Sample records for ulnar nerve lesions

  1. Surgical Outcomes of Ulnar Nerve Lesions in Children

    Microsoft Academic Search

    Alper Baysefer; Yusuf Izci; Kamil Melih Akay; Hakan Kayali; Erdener Timurkaynak

    2004-01-01

    The ulnar nerve provides the major motor innervation of the interosseous muscles of the hand and the flexor muscles of the wrist and the fourth and fifth digits. Injury is most common at the wrist, forearm or elbow, secondary to trauma or entrapment. Pediatric ulnar nerve lesions differ from adult lesions by their quicker axonal regeneration. Neural plasticity is also

  2. Anomalous intrinsic hand muscle innervation in median and ulnar nerve lesions: An electrophysiological study

    Microsoft Academic Search

    A. Uncini; D. J. Lange; R. E. Lovelace

    1988-01-01

    A case with a median nerve lesion at the wrist without thenar atrophy and another with an ulnar nerve lesion at the elbow sparing the first dorsal interosseous are reported. Simultaneous multiple channel recording demonstrated in the first case a dual innervation of the abductor pollicis brevis by median and ulnar fibers via a Martin-Gruber anastomosis. In the second case,

  3. Does an ulnar nerve lesion influence the motion of the index finger?

    PubMed

    Hahn, P; Heindl, E

    1996-04-01

    Clawing of the ring and little fingers and "rolling" during prehension grip are well-known clinical phenomena of ulnar nerve lesions. In contrast to this the index and middle fingers seem to move normally. We compared the movement of right index fingers in healthy people with the right index fingers of people with an ulnar nerve lesion. The movement was measured using a three-dimensional real time motion analysis system based on ultrasound. The angles of the joints were plotted in a rectangular coordinate system. Statistical analysis of the numerical data showed no difference between the two groups. We trained a neural-network (Learning Vector Quantization) with the data of both groups. The network was able to distinguish between people with and without lesions of the ulnar nerve. We conclude that prehension grip of the index finger is also influenced by paralysis of the ulnar nerve. PMID:8732411

  4. Ulnar nerve damage (image)

    MedlinePLUS

    ... elbow because of elbow fracture or dislocation. The ulnar nerve is near the surface of the body where it crosses the elbow, so prolonged pressure on the elbow or entrapment of the nerve may cause damage. Damage to ...

  5. Interfascicular neurolysis in chronic ulnar nerve lesions at the elbow: an electrophysiological study.

    PubMed Central

    Nielsen, V K; Osgaard, O; Trojaborg, W

    1980-01-01

    Interfascicular neurolysis of the ulnar nerve at the elbow was performed in nine consecutive patients with moderate to severe ulnar palsy. Sensory and motor conduction velocities were determined before and up to six times after the operation, and a follow-up period of three years or more in all but two patients. None of the patients recovered after the operation, and all developed severe and sometimes persistent paraesthesiae. Electrophysiologically there was no evidence of improvement immediately following the operation. On the contrary in some patients there were changes suggesting deterioration. At the final investigation most electrophysiological parameters were still abnormal. The only significant change was an increase in the amplitude of sensory action potentials at the wrist and just below the elbow. Only one patient showed a more synchronised sensory potential after operation. It is our conclusion that interfascicular neurolysis of the ulnar nerve should be abandoned. Images PMID:7373325

  6. Ulnar Nerve Entrapment at the Wrist.

    PubMed

    Earp, Brandon E; Floyd, W Emerson; Louie, Dexter; Koris, Mark; Protomastro, Paul

    2014-11-01

    Presentation of ulnar nerve entrapment at the wrist varies based on differential anatomy and the site or sites of compression. Therefore, an understanding of the anatomy of the Guyon canal is essential for diagnosis in patients presenting with motor and/or sensory deficits in the hand. The etiologies of ulnar nerve compression include soft-tissue tumors; repetitive or acute trauma; the presence of anomalous muscles and fibrous bands; arthritic, synovial, endocrine, and metabolic conditions; and iatrogenic injury. In addition to a thorough history and physical examination, which includes motor, sensory, and vascular assessments, imaging and electrodiagnostic studies facilitate the diagnosis of ulnar nerve lesions at the wrist. Nonsurgical management is appropriate for a distal compression lesion caused by repetitive activity, but surgical decompression is indicated if symptoms persist or worsen over 2 to 4 months. PMID:25344595

  7. Ulnar nerve dysfunction

    MedlinePLUS

    Katirji B, Koontz D. Disorders of peripheral nerves. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice . 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012: ...

  8. Ulnar nerve entrapment syndrome in baseball players

    Microsoft Academic Search

    Wilson Del Pizzo; Frank W. Jobe; Lyle Norwood

    1977-01-01

    Ulnar nerve entrapment at the elbow has been described in the literature. This paper deals with 19 skeletally mature baseball play ers with ulnar nerve entrapment who under went surgery for correction of the problem. The surgery consisted of anterior transfer of the nerve and placement deep to the flexor muscles. Six players quit baseball because of continuing elbow problems,

  9. Endoscopic ulnar nerve release and transposition.

    PubMed

    Morse, Levi P; McGuire, Duncan T; Bain, Gregory I

    2014-03-01

    The most common site of ulnar nerve compression is within the cubital tunnel. Surgery has historically involved an open cubital tunnel release with or without transposition of the nerve. A comparative study has demonstrated that endoscopic decompression is as effective as open decompression and has the advantages of being less invasive, utilizing a smaller incision, producing less local symptoms, causing less vascular insult to the nerve, and resulting in faster recovery for the patient. Ulnar nerve transposition is indicated with symptomatic ulnar nerve instability or if the ulnar nerve is located in a "hostile bed" (eg, osteophytes, scarring, ganglions, etc.). Transposition has previously been performed as an open procedure. The authors describe a technique of endoscopic ulnar nerve release and transposition. Extra portals are used to allow retractors to be inserted, the medial intermuscular septum to be excised, cautery to be used, and a tape to control the position of the nerve. In our experience this minimally invasive technique provides good early outcomes. This report details the indications, contraindications, surgical technique, and rehabilitation of the endoscopic ulnar nerve release and transposition. PMID:24296546

  10. Ulnar nerve entrapment by anconeus epitrochlearis ligament.

    PubMed

    Tiong, William H C; Kelly, Jason

    2012-01-01

    Ulnar nerve entrapment at the elbow is the second most common upper limb entrapment neuropathy other than carpal tunnel syndrome. There have been many causes identified ranging from chronic aging joint changes to inflammatory conditions or systemic disorders. Among them, uncommon anatomical variants accounts for a small number of cases. Here, we report our experience in managing ulnar nerve entrapment caused by a rare vestigial structure, anconeus epitrochlearis ligament, and provide a brief review of the literature of its management. PMID:22351538

  11. Entrapment neuropathy of the ulnar nerve.

    PubMed

    Elhassan, Bassem; Steinmann, Scott P

    2007-11-01

    Ulnar nerve entrapment is the second most common nerve entrapment syndrome of the upper extremity. Although it may occur at any location along the length of the nerve, it is most common in the cubital tunnel. Ulnar nerve entrapment produces numbness in the ring and little fingers and weakness of the intrinsic muscles in the hand. Patient presentation and symptoms vary according to the site of entrapment. Treatment options are often determined by the site of pathology. Many patients benefit from nonsurgical treatment (eg, physical therapy, bracing, injection). When these methods fail or when sensory or motor impairment progresses, surgical release of the nerve at the site of entrapment should be considered. Surgical release may be done alone or with nerve transposition at the elbow. Most patients report symptomatic relief following surgery. PMID:17989418

  12. Ulnar Nerve Entrapment Due to Epitrochleoanconeus Muscle

    Microsoft Academic Search

    P. D. HODGKINSON; N. R. MCLEAN

    1994-01-01

    Two cases are described of ulnar nerve compression at the elbow due to an anomalous muscle—the epitrochleo-anconeus. In both cases the onset of symptoms may have been related to a period of excessive exercise of the upper limb. Both cases recovered rapidly and completely following medial epicondylectomy and excision of the abnormal muscle.

  13. Anterior Intramuscular Transposition of the Ulnar Nerve

    Microsoft Academic Search

    Peter Tang; Kevin D. Plancher; Shariff K. Bishai

    2006-01-01

    Summary: Though the literature is unclear, ulnar nerve anterior submuscular transposition has a role in the surgical treatment of cubital tunnel syndrome in the primary and revision setting. Along with the submuscular transposition technique, this article reviews some of the history of cubital tunnel syndrome treatment, the strengths and criticisms of each of the procedures, and the literature as of

  14. Anomalous muscle causing ulnar nerve compression at Guyon's canal.

    PubMed

    Paraskevas, Georgios K; Ioannidis, Orestis; Economou, Dimitrios S

    2012-09-01

    We report a rare anatomical variation of an anomalous supernumerary muscle in a male cadaver. It was crossing Guyon's canal, superficial to the ulnar nerve and ulnar artery, and inserted into the aponeurosis of the little finger. This muscle could potentially cause entrapment of the ulnar nerve in Guyon's canal. PMID:22747362

  15. Ulnar Neuropathy With Normal Electrodiagnosis and Abnormal Nerve Ultrasound

    Microsoft Academic Search

    Joon Shik Yoon; Francis O. Walker; Michael S. Cartwright

    2010-01-01

    Yoon JS, Walker FO, Cartwright MS. Ulnar neuropathy with normal electrodiagnosis and abnormal nerve ultrasound.Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. It is diagnosed with electrodiagnostic studies, but they can yield false-negative results. Ultrasound was used to examine 4 patients with UNE and negative electrodiagnostic findings, and it showed ulnar nerve enlargement near the

  16. Mononeuropathy of the deep motor palmar branch of the ulnar nerve: report of two unusual cases

    Microsoft Academic Search

    Th. Zambelis; N. Karandreas; P. Piperos

    2005-01-01

    Two female patients with lesions of the deep motor branch of the ulnar nerve are presented. In the first, a 40-year-old woman, the lesion was provoked by the stereotyped professional activity (screwing lids). In the second, aged 50 years, the nerve was damaged by a strike from a tennis ball. In both patients, we observed atrophy of the dorsal interosseous

  17. Isolated ulnar dorsal cutaneous nerve herpes zoster reactivation.

    PubMed

    Kayipmaz, Murat; Basaran, Serdar Hakan; Ercin, Ersin; Kural, Cemal

    2013-09-01

    Herpes zoster is a viral disease presenting with vesicular eruptions that are usually preceded by pain and erythema. Herpes zoster can be seen in any dermatome of the body but most commonly appears in the thoracic region. Herpes zoster virus is typically transmitted from person to person through direct contact. The virus remains dormant in the dorsal ganglion of the affected individual throughout his or her lifetime. Herpes zoster reactivation commonly occurs in elderly people due to normal age-related decline in cell-mediated immunity. Postherpetic neuralgia is the most common complication and is defined as persistent pain or dysesthesia 1 month after resolution of the herpetic rash. This article describes a healthy 51-year-old woman who experienced a burning sensation and shooting pain along the ulnar dorsal cutaneous nerve. Ten days after the onset of pain, she developed cutaneous vesicular eruption and decreased light-touch sensation. Wrist and fourth and fifth finger range of motion were painful and slightly limited. Muscle strength was normal. Nerve conduction studies indicated an ulnar dorsal cutaneous nerve lesion. She was treated with anti-inflammatory and antibiotic drugs and the use of a short-arm resting splint. At 5-month follow-up, she reported no residual pain, numbness, or weakness. Herpes zoster in the upper extremity may be mistaken for entrapment neuropathies and diseases characterized by skin eruptions; ulnar nerve zoster reactivation is rarely seen. The authors report an uncommon ulnar dorsal cutaneous nerve herpes zoster reactivation. Clinicians should be aware of this virus during patients' initial evaluation. PMID:24025017

  18. Ulnar nerve at the elbow – normative nerve conduction study

    PubMed Central

    2013-01-01

    Introduction A goal of our work was to perform nerve conduction studies (NCSs) of the ulnar nerve focused on the nerve conduction across the elbow on a sufficiently large cohort of healthy subjects in order to generate reliable reference data. Methods We examined the ulnar nerve in a position with the elbow flexion of 90o from horizontal. Motor response was recorded from the abductor digiti minimi muscle (ADM) and the first dorsal interosseous muscle (FDI). Results In our sample of 227 healthy volunteers we have examined 380 upper arms with the following results: amplitude (Amp)-CMAP(wrist) for ADM 9.6 ± 2.3 mV, MNCV at the forearm 60.4 ± 5.2 m/s, MNCV across the elbow 57.1 ± 5.9 m/s. Discussion Our study showed that motor NCSs of the ulnar nerve above elbow (AE) and below elbow (BE) in a sufficiently large cohort using methodology recommended by AANEM gave results well comparable for registration from FDI and ADM. PMID:23398737

  19. Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome)

    MedlinePLUS

    ... ibuprofen, to help reduce swelling around the nerve. Steroid injections. Steroids, like cortisone, are very e? ective anti-in? ammatory medicines. Injecting steroids around the ulnar nerve is generally not used ...

  20. Ulnar nerve injury following midshaft forearm fractures in children

    Microsoft Academic Search

    S. Stahl; N. Rozen; M. Michaelson

    1997-01-01

    We report three cases of ulnar nerve deficit in children following closed fractures of the forearm bones. Significant anterior angulation and displacement of the ulna was noted in all patients. Two patients were operated on at a later stage when no evidence of recovery was demonstrated; the ulnar nerve was found to be embedded in dense scar tissue. One patient

  1. [Entrapment neuropathies involving the ulnar nerve at the wrist (and into the hand) and the peroneal nerve].

