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[Electrophysiology in distal median nerve compression syndrome--the so-called carpal tunnel syndrome].

152 patients--110 women and 42 men--presenting a distal compression syndrome of the N. medianus, the so-called "carpal-canal syndrome" were examined electromyographically and electroneurographically on 198 hands. For avoiding a wrong diagnosis, the determination of the distal motor latency was carried out by means of concentric needle electrodes. Checkups could be carried out in 79 of the patients. Of these, 42 had in the meantime been subjected to an operation, 83 per cent of them with an improvement of the complaints. On the other hand, in 37 of the patients who had not been operated on, the complaints were unchanged or had increased. Only 27 per cent were free from complaints.

Carpal Tunnel Syndrome↗

Octavus nerve neurovascular compression syndrome.

The octavus nerve neurovascular compression syndrome is a neuropathy of the 8th cranial nerve caused by vascular compression. The clinical, neurophysiological and therapeutic aspects of this syndrome will be discussed on the basis of 10 patients.

Adult↗

Longitudinal sliding of the median nerve in patients with carpal tunnel syndrome.

In nerve compression syndromes restricted nerve sliding may lead to increased strain, possibly contributing to symptoms. Ultrasound was used to examine longitudinal median nerve sliding in 17 carpal tunnel syndrome patients and 19 controls during metacarpophalangeal joint movement. Longitudinal movement in the forearm averaged 2.62 mm in controls and was not significantly reduced in carpal tunnel syndrome (CTS) patients (mean=2.20 mm). In contrast, CTS patients had a 40% reduction in transverse nerve movement at the wrist on the most, compared to least, affected side and nerve areas were enlarged by 34%. Normal longitudinal sliding in the patients indicates that nerve strain is not increased and will not contribute to symptoms.

Adult↗

Proximal ulnar nerve compression. Cubital tunnel syndrome.

Ulnar nerve compression about the elbow is common. If diagnosed and treated early, satisfactory results can be expected. Severe chronic nerve compression may lead to permanent nerve damage. The diagnosis can be made by careful history, physical examination, knowledge of the nerve anatomy, and sometimes electrodiagnosis. Cubital tunnel syndrome must be differentiated from TOS and ulnar tunnel syndrome. Double-crush syndrome should be ruled out. Nonoperative treatment must be attempted first, whereas surgical treatment is indicated in severe and chronic cases. Satisfactory results can be achieved after surgery if nerve damage is absent and careful attention to technical details and gentle handling of the nerve are exercised.

Biomechanical Phenomena↗

[Treatment of common fibular nerve secondary compression syndrome].

OBJECTIVE: To investigate the mechanism, diagnosis, and treatment of common fibular nerve compression syndrome secondary to sciatic nerve injury. METHODS: Based on the clinical manifestation and Tinel's sign at fibular tunnel, 5 cases of common fibular nerve secondary compression following sciatic nerve injury were identified and treated by decompression and release of fibular tunnel. All 5 cases were followed up for 13-37 months, 25 months in average, and were evaluated in dorsal flexion strength of ankle. RESULTS: The dorsal flexion strength of ankle in 4 cases increased from 0-I degrees to III-V degrees, and did not recover in 1 case. CONCLUSION: Fibular tunnel is commonly liable to fibular nerve compression after sciatic nerve injury. Once the diagnosis is established, either immediate decompression and release of the entrapped nerve should be done or simultaneous release of fibular tunnel is recommended when the sciatic nerve is repaired.

Adolescent↗

Compartment syndromes in the forearm.

This paper has been written in response to a reader's set of questions: "Do compartment syndromes in the forearm exist? "I am also curious about the effects of nerve compression syndromes in the forearm. "What are the signs and symptoms of ulnar nerve compression and where is Guyon's canal? "What are the signs of posterior interosseus nerve compression syndrome?" The author emphasises that the answers are based on his experience as a plastic surgeon and could vary according to the experience of the surgeon consulted.

