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Atypical facial pain, ectasia of the basilar artery, and baclofen: a case report.

Atypical facial pain is a clinical syndrome of facial pain that has been related to depression but whose pathogenesis is not known. We describe a 72-year-old woman with a chronic facial pain, and ectasia and left sided deviation of the basilar artery, that responded dramatically to baclofen. This case suggests that vascular compression of the trigeminal nerve may be one of the mechanisms producing this syndrome and in these cases it might respond to baclofen.

Aged↗

Disputed radial tunnel syndrome.

True neurogenic radial tunnel syndrome is an uncommon condition caused by entrapment of the radial or posterior interosseous nerve in the radial tunnel and is usually easily identifiable by focal motor weakness in the distribution of the posterior interosseous nerve. Roles and Maudsley, analogizing to carpal tunnel syndrome, believed "radial tunnel syndrome" had a different presentation: proximal forearm pain and tenderness in the region of the supinator muscle. However, their patients lacked weakness or other neurologic deficit. They and subsequent surgeons have decompressed the radial nerve to treat forearm pain and tenderness, even though it is debatable whether radial nerve entrapment causes the forearm discomfort. The term "radial tunnel syndrome" is best reserved for the truly neurogenic cases. Surgical approaches to "persistent tennis elbow" should be assessed in a controlled fashion, rather than adopted on the basis of a flawed analogy to carpal tunnel syndrome.

Carpal Tunnel Syndrome↗

Myoclonus of peripheral origin: case secondary to a digital nerve lesion.

We present a patient with myoclonus of the left hand appearing 1 month after surgical correction of a stenosing tenosynovitis of the thumb. An extensive fibrosis of the external palmar digital nerve was shown, and the successful liberation of this median nerve terminal branch completely and rapidly eliminated the movement disorder.

Adolescent↗

[Tunnel syndromes of the upper limb].

The main canalicular syndromes affecting the upper extremities are reviewed with a description of their aetiopathogenesis. Particular emphasis is placed on the need for early diagnosis and microsurgical treatment that on the basis of personal experience is held to guarantee early recovery.

Arm↗

The contribution of electrodiagnosis to plastic surgery.

The numb or painful hand or foot may result from a peripheral nerve entrapment. Detailed examination including electromyography frequently reveals to the plastic surgeon the exact site of pathology and the indicated treatment.

Carpal Tunnel Syndrome↗

Ischaemia of peripheral nerve and muscle.

Although skeletal muscle and peripheral nerves are both resistant to ischaemia there are nevertheless many syndromes in which they are affected, either separately or together. It is frequently difficult to distinguish the effects of arterial ischaemia from those of compression, which may operate through vascular occlusion, or, in the case of peripheral nerve, by mechanical deformation of nerve fibres. A great deal has been learned from experimental models, but not all of it is applicable to the complexity of human neuromuscular ischaemia which requires further study.

Arteriosclerosis↗

[Electrophysiological methods for diagnosis of entrapment syndromes of peripheral nerves].

Summary. Apart from clinical findings, the diagnosis of compression syndromes of peripheral nerves is based on electrophysiological investigations. This includes the determination of nerve conduction velocities, distal motor latency and electromyography, which gives a qualitative indication of the condition of nerves and their related muscles. In the 1980s, new methods were developed for quantifying the diagnoses of nerve lesions and their recovery. Due to the development of new software, we can now carry out these investigations with commercial equipment. The macro-EMG and the motor-unit-estimation give information about the size and number of activated motor units of muscles. One needs a special needle which derives single-fibre- and macro-potentials for recording of the macro-EMG. The single-fibre-potential is used for triggering. The motor-unit-estimation represents a non-invasive method to determine the approximate number of motor units. Multiple point stimulation of the nerve is used to determine action potentials which are registered by surface electrodes. Afterwards, the medians of amplitudes and areas of motor unit action potential are defined and must be divided by the corresponding value of maximal compound muscle action potential for estimating motor units. In this way, the extent of nerve damage can be determined exactly. Additionally, a post-operative follow-up is possible. Furthermore, these methods give information about regeneration processes after nerve damage and their recovery after reconstruction and transplantation. From our point of view, these methods should be included in investigation routinely.

Decompression, Surgical↗

Multiple compression neuropathies and the double-crush syndrome.

Multiple compressions along a nerve have a cumulative effect on condition, both antegrade and retrograde. This nerve compromise renders the nerve more susceptible to a second source of compression. The proximal source of compression may be subclinical yet partially responsible for the cumulative compression syndrome. The primary "crush" may be anatomic or metabolic in origin. Strict attention to the patient's history and physical findings permit separation of the multiple compressions, making the choice of surgical decompression easier. Provocative testing and work simulation are important in examination, as is EMG testing. Complete medical evaluation can aid in diagnosing patients presenting with peripheral nerve compression and additional risk factors. Surgical decompression of a nerve with multiple levels of compression may not relieve all symptoms. Dynamic compressions in the work place and other nonsurgical types of compression must be identified so the prognosis for complete recovery is improved.

Adult↗