    PubMed

    Bouche, P; Séror, R; Psimaras, D; Séror, P; Ebelin, M

    2008-12-01

    We report our experience with patients who underwent surgery for entrapment neuropathies involving the ulnar nerve at the wrist and into the hand and the peroneal nerve. For the ulnar nerve, the cause of the lesion was identified in all patients, generally a cyst which had developed in the Guyon canal. The patients usually recovered completely. For the peroneal nerve, there was a wide variety of causes, with mucoid cysts frequently involved. Recovery was often incomplete, because of the very marked initial axonal damage. We emphasized the need for rapid diagnosis and surgical treatment. PMID:19041106

  2. Sonoanatomy of the ulnar nerve in the cubital tunnel: a multicentre study by the GEL

    Microsoft Academic Search

    D. Jacob; V. Creteur; C. Courthaliac; R. Bargoin; B. Sassus; C. Bacq; J. L. Rozies; J. P. Cercueil; J. L. Brasseur

    2004-01-01

    The objective is to determine the normal appearance of the ulnar nerve on a posterior axial sonogram section of the elbow through the medial epicondyle and the humeroulnar joint space. Ultrasound evaluation was carried out on 400 elbows with measurement of the ulnar nerve cross-sectional area and ulnar nerve-cortex distance, as well as recording of apparent ulnar nerve division. Factors

  3. Functional outcome of anterior transposition of the vascularized ulnar nerve for cubital tunnel syndrome

    Microsoft Academic Search

    A. Asami; K. Morisawa; T. Tsuruta

    1998-01-01

    Anterior transposition of the ulnar nerve is a widely used treatment for cubital tunnel syndrome, but neurolysis performed at the time of surgery may impair the blood supply to the ulnar nerve. This study compared the results of intramuscular anterior transposition of the ulnar nerve with or without preserving the extrinsic vessels of the ulnar nerve in 35 patients. The

  4. Ulnar nerve entrapment at wrist associated with carpal tunnel syndrome

    Microsoft Academic Search

    E Gozke; N Dortcan; A Kocer; M Cetinkaya; G Akyuz

    2003-01-01

    In this study, ulnar nerve entrapments at the wrist were investigated using nerve conduction studies in cases with established diagnosis of carpal tunnel syndrome (CTS). Cases with cervical radiculopathy and polyneuropathy as well as patients with ulnar nerve entrapment at elbow were excluded from the study. Fifty-three cases (46 females, seven males) whose ages ranged between 20 and 72 years (mean: 49.31 ± 13.78) were

  5. Ulnar nerve palsy associated with closed midshaft forearm fractures.

    PubMed

    Suganuma, Seigo; Tada, Kaoru; Hayashi, Hiroyuki; Segawa, Takeshi; Tsuchiya, Hiroyuki

    2012-11-01

    Ulnar nerve palsy is a rare complication of closed midshaft forearm fractures; only 8 cases have been reported. This article describes a case of ulnar nerve palsy associated with a midshaft forearm fracture. A 12-year-old girl sustained a right midshaft forearm fracture. Whether she had a peripheral nerve injury was unknown due to strong pain. She underwent emergency manual reduction and intramedullary pinning. However, ulnar nerve palsy was remarkable postoperatively and gradually worsened. Therefore, neurolysis was performed 9 weeks later. The nerve had adhered to surrounding scar tissue. Six months after a second surgery, she had no motor dysfunction. The pathogenesis of ulnar nerve palsy complicated with midshaft forearm fractures varies and may be the result of direct contusion, direct damage by a bony spike, bony entrapment after closed reduction, and entrapment by a scar. In the current case, the patient was uncooperative at initial examination. Therefore, it is unknown whether she presented with immediate ulnar nerve palsy after the fracture. However, the ulnar nerve was not entrapped at the fracture site, and the surrounding muscle was intact but adhered to the surrounding scar tissue. The etiology of this case was considered to be entrapment by scar formation. According to a literature search, the authors recommend exploring the nerve approximately 8 to 10 weeks after primary surgery, after which neurological symptoms do not tend to improve. PMID:23127466

  6. Kaplan anastomosis of the ulnar nerve: a case report

    PubMed Central

    Paraskevas, Georgios; Ch Gekas, Christos; Tzaveas, Alexandros; Spyridakis, Ioannis; Stoltidou, Alexandra; Ph Tsitsopoulos, Parmenion

    2008-01-01

    Introduction The sensory innervation of the hand is usually unvarying and anomalies in this area are uncommon. Case presentation We report the case of a rare ulnar nerve branch called a Kaplan anastomosis, which anastomosed the dorsal cutaneous branch with the ulnar nerve prior to its bifurcation into the superficial and deep ramus. Conclusion Many authors have reported unusual ulnar nerve branches and knowledge of these anatomical variations is important for the interpretation of pain and sensory loss in the area sustained during injuries or surgical procedures. Our finding is the fourth case of a Kaplan anastomosis to be described in the literature. PMID:18412973

  7. CUBITAL TUNNEL SYNDROME: REVIEW OF 14 ANTERIOR SUBCUTANEOUS TRANSPOSITIONS OF THE VASCULARIZED ULNAR NERVE

    Microsoft Academic Search

    M. Farzan; S. M. J. Mortazavi; S. Asadollahi

    Anterior transposition of the ulnar nerve is widely implemented for treatment of cubital tunnel syndrome. However, preservation of the extrinsic blood supply of the ulnar nerve may result in better clinical outcomes. Fourteen patients with cubital tunnel syndrome, 11 men and 3 women, were treated by anterior subcutaneous transposition of the ulnar nerve. The extrinsic blood supply of the ulnar

  8. Ulnar nerve entrapment in Guyon's canal due to a lipoma.

    PubMed

    Ozdemir, O; Calisaneller, T; Gerilmez, A; Gulsen, S; Altinors, N

    2010-09-01

    Guyon's canal syndrome is an ulnar nerve entrapment at the wrist or palm that can cause motor, sensory or combined motor and sensory loss due to various factors . In this report, we presented a 66-year-old man admitted to our clinic with a history of intermittent pain in the left palm and numbness in 4th and 5th finger for two years. His neurological examination revealed a sensory impairment in the right fifth finger. Also, physical examination displayed a subcutaneous mobile soft tissue in ulnar side of the wrist. Electromyographic examination confirmed the diagnosis of type-1 Guyon's canal syndrome. Under axillary blockage, a lipoma compressing the ulnar nerve was excised totally and ulnar nerve was decompressed. The symptoms were improved after the surgery and patient was symptom free on 3rd postoperative week. PMID:21423081

  9. 290 Surgical Procedures for Ulnar Nerve Entrapment at the Elbow: Physiopathology, Clinical Experience and Results

    Microsoft Academic Search

    M. Artico; F. S. Pastore; F. Nucci; R. Giuffre

    2000-01-01

    Summary  ??Ulnar nerve entrapment at the elbow is an important and relatively frequent pathological condition that may be related to\\u000a diffent causes depending on individual or external factors. The cause of the nerve lesion is also idiopathic in about one-quarter\\u000a to one-third of cases. This variable aetiopathogenetic presentation has often suggested different diagnostic and clinical\\u000a approaches and, moreover, various surgical procedures.

  10. The anatomy of ulnar nerve branches in anterior transposition.

    PubMed

    Ng, Zhi Yang; Mitchell, Jennifer H; Fogg, Quentin A; Hart, Andrew M

    2013-01-01

    Cubital tunnel syndrome is the second most common nerve entrapment neuropathy. When non-operative treatments fail, surgical intervention is indicated. Although there remains no consensus between simple decompression and anterior transposition, there is a growing recognition of improved clinical outcomes in the latter. Few details of ulnar nerve branches around the elbow are available however and their sacrifice may be necessary to facilitate anterior transposition. Therefore, ten cadaveric upper extremities were dissected to delineate the course and branching pattern of the ulnar nerve around the elbow joint; anterior transposition was also performed in the cadaveric specimens. Digital photographs of the dissection study were analyzed using the Image J package. Results show that distal ulnar nerve branches are distributed more laterally towards the olecranon and may potentially restrict transposition more than has been recognized; proximal branches may also overlap incision lines of such transposition procedures. PMID:24156569

  11. Deep palmar communications between the ulnar and median nerves.

    PubMed

    Loukas, Marios; Bellary, Sharath S; Tubbs, R Shane; Shoja, Mohammadali M; Cohen Gadol, Aaron A

    2011-03-01

    Innervation of the hand is supplied via the radial, median, and ulnar nerves. A common border of sensory distribution between the ulnar and median nerves is along the fourth digit. However, this sensory distribution may be affected by communication between these two nerves. Among the known communications between the median and ulnar nerves, the deep anastomotic branch in the hand is the least described and rarely illustrated in the literature. This study aims to provide data on the prevalence of a deep communicating branch via cadaveric dissection. We examined 50 hands taken from 25 adult cadavers. Communicating branches were found in 16% of the hands examined, with rami occurring bilaterally in two specimens. By describing the origin and pathway of this communicating branch, we hope to provide surgeons and clinicians with knowledge that may help avoid iatrogenic injuries. PMID:21322041

  12. DIAGNOSTIC ULTRASONOGRAPHY OF THE ULNAR NERVE IN CUBITAL TUNNEL SYNDROME

    Microsoft Academic Search

    M. OKAMOTO; M. ABE; H. SHIRAI; N. UEDA

    2000-01-01

    Thirty-two elbows in 31 patients diagnosed as having cubital tunnel syndrome underwent ultrasonographic examination to assess morphological changes in the ulnar nerve and its surrounding tissues. On longitudinal images, the site of constriction due to the fibrous band and proximal swelling of the nerve were observed by ultrasonography and were confirmed intraoperatively. On axial images, the lengths of the major

  13. Diagnostic ultrasonography of the ulnar nerve in cubital tunnel syndrome

    Microsoft Academic Search

    M. Okamoto; M. Abe; H. Shirai; N. Ueda

    2000-01-01

    Thirty-two elbows in 31 patients diagnosed as having cubital tunnel syndrome underwent ultrasonographic examination to assess morphological changes in the ulnar nerve and its surrounding tissues. On longitudinal images, the site of constriction due to the fibrous band and proximal swelling of the nerve were observed by ultrasonography and were confirmed intraoperatively. On axial images, the lengths of the major

  14. Diagnostic ultrasonography of the ulnar nerve in cubital tunnel syndrome.

    PubMed

    Okamoto, M; Abe, M; Shirai, H; Ueda, N

    2000-10-01

    Thirty-two elbows in 31 patients diagnosed as having cubital tunnel syndrome underwent ultrasonographic examination to assess morphological changes in the ulnar nerve and its surrounding tissues. On longitudinal images, the site of constriction due to the fibrous band and proximal swelling of the nerve were observed by ultrasonography and were confirmed intraoperatively. On axial images, the lengths of the major axis [7.2 (SD 1.6) mm] and the minor axis [3.7 (0.9) mm] of the nerve at the medial epicondyle were greater than those in normal subjects. There was a correlation between the stage of ulnar nerve palsy and the diameter of the major axis. Preoperatively, ganglia were detected by ultrasonography in the cubital tunnel in three cases and an anconeus epitrochlearis muscle in two. PMID:10991822

  15. The pathology of the ulnar nerve in acromegaly

    Microsoft Academic Search

    Alberto Tagliafico; Eugenia Resmini; Raffaella Nizzo; Lorenzo E. Derchi; Francesco Minuto; Massimo Giusti; Carlo Martinoli; Diego Ferone

    2008-01-01

    Context: Acromegalic patients may complain of sensory disturbances in their hands. Cubital tunnel syndrome, the ulnar nerve neuropathy at the cubital tunnel (UCT), in acromegalic patients has never been reported. Objective: To describe and assess the prevalence of UCT in acromegalic patients and the effects of 1 year of therapy on UCT. Patients: We examined prospectively 37 acromegalic patients with

  16. Ulnar Neuropathy With Normal Electrodiagnosis and Abnormal Nerve Ultrasound

    PubMed Central

    Yoon, Joon Shik; Walker, Francis O.; Cartwright, Michael S.

    2010-01-01

    Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. It is diagnosed with electrodiagnostic studies, but they can yield false-negative results. Ultrasound was used to examine 4 patients with UNE and negative electrodiagnostic findings, and it showed ulnar nerve enlargement near the elbow in all cases, with a mean cross-sectional area of 20.1mm2. This indicates that ultrasound may be a useful tool for assessing those with UNE symptoms and normal electrodiagnostic findings. PMID:20159139

  17. Ulnar neuropathy with normal electrodiagnosis and abnormal nerve ultrasound.

    PubMed

    Yoon, Joon Shik; Walker, Francis O; Cartwright, Michael S

    2010-02-01

    Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. It is diagnosed with electrodiagnostic studies, but they can yield false-negative results. Ultrasound was used to examine 4 patients with UNE and negative electrodiagnostic findings, and it showed ulnar nerve enlargement near the elbow in all cases, with a mean cross-sectional area of 20.1 mm. This indicates that ultrasound may be a useful tool for assessing those with UNE symptoms and normal electrodiagnostic findings. PMID:20159139

  18. Endoscopic robotic decompression of the ulnar nerve at the elbow.

    PubMed

    Garcia, Jose Carlos; de Souza Montero, Edna Frasson

    2014-06-01

    Ulnar nerve entrapment can be treated by a number of surgical techniques when necessary. Endoscopic techniques have recently been developed to access the ulnar nerve by use of a minimally invasive approach. However, these techniques have been considered difficult and, many times, dangerous procedures, reserved for experienced elbow arthroscopic surgeons only. We have developed a new endoscopic approach using the da Vinci robot (Intuitive Surgical, Sunnyvale, CA) that may be easier and safer. Standardization of the technique was previously developed in cadaveric models to achieve the required safety, reliability, and organization for this procedure, and the technique was then used in a live patient. In this patient the nerve entrapment symptoms remitted after the surgical procedure. The robotic surgical procedure presented a cosmetic advantage, as well as possibly reduced scar formation. This is the first note on this surgical procedure; the procedure needs to be tested and even evolved until a state-of-the-art standard is reached. PMID:25126508

  19. Endoscopic Robotic Decompression of the Ulnar Nerve at the Elbow

    PubMed Central

    Garcia, Jose Carlos; de Souza Montero, Edna Frasson

    2014-01-01

    Ulnar nerve entrapment can be treated by a number of surgical techniques when necessary. Endoscopic techniques have recently been developed to access the ulnar nerve by use of a minimally invasive approach. However, these techniques have been considered difficult and, many times, dangerous procedures, reserved for experienced elbow arthroscopic surgeons only. We have developed a new endoscopic approach using the da Vinci robot (Intuitive Surgical, Sunnyvale, CA) that may be easier and safer. Standardization of the technique was previously developed in cadaveric models to achieve the required safety, reliability, and organization for this procedure, and the technique was then used in a live patient. In this patient the nerve entrapment symptoms remitted after the surgical procedure. The robotic surgical procedure presented a cosmetic advantage, as well as possibly reduced scar formation. This is the first note on this surgical procedure; the procedure needs to be tested and even evolved until a state-of-the-art standard is reached. PMID:25126508

  20. Tendon Transfers Part II: Transfers for Ulnar Nerve Palsy and Median Nerve Palsy

    PubMed Central

    Sammer, Douglas M.; Chung, Kevin C.