Acute Disease↗

[Compression syndromes of peripheral nerves of the upper extremity (author's transl)].

Among the non-traumatic lesions of peripheral nerves the compression syndromes occupy a numerically leading position. After mentioning the common characteristics the individual compression syndromes of the brachial plexus and peripheral nerves of the upper extremity are described: the compression of the brachial plexus in the posterior triangle of the neck, in the costoclavicular passage and on hyperabduction. The suprascapular notch syndrome ist mentioned. The distal compression syndrome of the median nerve, the carpal tunnel syndrome is described in detail as the most common of the compression syndromes. The proximal compression syndrome of the ulnar nerve, the cubital tunnel syndrome, ist also described as are the distal compression syndrome of this nerve, Guyon's recess syndrome and the ramus profundus nervi ulnaris lesion. The supinator recess syndrome of the radial nerve is briefly mentioned.

Arm↗

[3D-MR myelography in diagnosis of lumbar spinal nerve root compression syndromes. Comparative study with conventional myelography].

65 patients with nerve root compression syndrome were examined using a new type of MR-technique, which is comparable to the conventional X-ray myelography. The results of the prospective case study were compared with previous clinical experiences (1). For the examinations a 1.0T whole body MR-system (Siemens Magnetom Impact) was used. A strong T2*-weighted 3D-FISP sequence (TR = 73 ms, TE = 21 ms, alpha = 7 degrees) was applied in sagittal orientation using a circularly polarized oval spine coil. To obtain fat suppression a frequency selective 1-3-3-1 prepulse was applied prior to the imaging sequence. The acquired 3D-data set was evaluated using a Maximum Intensity Projection (MIP) program. Our results confirmed earlier experiences which showed that the diagnostic sensitivity of 3D-MR myelography (3D-MRM) is comparable to that of conventional X-ray myelography. In cases of severe spinal canal stenosis and spondylolisthesises, and in cases of postoperative scar tissue with nerve root compressions, the sensitivity of the 3D-MRM is higher as compared to that of conventional X-ray myelography.

Adult↗

[Cranial nerve vascular compression syndromes and neurogenic hypertension].

The presented paper is a review of syndromes which till recently had an obscure cause and still have attributes such as "primary" or "essential". Their common denominator is vascular compression of the roots of the appropriate cephalic nerves. The syndromes include trigeminal neuralgia, glossopharyngeal neuralgia, hemifacial spasm, some forms of tinnitus and vertigo, exceptionally toricollis. Vascular compression of the ventrolateral oblongata on the left leads to neurogenic hypertension. The author discusses the state of knowledge on the aetiology of syndromes, the clinical and laboratory research of which contributed some findings on the physiology and pathophysiology of the mentioned conditions. At the same time the authors present their own experience with the therapeutic method of syndromes--microvascular decompression.

Cerebrovascular Disorders↗

The moving two-point discrimination test: clinical evaluation of the quickly adapting fiber/receptor system.

As the Weber test evaluates the slowly adapting fiber-receptor system (constant touch), the "moving two-point discrimination test" evaluates the innervation density of the quickly adapting fiber-receptor system which mediates the perception of touch stimuli moving across the hand. Results with this test in 39 hands used as controls and in 63 patients with nerve injuries show it to be a simple, quick, and valid diagnostic tool in nerve compression syndromes and nerve lacerations and an accurate prognosticator and monitor during sensory reeducation following nerve repair.

Adolescent↗

[Non-traumatically-induced paralysis of the ramus profundus nervi radialis. Aspects of a rare disease picture].

Both radial tunnel syndrome and posterior interosseous nerve compression syndrome are caused by compression of the posterior interosseous nerve. Posterior interosseous nerve (PIN) compression syndrome is a rare condition--less than 10 percent of our cases of PIN-compression showed signs of palsy--and must be differentiated from tendinous lesions. From 1992 to 1997, we decompressed the PIN using an anterior approach in nine cases because of palsy without a history of trauma. Only one patient was lost to follow-up. Our study indicates that the results of operative decompression of the PIN depend on the time interval between first symptoms of palsy and operation. On the other hand, some cases of posterior interosseous nerve compression syndrome show spontaneous recovery. We recommend operative decompression of the PIN if incomplete palsy worsens or if complete palsy persists for more than 12 weeks.

