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PubMed1988

The double crush syndrome.

Multilevel lesions along a peripheral nerve trunk do occur. In the double crush syndrome as postulated by Upton and McComas, the presence of a more proximal lesion does seem to render the more distal nerve trunk more vulnerable to compression. While the exact pathophysiologic mechanism of this interaction is not yet elucidated, it most likely relates to disturbances in axonal flow kinetics and the disruption of the neurofilament architecture. On a practical level our studies show that given a more proximal root compression less involvement of the median nerve across the carpal tunnel was required to produce symptoms. Furthermore, the surgical outcome of carpal tunnel release in this double crush group was poorer than in that group with isolated carpal tunnel involvement. It is important to preoperatively identify those patients who may have double crush lesions and thus anticipate a less than optimal result from surgical release of the peripheral nerve. Finally, when the double crush syndrome is present, both entrapments may require treatment for optimal results.

Animals↗
PubMed2004

Investigation of two possible compression sites of the deep branch of the radial nerve and nerve supply of the extensor carpi radialis brevis muscle.

The posterior interosseous nerve arises from the deep branch of the radial nerve, and compression by adjacent structures results in posterior interosseous nerve syndrome. Sixty upper limbs from 30 Turkish subjects (18 males and 12 females) were dissected to reveal the course of the posterior interosseous nerve and to examine possible compression sites at the proximal and distal edges of the supinator muscle, and the exit of the nerve from the extensor carpi radialis brevis muscle. Posterior interosseous nerve syndrome is most probably caused by the tendinous part of the supinator muscle at the proximal edge.

Adult↗
PubMed1984

Ulnar tunnel syndrome.

Ulnar tunnel syndrome or compression of the ulnar nerve at the wrist is of two distinct types. In the first type compression is at the level of the pisiform with involvement of both sensory and motor fibres. In the second type compression is distal to the pisiform with involvement of the motor fibres only.

Electromyography↗
PubMed2002

Unusual presentation of multiple myeloma with unilateral visual loss and numb chin syndrome in a young adult.

A 39-year-old man presented with unilateral visual loss as the first sign of multiple myeloma (MM). His visual loss was due to a plasmacytoma in the sphenoid sinus compressing the optic nerve with resultant optic nerve atrophy. Shortly after this presentation he developed numb chin syndrome due to a mandibular plasmocytoma compressing the mental nerve. His MM progressed rapidly despite treatment with high-dose steroids and alkylating agents and he required allogeneic bone marrow transplantation in order to achieve a remission. We reviewed the published medical literature on the presentation of MM with visual impairment and present a summary in tabular form in this paper. This is the first reported case of MM presenting with isolated complete visual loss due to intracranial extrinsic compression of the optic nerve since the advent of modern cross-sectional imaging. Multiple myeloma needs to be included in the differential diagnosis of cranial neuropathies and skull base neoplasms even in adults under 40 years of age.

Adult↗
PubMed2000

Compressive radial neuropathies.

Radial neuropathy can have one of several clinical presentations, depending on the level of compression: high radial nerve palsy, PIN palsy, radial tunnel syndrome, and Wartenberg's syndrome. Elucidating the history and progression of symptoms with a physical examination directed at testing individual muscles will determine the approximate anatomic level of radial injury. Identification of a Tinel's sign will often locate the site of compression. Electrodiagnostic studies can confirm the diagnosis in a radial motor neuropathy, but are unreliable in radial tunnel syndrome and sensory radial nerve compression. A trial of nonsurgical treatment is warranted in all cases except those with progressive motor weakness or palsy. Patients who do not respond or continue to progress despite conservative treatment are candidates for surgical decompression.

Diagnosis, Differential↗
PubMed1987

Dupuytren's disease as a cause of ulnar tunnel syndrome.

Two clinical cases of documented ulnar nerve compression in Guyon's canal caused by Dupuytren's disease are described. Surgical decompression of the canal promptly relieved the symptoms, and histologic studies confirmed the presence of Dupuytren's disease.

Adult↗
PubMed1996

Ulnar tunnel syndrome.

Compression neuropathies are a significant source of pain in the upper extremity. Although ulnar tunnel syndrome occurs much less frequently than cubital tunnel syndrome, compression of the nerve at this level is a readily treatable condition. Ulnar tunnel syndrome should be kept in the differential diagnosis when the patient complains of numbness of the ring and small fingers, hand weakness, and pain on the ulnar side of the wrist.

Humans↗
PubMed1976

[Radial nerve compression].

A new compression syndrome of the deep branch of the radial nerve is described, in which a sudden anterior displacement of a part of this nerve under maximal tension is followed by an axonotmesis. This happens in an area in which the deep branch of the radial nerve crossed some narrow structures which are unyielding and have more compression strength (tense cords of connective tissue Fig. 3). The operative finding of a torsion of the injured fascicles justifies the correctness of the immediate operative revision; otherwise the nerve regeneration would be impaired by the torted empty endoneural tubes. This description is a further constribution not observed before to the compression syndromes of the radial nerve, since in 1970 the author was able to give an explanation for the pathogenesis of compression palsies of the radial nerve, unclear up to that time but observed after forceful muscle contractions again and again since the beginning of this century. This observation gives the evidence that the occurrence of a peripheral compression lesion of nerves is not bound absolutely on the existence of a "physiological narrowness" (fibrous or osteofibrous tunnel etc.). This is also true for the median nerve.

Humans↗
PubMed1999

Anterior interosseous nerve compression after supracondylar fracture of the humerus: a metaanalysis.

OBJECT: The authors conducted a metaanalysis of reports of anterior interosseous nerve syndrome, a rare nerve compression neuropathy that affects only the motor branch of the median nerve. This syndrome is characterized by paralysis of the flexor pollicis longus, the flexor digitorum profundus to the index finger, and the pronator quadratus, with weakness on flexion of the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger without sensory loss. METHODS: The authors reviewed reports of 34 cases of anterior interosseous nerve syndrome combined with supracondylar fractures of the humerus in children. They have added a new case identified in a 7-year-old boy in whom a diagnosis was made from the clinical findings and whose treatment and outcome are analyzed. The ages of patients reported in the literature ranged from 4 to 10 years. Ten patients (29%) were treated with closed reduction and application of a cast, whereas 25 patients (71%) were treated with open reduction and fixation of the fracture. CONCLUSIONS: All patients regained full flexion and strength after 4 to 17 weeks. The fractures that were surgically treated showed no entrapment of the anterior interosseous nerve.

Casts, Surgical↗
PubMed1996

[Injection therapy in cervical syndromes].

Injection therapy is highly significant in the treatment of cervical syndromes. Following the differential diagnosis and analysis of the symptoms, injection treatment leads to a worthwhile degree of pain relief as a result of the anaesthetic effect on the nerve. This paper describes the general criteria for such treatment and also the various injection techniques in use.

Anesthetics, Local↗