    2009-01-01

    Objectives After reading this article (part II of II), the participant should be able to: 1. Describe the anatomy and function of the median and ulnar nerves in the forearm and hand. 2. Describe the clinical deficits associated with injury to each nerve. 3. Describe the indications, benefits, and drawbacks for various tendon transfer procedures used to treat median and ulnar nerve palsy.4. Describe the treatment of combined nerve injuries. 5. Describe postoperative care and possible complications associated with these tendon transfer procedures. Summary This article discusses the use of tendon transfer procedures for treatment of median and ulnar nerve palsy as well as combined nerve palsies. Postoperative management and potential complications are also discussed. PMID:19730287

  1. Entrapment neuropathy of the ulnar nerve by a constriction band: the role of MRI

    Microsoft Academic Search

    Ralph J. Mobbs; Chris Rogan; Peter Blum

    2003-01-01

    The diagnosis of ulnar nerve entrapment at the elbow has relied primarily on clinical and electrodiagnostic findings. Magnetic resonance imaging (MRI) has been used in the evaluation of peripheral nerve entrapment disorders to document signal and configurational changes in nerves. In this case report we review the MRI and operative findings of a rare constriction band causing ulnar nerve compression

  2. Ulnar nerve measurements in healthy individuals to obtain reference values.

    PubMed

    Yalcin, Elif; Onder, Burcu; Akyuz, Mufit

    2013-05-01

    The aim of this study was to obtain the ultrasonographical reference values of ulnar nerve cross-sectional areas at the common areas of nerve entrapment as well as any differences related to age, sex, weight, height, dominant arm. Cross-sectional areas of the ulnar nerves of 72 healthy volunteers were measured bilaterally at the level of the epicondyle, 2 cm proximal to and 2 cm distal to the epicondyle, just at the entrance of cubital tunnel, at arterial split, at Guyon's canal. Age, sex, body weight, height, body mass index, and dominant extremity were recorded. The mean ulnar nerve cross-sectional area was 5.8 ± 1.1 mm(2) at 2 cm proximal to medial epicondyle, 6.2 ± 1.1 mm(2) at the medial epicondyle, 5.6 ± 0.9 mm(2) at the entrance of the cubital tunnel, 5.6 ± 1.0 mm(2) at 2 cm distal to medial epicondyle (inside the flexor carpi ulnaris), 5.0 ± 0.6 mm(2) at arterial split, and 4.9 ± 0.6 mm(2) at Guyon's canal. There was statistically no difference between the dominant and nondominant sides (p > 0.05). Females had statistically smaller nerves than males (p < 0.05). There was a significant correlation with height at all levels; also, weight was significantly correlated with cross-sectional areas except at two levels: tip of medial epicondyle and 2 cm distal. This study provides normative data of ulnar nerve ultrasonography and as well as any differences related to age, sex, height, weight, and dominant arm. PMID:22948543

  3. Ulnar Neuropathy at the Wrist

    Microsoft Academic Search

    Carisa Pearce; Joseph Feinberg; Scott W. Wolfe

    2009-01-01

    A case of ulnar nerve compression at the wrist within Guyon’s canal is reported. The clinical presentation initially appeared\\u000a consistent with an ulnar nerve entrapment at the elbow. The true diagnosis of an ulnar sensorimotor nerve lesion occurring\\u000a within the canal of Guyon was made electrophysiologically. Magnetic resonance imaging demonstrated compression of the nerve\\u000a within the canal by a ganglionic

  4. Anatomical basis for a technique of ulnar nerve transposition

    Microsoft Academic Search

    Peter C Amadio

    1986-01-01

    Summary  There are five major anatomical locations where the ulnar nerve may be compressed near the elbow. Multiple sites of compression\\u000a are often noted clinically; in other cases, the site of compression is difficult to identify. Clinical experience and results\\u000a of a series of 20 anatomical dissections suggest that local decompression or subcutaneous transfer may be performed without\\u000a necessarily exposing all

  5. A cadaveric study comparing the three approaches for ulnar nerve block at wrist

    PubMed Central

    Varshney, Rohit; Sharma, Nidhi; Malik, Shraddha; Malik, Sunny

    2014-01-01

    Background: Ulnar nerve blockade as a component of wrist block is a promising technique for adequate anesthesia and analgesia for different surgeries of the hand. Due to anatomical variations in the location of ulnar nerve under the flexor carpi ulnaris (FCU) a technique with good results and minimal complications are required. Aim: The aim of the following study is to compare the three techniques (volar, transtendinous volar [TTV] and ulnar) for ulnar nerve block at the wrist in human cadaveric wrists. Materials and Methods: Our study was conducted using 40 cadaver wrists. After inserting standard hypodermic needles by three techniques for ulnar nerve blockade at the wrist, a detailed dissection of FCU was done. The mean distance from the tip of the needle to ulnar artery/nerve and number of instances in which the ulnar artery/nerve pierced were observed. Results: Inter-group statistical significance was observed in measurement of the mean distance (mm) from the tip of the needle to the ulnar artery (volar [0.92 ± 0.11], TTV [3.96 ± 0.14] and ulnar [7.14 ± 0.08] approaches) and ulnar nerve (volar/TTV/ulnar approaches were 0.71 ± 0.12/3.61 ± 0.10/6.31 ± 0.49, respectively) (P = 0.001). Inadvertent intra-arterial/intraneural injections was seen with volar approach in 14 (35%) and 16 (40%) of the cadaveric wrists respectively, statistically significant with transtendinous and ulnar techniques of ulnar nerve block. Conclusion: TTV approach could be a better technique of choice for ulnar nerve blockade at the wrist because of its ease to practice, safer profile and minimum chances of inadvertent intra-arterial/intraneural injection with adequate anesthesia/analgesia. PMID:25538516

  6. Median-ulnar nerve communications: electrophysiological demonstration of motor and sensory fibre cross-over

    Microsoft Academic Search

    L. Santoro; R. Rosato; G. Caruso

    1983-01-01

    In a 33-year-old female with carpal tunnel syndrome the presence of anomalous communications between median and ulnar nerves was electrophysiologically demonstrated in the forearm. Motor latencies from proximal and distal stimulation sites along the median nerve fibres to the abductor pollicis brevis were identical. Proximal latency “increased” after procaine infiltration of the ulnar nerve at the wrist. Normal latency to

  7. Transposition of the ulnar nerve and its vascular bundle for the entrapment syndrome at the elbow

    Microsoft Academic Search

    A. Messina; J. C. Messina

    1995-01-01

    Surgical findings show important alterations of the extrinsic and intrinsic vascularity of the ulnar nerve in the epitroclear groove. Current procedures are only able to solve the mechanical aspect of nerve compression. Transposition may cause additional iatrogenic ischaemic damage of endoneural vascularity if the nerve is separated from the ulnar collateral artery to achieve anterior mobilization.Our technique of transposition of

  8. Ulnar nerve excursion and strain at the elbow and wrist associated with upper extremity motion

    Microsoft Academic Search

    Thomas W. Wright; Frank Glowczewskie; David Cowin; Donna L. Wheeler

    2001-01-01

    Significant excursion of the ulnar nerve is required for unimpeded upper extremity motion. This study evaluated the excursion necessary to accommodate common motions of daily living and associated strain on the ulnar nerve. The 2 most common sites of nerve entrapment, the cubital tunnel and the entrance of Guyon's canal, were studied. Five fresh-frozen, thawed transthoracic cadaver specimens (10 arms)

  9. Severe ulnar nerve entrapment at the elbow: functional outcome after minimally invasive in situ decompression

    Microsoft Academic Search

    K. Karthik; R. Nanda; S. Storey; J. Stothard

    2012-01-01

    The role of in situ decompression in patients with severe ulnar nerve compression is still controversial. Thirty patients with severe ulnar nerve compression confirmed clinically and electrophysiologically underwent simple decompression. The mean age of the patients was 58 (range 26–87) years. Through incisions ?4 cm the nerves were fully visualized and decompressed. Outcome was measured prospectively using Modified Bishop’s score

  10. MRI Appearance of Nerve Regeneration in a Surgically Repaired Ulnar Nerve

    Microsoft Academic Search

    Catherine Maldjian; Karen Buckley

    2010-01-01

    \\u000a Abstract\\u000a \\u000a \\u000a Background and Purpose:\\u000a   Magnetic resonance imaging (MRI) findings for surgical repair of a transected nerve have not been published. We describe the\\u000a first reported postoperative MR imaging findings of a repaired transected ulnar nerve.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Methods:\\u000a   A patient presented to our institution following surgical repair of a severed ulnar nerve at the level of the forearm. MRI\\u000a was obtained to

  11. Ulnar nerve entrapment in Guyon's canal due to recurrent carpal tunnel syndrome: case report.

    PubMed

    Ozdemir, Ozgur; Calisaneller, Tarkan; Gulsen, Salih; Caner, Hakan

    2011-01-01

    Guyon's canal syndrome is a compression neuropathy of the ulnar nerve entrapment at the wrist. Compression of the ulnar nerve at the wrist by a ganglion, lipomas, diseases of the ulnar artery, fractures of the hamate and trauma are common etiologcal factors. Unlike Guyon's canal syndrome, carpal tunnel syndrome (CTS) is the most common nerve entrapment of the upper extremity. Although, open (OCTR) or endoscopic carpal tunnel release (ECTR) is highly effective in relieving pain, failure with carpal tunnel release is seldom seen. In this paper, we presented a patient with ulnar nerve entrapment associated with recurrent CTS and discussed the possible pathomechanism with a review of current literature. PMID:21845587

  12. Acute ulnar nerve compression syndrome in a powerlifter with triceps tendon rupture--a case report.

    PubMed

    Duchow, J; Kelm, J; Kohn, D

    2000-05-01

    We report on the case of a bodybuilder and powerlifter who suffered from triceps tendon rupture complicated by acute ulnar nerve compression syndrome. The diagnosis was made clinically, radiologically, and sonographically. Ultrasound was helpful to demonstrate a large hematoma at the site of the injury. Early surgical intervention confirmed the presence of the hematoma compressing the ulnar nerve and led to a complete restoration of ulnar nerve and triceps muscle function. Few reports on distal triceps rupture have been published but its complication by acute ulnar nerve compression has not been reported on yet despite the close anatomical relationship of both structures. PMID:10853704

  13. Early nerve protection with anterior interosseous nerve in modified end-to-side neurorrhaphy repairs high ulnar nerve injury: a hypothesis of a novel surgical technique.

    PubMed

    Li, Qingtian; Zhang, Peixun; Yin, Xiaofeng; Jiang, Baoguo

    2015-04-01

    High ulnar nerve injuries frequently result in poor functional recovery. The prolonged denervation of target muscle largely accounts for the poor functional outcome. There are no approved effective treatments for high ulnar nerve injuries. However, the technique of reverse end-to-side (RETS) offers novel possibilities. The RETS nerve transfer not only provides earlier motor end-plate reinnervation to "babysit" the target muscle until native axons from the original high nerve regenerate, but also augments the regenerating axons. We postulate that coaptation of anterior interosseous nerve to the side of distal ulnar nerve by RETS technique could be an effective therapeutic intervention for high ulnar nerve injuries in human. PMID:24195580

  14. Brachial artery perforator-based propeller flap coverage for prevention of readhesion after ulnar nerve neurolysis.

    PubMed

    Sekiguchi, Hirotake; Motomiya, Makoto; Sakurai, Keisuke; Matsumoto, Dai; Funakoshi, Tadanao; Iwasaki, Norimasa

    2015-02-01

    It is difficult for most plastic and orthopaedic surgeons to treat nerve dysfunction related to neural adhesion because the pathophysiology and suitable treatment have not been clarified. In the current report, we describe our experience of surgical treatment for adhesive ulnar neuropathy. A 58-year-old male complained of pain radiating to the ulnar nerve-innervated area during elbow and wrist motion caused by adhesive ulnar neuropathy after complex open trauma of the elbow joint. The patient obtained a good clinical outcome by surgical neurolysis of the ulnar nerve combined with a brachial artery perforator-based propeller flap to cover the soft tissue defect after resection of the scar tissue and to prevent readhesion of the ulnar nerve. This flap may be a useful option for ulnar nerve coverage after neurolysis without microvascular anastomosis in specific cases. PMID:25088214

  15. Risk factors for dislocation of the ulnar nerve after simple decompression for cubital tunnel syndrome.

    PubMed

    Murata, K; Omokawa, S; Shimizu, T; Nakanishi, Y; Kawamura, K; Yajima, H; Tanaka, Y