Adult↗

[Compression syndrome of the radial nerve in the area of the supinator groove. Experiences with 110 patients].

Both radial tunnel syndrome and posterior interosseous nerve (PIN) compression syndrome are caused by compression of the posterior interosseous nerve. There is a controversy about certain features of PIN compression especially with regard to diagnostic criteria and therapy as well as differentiation from tennis elbow. From 1992 to 1997, we operated 110 patients because of PIN compression. Diagnosis was based on clinical examination only. As a rule, we decompressed the PIN directly using an anterior approach. With regard to radial tunnel syndrome, we could review 69 from 103 operations with an average follow-up of 41 months. Using the criteria originally proposed by Roles and Maudsley, only 60% showed excellent or good results. The mean DASH score was 32. Recompression of the PIN by scarring was found in as much as 17% of patients and proved to be a serious complication of direct decompression of the PIN. Furthermore, 52% of our patients operated on because of PIN compression suffered from tennis elbow as well. We therefore believe that radial tunnel syndrome is a specific form of tennis elbow. From an anatomical point of view, the inseparable origin of the radial wrist extensors and supinator muscle seems to link tennis elbow and radial tunnel syndrome. To avoid recompression of the PIN by scarring, we have abandoned direct decompression and now routinely use Wilhelm's denervation procedure for the treatment of tennis elbow as well as radial tunnel syndrome. This procedure indirectly decompresses the PIN by cutting the superficial origin of the supinator muscle with consecutive relaxation of Frohse's arcade. Preliminary results are promising and show improvement of preoperative neurologic status by indirect decompression.

Adolescent↗

A review of compressive ulnar neuropathy at the elbow.

OBJECTIVE: To review the anatomy, etiology, and symptoms associated with compressive ulnar neuropathy at the elbow and to discuss the diagnosis and treatment of this condition. DATA SOURCE: The following were searched for information relevant to cubital tunnel syndrome: MEDLINE, WorldCat, and Index to Chiropractic Literature. RESULTS: Cubital tunnel syndrome is the second most common nerve compression syndrome of the upper extremity. Clinical features of this syndrome are described along with electrodiagnostic techniques that can be used to provide evidence concerning the probable location, character, and severity of the lesion affecting the ulnar nerve. Conservative treatment of cubital tunnel syndrome is recommended for patients with intermittent symptoms and without changes in cutaneous sensation or muscle atrophy. CONCLUSION: A definitive diagnosis can best be made using clinical tests along with nerve conduction studies and electromyography, conservative treatment can be effective in treating this neuropathy in mild cases; in moderate or severe cases, surgery may be necessary.

Cubital Tunnel Syndrome↗

Aneurysmal peroneal nerve compression.

Vascular compression syndromes of the peroneal nerve are rare. The case history of a patient with a peroneal nerve compression caused by a true anterior tibial artery aneurysm is reported. The surgical excision of the aneurysm resulted in marked improvement.

Aneurysm↗

[About the problem of radial tunnel syndrome or "where does the tennis elbow end and where does the radial tunnel syndrome begin?"].

Tennis elbow or epicondylitis lateralis humeri is a commonly seen pain-syndrome. Radial tunnel syndrome is generally assumed to be a rare nerve compression syndrome. This study intents to demonstrate that tennis elbow is the most common manifestation of radial tunnel syndrome or in other words, tennis elbow is nothing else but radial tunnel syndrome. In patients with tennis elbow one will always find the ramus profundus n. radialis compressed by the arcade of Frohse. The author is convinced that following the carpal tunnel syndrome, the radial tunnel syndrome is the second most common nerve compression in upper extremity.

Adult↗