[True lumbago as a prodromal sign in vertebral-nerve root herniated disk syndromes].
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Piriformis syndrome, a term applied to an abnormal condition of the piriformis muscle, is characterized by symptoms and signs due to sciatic nerve entrapment at the greater sciatic notch. Recently we reviewed a case of unusual low back pain, radiating to the left lower extremity with tenderness particular in the left buttock. The patient was successfully treated by sectioning the piriformis tendon. We described the clinical features of a case of piriformis syndrome and reviewed the foreign literature.
Penile insensitivity is a symptom commonly observed after traumatic or iatrogenic nerve lesions, or in association with neurological or vascular diseases. In contrast, we report 2 cases of intermittent genital hypesthesia that occurred in cyclists after long-term bicycle riding. Anatomical studies show that this condition was probably caused by an irritation of the pudendal nerve during its course through the Alcock canal as reported in the literature. No pathological findings were demonstrated on extensive physical examinations, medical history and all medical imagings (sonography of abdomen, prostate and testes, and magnetic resonance imaging of the pelvis and lumbar spine) as well as radiodiagnostics and Doppler sonography, nor was there evidence of other neurological disturbances. The symptoms in the 2 patients spontaneously resolved after 4 and 7 weeks, respectively, without specific medical therapy.
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Thirty patients ranging in age from twenty-five to seventy-seven years old underwent medial epicondylectomy with anterior transposition of the ulnar nerve for the cubital tunnel syndrome. Presenting symptoms invariably included hypesthesia in the hand; other common complaints included dysesthesia and weakness of grip. The preoperative nerve-conduction velocity was slowed in all the patients studied. Postoperative responses in all patients included almost immediate relief of pain, no limitation of range of motion of the elbow, and a return to normal of nerve-condition velocity in all but two of the patients tested. The procedure is recommended for patients with cubital tunnel syndrome associated with abnormal nerve-conduction velocity.
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The pain associated with refractory epicondylitis humeri radialis can be eliminated not only by denervation, i.e. palliatively, but also by decompression of the radial nerve in certain cases. We assume that the latter procedure eliminates an important cause of irritation, particularily by resection of the tendineous origin of the proximal caput of triceps muscle. In this respect we consider the inferior cervical syndrome, present in all cases, to be the primary pathogenetic factor in accordance with REISCHAUER.
Vascular compression of the vestibulocochlear (VIIIth) nerve may cause constant or recurrent positional vertigo, tinnitus, and/or hearing loss. At present the diagnosis is based upon history, physical findings, audiologic assessment, vestibular function testing, and auditory brainstem evoked responses. Delineation of the vascular and neural anatomy within the cerebellopontine angle (CPA) has not been part of the preoperative assessment. We recently treated a patient demonstrating the clinical features of this syndrome. A magnetic resonance imaging (MRI) study revealed a vascular loop of the anterior inferior cerebellar artery intimately associated with the VIIIth nerve at the porus acusticus. To better define the significance of this finding, we retrospectively reviewed the CPA neurovascular anatomy of 100 (200 sides) otherwise normal MRI scans performed for unrelated disorders. Vessels were identified on 59.9 percent of sides while nerves were seen on 40 percent of sides. Contact between vessel and nerve occurred on 12.5 percent of sides and when both nerve and vessels were seen concurrently, they were in contact 50 percent of the time. These findings may preclude the use of MRI as the definitive diagnostic test in the preoperative assessment of vascular VIIIth nerve compression.
Although neuropathies in the athlete's foot and ankle are uncommon, they are often underdiagnosed. This is primarily due to the complex interplay of factors that are required for their presentation. The most frequently encountered entrapment syndromes (in decreasing order) involve the interdigital nerves, first branch of the lateral plantar nerve, isolated medial or lateral plantar nerves, posterior tibial nerve, deep peroneal nerve, superficial peroneal nerve, sural nerve, and saphenous nerve. A thorough knowledge of peripheral nerve anatomy is essential in establishing the diagnosis. Roentgenograms may reveal bony abnormalities that are the diagnosis. Roentgenograms may reveal bony abnormalities that are commonly contributory. Electrodiagnostic tests may be normal because these dynamic syndromes often resolve at rest. In most cases, correction of underlying etiologies combined with rest, NSAIDs, and occasionally injections will allow resolution of the syndrome. Recalcitrant cases may require surgical decompression, which frequently provides satisfactory results.