    2014-01-01

    Anterior dislocation of the ulnar nerve is occasionally encountered after simple decompression of the nerve for treatment of cubital tunnel syndrome. The purpose of this study was to determine whether the incidence of dislocation of the nerve following simple decompression of the nerve is correlated with the patient's preoperative characteristics and/or elbow morphology. We studied 51 patients with cubital tunnel syndrome who underwent surgery at our institution. Intraoperatively, we simulated dislocation of the nerve after simple decompression by flexing the elbow after releasing the nerve in each patient. Univariate and multiple logistic regression analysis showed that young age and a small ulnar nerve groove angle are positively correlated with dislocation of the nerve. Our results suggest that patients who are young and/or have a sharply angled ulnar nerve groove identified radiographically have a high probability of experiencing anterior dislocation of the ulnar nerve after simple decompression. PMID:24641735

  16. Ulnar nerve strain at the elbow in patients with cubital tunnel syndrome: effect of simple decompression.

    PubMed

    Ochi, K; Horiuchi, Y; Nakamura, T; Sato, K; Arino, H; Koyanagi, T

    2013-06-01

    Simple decompression of the ulnar nerve at the elbow has not been shown to reduce nerve strain in cadavers. In this study, ulnar nerve strain at the elbow was measured intraoperatively in 11 patients with cubital tunnel syndrome, before and after simple decompression. Statistical analysis was performed using a paired Student's t-test. Mean ulnar nerve strain before and after simple decompression was 30.5% (range 9% to 69%) and 5.5% (range -2% to 11%), respectively; this difference was statistically significant (p < 0.01) with a statistical power of 96%. Simple decompression reduced ulnar nerve strain in all patients by an average of 24.5%. Our results suggest that the pathophysiology of cubital tunnel syndrome may be multifactorial, being neither a simple compression neuropathy nor a simple traction neuropathy, and simple decompression may be a favourable surgical procedure for cubital tunnel syndrome in terms of decompression and reduction of strain in the ulnar nerve. PMID:23100298

  17. Systematic Review of Sonographic Measurements of the Ulnar Nerve at the Elbow

    Microsoft Academic Search

    Kerry Thoirs; Marie A. Williams; Maureen Phillips

    2007-01-01

    A systematic review was performed to identify studies reporting summary data (mean, standard deviation) of sonographic cross-sectional measurements of the ulnar nerve at the elbow. Comparisons of measurements were performed to determine whether statistical differences existed between groups of individuals symptomatic and asymptomatic of ulnar nerve entrapment at the elbow (UNE). Across the four studies meeting the selection criteria of

  18. Regional differences in ulnar nerve excitability may predispose to the development of entrapment neuropathy

    Microsoft Academic Search

    Arun V. Krishnan; Susanna B. Park; Mike Payne; Cindy S.-Y. Lin; Steve Vucic; Matthew C. Kiernan

    2011-01-01

    ObjectiveTo assess whether there are differences in nerve excitability properties between proximal and distal stimulation sites in the ulnar nerve in healthy controls, which may provide information on whether alteration in ion channel function predisposes to the development of ulnar neuropathy at the elbow.

  19. (iii) Management of mechanical neuropathy of the ulnar nerve at the elbow

    Microsoft Academic Search

    A. Collier; P. Burge

    2001-01-01

    Mechanical neuropathy of the ulnar nerve is most commonly due to entrapment within the cubital tunnel. Flexion of the elbow is associated with narrowing of the cubital tunnel, flattening of the ulnar nerve and increases in intraneural and extraneural pressure. Debate continues about the importance of compression, traction and friction in the pathogenesis of the localized microvascular impairment, segmental demyelination,

  20. An unusual complication of ulnar nerve entrapment in a pediatric olecranon fracture: a case report.

    PubMed

    Ertem, Kadir

    2009-05-01

    The rates of rare complications of acute or late ulnar nerve entrapment after supracondylar fractures, medial condyl fractures, elbow dislocations, forearm fractures, Galeazzi fracture dislocations, and epiphyseal separation of the distal ulna were reported earlier in the literature. Here, we report a late ulnar nerve entrapment after displaced olecranon fracture in a 10-year-old boy. PMID:19369899

  1. Scand J Work Environ Health . Author manuscript Incidence of ulnar nerve entrapment at the elbow in repetitive work

    E-print Network

    Paris-Sud XI, Université de

    Scand J Work Environ Health . Author manuscript Page /1 9 Incidence of ulnar nerve entrapment working conditions and ulnar nerve entrapment at the elbow (UNEE) has not been the object of much study ; Risk Factors ; Workplace ; psychology Author Keywords elbow ; repetitive work ; ulnar nerve entrapment

  2. Outcome study of ulnar nerve compression at the elbow treated with simple decompression and an early programme of physical therapy

    Microsoft Academic Search

    P. A. Nathan; R. C. Keniston; K. D. Meadows

    1995-01-01

    Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper limb. This paper presents the experience of treating cubital tunnel syndrome with simple decompression in 131 patients (164 ulnar nerves) over the past 12 years. 85% of these patients had mild or moderate ulnar nerve disease. In 146\\/164 ulnar nerves (89%), simple decompression resulted in good or

  3. Submuscular transposition of the ulnar nerve for the treatment of cubital tunnel syndrome.

    PubMed

    Janjua, Rashid M; Fernandez, Julius; Tender, Gabriel; Kline, David G

    2008-10-01

    THE ULNAR NERVE is compressed at the cubical notch in patients with cubital tunnel syndrome. To definitively alleviate this compression, the nerve can be transposed under the pronator teres and flexor carpi ulnaris muscles. This procedure is also known as medianization of the ulnar nerve because it then courses parallel to the median nerve. In the current article the procedure is described in a step-by-step fashion. PMID:18981838

  4. Pearls & Oy-sters: false positives in short-segment nerve conduction studies due to ulnar nerve dislocation.

    PubMed

    Kim, B J; Koh, S B; Park, K W; Kim, S J; Yoon, J S

    2008-01-15

    The possibility that a technical error may occur during nerve conduction studies due to ulnar nerve dislocation when the elbow is flexed has recently been suggested. We investigated normal volunteers using ultrasonography to observe the effects of ulnar nerve dislocation during elbow flexion on short-segment nerve conduction studies. We found significant conduction block in all of the subjects with ulnar nerve dislocation, and the finding was defined as a technical error caused by volume conduction. The results of the present study suggest that caution should be exercised when interpreting the results of short-segment nerve conduction studies at the across-elbow segment due to the possibility of technical error induced by ulnar nerve dislocation. PMID:18195259

  5. Median nerve entrapment and ulnar nerve palsy following elbow dislocation in a child.

    PubMed

    Petratos, Dimitrios V; Stavropoulos, Nikolaos A; Morakis, Emmanouil A; Matsinos, George S

    2012-01-01

    This report presents a rare case of a child who presented with neglected intra-articular entrapment of the median nerve, ulnar nerve palsy, and intra-articular incarceration of the medial epicondyle following closed reduction of an elbow dislocation. In the present case, as in most other cases, the diagnosis and treatment were delayed. Careful initial and postreduction neurological examination, as well as careful interpretation of the plain radiographs, is necessary for early detection of any nerve complications and associated fractures of an elbow dislocation. The authors' opinion is that a child with an elbow dislocation, which is initially neurologically intact but advances to a median or ulnar nerve deficit after the reduction, must undergo early surgical exploration, especially when the dislocation is associated with a medial epicondyle fracture. PMID:23199945

  6. Axonal degeneration of the ulnar nerve secondary to carpal tunnel syndrome: fact or fiction?

    PubMed

    Azmy, Radwa Mahmoud; Labib, Amira Ahmed; Elkholy, Saly Hassan

    2013-05-25

    The distribution of sensory symptoms in carpal tunnel syndrome is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment is still unclear. In this study, we measured ulnar nerve function in 82 patients with carpal tunnel syndrome. The patients were divided into group I with minimal carpal tunnel syndrome (n = 35) and group II with mild to moderate carpal tunnel syndrome (n = 47) according to electrophysiological data. Sixty-one age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. There were no significant differences in ulnar sensory nerve peak latencies or conduction velocities from the 4(th) and 5(th) fingers between patients with carpal tunnel syndrome and the control group. The ulnar sensory nerve action potential amplitudes from the 4(th) and 5(th) fingers were lower in patients with carpal tunnel syndrome than in the control group. The ratios of the ulnar sensory nerve action potential amplitudes from the 4(th) and 5(th) fingers were almost the same in patients with carpal tunnel syndrome as in the control group. These findings indicate that in patients with minimal to moderate carpal tunnel syndrome, there is some electrophysiological evidence of traction on the adjacent ulnar nerve fibers. The findings do not indicate axonal degeneration of the ulnar nerve. PMID:25206437

  7. Axonal degeneration of the ulnar nerve secondary to carpal tunnel syndrome: fact or fiction??

    PubMed Central

    Azmy, Radwa Mahmoud; Labib, Amira Ahmed; Elkholy, Saly Hassan

    2013-01-01

    The distribution of sensory symptoms in carpal tunnel syndrome is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment is still unclear. In this study, we measured ulnar nerve function in 82 patients with carpal tunnel syndrome. The patients were divided into group I with minimal carpal tunnel syndrome (n = 35) and group II with mild to moderate carpal tunnel syndrome (n = 47) according to electrophysiological data. Sixty-one age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. There were no significant differences in ulnar sensory nerve peak latencies or conduction velocities from the 4th and 5th fingers between patients with carpal tunnel syndrome and the control group. The ulnar sensory nerve action potential amplitudes from the 4th and 5th fingers were lower in patients with carpal tunnel syndrome than in the control group. The ratios of the ulnar sensory nerve action potential amplitudes from the 4th and 5th fingers were almost the same in patients with carpal tunnel syndrome as in the control group. These findings indicate that in patients with minimal to moderate carpal tunnel syndrome, there is some electrophysiological evidence of traction on the adjacent ulnar nerve fibers. The findings do not indicate axonal degeneration of the ulnar nerve. PMID:25206437

  8. Sensory nerve conduction velocities of median, ulnar and radial nerves in patients with vibration syndrome

    Microsoft Academic Search

    Mamoru Hirata; Hisataka Sakakibara

    2007-01-01

    Objective  The present study aimed to clarify the range of involvement for hand-arm vibration syndrome (VS) in the median, ulnar and\\u000a radial nerves of the hand.\\u000a \\u000a \\u000a \\u000a Methods  Sensory nerve conduction velocities (SCVs) for 3 nerves in the hands and arms were examined for 34 patients with VS and 23\\u000a age-matched controls. Neuropathy types were classified by possible carpal tunnel syndrome (CTS), Guyon’s

  9. Surgical management of Guyon's canal syndrome, an ulnar nerve entrapment at the wrist: report of two cases

    Microsoft Academic Search

    Paulo Henrique Aguiar; Edson Bor-Seng-Shu; Fernando Gomes-Pinto; Ricardo Jose de Almeida-Leme; Alexandre Bruno R. Freitas; Roberto S. Martins; Edison S. Nakagawa; Antonio J. Tedesco-Marchese

    2001-01-01

    Guyonís canal syndrome, an ulnar nerve entrapment at the wrist, is a well-recognized entity. The most common causes that involve the ulnar nerve at the wrist are compression from a ganglion, occupational traumatic neuritis, a musculotendinous arch and disease of the ulnar artery. We describe two cases of Guyonís canal syndrome and discuss the anatomy, aetiology, clinical features, anatomical classification,

  10. Supercharged end-to-side anterior interosseous to ulnar motor nerve transfer for intrinsic musculature reinnervation.

    PubMed

    Barbour, John; Yee, Andrew; Kahn, Lorna C; Mackinnon, Susan E

    2012-10-01

    Functional motor recovery after peripheral nerve injury is predominantly determined by the time to motor end plate reinnervation and the absolute number of regenerated motor axons that reach target. Experimental models have shown that axonal regeneration occurs across a supercharged end-to-side (SETS) nerve coaptation. In patients with a recovering proximal ulnar nerve injury, a SETS nerve transfer conceptually is useful to protect and preserve distal motor end plates until the native axons fully regenerate. In addition, for nerve injuries in which incomplete regeneration is anticipated, a SETS nerve transfer may be useful to augment the regenerating nerve with additional axons and to more quickly reinnervate target muscle. We describe our technique for a SETS nerve transfer of the terminal anterior interosseous nerve (AIN) to the pronator quadratus muscle (PQ) end-to-side to the deep motor fascicle of the ulnar nerve in the distal forearm. In addition, we describe our postoperative therapy regimen for these transfers and an evaluation tool for monitoring progressive muscle reinnervation. Although the AIN-to-ulnar motor group SETS nerve transfer was specifically designed for ulnar nerve injuries, we believe that the SETS procedure might have broad clinical utility for second- and third-degree axonotmetic nerve injuries, to augment partial recovery and/or "babysit" motor end plates until the native parent axons regenerate to target. We would consider all donor nerves currently utilized in end-to-end nerve transfers for neurotmetic injuries as candidates for this SETS technique. PMID:23021177

  11. Comparative study of different surgical transposition methods for ulnar nerve entrapment at the elbow.

    PubMed

    Zhong, W; Zhang, W; Zheng, X; Li, S; Shi, J

    2011-01-01

    This study compared the therapeutic effects of two techniques for surgical decompression treatment for ulnar nerve entrapment at the elbow: subcutaneous transposition and modified submuscular transposition with Z-lengthening of the pronator teres origin. A total of 278 patients with ulnar nerve entrapment (McGowan grades I - III) were randomly assigned to undergo one of these techniques. All patients were followed-up for 2 years. The effects were assessed by preoperative and postoperative cross-sectional area, motor conduction velocity, sensory conduction velocity and nerve action potential. All of these parameters improved after surgery in both groups. For patients with grade I disease, there were no significant differences between the two techniques. For patients with grade II and III disease, modified submuscular transposition was associated with significantly greater improvements compared with subcutaneous transposition. In conclusion, subcutaneous ulnar nerve transposition is recommended for grade I patients and modified submuscular ulnar nerve transposition for grade II and III patients. PMID:22117977

  12. The dilemma of ulnar nerve entrapment at wrist in carpal tunnel syndrome

    Microsoft Academic Search

    Ali Moghtaderi; Maryam Ghafarpoor

    2009-01-01

    ObjectiveThe commonest compression neuropathy in human being is carpal tunnel syndrome (CTS). The association between CTS and ulnar nerve entrapment is debatable. The objective of this study is to determine the presence of any association between CTS and ulnar entrapment neuropathy at the wrist.

