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At least 235 records · Page 13Linked to original sources
PubMed2005

Technical note: the design of a stereotactic frame for direct MRI-anatomical correlation of the brachial plexus.

The purpose of this study was to identify optimal magnetic resonance imaging (MRI) conditions to visualize discrete alterations of brachial plexus components, as part of a biomechanical study of minor nerve compression syndromes. A method was developed allowing direct comparison between the MRI image and the subsequently obtained matching anatomic section of the same specimen. We designed a stereotactic frame to obtain the precise orientation of the MRI plane with reference to the specimen and adapted a vertical band saw for multiplanar sectioning of cadaveric specimens. Two cadaveric upper quadrants were examined by MRI (TR 450 ms, TE 13 ms, pixel matrix 512 x 512 and FOV 23-26 cm) and anatomical slices were produced. One specimen was sectioned axially, while the second specimen was sectioned in an oblique plane corresponding to the natural longitudinal axis of the upper part of the brachial plexus. MR images and the corresponding slices exhibited a strong correlation. This correlation was checked by using vitamin A pearls as landmarks. MR images revealed more detail after the correlating anatomical slices were analyzed. The present study shows that the method is suited for direct MRI-anatomic comparison of the brachial plexus and is also proposed for application to other topographical regions.

Acromioclavicular Joint↗
PubMedDate not supplied

Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features.

The median, radial, and ulnar nerves of the upper limbs may be affected by various peripheral neuropathies, each of which may be categorized according to its cause, as either an entrapment or a nonentrapment neuropathy. Entrapment neuropathies, also referred to as nerve compression syndromes, include the supracondylar process syndrome, pronator syndrome, anterior interosseous nerve syndrome, carpal tunnel syndrome, posterior interosseous nerve syndrome, cubital tunnel syndrome, and Guyon canal syndrome. Nonentrapment neuropathies include traumatic nerve injuries, infectious and inflammatory conditions, polyneuropathies, and mass lesions at anatomic locations where entrapment syndromes typically do not occur. Although clinical examination and electrophysiologic testing are the cornerstone of the diagnostic work-up, in certain cases magnetic resonance (MR) imaging may provide key information about the exact anatomic location of a lesion or may help narrow the differential diagnosis. In patients with a diagnosis of peripheral neuropathy, MR imaging may help establish the cause of the condition and provide information crucial for conservative management or surgical planning. In addition, knowledge of the normal anatomy and of the possible causes, typical clinical findings, and MR imaging features of peripheral neuropathies that affect the median, radial, and ulnar nerves allows greater confidence in the diagnosis.

Humans↗
PubMed1994

Handlebar problems in bicycling.

Handlebar problems are common among serious bicyclists. Compression neuropathy, more commonly ulnar than median, is frequent but seldom produces permanent injury or deficit if promptly recognized and managed by attending to bicycle fit, energy-absorbing gloves and handlebar treatments, and cycling technique. Overuse symptoms may be seen if bicycle design and fit couple with repetitive motion to aggravate wrist tendons or connective tissues of the neck and shoulder. Mechanical and medical management are effective in relieving symptoms and preventing recurrence.

Bicycling↗
PubMed1996

Anatomy, function, and pathophysiology of peripheral nerves and nerve compression.

The basic pathophysiology of nerve compression injuries is complex and it is important to consider the microanatomy of the neuron and the peripheral nerve. The clinical stages of nerve compression lesions can be related to changes in intraneural microcirculation and nerve fiber structure; alterations in vascular permeability, with subsequent formation of edema; and deterioration of nerve function observed in experimental studies. The double-crush and reversed double-crush syndromes are related to disturbances in axonal transport induced by compression, followed by morphologic and functional changes in the nerve cell bodies. An underlying neuropathy in subjects can make the peripheral nerves more susceptible to compression injuries.

Animals↗
PubMed2002

Concomitant compression of median and ulnar nerves in a hemophiliac patient: a case report.

A 15-year-old boy, with a diagnosis of hemophilia A, suffered bleeding into his left forearm 5 months before being admitted to our medical center. His neurological examination revealed a pronounced median neuropathy and a minor ulnar neuropathy on the left side. There was marked muscle atrophy on the thenar side and, to a lesser degree, on the hypothenar side and in the forearm. Electromyographic findings demonstrated an evident, nearly complete, sensorimotor axonal loss in the median nerve. Magnetic resonance imaging studies showed atrophy in muscles of the left forearm and median nerve. The patient was diagnosed as having median nerve axonotmesis and ulnar nerve neuropraxia due to compartment syndrome. In hemophiliac patients, frequent single nerve compressions (often involving the femoral nerve) can be seen. However, concomitant median and ulnar nerve injuries with differing severity are rare.

Adolescent↗
PubMed1977

The external compression syndrome of the ulnar nerve at the cubital tunnel.

