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The clinical and electrodiagnostic presentation of peroneal neuropathies are detailed in this article. There is a special emphasis on nerve conduction study findings and their relationship to prognosis and management. The differential diagnosis of foot drop, including when caused by the anterior compartmental syndrome of the leg, is also discussed.
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In general, musculotendinous injuries of the forearm are not uncommon and are generally self-limited. The fact that there are so many different modalities of treatment speaks well for the human body to repair itself under some very adverse circumstances. Rest and splinting of the part, elevation, and judicious use of analgesics is still the treatment of choice. The injudicious use of heat and cold and electrical appliances of various types usually indicate a therapist in search of a treatment.
A compression syndrome of the median nerve in the forearm of a 16-years-old girl was caused by an atypical distal belly of the palmaris longus muscle with a tumorlike appearance. Special swimming training with so called "paddles" is thought to be the reason for the enlargement of this muscle.
This syndrome, which involves nerve compression, is probably often overlooked and is, therefore, more frequent than supposed. It is characterized by pain of the forefoot, especially the 3rd and 4th toe, and is induced by pressure of the intermetatarsal space, or extension of the metatarsophalangeal joints. Results of the present study suggest that it can be successfully treated by surgery. Fifty-four patients--mostly women in midlife--had undergone operation by dorsal excision of the "neuroma" which had been performed under local anaesthesia in a bloodless field. Forty of the patients (74.1%) had recovered completely within an observation period of 1-6 years. Four (7.4%) demonstrated significant, and another 4, only slight improvement. In 6 cases (11.1%), surgery failed. The 6 unsuccessful cases had not exhibited any preoperative disturbance to the sensibility of the 4th toe. They showed, rather, symptoms of conversion disorder with depressive features, e.g. increased nocturnal suffering which is atypical for Morton's metatarsalgia. It is concluded that the accuracy of diagnosis according to strict criteria is decisive for surgical outcome.
METHODS AND RESULTS: In the majority of cases surgical operation is successful in the carpal tunnel syndrome, the pain in particular is eliminated. Distrubances of sensitivity improve more slowly. If motor disturbances are already present, improvement is less likely, only in about 10% of cases. Therefore early operation is recommended. If simple severing of the circular ligament is not successful, neurolysis should be undertaken, the results of which far exceed those of division. The symptoms may also be eliminated by infiltration with hydro-cortisone. However, if infiltration is repeated too often, changes in the flexor tendons may occur, possibly a rupture.
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When the diagnosis of suprascapular nerve entrapment syndrome is being considered, variations in anatomy are possible etiologic factors. Seventy-nine shoulders from 41 cadavers were examined for anatomic variations and for ganglion cyst formation in the suprascapular notch, superior transverse scapular ligament, and inferior transverse scapular ligament. The morphologic evaluation of the suprascapular notch revealed a "U" shape in 77% and a "V" shape in 23%, with 89% of cadavers having the same notch shape bilaterally. In 23% of shoulders a variation of the superior transverse scapular ligament was demonstrated such as partial and complete ossification and multiple bands including the first report of a trifid superior transverse scapular ligament. An inferior transverse scapular ligament was observed in only 14% of shoulders. One ganglion cyst was identified, for an incidence of 1%. The mass was located in the supraspinatus fossa adjacent to the superior transverse scapular ligament and appeared to compress and alter the course of the suprascapular nerve. When operative treatment is elected for suprascapular nerve entrapment syndrome and an open surgical approach is undertaken, the location and source of disease and morphologic and anatomic variants must be recognized to ensure adequate access and complete decompression of the suprascapular nerve. The classical description of the superior transverse scapular ligament as a completely nonossified single band should be expected, on average, in approximately three fourths of the cases. Partial or complete ossification and anomalous bands of the superior transverse scapular ligament or a ganglion cyst along the course of the suprascapular nerve may be encountered. Although a superior transverse scapular ligament should be anticipated in all shoulders, an inferior transverse scapular ligament will be a much less frequent finding. The role and significance of suprascapular notch morphologic characteristics warrant further investigation.
Suprascapular entrapment neuropathy represents a chronic lesion of the suprascapular nerve due to compression, traction and/or friction within the area of the suprascapular notch. The surgical treatment consists of excision of the entire suprascapular ligament. The surgical exposure of the suprascapular notch through the trapezius muscle is illustrated using anatomical dissections.
This article reports 25 cases of syndrome of entrapment of posterior interosseous nerve, among them 23 cases had been operated. Compression of the posterior interosseous nerve were found to be by tendinous tissue in 14 cases, vascular in 12, scar tissue in 6, in 11 cases which had more than 2 locations of compression no definite cause was found in 3 cases. Nineteen cases had undergone neurolysis when the compressed nerves became membranous it was excised and direct end-to-end anastomosis were performed in 4 cases. Histological examination in 10 cases showed a common pathological change of proliferation and inflammation. The authors discussed the etiology of this disease, and emphasized that early diagnosis and treatment will influence greatly on its prognosis.
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