  13. The Traumatic Nerve-Vascular Lesions

    Microsoft Academic Search

    Roberto Adani; Giovanni Leo; Luigi Tarallo

    The elbow represents an important point of passage between vascular (brachial artery) and nervous (median, radial, and ulnar\\u000a nerve) structures, susceptible to direct trauma when there is intra-articular trauma to an elbow.

  14. Ulnar Nerve Transposition at the Elbow under Local Anesthesia: A Patient Satisfaction Study.

    PubMed

    Del Vecchio, Pietro M Roberti; Christen, Thierry; Raffoul, Wassim; Erba, Paolo

    2015-03-01

    Background?Ulnar nerve decompression at the elbow traditionally requires regional or general anesthesia. We wished to assess the feasibility of performing ulnar nerve decompression and transposition at the elbow under local anesthesia. Methods?We examined retrospectively the charts of 50 consecutive patients having undergone ulnar nerve entrapment surgery either under general or local anesthesia. Patients were asked to estimate pain on postoperative days 1 and 7 and satisfaction was assessed at 1 year. Results?On day 1, pain was comparable among all groups. On day 7, pain scores were twice as high when transposition was performed under general anesthesia when compared with local anesthesia. Patient satisfaction was slightly increased in the local anesthesia group. These patients were significantly more willing to repeat the surgery. Conclusion?Ulnar nerve decompression and transposition at the elbow can be performed under local anesthesia without added morbidity when compared with general anesthesia. PMID:25360859

  15. Endoscopically assisted release of the ulnar nerve for cubital tunnel syndrome

    Microsoft Academic Search

    Leandro Pretto Flores

    2010-01-01

    Purpose  Recently, the simple decompression of the ulnar nerve has been advocated as the best surgical approach for the treatment of\\u000a the cubital tunnel syndrome. Encouraged by the positive results observed with the use of the endoscopic approach for the treatment\\u000a of the carpal tunnel syndrome, there have been reports about the use of endoscopes for decompression of the ulnar nerve

  16. Electromyography and Ultrasonography in the Diagnosis of A Rare Double-Crush Ulnar Nerve Injury

    Microsoft Academic Search

    Mufit Akyuz; Elif Yalcin; Barin Selcuk; Burcu Onder; Levent Özçakar

    2011-01-01

    Akyuz M, Yalcin E, Selcuk B, Onder B, Özçakar L. Electromyography and ultrasonography in the diagnosis of a rare double-crush ulnar nerve injury.Reported here is a 46-year-old man who was seen for pain, numbness, and weakness in his left upper limb and hand. Electromyographic studies demonstrated denervation of ulnar-innervated muscle groups except for the flexor carpi ulnaris. A localized nerve

  17. Use of ultrasonography in ulnar nerve entrapment surgery—a prospective study

    Microsoft Academic Search

    Murat Kutlay; Ahmet Çolak; Hakan ?im?ek; Ersin Öztürk; Mehmet Güney ?enol; K?vanç Topuz; Mehmet Nusret Demircan

    2009-01-01

    The purpose of our study is to assess the usefulness of high-resolution ultrasonography in observing the morphology and dynamics\\u000a of the ulnar nerve in the cubital tunnel and also the efficacy of ultrasonography in a more accurate diagnosis and appropriate\\u000a surgical treatment decision. Cross-sectional area of the ulnar nerves of 40 healthy volunteers in the control group were measured\\u000a bilaterally

  18. Ganglion Cyst Associated with Triangular Fibrocartilage Complex Tear That Caused Ulnar Nerve Compression

    PubMed Central

    Cinar, Can; Tasdelen, Neslihan

    2015-01-01

    Summary: Ganglions are the most frequently seen soft-tissue tumors in the hand. Nerve compression due to ganglion cysts at the wrist is rare. We report 2 ganglion cysts arising from triangular fibrocartilage complex, one of which caused ulnar nerve compression proximal to the Guyon's canal, leading to ulnar neuropathy. Ganglion cysts seem unimportant, and many surgeons refrain from performing a general hand examination. PMID:25878929

  19. Short segment stimulation of the anterior transposed ulnar nerve at the elbow

    Microsoft Academic Search

    Tatjana Paternostro-Sluga; Ruxandra Ciovika; Edwin Turkof; Andrea Zauner-Dungl; Martin Posch; Veronika Fialka-Moser

    2001-01-01

    Paternostro-Sluga T, Ciovika R, Turkof E, Zauner-Dungl A, Posch M, Fialka-Moser V. Short segment stimulation of the anterior transposed ulnar nerve at the elbow. Arch Phys Med Rehabil 2001;82:1171-5. Objective: To determine whether short segment stimulation after anterior subcutaneous transposition of the ulnar nerve reaches normal values and correlates with postoperative clinical findings. Design: Comparative cross-sectional study. Setting: Outpatient clinic

  20. Ulnar artery thrombosis and nerve entrapment at Guyon's canal: our diagnostic and therapeutic algorithm.

    PubMed

    Monacelli, G; Rizzo, M I; Spagnoli, A M; Monarca, C; Scuderi, N

    2010-01-01

    Hypothenar hammer syndrome is a rare condition of ulnar artery aneurysm or thrombosis, which can be associated with a neuropathy of the ulnar nerve. There is no agreement regarding an optimal diagnosis and treatment for this syndrome. Most authors suggest angiography as the gold standard for diagnosis and recommend observation for the thrombotic type, and reconstructive surgery for the aneurysmal type. We report here our diagnostic and therapeutic algorithm, reviewing 9 patients with ulnar artery thrombosis and nerve entrapment at Guyon's canal; and an evaluation of the type of management including: anamnesis, diagnostic tests, and reconstructive surgery. We consider resection of the arterial thrombotic segment as the treatment of choice, due to the fact that ulnar arterial thrombosis can induce severe chronic inflammation into Guyon's canal and ulnar nerve sufferance. Therefore, we propose a planned approach, including 3 steps: clinical evaluation with Tinel and Allen's tests; magnetic resonance and ultrasound images; ulnar nerve decompression and arterial reconstruction. We believe that this practice is important for the early therapy of ulnar arterio-neuropathy in affected patients. PMID:20952749

  1. Comparison of the Volar and Medial Approach in Peripheral Block of Ulnar Nerve at the Wrist – A Cadaveric Study

    PubMed Central

    Joy, Praisy; Satyanandan, Cephas

    2014-01-01

    Context: Two standard approaches are described to block the ulnar nerve at wrist. These include a) the traditional Volar approach where the needle is inserted lateral to tendon of flexor carpi ulnaris (FCU) b) Medial approach where the needle is inserted posterior to the tendon of FCU. Caution must be exercised to avoid puncture of the ulnar artery and/or intraneural injection of the ulnar nerve in both the approaches. Aim: This study compares the volar and medial approach to the peripheral block of ulnar nerve at the wrist. The objective was two fold: a) to analyze the position of the ulnar nerve and the ulnar artery in relation to the Flexor Carpi Ulnaris tendon b) to assess the risk of injury to ulnar artery in both the volar and medial approach. Settings and Designs: Twelve cadaveric upper limbs were used and both approaches compared by an observational study. Materials and Methods: Two 18 G needles were inserted up to a depth of 7 mm using the standard volar and medial approach. The pattern of arrangement and positions of the ulnar artery and nerve in relation to FCU tendon were observed. The distance between the tip of needle and its proximity to the ulnar artery, and risk of injury were determined. Statistical analysis was done using SPSS for Windows, Version 16.0. Chicago, SPSS Inc. Results: Three patterns of arrangement and position of the ulnar nerve and artery were observed. Puncture of ulnar artery was seen in 50% of cases in the volar approach as compared to no injury at all in the medial approach. The ulnar artery is highly liable to injury during the volar approach in type I and II and safe only in type III arrangement of ulnar artery. The medial approach showed no injury to the ulnar artery or nerve at a penetration depth of 7mm. Conclusion: The medial approach is safer compared to volar approach for peripheral block of ulnar nerve at wrist. PMID:25584201

  2. Bilateral ulnar nerve entrapment by the M. anconeus epitrochlearis. A case report and literature review.

    PubMed

    Dekelver, Ingrid; Van Glabbeek, Francis; Dijs, Henk; Stassijns, Gaëtane

    2012-07-01

    Ulnar neuropathy at the elbow is the second most common entrapment neuropathy. Ulnar nerve entrapment has several causes. A case report is presented with the presence of the M. anconeus epitrochlearis at both sides. The patient contacted our department with chronic, diffuse bilateral elbow pain irradiating into both forearms. She experienced typical nocturnal paresthesias involving digit IV and V of both hands. Tinel's sign was present just proximal to the medial epicondyle. A bilateral ulnar nerve entrapment was clinically suspected. An electromyographic (EMG) investigation revealed slowing of the motor conduction velocity in the ulnar nerve across the elbow. An ultrasound and MRI investigation demonstrated the presence of an anomalous muscle, called the M. anconeus epitrochlearis, at both sides. Treatment consisted of bilateral surgical excision of the muscle and retinacular release, followed by physical therapy. The outcome was favourable. PMID:22555819

  3. The Muscular Branching Patterns of the Ulnar Nerve to the Flexor Carpi Ulnaris and Flexor Digitorum Profundus Muscles

    Microsoft Academic Search

    Tania Marur; Salih Murat Akk?n; Mehmet Alp; Selman Demirci; Levent Yalç?n; Tahir Ögüt; I??k Akgün

    2005-01-01

    The branching pattern of the ulnar nerve in the forearm is of great importance in anterior transposition of the ulnar nerve\\u000a for decompression after neuropathy of cubital tunnel syndrom and malformations resulting from distal end fractures of the\\u000a humerus. In this study, 37 formalin-fixed forearms were used to demonstrate the muscular branching patterns from the main\\u000a ulnar nerve to the

  4. Recurrent ulnar nerve entrapment at the elbow: Correlation of surgical findings and 3-Tesla magnetic resonance neurography.

    PubMed

    Chhabra, Avneesh; Wadhwa, Vibhor; Thakkar, Rashmi S; Carrino, John A; Dellon, A Lee

    2013-01-01

    The authors describe the correlation between 3-Tesla magnetic resonance neurography (MRN) and surgical findings in two patients who underwent multiple previous failed ulnar nerve surgeries. MRN correctly localized the site of the abnormality. Prospectively observed MRN findings of perineural fibrosis, ulnar nerve re-entrapment abnormalities, medial antebrachial cutaneous neuroma and additional median nerve entrapment were confirmed surgically. PMID:24421652

  5. Recurrent ulnar nerve entrapment at the elbow: Correlation of surgical findings and 3-Tesla magnetic resonance neurography

    PubMed Central

    Chhabra, Avneesh; Wadhwa, Vibhor; Thakkar, Rashmi S; Carrino, John A; Dellon, A Lee

    2013-01-01

    The authors describe the correlation between 3-Tesla magnetic resonance neurography (MRN) and surgical findings in two patients who underwent multiple previous failed ulnar nerve surgeries. MRN correctly localized the site of the abnormality. Prospectively observed MRN findings of perineural fibrosis, ulnar nerve re-entrapment abnormalities, medial antebrachial cutaneous neuroma and additional median nerve entrapment were confirmed surgically. PMID:24421652

  6. Ultrasound-guided surgical treatment for ulnar nerve entrapment: a cadaver study.

    PubMed

    Poujade, T; Hanouz, N; Lecoq, B; Hulet, C; Collon, S

    2014-09-01

    Several open and endoscopic techniques for the surgical treatment of ulnar nerve entrapment at the elbow (cubital tunnel syndrome) have been described that provide decompression with or without anterior transposition. Based on our experience with US-guided decompression for carpal tunnel syndrome in our department, we developed a similar surgical technique for the decompression of the ulnar nerve at the elbow. Using sixteen cadaver upper limbs, we performed decompression of all the structures possibly responsible for ulnar nerve compression at the elbow. The structures involved were Struthers' arcade, the cubital tunnel retinaculum, Osborne's fascia and Amadio-Beckenbaugh's arcade. The procedure was followed by anatomical dissection to confirm complete sectioning of the compressive structures, absence of iatrogenic vascular or nervous injuries and absence of nerve dislocation or instability. There were no remaining compressive structures after the release procedure. There was no iatrogenic damage to the nerves and no nerve dislocation was observed during elbow flexion or extension. In 3.4% cases, a thin superficial layer of one or more of the identified structures remained but these did not appear to compress the nerve based on US imaging. Using ultrasonographic visualization of the nerve and compressive structures is easy. Each procedure can be tailored according to the nerve compression sites. Our cadaveric study shows the feasibility of an US-guided percutaneous surgical release for ulnar nerve entrapment. PMID:24981578

  7. Applied anatomical study of the vascularized ulnar nerve and its blood supply for cubital tunnel syndrome at the elbow region.

