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Results for “Nerve Compression Syndromes”
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[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.
Guyon's canal decompression.
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The entrapment neuropathies of rheumatoid arthritis.
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[Surgical treatment of tunnel lesions of the nerves of the arm].
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Nontraumatic mononeuropathies: a review.
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[Clinical and electrophysiological diagnosis of the carpal and cubital syndrome].
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Entrapment neuropathies: clinical overview.
Causes include congenital defects, trauma, and inflammation. Some forms are overdiagnosed, particularly carpal tunnel syndrome. Others--such as thoracic outlet syndrome and anterior interosseous nerve syndrome--are rare. Diagnosis and management are relatively straightforward in most cases, but much remains to be learned about the natural course and prevention of these disorders.
Compression neuropathies in the anterior forearm.
In nerve entrapment syndromes in the upper extremity, the surgeon must first become a diagnostician. When the symptoms of entrapment are bilateral, diabetes mellitus and cervical arthritis are found in a significant statistical number over the general population. These diseases can result in incomplete relief of symptoms, even after decompression of the entrapment. In Upton's double crush theory, proximal nerve impingement can cause increasing symptoms distally and this can account for some failures following carpal tunnel surgery. Bilateral carpal tunnel patients are often predisposed by anatomically small carpal tunnel canals, cervical arthritis, or diabetes mellitus. Usually, with a precise diagnosis and a careful treatment plan, excellent results can be achieved with removal of the anatomic constriction or mechanical block.
Neurolysis in compressive neuropathies.
The application of microsurgical neurolytic techniques in cases of peripheral nerve entrapments offers greater advantages than other techniques, as it allows a better understanding of the neural alterations. In most cases, a longitudinal epineurectomy is necessary to free the fascicles of the epineural fibrosis. Less frequently, internal neurolysis is needed for removal of interfascicular scarring. Fifty cases of elbow ulnar neuropathy and 58 of the carpal tunnel syndrome were treated with this technique: 72% of the results were satisfactory.
Compression syndrome of the deep motor branch of the ulnar nerve. (Piso-Hamate Hiatus syndrome).
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[Pyramidal syndrome. Apropos of 4 cases treated by surgery and review of the literature].
PURPOSE OF THE STUDY: The authors report 4 observations of Piriformis syndrome, defined as a truncked sciatalgy with sciatic nerve and branches located compression at the buttock passing through the subpiriformis canal. MATERIAL: 4 sportive patients, 26 to 41 years old have been treated surgically after an average of one year and a half of evolution and failure of conservative treatments. The surgical procedure consisted in section of the piriformis muscle and neurolysis of the sciatic nerve. METHODS: The follow-up ranged from one year and a half. The observations were confronted with 11 english language publications, representing 20 observations. RESULT: 2 excellent results. One fair. The result of the last patient is uninterpreted due to a post-operative deficiency of the inferior gluteus nerve. But the pre-operative symptomatology has completely disappeared. DISCUSSION: Symptomatology associated a trunked sciatalgy arising during effort and during a long time sitting position, without lumbar pain. Paresthesy and dyspareunia can sometimes added. The specifics clinical signs are pain induced by palpation at the sacrum lateral edge, perception of a tense piriformis ("sausage shaped mass"), pain reproduction by stretching the piriformis (Freiberg) or by its opposite tensing (Pace and Nagle, Beatty). The complementary exams first allow to eliminate all rachidian or discal aetiology. The diagnosis is based on CT, MRI and bone scan which can show modifications of the piriformis muscle and especially the electrommyogram which confirms the syndrome and specifies the compression level. The aetiology is changeable, mainly represented by modification of piriformis (hypertrophy, contracture or micro traumatisms due to sport or after-effects of direct traumatism) and by anatomical modifications of the sciatic nerve, passing completely or in part through the muscle. First, the treatment must be conservative by sport rest, correction of occupational diseases, local injections and especially stretchings. The results are more often favourable. In case of failure and diagnosis certitude, the surgical treatment is the neurolysis of the sciatic nerve and the muscle section at the musculo-tendinous junction. CONCLUSION: This syndrome must be known but, in spite of its proved authenticity now, must stay an exceptional diagnosis and be based on irrefutable criteria.
Vertigo caused by basilar artery compression of the eighth nerve.
Vascular compression syndromes in the posterior cranial fossa have become well described clinical entities, especially for the fifth and seventh cranial nerves. Jannetta has proposed vascular compression of the eighth nerve as the etiology of hearing loss, tinnitus, and vertigo in some patients. The case that follows illustrates a clear-cut example of vestibular symptoms arising from vascular compression of the eighth nerve. The patient involved had disabling peripheral vertigo refractory to medical management. Magnetic resonance imaging documented a tortuous basilar artery compressing the eighth nerve on the involved side. This was confirmed at surgery, and a selective section of the vestibular nerve provided complete relief of disabling symptoms and preservation of hearing. The authors describe the details of this case and the enigma of eighth nerve symptoms due to vascular compression.
Anterior interosseous nerve paralysis: cubital tunnel (kiloh-nevin) syndrome.
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Peripheral nerve surgery.
In treating the three main surgical problems of peripheral nerves--nerve sheath tumors, entrapment neuropathies, and acute nerve injuries--the overriding consideration is the preservation and restoration of neurologic function. Because of this, certain other principles may need to be compromised. These include achieving a gross total excision of benign tumors, employing conservative therapy as long as a disease process is not clearly progressing, and delaying repair of a nerve transection until the skin wound has healed. Only three pathophysiologic processes need be considered: neurapraxia (focal segmental dymyelination), axonotmesis (wallerian degeneration caused by a lesion that does not disrupt fascicles of nerve fibers), and neurotmesis (wallerian degeneration caused by a lesion that interrupts fascicles). With nerve sheath tumors and entrapment neuropathies, the goal is minimize the extent to which neurapraxia progresses to axonotmesis. The compressive force is relieved without carrying out internal neurolysis, a procedure that is poorly tolerated, presumably because a degree of nerve ischemia exists with any long-standing compression. When the nerve has sustained blunt trauma (through acute compression, percussion, or traction), the result can be a total loss of function and an extensive neuroma-in-continuity (scarring within the nerve). However, the neural pathophysiology may amount to nothing more than axonotmesis. Although this lesion, in time, leads to full and spontaneous recovery, it must be differentiated from the neuroma-in-continuity that contains disrupted fascicles requiring surgery. Finally, with open nerve transection, the priority is to match the fascicles of the proximal stump with those of the distal stump, a goal that is best achieved if primary neurorrhaphy is carried out.
[Evolution of the compressive syndrome of the upper extremity].
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