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PubMedDate not supplied

Radial nerve paralysis associated with fractures of the humerus. A review of 62 cases.

Sixty-two patients with radial nerve paralysis associated with fractures of the humerus were reviewed. Seventy-three per cent of the patients had primary radial nerve paralysis and 27% had secondary paralysis. Conservative management has led to excellent nerve recovery in all groups of patients. Overall, 95% of the patients with radial nerve paralysis recovered normal or near normal function. All patients with secondary paralysis had full functional recovery of the radial nerve. Conservative management is recommended in patients with radial nerve paralysis associated with fractures of the humerus, regardless of age of the patient, cause of injury, level of fracture, type of fracture, and whether paralysis is primary or secondary. Use of dynamic splints and exercises, to keep all joints of the hand and wrist supple, should be an integral part of the treatment. Indications for early surgery are unacceptable fracture reduction, open fractures requiring debridement, and associated vascular injuries. In all open procedures, the radial nerve should be explored at the same time and treated appropriately. EMG studies are recommended at four and six months. If there Is no evidence of recovery, the nerve should be explored. Except in unequivocal irreparable radial nerve damage, tendon transfers should be deferred for at least six months, preferably for one year. The possible effect of entrapment of nerve by scar and callus remains to be established.

Adult↗

PubMed1991

[Tennis elbow].

Tennis elbow is most often due to a tendinitis of the extensor carpi radialis brevis, and occasionally of the extensor digitorum. Pain felt at the outer aspect of the elbow, is elicited by grasping. Passive movements are painless, and of full range, excepted for extension, and varus strain tested in slight flexion. Isometric contraction of all the muscles controlling the joint are painless, excepted resisted extension of the wrist. The most usual painful spots lay on the lateral epicondyle, or lower on the common tendon. Diagnosis is confirmed when signs disappear immediately after a correct injection of lignocaine, and persist at least 3 Weeks if a corticoïd is added. The two outstanding differential diagnoses are internal derangement of the humero-radial joint, and entrapment of the sensory branch of the radial nerve. Many treatments are indicated. In a series of 58 cases, cervical manipulations give in most cases only a temporary relief; deep transverse massage applied on the tendon below the epicondyle, gives in a series of 131 cases good and excellent results in 63% of the cases. In a series of 257 cases, injections of corticoïds gives full relief in all cases, but the rate of recurrences is 66.7%, although 67% of those recur only once or twice. Percutaneous tenotomy performed only in patients recurring after temporary cure, drops the rate of recurrences to 13%. The last alternative is open surgery, releasing the common tendon.

Humans↗

PubMed1975

A simplified technique for treating the complex dislocation of the index metacarpophalangeal joint.

The volar approach to open reduction of the complex dislocation of the index metacarpophalangeal joint as described by Kaplan proved to have certain disadvantages. Digital nerves are easily damaged during exposure and there is a limited view of the entrapped fibrocartilaginous volar plate dorsal to the metarcarpal head. A direct dorsal longitudinal incision through the skin and extensor tendon gives full exposure. The volar plate attached to the proximal phalanx and trapped over the dorsal aspect of the metacarpal head is in full view. The volar plate is split longitudinally and the dislocation reduces spontaneously as the flexor tendons and lumbrical muscle slip by the metacarpal head. The advantages of this approach as compared with the volar approach are: (1) there is full exposure of the fibrocartilaginous volar plate, the main structure blocking reduction; (2) digital nerves are not as apt to be damaged; and (3) accurate reduction and fixation of the osteochondral fracture of the metacarpal head, frequently seen with this dislocation, is possible.

Adolescent↗

PubMed2002

[Update on lateral and medial spaces of the dorsal wall of the axillary fossa].