    PubMed

    Li, Mei-Xiu-Li; He, Qiong; Hu, Zhong-Lin; Chen, Sheng-Hua; Lv, Yun-Cheng; Liu, Zheng-Hai; Wen, Yong; Peng, Tian-Hong

    2015-01-01

    Cubital tunnel syndrome is often accompanied by paresthesia in ulnar nerve sites and hand muscle atrophy. When muscle weakness occurs, or after failure of more conservative treatments, anterior transposition is used. In the present study, the ulnar nerve and its blood vessels were examined in the elbows of 18 adult cadavers, and the external diameter of the nutrient vessels of the ulnar nerve at the point of origin, the distances between the origin of the vessels and the medial epicondyle of the humerus, and the length of the vessels accompanying the ulnar nerve in the superior ulnar collateral artery, the inferior ulnar collateral artery, and the posterior ulnar recurrent artery were measured. Anterior transposition of the vascularized ulnar nerve was performed to treat cubital tunnel syndrome. The most appropriate distance that the vascularized ulnar nerve can be moved to the subcutaneous tissue under tension-free conditions was 1.8 ± 0.6 cm (1.1-2.5 cm), which can be used as a reference value during the treatment of cubital tunnel syndrome with anterior transposition of the vascularized ulnar nerve. PMID:25788935

  8. Applied anatomical study of the vascularized ulnar nerve and its blood supply for cubital tunnel syndrome at the elbow region

    PubMed Central

    Li, Mei-xiu-li; He, Qiong; Hu, Zhong-lin; Chen, Sheng-hua; Lv, Yun-cheng; Liu, Zheng-hai; Wen, Yong; Peng, Tian-hong

    2015-01-01

    Cubital tunnel syndrome is often accompanied by paresthesia in ulnar nerve sites and hand muscle atrophy. When muscle weakness occurs, or after failure of more conservative treatments, anterior transposition is used. In the present study, the ulnar nerve and its blood vessels were examined in the elbows of 18 adult cadavers, and the external diameter of the nutrient vessels of the ulnar nerve at the point of origin, the distances between the origin of the vessels and the medial epicondyle of the humerus, and the length of the vessels accompanying the ulnar nerve in the superior ulnar collateral artery, the inferior ulnar collateral artery, and the posterior ulnar recurrent artery were measured. Anterior transposition of the vascularized ulnar nerve was performed to treat cubital tunnel syndrome. The most appropriate distance that the vascularized ulnar nerve can be moved to the subcutaneous tissue under tension-free conditions was 1.8 ± 0.6 cm (1.1–2.5 cm), which can be used as a reference value during the treatment of cubital tunnel syndrome with anterior transposition of the vascularized ulnar nerve.

  9. Compression of the ulnar nerve at the elbow: cubital tunnel syndrome.

    PubMed

    Gellman, Harris

    2008-01-01

    Although cubital tunnel syndrome has been described as the most common entrapment of the ulnar nerve, there is still considerable difficulty identifying the exact location of the pathologic compression of the nerve and deciding on the correct surgical or nonsurgical treatment. The most commonly recommended surgical techniques include simple (in situ) decompression, decompression with medial epicondylectomy, anterior subcutaneous transposition, and anterior submuscular transposition of the ulnar nerve at the elbow. It is important to understand the pitfalls and possible complications of these commonly used treatments. PMID:18399580

  10. Ulnar Nerve Compression in the Cubital Tunnel by an Epineural Ganglion: A Case Report

    PubMed Central

    Dimitriou, Christos G.

    2006-01-01

    Epineural ganglia are considered to be a usual cause of peripheral nerve compression. In this report, we present a rare case of ulnar nerve compression by an epineural ganglion in the cubital tunnel. A 28-year-old right-handed female secretary developed progressive pain, numbness, and weakness in her right elbow, forearm, and hand for 6 months. Atrophy of the adductor pollicis and the first dorsal interosseous muscles was apparent. Clinical examination revealed a cystic mass at the posterior side of the elbow. Magnetic resonance imaging identified a ganglion while electrophysiologic studies revealed a severe conduction block of the ulnar nerve at the elbow. During surgery a 2-cm diameter epineural ganglion was identified compressing the ulnar nerve and was excised using microsurgery techniques. Two months postoperatively, the clinical recovery of the patient was very satisfactory, although the postoperative electrophysiologic studies demonstrated a less dramatic improvement. PMID:18780042

  11. Self-reported outcome following anterior transposition of ulnar nerve in the elderly.

    PubMed

    Sreedharan, S; Yam, A K T; Tay, S C

    2010-01-01

    Cubital tunnel syndrome is a common entrapment neuropathy of the upper limb. This condition can result in significant sensory disturbances and motor deficits in the distribution of the ulnar nerve. Surgical management of cubital tunnel syndrome is indicated when non-operative measures fail. However, in the elderly population, there may be a tendency to avoid surgery as nerve healing has been found to be poor. In our study, we reviewed the results of anterior transposition of ulnar nerve in patients 60 years of age and older. Our results were based on a self-reported outcome at a minimum of one year after surgery - 94.7% of our surgeries resulted in some improvement in symptoms experienced by the patients while there was an overall satisfaction rate of 83.3%. Based on our results, we recommend ulnar nerve transposition in the management of cubital tunnel syndrome in this group of patients if non-operative measures fail. PMID:21089190

  12. Associations between ulnar nerve strain and accompanying conditions in patients with cubital tunnel syndrome.

    PubMed

    Ochi, Kensuke; Horiuchi, Yukio; Nakamura, Toshiyasu; Sato, Kazuki; Morita, Kozo; Horiuchi, Koichi

    2014-01-01

    Pathophysiology of cubital tunnel syndrome (CubTS) is still controversial. Ulnar nerve strain at the elbow was measured intraoperatively in 13 patients with CubTS before simple decompression. The patients were divided into three groups according to their accompanying conditions: compression/adhesion, idiopathic, and relaxation groups. The mean ulnar nerve strain was 43.5 ± 30.0%, 25.5 ± 14.8%, and 9.0 ± 5.0% in the compression/adhesion, idiopathic, and relaxation groups respectively. The mean ulnar nerve strains in patients with McGowan's classification grades I, II, and III were 18.0 ± 4.2%, 27.1 ± 22.7%, and 33.7 ± 24.7%, respectively. The Jonckheere-Terpstra test showed that there were significant reductions in the ulnar nerve strain among the first three groups, but not in the three groups according to McGowan's classification. Our results suggest that the pathophysiology, not disease severity, of CubTS may be explained at least in part by the presence of ulnar nerve strain. PMID:25121945

  13. Bilateral additional slips of triceps brachii forming osseo-musculo-fibrous tunnels for ulnar nerves.

    PubMed

    Swamy, Rs; Rao, Mkg; Somayaji, Sn; Raghu, J; Pamidi, N

    2013-07-01

    Rare additional slips of triceps brachii muscle was found bilaterally in a sixty two year old South Indian male cadaver during routine dissection of upper limb for undergraduate students at Melaka-Manipal Medical College, Manipal University, Manipal, India. On left side, the variant additional muscle slip took origin from the lower part of the medial intermuscular septum about 4 cm proximal to the medial humeral epicondyle. From its origin, the muscle fibres were passing over the ulnar nerve and were joining the triceps muscle to get inserted to the upper surface of olecranon process of ulna. On right side, the additional muscle slip was larger and bulkier and was arising from the lower part of the medial border of the humerus about 4 cm proximal to the medial epicondyle in addition to its attachment to the medial intermuscular septum. On both sides, the additional slips were supplied by twigs from the radial nerve. On both sides, the ulnar nerve was passing between variant additional slip and the lower part of the shaft of the humerus in an osseo-musculo-fibrous tunnel. Such variant additional muscle slips may affect the function of triceps muscle and can lead to snapping of medial head of triceps and ulnar nerve over medial epicondyle and also can dynamically compress the ulnar nerve during the contraction of triceps leading to ulnar neuropathy around the elbow. PMID:24116332

  14. Nerve lesioning with direct current

    NASA Astrophysics Data System (ADS)

    Ravid, E. Natalie; Shi Gan, Liu; Todd, Kathryn; Prochazka, Arthur

    2011-02-01

    Spastic hypertonus (muscle over-activity due to exaggerated stretch reflexes) often develops in people with stroke, cerebral palsy, multiple sclerosis and spinal cord injury. Lesioning of nerves, e.g. with phenol or botulinum toxin is widely performed to reduce spastic hypertonus. We have explored the use of direct electrical current (DC) to lesion peripheral nerves. In a series of animal experiments, DC reduced muscle force by controlled amounts and the reduction could last several months. We conclude that in some cases controlled DC lesioning may provide an effective alternative to the less controllable molecular treatments available today.

  15. Use of ultrasonography in ulnar nerve entrapment surgery--a prospective study.

    PubMed

    Kutlay, Murat; Colak, Ahmet; Sim?ek, Hakan; Oztürk, Ersin; Senol, Mehmet Güney; Topuz, Kivanç; Demircan, Mehmet Nusret

    2009-04-01

    The purpose of our study is to assess the usefulness of high-resolution ultrasonography in observing the morphology and dynamics of the ulnar nerve in the cubital tunnel and also the efficacy of ultrasonography in a more accurate diagnosis and appropriate surgical treatment decision. Cross-sectional area of the ulnar nerves of 40 healthy volunteers in the control group were measured bilaterally at the level of the epicondyle, 2 cm proximal to and 2 cm distal to the epicondyle. Measurements were obtained for elbows both in extension and flexion. Then, we prospectively obtained the cross-sectional area values of 18 patients at the same levels, elbows in extension and flexion position, and compared the data obtained from the patient group and the control group. The differences between the cross-sectional areas of the ulnar nerves in extension and flexion were statistically significant in the patient population (p < 0.001). Mean cross-sectional area of the ulnar nerve in the patient population was calculated as 0.16 cm(2), and we accepted the cut-off point as 0.1 cm(2). This value for cross-sectional area yielded a sensitivity of 90% and a specificity of 100% in diagnosis of ulnar nerve entrapment. Results substantiated conspicuous morphological changes in ulnar nerve during flexion and extension of the elbow. We also observed that as the degree of the nerve displacement by virtue of elbow flexion that is discerned by ultrasonography increased, a more aggressive decompressive surgery was needed for an appropriate treatment. PMID:18797947

  16. Missed ulnar nerve injury and closed forearm fracture in a child.

    PubMed

    Amit, Batra; Ashish, Devgan; Vinit, Verma; Raj, Singh; Shivani, Batra; Narender, Magu; Rohit, Singla; Paritosh, Gogna; Navdeep, Gupta

    2013-01-01

    Ulnar nerve injury in closed fracture of forearm in children is uncommon.Commonly, neurapraxia is the reason for this palsy but other severe injuries or nerve entrapment has been reported in some cases. The importance of diagnosis concerning the types of the nerve injury lies in the fact that they have totally different management.We present a case of ulnar nerve deficit in a child following a closed fracture of the forearm bones. It is imperative to diagnose exact cause of palsy as it forms the basis for treatment. MRI scan can help diagnosis and accordingly guide the management. Simple nerve contusion should be treated conservatively, and exploration with fixation of the fracture should be done in lacerations and entrapments of the nerve. Surgery is not the treatment of choice in cases that could be managed conservatively. PMID:23910681

  17. Nerve Conduction Study Among Healthy Malays. The Influence of Age, Height and Body Mass Index on Median, Ulnar, Common Peroneal and Sural Nerves

    PubMed Central

    Awang, Mohamed Saufi; Abdullah, Jafri Malin; Abdullah, Mohd Rusli; Tharakan, John; Prasad, Atul; Husin, Zabidi Azhar; Hussin, Ahmad Munawir; Tahir, Adnan; Razak, Salmi Abdul

    2006-01-01

    Nerve conduction study is essential in the diagnosis of focal neuropathies and diffuse polyneuropathies. Age, height and body mass index (BMI) can affect nerve velocities as reported by previous studies. We studied the effect of these factors on median, ulnar, common peroneal and sural nerves among healthy Malay subjects. We observed slowing of nerve conduction velocities (NCVs) with increasing age and BMI (except ulnar sensory velocities). No demonstrable trend can be seen across different height groups except in common peroneal nerve. PMID:22589600

  18. The spaghetti wrist. Simultaneous laceration of the median and ulnar nerves with flexor tendons at the wrist.

    PubMed

    Hudson, D A; de Jager, L T

    1993-04-01

    The outcome of 15 patients who sustained simultaneous laceration of the median and ulnar nerves with flexor tendons at the wrist is described. Primary nerve repair yielded satisfactory results, the median nerve achieving a better outcome than the ulnar nerve. Most patients regained a functional range of wrist movement. Flexor tendons yielded the poorest results. A functional, albeit impaired outcome can usually be anticipated following this severe injury. PMID:8501364

  19. Clinical consequences of reinnervation disorders after focal peripheral nerve lesions.

    PubMed

    Valls-Sole, Josep; Castillo, Carlos David; Casanova-Molla, Jordi; Costa, Joao

    2011-02-01

    Axonal regeneration and organ reinnervation are the necessary steps for functional recovery after a nerve lesion. However, these processes are frequently accompanied by collateral events that may not be beneficial, such as: (1) Uncontrolled branching of growing axons at the lesion site. (2) Misdirection of axons and target organ reinnervation errors, (3) Enhancement of excitability of the parent neuron, and (4) Compensatory activity in non-damaged nerves. Each one of those possible problems or a combination of them can be the underlying pathophysiological mechanism for some clinical conditions seen as a consequence of a nerve lesion. Reinnervation-related motor disorders are more likely to occur with lesions affecting nerves which innervate muscles with antagonistic functions, such as the facial, the laryngeal and the ulnar nerves. Motor disorders are better demonstrated than sensory disturbances, which might follow similar patterns. In some instances, the available examination methods give only scarce evidence for the positive diagnosis of reinnervation-related disorders in humans and the diagnosis of such condition can only be based on clinical observation. Whatever the lesion, though, the restitution of complex functions such as fine motor control and sensory discrimination would require not only a successful regeneration process but also a central nervous system reorganization in order to integrate the newly formed peripheral nerve structure into the prepared motor programs and sensory patterns. PMID:20656551

  20. Sleeve bridging of the rhesus monkey ulnar nerve with muscular branches of the pronator teres: multiple amplification of axonal regeneration

    PubMed Central

    Kou, Yu-hui; Zhang, Pei-xun; Wang, Yan-hua; Chen, Bo; Han, Na; Xue, Feng; Zhang, Hong-bo; Yin, Xiao-feng; Jiang, Bao-guo