Diagnosis of the cubital tunnel external compression syndrome, and subsequent avoidance of further external pressure, minimizes the possibility of progressive crippling of the hand. The usual clinical features are local tenderness over the cubital tunnel, often accompanied by distal paresthesias, and neurological deficit in the ulnar nerve distribution with sparing of the flexor digitorum profundus and flexor carpi ulnaris muscles; the elbow flexion test, described by the author, awaits evaluation in the diagnosis of the syndrome. Clinicians and others concerned with positioning patients on the operating room table or caring for patients in the ward should be aware of the syndrome. Avoidance of a position of the elbow which predisposes to external compression of the cubital tunnel is mandatory and active elbow movement should be encouraged in bedridden and chair-bound patients. Surgical treatment is sometimes indicated, at least to halt progression of the palsy. A classification of the cubital tunnel syndrome is proposed: physiological, acute and subacute due to external pressure (both forming the cubital tunnel external compression syndrome) and chronic (space-occupying lesions and loss of volume due to lateral shift of the ulnar as a consequence of childhood injury to the capitular epiphysis). Nerve conduction studies may be helpful in the diagnosis of the doubtful cubital tunnel syndrome, particularly when there is definite impairment of power or sensation in the hand.

Acute Disease↗
PubMed1996

Bilateral carpal tunnel syndrome secondary to tophaceous compression of the median nerves.

A 65-year-old man with long-term gouty arthritis developed bilateral carpal tunnel syndrome. At surgery a chalky substance, which showed negative birefringence on polarized microscopy, was found infiltrating around the intensely inflamed transverse carpal ligaments. In differential diagnosis of carpal tunnel syndrome, tophaceous compression over the median nerve should be taken into consideration.

Arthritis, Gouty↗
PubMed1981

The pronator teres syndrome: compressive neuropathy of the median nerve.

Thirty-nine patients with a clinical diagnosis of the pronator teres syndrome were seen during a seven-year period. They typically complained of aching discomfort in the forearm, weakness in the hand, and numbness in the thumb and index finger. Cyclic stress usually brought on the symptoms. The distinctive physical finding was tenderness over the proximal part of the pronator teres, which was aggravated by resisted pronation of the forearm, flexion of the elbow, and occasionally by resisted contraction of the flexor superficialis of the long finger. Electrophysiological testing of the median nerve showed abnormalities in a few patients, but localization of the abnormality was possible only rarely. Intraoperative recordings showed some improvement shortly after release of the median nerve in six of the ten forearms that were tested. Surgical exploration of thirty-six forearms in thirty-two patients showed intramuscular tendinous bands in the pronator, indentation of the muscle belly of the flexor superficialis in most forearms. Vascular and muscular abnormalities were seen occasionally. Of the thirty-six operations, twenty-eight gave good or excellent results; five, fair; and in three patients the symptoms were unchanged. The cause of failure was either inadequate decompression or misdiagnosis.

Adolescent↗
PubMed1997

[Common fibular nerve lesions. Etiology and treatment. Apropos of 146 cases with surgical treatment].

PURPOSE OF THE STUDY: Common peroneal nerve lesion on the lateral aspect of the knee is one of the most frequent neurologic injury of the lower limb. We reported the results of surgical procedure for each etiological group. MATERIAL AND METHODS: In the peroneal nerve entrapment group, we individualised 62 fibular tunnel syndroms (55 idiopathic, 4 postural, 3 dynamic), and 16 external compression. Traumatic causes were represented by 22 varus injuries of the knee and by 11 fractures, 16 iatrogenic lesions, 2 wounds, 5 wound sequelae, 2 contusions and 1 burn. Tumoral group was represented by 7 intraneural ganglionic cyst and 2 extraneural tumour (1 exostosis and 1 chondromatosis of the proximal tibio fibular joint). All patients underwent surgical procedure. Neurolysis was performed when the nerve was in continuity. Suture or nerve grafting was performed in the other cases. In the case of intraneural ganglionic cyst, a complete tumoral excision was realised. RESULTS: Eighty-three per cent of excellent and good results were obtained for the fibular tunnel syndrom, 62.5 per cent for external compression, 36 per cent for varus injury of the knee, 78 per cent for the other traumatic causes and 89 per cent for tumoral lesions. DISCUSSION: This report confirms that the result depends on the etiology of the common peroneal nerve lesion. We propose surgical treatment within 2 to 4 months for the patients without clinical and electrophysiological improvement. If there is doubt on the continuity of the nerve, we propose an earlier surgical treatment. Our results were in general satisfactory except when a nerve graft was necessary furthermore if it was a traction injury and if the length of the graft was longer than 6 centimeters.

Adolescent↗
PubMed1995

Dorsal scapular nerve compression. Atypical thoracic outlet syndrome.