Lateral and medial axillary spaces (also named quadrilateral and triangular spaces) correspond to orifices of the posterior wall of axillary fossa communicating with deltoid and scapular areas. We attempt to become clear the anatomic boundaries of these spaces and the structures passing through. We studied by dissection 18 fresh and embaulmed human upper limb of both sex. Lateral axillary space was limited by lateral edge of the long head of the triceps muscle medialy, the medial edge of the surgical neck of the humerus lateraly. The tendon of teres major and latissimus dorsi muscles constituted lower limit and the superior boundary was the scapulohumeral capsule rather than the teres minor muscle. Structures passing through the quadrilateral space where the axillary nerve and the posterior humeral circumflex vascular pedicle. Boundaries of the triangular space where, lateraly the medial edge of the long head of the triceps, superiorly the inferior edge of the teres minor and the axillary border of the scapula; the upper edge of the teres major corresponded to the superior limit. Abduction of the upper limb is a movement which increase the risk of entrapment phenomenon of the axillary nerve in relation to rigid anatomic structures like the surgical neck of the humerus, the scapulohumeral capsule and the tendon of latissimus dorsi and teres major muscles. Neverless genetics cause of anatomic predisposition is evocated in the quadrilatere space syndrome.

Aged↗

PubMed1998

Limited surgical treatment of de Quervain's disease: decompression of only the extensor pollicis brevis subcompartment.

A septum between the abductor pollicis longus tendon and the extensor pollicis brevis (EPB) tendon in the first extensor compartment is frequently encountered during surgical treatment of de Quervain's disease. It was hypothesized that de Quervain's disease was secondary to EPB entrapment and the decision was made to decompress only the EPB subcompartment. Twenty-two patients were treated with this method. Sixteen patients had a septum in the first extensor compartment and 6 patients had a single canal. After surgery, all patients had complete relief of pain and tenderness over the first extensor compartment. The results of Finkelstein's test were negative in all cases. We conclude that de Quervain's disease is secondary to EPB entrapment. In those cases with a septum, it is sufficient to decompress only the EPB subcompartment.

Adult↗

PubMed2005

Entrapment of a displaced common peroneal nerve following knee ligament reconstruction.

We present a case of disruption of the posterolateral corner of the knee with avulsion of the tendon of biceps femoris. Repair and reconstruction included an allogenic tendon graft to replace the posterior cruciate ligament. Surgery was followed by a complete common peroneal nerve palsy. Revision surgery revealed that the nerve had been displaced anteriorly by avulsion of the biceps tendon and the tendon graft encircled it. Release of the nerve restored normal function at five months.

Adult↗

PubMedDate not supplied

Differential diagnosis of leg pain in the athlete.

Leg pain in the athlete is common and has many different etiologies. The most common causes include muscle or tendon injury, medial tibial stress syndrome, stress fracture, and exertional compartment syndrome. Less common causes of leg pain include lumbosacral radiculopathy, lumbosacral spinal stenosis, focal nerve entrapment, vascular claudication from atherosclerosis, popliteal artery entrapment syndrome, and venous insufficiency. This article reviews the essential history and physical examination findings and the various causes of leg pain to help the clinician pinpoint the diagnosis and facilitate the athlete's return to sport participation.

Athletic Injuries↗

PubMed1999

High-frequency ultrasound examination of the wrist and hand.

High-frequency ultrasound (US) is an efficient, rapid and inexpensive altenative to magnetic resonance imaging (MRI) for investigation of diseases in the soft tissues of the wrist and hand. US allows detection of foreign bodies and the reliable identification of a variety of traumatic lesions affecting tendons, annular pulleys, ligaments, vessels and nerves. Inflammatory diseases of tendons, including acute and chronic tenosynovitis and some degenerative conditions in the wrist and hand, can also be diagnosed. In entrapment neuropathies, US is able to identify nerve shape changes and possible extrinsic space-occupying lesions that may cause nerve compression within the tunnels. In patients with localized swelling of the hand or wrist, US is able to assess the presence of an expansile lesion and to characterize its nature in most cases. The objective of this article is to review the main findings and the primary indications of US in the investigation of disorders of the hand and wrist.

Diagnosis, Differential↗

PubMedDate not supplied

[Anatomo-functional aspects and diagnostic algorithm (of the upper limb pathologies secondary to repeated trauma)].

The epidemiology of work-related musculo-skeletal pathologies of the upper limbs has become significantly relevant in the last years, and a sharp increasing trend can be observed. This paper mainly focuses on the chronic inflammatory and degenerative conditions, which are more complex and difficult to accurately diagnose and treat. A synthesis of the diagnostic picture of the different types, involving the joints, muscles and tendons, and peripheral nerves is provided, with mention of the sensitivity and specificity of the main diagnostic tests. The possible entrapments of the radial, median and ulnar nerves are described in detail. Finally, a brief critical review on the principal movements of the upper limbs which are responsible of the onset of such conditions is presented.