    2015-01-01

    Multiple-bud regeneration, i.e., multiple amplification, has been shown to exist in peripheral nerve regeneration. Multiple buds grow towards the distal nerve stump during proximal nerve fiber regeneration. Our previous studies have verified the limit and validity of multiple amplification of peripheral nerve regeneration using small gap sleeve bridging of small donor nerves to repair large receptor nerves in rodents. The present study sought to observe multiple amplification of myelinated nerve fiber regeneration in the primate peripheral nerve. Rhesus monkey models of distal ulnar nerve defects were established and repaired using muscular branches of the right forearm pronator teres. Proximal muscular branches of the pronator teres were sutured into the distal ulnar nerve using the small gap sleeve bridging method. At 6 months after suture, two-finger flexion and mild wrist flexion were restored in the ulnar-sided injured limbs of rhesus monkey. Neurophysiological examination showed that motor nerve conduction velocity reached 22.63 ± 6.34 m/s on the affected side of rhesus monkey. Osmium tetroxide staining demonstrated that the number of myelinated nerve fibers was 1,657 ± 652 in the branches of pronator teres of donor, and 2,661 ± 843 in the repaired ulnar nerve. The rate of multiple amplification of regenerating myelinated nerve fibers was 1.61. These data showed that when muscular branches of the pronator teres were used to repair ulnar nerve in primates, effective regeneration was observed in regenerating nerve fibers, and functions of the injured ulnar nerve were restored to a certain extent. Moreover, multiple amplification was subsequently detected in ulnar nerve axons. PMID:25788920

  1. Use of a pedicled adipose flap as a sling for anterior subcutaneous transposition of the ulnar nerve.

    PubMed

    Danoff, Jonathan R; Lombardi, Joseph M; Rosenwasser, Melvin P

    2014-03-01

    In patients with primary cubital tunnel syndrome, we hypothesize that using a vascularized adipose sling to secure the ulnar nerve during anterior subcutaneous transposition will lead to improved patient outcomes. The adipose flap is designed to surround the ulnar nerve with a pliable, vascularized fat envelope, mimicking the natural fatty environment of peripheral nerves. This technique may offer advantages in securing the anteriorly transposed ulnar nerve and reducing instances of postoperative perineural scarring. Patients experience good functional outcomes; most experience resolution of symptoms. PMID:24503232

  2. The muscular branching patterns of the ulnar nerve to the flexor carpi ulnaris and flexor digitorum profundus muscles.

    PubMed

    Marur, Tania; Akkin, Salih Murat; Alp, Mehmet; Demirci, Selman; Yalçin, Levent; Ogüt, Tahir; Akgün, I?ik

    2005-11-01

    The branching pattern of the ulnar nerve in the forearm is of great importance in anterior transposition of the ulnar nerve for decompression after neuropathy of cubital tunnel syndrom and malformations resulting from distal end fractures of the humerus. In this study, 37 formalin-fixed forearms were used to demonstrate the muscular branching patterns from the main ulnar nerve to the flexor carpi ulnaris muscle (FCU) and ulnar part of the flexor digitorum profundus muscle (FDP). Eight branching patterns were found and classified into four groups according to the number of the muscular branches leaving the main ulnar nerve. Two (Group I) and three (Group II) branches left the main ulnar nerve in 18 and 17 forearms respectively. The remaining two specimens had four (Group III) and five (Group IV) branches each. Usually one or two branches were associated with the innervation of the FCU. However, in 2 cases, three and in one, four branches to FCU were observed. The FDP received a single branch in all cases, except in four, all of which had two branches. In six forearms, a common trunk was observed arising from the ulnar nerve to supply the FCU and FDP. The distribution of the muscular branches to the revealed muscles was outlined in figures and the distance of the origin of these branches from the interepicondylar line was measured in millimeters. The first muscular branch leaving the main ulnar nerve was the FCU-branch in all specimens. The terminal muscular branch of the ulnar nerve to the forearm muscles arose at the proximal 1/3 of the forearm in all specimens. In 7 forearms, Martin-Gruber anastomosis in form of median to ulnar was observed. PMID:15977022

  3. Ultrasonographic reference sizes of the median and ulnar nerves and the cervical nerve roots in healthy Japanese adults.

    PubMed

    Sugimoto, Takamichi; Ochi, Kazuhide; Hosomi, Naohisa; Mukai, Tomoya; Ueno, Hiroki; Takahashi, Tetsuya; Ohtsuki, Toshiho; Kohriyama, Tatsuo; Matsumoto, Masayasu

    2013-09-01

    The objective of this study was to identify, for practical use, ultrasonographic reference values for nerve sizes at multiple sites, including entrapment and non-entrapment sites along the median and ulnar nerves and among the cervical nerve roots. We verified reliable sites and site-based differences between the reference values. In addition, we found associations between the reference nerve sizes and several physical characteristics (gender, dominant hand, age, height, weight, body mass index [BMI] and wrist circumference). Nerves were measured bilaterally at 26 sites or levels in 60 healthy Japanese adults (29 males; age, 35.4 ± 9.7 y; BMI, 22.3 ± 3.6 kg/m(2); wrist circumference, 16.0 ± 1.3 cm on the right side and 15.9 ± 1.2 cm on the left side). The mean reference nerve sizes were 5.6-9.1 mm(2) along the median nerve, 4.1-6.7 mm(2) along the ulnar nerve and 2.14-3.39 mm among the cervical nerve roots. Multifactorial regression analyses revealed that the physical characteristics most strongly associated with nerve size were age, BMI and wrist circumference at the entrapment sites (F = 7.6, p < 0.01, at the pisiform bone level of the carpal tunnel; F = 15.1, p < 0.001, at the level of Guyon's canal), as well as wrist circumference and gender at the non-entrapment sites (F = 70.6, p < 0.001, along the median nerve; F = 24.7, p < 0.001, along the ulnar nerve). Our results suggest that the factors with the greatest influence on nerve size differed between entrapment and non-entrapment sites. Site-based differences in nerve size were determined using one-way analyses of variance (p < 0.001). Intra- and inter-observer reliability was highest for the median nerve, at both the distal wrist crease and mid-humerus; at the arterial split along the ulnar nerve; and at the fifth cervical nerve root level. No systematic error was indicated by Bland-Altman analysis; the coefficients of variation were 5.5%-9.2% for intra-observer reliability and 7.1%-8.7% for inter-observer reliability. PMID:23830101

  4. Granular Cell Tumor of the Ulnar Nerve: MR Neurography Characterization

    PubMed Central

    Wadhwa, Vibhor; Salaria, Safia N; Chhabra, Avneesh

    2014-01-01

    The authors report an unusual case of ulnar neuropathy caused by granular cell tumor. The report describes the anatomic 3 Tesla MR Neurography and functional diffusion tensor findings of the case, which was subsequently confirmed on surgical excision and histopathology. PMID:25426230

  5. Simple decompression of the ulnar nerve at the elbow via proximal and distal mini skin incisions.

    PubMed

    Calisaneller, Tarkan; Ozdemir, Ozgur; Caner, Hakan; Altinors, Nur

    2011-01-01

    The purpose of the present study was to describe a new minimally invasive surgical technique for decompression of the ulnar nerve at the elbow for treatment of cubital tunnel syndrome. Four patients underwent surgical treatment for cubital tunnel syndrome. Preoperative clinical states were classified by using the McGowan grading system and the postoperative states were recorded by using the Wilson and Krout grading system. Preoperative and last follow-up electromyographic results were also recorded. At the last follow-up, three patients were recorded as excellent and one patient was recorded as good according to Wilson and Krout grading system. One patient showed improvement in sensory nerve conduction velocity another showed improvement in motor nerve conduction velocity at the last follow-up. We conclude that simple decompression of the ulnar nerve at elbow via proximal and distal mini skin incisions is an effective, technically simple and safe surgical method in the treatment of cubital tunnel syndrome. PMID:21534197

  6. Severe ulnar nerve entrapment at the elbow: functional outcome after minimally invasive in situ decompression.

    PubMed

    Karthik, K; Nanda, R; Storey, S; Stothard, J

    2012-02-01

    The role of in situ decompression in patients with severe ulnar nerve compression is still controversial. Thirty patients with severe ulnar nerve compression confirmed clinically and electrophysiologically underwent simple decompression. The mean age of the patients was 58 (range 26-87) years. Through incisions ?4?cm the nerves were fully visualized and decompressed. Outcome was measured prospectively using Modified Bishop's score (BS), grip and pinch strengths and two-point discrimination (2PD). Significant improvement in power (p?=?0.01) and pinch grip (p?=?0.001) was noted at 1 year. The grip strength continued to improve up to 1 year. According to the BS, 24 patients (80%) had good to excellent results at 1 year. Minimally invasive in situ decompression is technically simple, safe and gives good results in patients with severe nerve compression. The BS and 2PD were more reliable than grip strength in assessing these patients at follow-up. PMID:21914694

  7. Subcutaneous anterior transposition of the ulnar nerve for failed decompression of cubital tunnel syndrome

    Microsoft Academic Search

    Andrew E. Caputo; H. Kirk Watson

    2000-01-01

    The current literature universally suggests that submuscular anterior transposition is the standard operative treatment for recurrent cubital tunnel syndrome. Regardless of the type of initial failed procedure, including submuscular transposition, 20 patients underwent anterior subcutaneous transposition of the ulnar nerve. All patients were monitored for a minimum of 2 years after surgery. The most common sites of compression were the

  8. Ulnar nerve entrapment neuropathy at the elbow: decisional algorithm and surgical considerations

    Microsoft Academic Search

    C. Mandelli; M. Baiguini

    2009-01-01

    Summary Introduction. We propose our surgical experience and the decisional algorithm we use to select the sur- gical procedure for the ulnar nerve entrapment at the elbow according to defined parameters. Materials and methods. Between 2005 and 2007, 44 patients were operated according to our algorithm that is based both on clinical parameters, classified through the McGowan scale, and on

  9. IN-RATIO: A new test to increase diagnostic sensitivity in ulnar nerve entrapment at elbow

    Microsoft Academic Search

    P. Caliandro; M. Foschini; C. Pazzaglia; G. La Torre; I. Aprile; G. Granata; P. Tonali; L. Padua

    2008-01-01

    ObjectiveMotor conduction velocity may yield false-negative results in mild ulnar nerve entrapment at elbow (UNE). There is evidence that the clinical heterogeneity of UNE may be due to the different involvement of fascicles. We hypothesized that, if fibres to FDI are more damaged than fibres to ADM, a relative slowing of motor conduction velocity (CV) at the segment across the

  10. MR imaging of ulnar nerve entrapment secondary to an anomalous wrist muscle

    Microsoft Academic Search

    Martin J. Ruocco; John J. Walsh; Joseph P. Jackson

    1998-01-01

    MR imaging of an anomalous hypothenar adductor muscle causing isolated deep ulnar nerve branch compression and producing a\\u000a purely motor neuropathy is presented. The muscle appears to represent a type 1 variant of the intrinsic anomalous hypothenar\\u000a adductor muscle.

  11. Electromyography and ultrasonography in the diagnosis of a rare double-crush ulnar nerve injury.

    PubMed

    Akyuz, Mufit; Yalcin, Elif; Selcuk, Barin; Onder, Burcu; Ozçakar, Levent

    2011-11-01

    Reported here is a 46-year-old man who was seen for pain, numbness, and weakness in his left upper limb and hand. Electromyographic studies demonstrated denervation of ulnar-innervated muscle groups except for the flexor carpi ulnaris. A localized nerve conduction block could not be depicted because of severe axonal loss. Ultrasonographic evaluation showed enlargement of the ulnar nerve at 2 sites: at the level of the epicondylar groove and the inside of the flexor carpi ulnaris muscle. Herein, we would like to emphasize the complementary role of an ultrasound in peripheral nerve pathologies, not only does it confirm the entrapment but it also displays the underlying cause(s). PMID:21839984

  12. High origin of dorsal branch of the ulnar nerve and variations in its branching pattern and distribution: a case report

    PubMed Central

    2009-01-01

    Introduction Ulnar nerve is a branch of the brachial plexus. In the front of the forearm, normally near the wrist joint, it gives a dorsal cutaneous branch which supplies the skin of the dorsum of the hand. Case presentation The present case reports a very rare finding, the dorsal branch of the ulnar nerve along with the main nerve trunk originated between the two heads of the flexor carpi ulnaris muscle, after descending along the medial border of the forearm extensor surface, on the dorsal aspect of the wrist it is divided into three branches, one medial and two lateral. The medial most division received a communicating branch from the superficial ramus of the ulnar nerve and continued as the medial proper digital nerve of the little finger. The lateral two divisions became cutaneous on the medial half of the dorsum of the hand along the medial three digits i.e. radial and ulnar side of little, ring and middle finger. Conclusion The site, extent of injury, variations and the delay in the treatment, significantly influences the outcome of ulnar nerve repair. Thus, an adequate knowledge of all possible variations in the ulnar nerve may be important for clinicians and may help to explain uncommon symptoms. PMID:20062647

  13. Compression neuropathy of the ulnar digital nerves in the thumbs of a massage therapist.

    PubMed

    Chen, Chien-Chang; Chien, Hsiung-Fei; Chen, Chien-Lian

    2014-01-01

    Compression neuropathies of digital nerves, caused by hypertrophied or anomalous muscles, are rare compared with such occurrences above the wrist. We reported a case of compression neuropathy of the ulnar digital nerves in bilateral thumbs of a massage therapist. Entrapment of the digital nerves by the hypertrophied first dorsal interosseous and adductor pollicis muscles over the first web space of the right hand was detected by magnetic resonance imaging. Surgical debulking of the muscles and neurolysis were performed on the dominant right hand. The left hand was successfully treated with botulinum toxin. No recurrence was noted in a follow-up of 36 months. PMID:23486120