The dorsal scapular nerve and long thoracic nerve of 10 cadavers (20 sides) and 36 patients with dorsal scapular nerve compression were studied anatomically. The origin of the dorsal scapular nerve of a section frequently shared a common trunk with the long thoracic nerve, and went through the scalenus medius anterointernally and posterolaterally with the presence of some tendinous tissues. Leaving the long thoracic nerve, it might give branches to the shoulder and the subaxillary region and finally have the branches join the long thoracic nerve again. The compression of the section near the origin caused discomfort and sourness of the neck, shoulder and back region. Clinically, the severance of the scalenus anterior and medius ameliorated or relieved the compression of the dorsal scapular nerve. Complete decompression required cutting of the scalenus medius and its tendinous tissue superficial to the dorsal scapular nerve. Among 24 sides of 22 patients undergoing surgery, the symptoms of 20 sides of 19 patients were completely or partially relieved.

Adult↗
PubMed1985

A primate model for chronic nerve compression.

Peripheral compression neuropathy is a common clinical entity but little human nerve material has been available for study. It has been difficult to develop an experimental model of chronic nerve compression which is reliable and reproducible, making it difficult to assess the various treatment modalities currently in use to manage this problem. In a recent study using a rat model, connective tissue and nerve fiber changes associated with chronic nerve compression were described by the authors. The present study expands this same model of chronic nerve compression to the multifascicular median nerve of the cynomolgus monkey, using this model to test whether or not current surgical treatment modalities for nerve entrapment will alter the course of chronic nerve compression. Using histologic and morphometric parameters, there did not appear to be a difference between nerves treated by decompression alone or by decompression and internal neurolysis. Total number of nerve fibers remained constant, as did axon size, but a demyelinating process was demonstrated which is a significant component of chronic nerve compression. Although the small number of experimental animals (7) makes precise evaluation of the clinical modalities impossible, the authors expect that further study of the multifascicular median nerve of the cynomolgus monkey will prove to be a useful source of future experimental evidence and will help to interpret the diverse therapeutic and operative techniques currently in use.

Animals↗
PubMed1986

Peripheral nerve surgery--today and looking ahead.

The trend in peripheral nerve surgery is toward earlier definitive treatment of the lesion, based on the optimal use of preoperative and intraoperative electrodiagnostic techniques. Newer diagnostic tools include computed tomography (CT) and thermography. Knowledge is still being gained about the technology and limitations of the autogenous nerve grafts that are being used to overcome nerve gaps. The technique of nerve anastomosis is undergoing rapid improvement, and better methods have been developed for identifying motor and sensory fascicles at the time of operation. Research activity into the problem of nerve damage produced at the time of trimming nerve stumps promises to change to the technology of nerve repair in the near future. For benign nerve sheath tumors (schwannoma, neurofibroma), the trend is away from nerve excision and in the direction of tumor enucleation. Histologic methods for diagnosing malignant nerve tumors have been improved, making it possible to embark on radical excision with less hesitation. The pain syndromes (causalgia, phantom limb pain, and stump pain) that may follow nerve injury continue to present a problem in management, but steady progress is being made toward a rational program of management. A more distant prospect is for pharmacologic and electrophysiologic methods to accelerate axonal regeneration.

Carpal Tunnel Syndrome↗
PubMedDate not supplied

Suprascapular nerve rotator cuff compression syndrome in volleyball players.

Selective denervation of the infraspinatus muscle producing weakness and wasting has been reported in certain sports (eg, volleyball and baseball). Nerve kinking or friction caused by excessive infraspinatus motion and compression by superior or inferior transverse scapular ligament or ganglions have been proposed as possible causes. However, in extreme abduction with full external rotation of the shoulder, the medial tendinous margin between the infraspinatus and supraspinatus muscles impinges strongly against the lateral edge of scapular spine, compressing the intervening infraspinatus branch of the suprascapular nerve. Spinaglenoid notchplasty has been performed in 5 elite volleyball players with infraspinatus neuropathy, allowing recovery of shoulder function in all patients and correction of infraspinatus muscle wasting. All returned to the same or higher level of volleyball by 8 months after surgery. An alternative cause of infraspinatus compromise in volleyball players is proposed and has been treated surgically with satisfactory outcome.

Adult↗
PubMed2004

MR imaging of common entrapment neuropathies at the wrist.

MR imaging is a useful technique in the work-up of compressive neuropathies at the wrist, providing fine anatomical detail and excellent diagnostic accuracy. MR imaging, however, should be reserved for those cases in which the clinical and electrodiagnostic findings are inconclusive, the symptoms are unusually severe, or when a tumor is suspected. This article reviews the normal anatomy and the MR imaging features of the most common compressive neuropathies at the wrist: carpal and ulnar tunnel syndromes.

Carpal Tunnel Syndrome↗