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[Functional mechanisms of the proximal ulnar nerve compression syndrome].

The proximal ulnar compression syndrome when it is not a result of trauma, tumors, inflammatory and degenerative processes, inborn deformations or external pressure, is caused by two mechansims, namely the pinching of the ulnar nerve between the proximal edge of the ligamentous and muscular coverings of the cubital tunnel and of the exit of the nerve from the tunnel under the tendinous arch of the flexor carpi ulnaris. The compression itself is dependent upon the possibility of subluxation of the ulnar nerve. Therapy should consists not only in "decompression", but also in a simultaneous anterior transposition of the ulnar nerve.

Elbow↗

[Nerve compression syndromes of the extremities].

Peripheral entrapment neuropathies occur in high frequency and present clinically with a wide range of variations. They need to be recognized early enough in order to initiate correct therapy and so to obviate serious nerve lesions and possible neurological sequelae. This paper overviews the essentials of the compression neuropathies as they are encountered in both upper and lower extremities. Pathomechanisms , pathogenesis, evaluation considerations as well as differential diagnosis and basic treatment algorithms are emphasized.

Carpal Tunnel Syndrome↗

[Proximal radial nerve compression syndrome. Treatment and results].

Radial palsy after a single brisk contraction of the triceps muscle was first described by Gowers in 1892. The cause of such paralyses, which also can be found after chronic overexposure, in the course of fracture healing and because of inflammation or tumors, has not been explained until 1969. Two mechanisms are of importance for pressure effects on the radial nerve; either the nerve can be compressed in the hiatus nervi radialis due to swellings or a direct lesion occurs. The latter can happen because of a sudden brisk muscle contraction or on account of chronic trauma caused by the lateral head of the triceps. Since 1969, twenty patients with such radial nerve compressions have received surgical treatment and follow-up in our clinic.

Adolescent↗

Unusual complication of an opposition tendon transfer at the wrist: ulnar nerve compression syndrome.

Restoration of thumb opposition by tendon transfer may be necessary in cases of severe thenar atrophy caused by long-standing carpal tunnel syndrome. Routing the extensor indicis proprius transfer subcutaneously around the ulna to reanimate thumb opposition is an accepted procedure and is considered safe. Ulnar nerve compression leading to palsy is possible, however, as shown in the patient presented. Neurolysis failed to improve the palsy. Rerouting of the transfer deep to the ulnar nerve was necessary to treat the iatrogenic condition. Possible nerve compression should be kept in mind when planning a tendon transfer around the ulnar side of the forearm or carpus and when following up with the patient. Early intervention is necessary to prevent permanent sequelae.

Adult↗

[Nerve compression syndrome caused by synovial cyst of the hip joint].

Synovitis of the iliopectineal bursa have been described in pigmented villanodular synovitis, synovial chondromatosis, rheumatoid arthritis, osteoarthritis and necrosis of the femoral head. We report a case of enlargement of such a cyst in necrosis of femoral head and consecutive osteoarthritis, leading to entrapment of the femoral nerve. Simple drainage of the cyst did resolve pain for a short period and only elimination of the primum pathologicum agens did definitively release pain, irradiating to the ipsilateral leg.

Diagnosis, Differential↗

[Ulnar nerve compression syndrome of the elbow. Analysis of 50 operated cases].

This is a retrospective review of 50 elbows (44 patients) treated operatively by simple decompression (seven cases), decompression with epitrochlectomy (13 cases), and anterior transposition (30 cases) for compression neuropathy of the ulnar nerve at the elbow. We performed a superficial transposition in five cases, an intramuscular transposition in 13 cases, and a deep submuscular transposition in 12 cases. The mean follow-up was three years and two months. The overall results show cure or improvement in 78% of cases, no changes in 20% of cases, and one case with subjective worsening. The postoperative result was inversely proportional to the initial degree of the neuropathy. The cases related to trauma obtained a better result.

Adolescent↗

[Rare location of an epidermoid cyst in the forefoot region with nerve compression syndrome. Contribution to the differential diagnosis of Morton's metatarsalgia (author's transl)].

The case of a rare location of an epiderman cyst in the forefoor region is reported. Very intense pain on pressure or tension in the plantar region of the second and third metatarsals suggested a metatarsalgia and the existing diffuse swelling a synovitis. Surgical revision revealed an epidermoid cyst the size of a hazelnut which pressed the N. digitalis plantaris communis against the head of the third metartarsal.

Adult↗

[Choice of procedure in therapy of distal median nerve compression syndrome].

Endoscopic carpal tunnel release is frequently recommended. This technique allows only for division of the retinaculum flexorum, but does not enable the surgeon to address concommitant synovialitis or compression of the motor branch of the median nerve. In 67 patients, we attempted to differentiate the indications for procedures by endoscopic versus open carpal tunnel release. Beside an electrophysiological investigation, sonography of the wrist was performed to evaluate the extent of accompanying tenosynovialitis of the flexor tendons. A possible participation of the thenar branch was examined by electromyography. If there were no additional pathologic findings in the preoperative diagnostic work-up, a simple carpal tunnel release was performed. In all other cases, open surgical release was performed.

Adult↗