Algorithms↗

PubMed1997

Magnetic resonance imaging of the musculoskeletal system. Part 6. The Shoulder.

The role of magnetic resonance imaging in the diagnosis and treatment of patients with shoulder pain has increased remarkably in recent years, largely because of improved resolution of images and increased experience of musculoskeletal radiologists. In rotator cuff disease/impingement and instability, magnetic resonance imaging adds a new dimension to the clinical findings through the noninvasive visualization of either the pathology itself or frequently associated abnormalities. It is the associated abnormalities that are depicted in instability: glenoid irregularities, labral tears, capsular laxity, and Hill-Sachs deformities. Glenoid, labral, and Hill-Sachs abnormalities can be assessed with either magnetic resonance imaging or computed tomography arthrography. Magnetic resonance imaging has the advantages of noninvasiveness, multiplanar imaging capability and exquisite soft tissue contrast. In rotator cuff disease, magnetic resonance imaging depicts the status of the rotator cuff itself, revealing partial and full thickness tears, allowing an estimation of size and quality of tendon edges. Possible impingement sites can be identified. Primary instability with secondary impingement may be first suspected on magnetic resonance imaging. Postoperative complications, including recurrent tendon detachment, deltoid dehiscence, and infection, are clarified. Unsuspected but clinically important lesions, such as neoplasm, osteonecrosis, and ganglion with entrapment of the suprascapular nerve, each have characteristic magnetic resonance imaging appearances.

Diagnostic Imaging↗

PubMed1994

Accessory fasciculi of the human pronator teres muscle: incidence, morphological characteristics and relation to the median nerve.

The purpose of this study is to determine the incidence of the accessory fasciculi of the pronator teres muscle and to evaluate the predispositional role of its morphological characteristics to median nerve entrapment. The accessory fasciculi of the pronator teres muscle have been found in 8.3% of 60 upper extremities which were studied. These fasciculi arose from the tendon of the brachialis muscle (5.0%), from the radial tendon of the biceps brachii muscle (3.3%), from the Gantzer's muscle (1.6%) or from the flexor digitorum superficialis muscle (1.6%). They were slips of origin of the deep head of the pronator teres muscle. They represented the deep head, when there was no other origin slip, or they were additional origin slips when the deep head also had a coronoid origin. Only the accessory fasciculi that represented the deep head and the accessory fasciculi located inside to the coronoid fasciculus were related directly to the median nerve. Three characteristics of these accessory fasciculi adjacent to the median nerve could be considered to be factors that predispose to the nerve entrapment: 1) the location dorsal to the superficial head of the pronator teres muscle, because it increases the area of contact with the median nerve; 2) the location between the superficial head and the coronoid fasciculus, because it reduces the space occupied by the median nerve; and 3) the tendinous nature of considerable segments of short accessory fasciculi because they are less extensible.

Cadaver↗

PubMedDate not supplied

Radial sensory nerve entrapment in carpal tunnel syndrome.

In 100 subjects with Carpal Tunnel Syndrome (CTS) and any other illness, the conduction velocity of the radial sensory nerve (RSN) was studied on the hypothesis that, because of the relation with the tendon of the brachioradialis and extensor carpi radialis longus muscles, microtrauma can injure the RSN. In 13 patients, for a total of 15 limbs involved, the SCV is reduced less than 2.5 SD, in 5 the distal latency is prolonged and in 1 there is both a slowing of SCV and prolonged distal latency. The involvement of RSN is more frequent in the dominant hand. There is no relation between the severity of CTS and damage of RSN or between clinical and electrophysiological data. It therefore seems that the entrapment of RSN is quite frequent and can explain some symptoms and modify the therapy.

Adult↗

PubMed1994

The locked metacarpophalangeal joint: report of four cases and review of the literature.

Four cases of locked finger metacarpophalangeal joints are reported. Two of these cases were caused by entrapment of the sesamoid behind an exostosis off the second metacarpal head. The third was from subluxation of the dorsal interosseous tendon over a dorsal osteophyte on the metacarpal. The fourth was from an exostosis tethering the accessory collateral ligament. Surgical exploration using a palmar approach was the treatment of choice. All patients regained full range of motion within two months. A review of the various causes and treatment options for this unusual condition is presented.

