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PubMed1989

[Nerve compression syndromes of the arm].

Among neural lesions of the arms, the most common one is the medianus lesion in the carpal tunnel, followed by the ulnar nerve lesion in the elbow, while the ulnar nerve compression in the Guyon tunnel is found rarely. Besides the history and the clinical picture, the electromyoneurographic analyses make an early and accurate diagnosis possible. The characteristics of the evoked muscle potential and distal latencies in the diagnosis of the carpal tunnel syndrome are of utmost importance. In diagnosing the cubital syndrome, the multisegmental determination of the motor conduction velocity of the ulnar nerve and the features of the M-potential obtained by means of stimulation above the compression are very important. Generally speaking, the slowing down of the motor conduction velocity remains localised to the entrapped segments. The neural potential over the compression in the elbow cannot be evoked, and it is hardly evoked in the wrist. Within the period of the last five years, the author examined 154 patients clinically and electrophysiologically. 132 had the carpal tunnel syndrome, 20 the ulnar groove syndrome, and 2 Guyon's canal syndrome. The patients were treated conservatively and operatively. The success in the conservative treatment of the carpal tunnel syndrome was evident in the first three months by the absence of sensory symptoms in more than 50% of cases. The constant effect was achieved after six months. In that period the EMG findings were not essentially changed, and motor symptoms were also stationary. With the operative treatment the unpleasant symptoms, pain and shudder, disappeared after a relatively short period. Definitive results were achieved after six months. Motor symptoms were less improved and the EMG findings were showing a tendency to improvement. The ulnar groove syndromes were not remarkably influenced by the conservative therapy. Half the operated patients lost their sensory symptoms. Within six months the other half remained with the same or even more trouble.

Adult↗
PubMed1998

[Nerve compression syndrome in the thoracic outlet].

INTRODUCTION: The nerve conduction studies, F-waves and dermatosomal and lor somatosensory evoked potential have a low level of sensitivity for Thoracic Outlet Compression Syndrome (TOCS) diagnosis. A standard negative electrodiagnostic study does not exclude the presence of TOCS. OBJECTIVE: The purpose of this neurophysiological note is that the Wright's hyperabduction, costoclavicular compression and Adson's scalenus tests important in making a clinical diagnosis of TOCS can be used as neurophysiological provocative maneuvers to determine the effect of braquial position on electrodiagnostic parameters. MATERIAL AND METHODS: Nine selected TOCS patients were evaluated previous and following provocative maneuvers for 3 and 6 minutes. RESULTS: The results showed a positive electrodiagnostic study in 7/9 patients. CONCLUSIONS: It is suggested that patients with presumptive TOCS and negative electrodiagnostic findings be reevaluated immediately after 6 minutes of Wright's, Adson's or costoclavicular compression provocative tests.

Brachial Plexus↗
PubMed2004

Pronator syndrome and other nerve compressions that mimic carpal tunnel syndrome.

The purpose of this clinical commentary is to provide a comprehensive review of compressive neuropathies that may mimic carpal tunnel syndrome, provide the clinician with information to differentially diagnose these median nerve compression sites, and provide an evidence-based opinion regarding conservative intervention techniques for the various compression syndromes. While rare in comparison to carpal tunnel syndrome, pronator syndrome and anterior interosseous nerve syndrome are proximal median nerve compressions that may be suspected if a patient with carpal tunnel syndrome fails to respond to conservative or surgical intervention. Differential diagnosis is based largely on the symptoms, patterns of paresthesia, and specific patterns of muscle weakness. Due to the relative rarity of pronator syndrome and anterior interosseous nerve syndrome, few controlled studies exist to determine the most effective treatment techniques. Based on sound anatomical and biomechanical considerations, anecdotal experience, and available research, however, treatment strategies for pronator syndrome and anterior interosseous nerve syndrome compression neuropathies can be divided into 4 major categories: (1) rest/immobilization, (2) modalities, (3) nerve gliding, and (4) nonconservative treatment.

Carpal Tunnel Syndrome↗
PubMed1991

[Distal ulnar nerve compression syndrome. Intra-operative pressure measurement and surgical procedure].

Four cases of different distal ulnar nerve lesions are presented. Compared with the median nerve in the carpal tunnel syndrome (CTS), the surgical procedure with the distal ulnar nerve has to be determined more by the location of the nerve lesion. Because of the small number of cases and the different types of lesion, pressure on the nerve in the "Loge de Guyon" cannot yet (in contrast to the CTS) be defined by intraoperative pressure recording. An extreme pressure elevation with active movements by the patient might point to a nerve entrapment syndrome. Compared with phalen's test in the carpal tunnel syndrome, and because of its low specificity abduction of digit 5 as a sensitive sign of sensory disturbances in the "Loge de Guyon" is unreliable.

Aged↗
PubMed1992

[Chronic ulnar nerve compression syndrome at the elbow. Apropos of 74 cases].

Seventy-four patients were operated at Bichat hospital for chronic ulnar nerve entrapment at the elbow between 1982 and 1988. For 62 of them, the etiology of the compression was idiopathic and these cases were treated by neurolysis only or, if the nerve was unstable, by neurolysis associated with medial epicondylectomy. For 12 of them, the etiology of the compression was post-traumatic and these cases were treated by anterior subcutaneous transposition of the nerve using a fat sling. The average follow-up is 28 months and the results take into account the clinical preoperative grading according Mac Gowan's classification: grade I subjective symptoms combined with hypoesthesia in ulnar fingers grade II: weakness and wasting of the interossei combined with subjective symptoms, grade III: marked weakness and wasting of the interossei, adductor pollicis, and hypothenar muscles combined with anesthesia in ulnar fingers. The 62 idiopathic compressions treated by neurolysis only or, if the nerve was unstable, by neurolysis associated with medial epicondylectomy showed 51 very good and good results. The 12 post-traumatic compressions treated by anterior subcutaneous transposition of the nerve using a fat sling showed 9 very good and good results. The authors stress the importance of their approach which takes account of the clinical preoperative grading and the etiology of the compression in order to apply correct surgical treatment.

Elbow↗
PubMed1985

[Median nerve--compression syndrome caused by atypical palm muscle].

A compression syndrome of the median nerve was caused by an atypical M. flexor digiti indicis in the palmar area and carpal tunnel. Apart from its anomalous anatomy, this muscle showed an abnormal histological structure. A persistent median artery was also seen in the carpal canal.

Adolescent↗
PubMed1975

Femoral nerve compression syndrome with paresis of the quadriceps muscle caused by radiotherapy of malignant tumours. A report of four cases.

Four patients showed signs of femoral nerve compression with subsequent paresis of the quadriceps muscle, after radiation therapy of malignant tumours. The compression was caused by scar tissue due to radiation treatment of the inguinal region. The first symptom was radiating pain in the front of the thigh and lower leg which appeared 12-16 months after X-ray treatment. A decrease in the strength of quadriceps muscle occurred some months later. In one case the femoral nerve was decompressed, another patient was treated by an intradural phenolglycerin injection and one patient was treated with cortisone and oxiphenbutazone. In these cases the pain decreased considerably, but in one case only the paresis of the quadriceps muscle improved after treatment.

Adult↗