cutaneous pressure threshold in the index-finger pulp in each individual, between the range of 2 mm and 8 mm of static 2 PD, using 1-mm intervals. Twenty normal controls were examined; ten patients were less than 45 years of age; and ten patients were greater than 45 years of age. This relationship of pressure to 2PD was also tested in eight patients with abnormal peripheral nerve function (four patients with carpal tunnel syndrome, and four patients with diabetic neuropathy). A curvilinear relationship was identified in which, for the same skin surface in the same individual, regardless of age or presence of nerve compression or neuropathy, the cutaneous pressure threshold was inversely related to static 2PD. This curve shifted upward and to the right with the increasing age of the normal population and with neurologic impairment. The awareness of this neurophysiologic relationship between 2PD and pressure threshold permits the design of strategies for sensibility testing and provides a basis for the interpretation of sensory test results.

Adolescent↗
PubMed1998

The anatomic basis for the innervated mylohyoid/digastric flap in facial reanimation.

This paper describes the anatomy of the neurovascular supply to the mylohyoid and digastric muscle and its potential use for a regional transposition to rehabilitate the paralyzed face and soft-tissue coverage in the head and neck area. The anatomy and the arc of rotation of this flap were determined in ten embalmed cadavers. To further demonstrate the vascular supply, the common carotid was injected with silicone in four additional fresh cadavers. In all specimens, the submental artery and the mylohyoid nerve were the sole contributors to the neurovascular supply of the mylohyoid and digastric muscle. The arc of rotation was an average of 5 cm (range 4 to 6.5 cm), which allowed the flap to be positioned appropriately between the zygomatic arch and the modiolus. From this anatomic study, the mylohyoid/digastric flap has a long enough neurovascular pedicle to be useful in facial reanimation and soft-tissue coverage in the head and neck area.

Anastomosis, Surgical↗
PubMed1998

Treatment of superficial and deep peroneal neuromas by resection and translocation of the nerves into the anterolateral compartment.

An approach to the treatment of dorsal foot pain of neuroma origin is described based upon principals demonstrated to be effective in the treatment of upper extremity dorsoradial neuromas: translocation of the appropriate nerves into a muscle environment away from the joint. In the lower extremity, this requires identification of the appropriate nerves by anesthetic block, resection of the dorsal foot neuroma(s), and translocation of the nerves into the muscles of the anterolateral compartment. This approach yielded excellent results in 9 of the 11 patients with a mean follow-up of 29 months.

Adult↗
PubMed1998

Cutaneous innervation of the medial ankle: an anatomic study of the saphenous, sural, and tibial nerves and their clinical significance.

The distribution and variability of the nerves innervating the skin overlying the medial ankle were determined in 22 human anatomic specimens using x3.5 loupe magnification for dissection. Five different types could be identified: (1) Type A received contributions from the saphenous (SP), sural (SR), and the tibial (TB) nerves (54%); (2) Type B received contributions from the SR and SP nerves (14%); (3) Type C received contributions from the TB and SP nerves (9%); (4) Type D was singularly innervated by the SP (14%); and (5) Type E received contributions only from the TB nerve (9%). In two specimens, an unusual connection between the SP and the medial plantar nerves was found. Based on these findings, an incision line for tarsal tunnel release is suggested to avoid injury to the small cutaneous branches of the SP, SR, and TB nerves.

Ankle↗
PubMed1997

Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury.

The anatomy of the lateral femoral cutaneous nerve was investigated through dissection of 52 human anatomic specimens. The variability of its course and locations as it exists the pelvis is described and related to soft-tissue and bony landmarks. Five different types are identified: type A, posterior to the anterior superior iliac spine, across the iliac crest (4 percent); type B, anterior to the anterior superior iliac spine and superficial to the origin of the sartorius muscle but within the substance of the inguinal ligament (27 percent); type C, medial to the anterior superior iliac spine, ensheathed in the tendinous origin of the sartorius muscle (23 percent); type D, medial to the origin of the sartorius muscle located in an interval between the tendon of the sartorius muscle and thick fascia of the iliopsoas muscle deep to the inguinal ligament (26 percent); and type E, most medial and embedded in loose connective tissue, deep to the inguinal ligament, overlying the thin fascia of the iliopsoas muscle, and contributing the femoral branch of the genitofemoral nerve (20 percent). The results of this study suggest that the lateral femoral cutaneous nerve is most susceptible to mechanical trauma when the nerve is type A, B, or C.

Humans↗
PubMed1996

The internal topography of the axillary nerve: an anatomic and histologic study as it relates to microsurgery.

The topography of the fascicular groups of the axillary nerve throughout its course from the posterior cord until its passage through the quadrangular space was studied in dissections of 40 brachial plexuses under x3.5 loupe magnification. Additionally, 10 axillary nerves were excised in toto, and histologic serial sections were done to define fascicular arrangement. In all specimens, the motor fascicular group for the deltoid muscle was located most superiorly at the level of the quadrangular space. This motor portion could be identified as a distinct entity, up to 45 mm proximal to this level. In surgical treatment of axillary nerve repair, one should direct special attention to the correct identification, matching, and alignment of this motor fascicle, to avoid wasteful regeneration of axons into the functionally unrelated fascicles to the teres minor and the lateral shoulder skin.

Axilla↗
PubMed1996

Evidence in support of collateral sprouting after sensory nerve resection.

The extent and time course of sensory recovery has been investigated in 13 patients who had resection of a cutaneous nerve. Seven patients were studied within 8 weeks of denervation; 6 others were studied more than 6 months after denervation. Touch sensation was evaluated using a computer-assisted measuring device that recorded the pressure thresholds for static and moving touch, and static and moving two-point discrimination within a continual range from 0.1 to 100 gm per square millimeter. Recovery of sensation within the autonomous zone of the resected nerve could be documented as early as 3 weeks after denervation. After 6 months, two-point discrimination had recovered in the previously denervated areas. Thresholds for all test modalities were found to be elevated within the sensory distribution of adjacent nerves, which suggests that these areas have been the donor source for reinnervation of the chronically denervated territory. Anesthetic block of these adjacent donor nerves resulted in loss of the recovered sensation.

Adult↗
PubMed1996

Innervation of the human shoulder joint and its implications for surgery.

The distribution and variability of the nerves innervating the shoulder joint were determined in 25 fresh human adult cadavers using 3.5x magnification for dissection. The results showed that 100% of the specimens had dual innervation of the coracoclavicular ligaments, the subacromial bursa, and the acromioclavicular joint. This dual innervation was from the articular branches of the suprascapular nerve and of the lateral pectoral nerve. Constant relationship of these 2 nerves to bony landmarks will permit anesthetic blocks for diagnosis and possible therapeutic intervention. A consistent pattern of innervation of the posterior and inferior shoulder joints also is described.

Adult↗