Adult↗

PubMed1991

[Isolated compression of the dorsal branch of the ulnar nerve].

The dorsal branch of the ulnar nerve was dissected in 20 upper extremities. The nerve arises from the ulnar aspect of the ulnar nerve at an average distance of 8.5 centimeters from the proximal border of the pisiforme. It courses deep to the palmar carpal ligament and pierces the ligament dorsal to the tendon of the flexor carpi ulnaris, becoming subcutaneous. The palmar carpal ligament has been found to be a cause of isolated entrapment of the dorsal branch of the ulnar nerve. A report of eleven operative cases is presented.

Adult↗

PubMed1996

Ultrasonography of peripheral nerves.

During sonographic examination of the extremities using high frequency "small-parts" equipment, peripheral nerves may be identified in virtually all patients. Peripheral nerves have a typical ultrasonographic pattern that correlates well with histologic structure and facilitates differentiation between nerves and tendons. The ability of this technique to depict peripheral nerves makes it possible, in many instances, to study nerve abnormalities in trauma, entrapment syndromes and tumors. Ultrasound can enable differentiation of an endoneural from an extraneural space-occupying lesion and evaluation of the extent and consistency of the lesion, as well as the integrity and dynamic behavior of the nerve involved at follow-up study. The purpose of this review article is to describe the normal ultrasonographic appearance of peripheral nerves and to discuss the potential role of this technique to image nerve lesions noninvasively. A series of paradigmatic ultrasound images of diverse pathologic processes involving peripheral nerves is presented. Although the ultrasound study of peripheral nerves remains in its infancy, with further refinement of ultrasound technology and a more precise knowledge of the ultrasound appearance of the extremities we may be optimistic to the future impact of this technique on diagnosis, treatment and prognosis in patients clinically suspected to have a nerve lesion.

Humans↗

PubMed1999

Synovial osteochondromatosis at the elbow producing ulnar and median nerve palsy. Case report and review of the literature.

The authors present the case of a 53-year-old woman suffering from synovial osteochondromatosis of her right elbow responsible for ulnar and median nerve entrapment neuropathy. This condition is characterised by the formation of multiple cartilaginous nodules in the metaplastic synovium of otherwise normal joints, bursae or tendon sheaths. Treatment consisted of partial synovectomy, removal of loose bodies and microscopic nerve release. Synovial osteochondromatosis complicated by nerve compression syndromes has been rarely reported, usually with ulnar tunnel syndrome at the elbow. The literature on this subject is reviewed.

Chondromatosis, Synovial↗

PubMed1991

Accessory palmaris longus muscle causing ulnar nerve compression at the wrist.

An accessory palmaris muscle that arose from the base of the fifth metacarpal passed proximally and inserted into the palmaris longus tendon. In its course it compressed the ulnar nerve and vessels. It was detached proximally and folded on itself to provide hypothenar bulk. The entrapment symptoms were relieved.

Humans↗

PubMed1990

A biomechanical in vitro comparison of open versus percutaneous repair of tendon Achilles.

A study was undertaken to compare the in vitro strengths of percutaneous Achilles tendon repair to open Achilles tendon repair. Ten fresh frozen cadaver below-the-knee specimens underwent Achilles tenotomy. The specimens were divided into two groups of five specimens each. Group I specimens underwent open Achilles repair using a Bunnell suture technique. Group II specimens underwent percutaneous repair. Each specimen was placed on an apparatus which produced progressive ankle dorsiflexion. Measurements of anastomotic gap were correlated with angle of dorsiflexion. Group I anastomoses were able to resist almost twice the amount of ankle dorsiflexion compared to Group II anastomoses (P less than .05). Entrapment of the sural nerve occurred in three out of five specimens in Group II. Percutaneous anastomoses were malaligned in four out of five specimens. Based on this study, percutaneous repair of Achilles tendon ruptures provides approximately 50% of the initial strength afforded by open repair. Percutaneous repair places the sural nerve at risk for injury.

Achilles Tendon↗