  14. T2-Signal of Ulnar Nerve Branches at the Wrist in Guyon’s Canal Syndrome

    PubMed Central

    Kollmer, Jennifer; Bäumer, Philipp; Milford, David; Dombert, Thomas; Staub, Frank; Bendszus, Martin; Pham, Mirko

    2012-01-01

    Objective To evaluate T2-signal of high-resolution MRI in distal ulnar nerve branches at the wrist as diagnostic sign of guyon’s-canal-syndrome (GCS). Materials and Methods 11 GCS patients confirmed by clinical/electrophysiological findings, and 20 wrists from 11 asymptomatic volunteers were prospectively included to undergo the following protocol: axial T2-weighted-fat-suppressed and T1-weighted-turbo-spin-echo-sequences (3T-MR-scanner, Magnetom/Verio/Siemens). Patients were examined in prone position with the arm extended and wrist placed in an 8-channel surface-array-coil. Nerve T2-signal was evaluated as contrast-to-noise-ratios (CNR) from proximal-to-distal in ulnar nerve trunk, its superficial/sensory and deep/motor branch. Distal motor-nerve-conduction (distal-motor-latency (dml)) to first dorsal-interosseus (IOD I) and abductor digiti minimi muscles was correlated with T2-signal. Approval by the institutional review-board and written informed consent was given by all participants. Results In GCS, mean nerve T2-signal was strongly increased within the deep/motor branch (11.7±4.8 vs.controls:?5.3±2.4;p?=?0.001) but clearly less and not significantly increased in ulnar nerve trunk (6.8±6.4vs.?7.4±2.5;p?=?0.07) and superficial/sensory branch (?2.1±4.9vs.?9.7±2.9;p?=?0.08). Median nerve T2-signal did not differ between patients and controls (?9.8±2.5vs.?6.7±4.2;p?=?0.45). T2-signal of deep/motor branch correlated strongly with motor-conduction-velocity to IOD I in non-linear fashion (R2?=??0.8;p<0.001). ROC-analysis revealed increased nerve T2-signal of the deep/motor branch to be a sign of excellent diagnostic performance (area-under-the-curve 0.94, 95% CI: 0.85–1.00; specificity 90%, sensitivity 89.5%). Conclusions Nerve T2-signal increase of distal ulnar nerve branches and in particular of the deep/motor branch is highly accurate for the diagnostic determination of GCS. Furthermore, for the first time it was found in nerve entrapment injury that T2-signal strongly correlates with electrical-conduction-velocity. PMID:23071777

  15. A new instrument for endoscopic release of the ulnar nerve in the cubital tunnel-a cadaveric investigation

    Microsoft Academic Search

    J. R. Tamarapalli; J. E. Lemons

    1996-01-01

    Ulnar nerve entrapment within the cubital tunnel is a common clinical condition. Traditionally, nerve releases have been performed utilizing a long incision on the medial side of the elbow leaving a long scar, usually with some damage to the cutaneous nerves around the elbow and associated morbidity, plus, on the average, a three-to-four day stay in the hospital, With endoscopic

  16. Oberlin partial ulnar nerve transfer for restoration in obstetric brachial plexus palsy of a newborn: case report

    Microsoft Academic Search

    Koji Shigematsu; Hiroshi Yajima; Yasunori Kobata; Kenji Kawamura; Naoki Maegawa; Yoshinori Takakura

    2006-01-01

    An 8 month old male infant with Erb's birth palsy was treated with two peripheral nerve transfers. Except for rapid motor reinnervations, elbow flexion was obtained by an Oberlin's partial ulnar nerve transfer, while shoulder abduction was restored by an accessory-to-suprascapular nerve transfer. The initial contraction of the biceps muscle occurred two months after surgery. Forty months after surgery, elbow

  17. Oberlin partial ulnar nerve transfer for restoration in obstetric brachial plexus palsy of a newborn: case report.

    PubMed

    Shigematsu, Koji; Yajima, Hiroshi; Kobata, Yasunori; Kawamura, Kenji; Maegawa, Naoki; Takakura, Yoshinori

    2006-01-01

    An 8 month old male infant with Erb's birth palsy was treated with two peripheral nerve transfers. Except for rapid motor reinnervations, elbow flexion was obtained by an Oberlin's partial ulnar nerve transfer, while shoulder abduction was restored by an accessory-to-suprascapular nerve transfer. The initial contraction of the biceps muscle occurred two months after surgery. Forty months after surgery, elbow flexion reached M5 without functional loss of the ulnar nerve. This case demonstrates an excellent result of an Oberlin's nerve transfer for restoration of flexion of the elbow joint in Erb's birth palsy. However, at this time partial ulnar nerve transfer for Erb's birth palsy is an optional procedure; a larger number of cases will need to be studied for it to be widely accepted as a standard procedure for Erb's palsy at birth. PMID:17147774

  18. Characterization of tests of functional recovery after median and ulnar nerve injury and repair in the rat forelimb.

    PubMed

    Galtrey, Clare M; Fawcett, James W

    2007-03-01

    The majority of human peripheral nerve injuries occur in the upper limb but the majority of studies in the rat are performed in the hindlimb. The upper and lower limbs differ in dexterity and control by supraspinal systems, so an upper limb model is a better representation of the common form of human injury. The purpose of this study was to further develop a rat model involving lesions of the median and ulnar nerves. To produce different degrees of misdirection of axons following nerve repair, we studied nerve crush, cut and repair of the two nerves, and cut and repair with crossover. Assessment of functional recovery was performed using a battery of motor and sensory tests: the staircase test, which assesses skilled forepaw reaching; grip strength meter, which assesses grip strength; pawprint analysis, which assesses toe spread and print length; horizontal ladder, which assesses forepaw placement during skilled locomotion; modified Randall-Selitto device and electronic von Frey probes, which assess fine touch; and cold probes, which assess temperature sensation. All tests revealed deficits in forepaw function after nerve injury except the print length and modified Randall-Selitto device. The time course of functional recovery was observed over 15 weeks. The final degree of functional recovery achieved was related to the misdirection of axon regeneration. The tests that most clearly revealed the effects of axon misdirection on function were the skilled paw reaching and grip strength tests. The lesion model and functional tests that we have developed will be useful in testing therapeutic strategies for treating the consequences of inaccurate axon regeneration following peripheral nerve injury in humans. PMID:17374098

  19. Clinical Assessment of the Ulnar Nerve at the Elbow: Reliability of Instability Testing and the Association of Hypermobility with Clinical Symptoms

    PubMed Central

    Calfee, Ryan P.; Manske, Paul R.; Gelberman, Richard H.; Van Steyn, Marlo O.; Steffen, Jennifer; Goldfarb, Charles A.

    2010-01-01

    Background: Ulnar nerve hypermobility has been reported to be present in 2% to 47% of asymptomatic individuals. To our knowledge, the physical examination technique for diagnosing ulnar nerve hypermobility has not been standardized. This study was designed to quantify the interobserver reliability of the physical examination for ulnar nerve hypermobility and to determine whether ulnar nerve hypermobility is associated with clinical symptoms. Methods: Four hundred elbows in 200 volunteer participants were examined. Each participant was queried regarding symptoms attributable to the ulnar nerve. Three examiners, unaware of reported symptoms, independently performed a standardized examination of both elbows to assess ulnar nerve hypermobility. Ulnar nerves were categorized as stable or as hypermobile, which was further subclassified as perchable, perching, or dislocating. Provocative maneuvers, consisting of the Tinel test and flexion compression testing, were performed, and structural measurements were recorded. Kappa values quantified the examination's interobserver reliability. Unpaired t tests, chi-square tests, Wilcoxon tests, and Fisher exact tests were utilized to compare data between those with hypermobile nerves and those with stable nerves. Results: Ulnar nerve hypermobility was identified in 37% (148) of the 400 elbows. Hypermobility was bilateral in 30% (fifty-nine) of the 200 subjects. For the three examiners, weighted kappa values on the right and left sides were 0.70 and 0.74, respectively. Elbows with nerve hypermobility did not experience a higher prevalence of subjective symptoms (snapping, pain, and tingling) than did elbows with stable nerves. Provocative physical examination testing for ulnar nerve irritability, however, showed consistent trends toward heightened irritability in hypermobile nerves (p = 0.04 to 0.16). Demographic data and anatomic measurements were similar between the subjects with stable nerves and those with hypermobile nerves. Conclusions: Ulnar nerve hypermobility occurs in over one-third of the adult population. Utilizing a standardized physical examination, a diagnosis of ulnar nerve hypermobility can be established with substantial interobserver reliability. In the general population, ulnar nerve hypermobility does not appear to be associated with an increased symptomatology attributable to the ulnar nerve. Clinical Relevance: The results of this study demonstrate the reliability of clinically diagnosing ulnar nerve hypermobility and the lack of association of ulnar nerve hypermobility with symptoms. PMID:21123610

  20. Anterior intramuscular transposition of the ulnar nerve for cubital tunnel syndrome

    Microsoft Academic Search

    Keith A Glowacki; Arnold-Peter C Weiss

    1997-01-01

    Forty-five sequential cubital tunnel releases with anterior transposition of the ulnar nerve in an intramuscular fashion were performed over a 4-year period. All patients had a positive Tinel's sign at the cubital tunnel and reported numbness and tingling in the ring and small finger of the affected arm. Thirty-three cases had preoperative electrodiagnostic studies performed. Twenty-three cases had positive electromyographic

  1. Anterior submuscular transposition of the ulnar nerve for cubital tunnel syndrome

    Microsoft Academic Search

    C. B. Pasque; G. M. Rayan

    1995-01-01

    48 patients with 50 involved limbs were retrospectively analyzed to determine factors influencing the outcome of surgical treatment for cubital tunnel syndrome. All patients were treated by anterior submuscular transposition of the ulnar nerve with Z-lengthening of the flexor-pronator origin. There were 24 men and 24 women with an average age of 42 years? 16.4 years (range, 5–75 years). The

  2. Focal hand dystonia in a patient with ulnar nerve neuropathy at the elbow

    Microsoft Academic Search

    Vasudeva Iyer; Sunil Thirkannad

    2010-01-01

    We describe a patient who presented with dystonia of her small finger secondary to entrapment neuropathy of the ulnar nerve\\u000a at the elbow. Pre operative electrophysiological studies suggested that the locus of entrapment was located proximal to the\\u000a medial epicondyle. This was confirmed intraoperatively by the presence of a thickened and prominent arcade of Struthers. Surgical\\u000a decompression resulted in a

  3. Risk factors for ulnar nerve compression at the elbow: a case control study

    Microsoft Academic Search

    R. H. M. A. Bartels; A. L. M. Verbeek

    2007-01-01

    Summary  \\u000a Background. Ulnar nerve compression at the elbow is frequently encountered as the second most common compression neuropathy in the arm.\\u000a As dexterity may be severely affected, the disease entity can seriously interfere with daily life and work. However, epidemiological\\u000a research considering the risk factors is rarely performed.\\u000a \\u000a This study intended to investigate whether potential risk factors based on historical

  4. Surgical Options for Ulnar Nerve Entrapment: An Example of Individualized Decision Analysis

    Microsoft Academic Search

    Jaime Gasco

    2009-01-01

    The decision-making process in the diagnosis and treatment of an ulnar nerve entrapment (UNE) at the elbow is presented from\\u000a the viewpoint of the patient and from that of a physician who in this case, were the same individual. The problems of diagnosis\\u000a and the selection of the appropriate therapy-conservative or surgical and the choice of a particular surgical approach

  5. Beware of ulnar nerve entrapment in flexion-type supracondylar humerus fractures

    Microsoft Academic Search

    Suzanne Steinman; Tracey P. Bastrom; Peter O. Newton; Scott J. Mubarak

    2007-01-01

    Purpose  A recent study reported a higher incidence of pre-operative ulnar nerve symptoms in patients with flexion-type supracondylar\\u000a fractures than in those with the more common extension supracondylar fractures and a greater need for open reduction (Kocher\\u000a in POSNA paper #49 2006). We have encountered a specific pattern of flexion supracondylar fractures that often require open\\u000a reduction with internal fixation (ORIF)

  6. Surgical options for ulnar nerve entrapment: an example of individualized decision analysis.

    PubMed

    Gasco, Jaime

    2009-12-01

    The decision-making process in the diagnosis and treatment of an ulnar nerve entrapment (UNE) at the elbow is presented from the viewpoint of the patient and from that of a physician who in this case, were the same individual. The problems of diagnosis and the selection of the appropriate therapy-conservative or surgical and the choice of a particular surgical approach are discussed in the light of recent evidence-based medicine (EMB) literature. PMID:19241112

  7. [Two anomalous muscles of a forearm revealed by ulnar nerve compressions, a Double Crush syndrome].

    PubMed

    Guidicelli, T; Londner, J; Gonnelli, D; Magalon, G

    2014-06-01

    This article describes the concomitant presence of two anomalous muscles on a left forearm in a 40-year-old man. The anconeus epitrochlearis muscle was responsible for a cubital tunnel syndrome and the unusual origin of the flexor digiti minimi brevis muscle was responsible for a compartment syndrome with ulnar nerve compression at the level of Guyon's canal during effort diagnosed by MRI. Resection of these muscles relieved the symptoms and allowed the patient to return to work. PMID:22534512

  8. Results of ulnar nerve neurotization to biceps brachii muscle in brachial plexus injury

    PubMed Central

    Rezende, Marcelo Rosa De; Rabelo, Neylor Teofilo Araújo; Silveira, Clóvis Castanho; Petersen, Pedro Araújo; Paula, Emygdio José Leomil De; Mattar, Rames

    2012-01-01

    OBJECTIVE: To evaluate the factors influencing the results of ulnar nerve neurotization at the motor branch of the brachii biceps muscle, aiming at the restoration of elbow flexion in patients with brachial plexus injury. METHODS: 19 patients, with 18 men and 1 woman, mean age 28.7 years. Eight patients had injury to roots C5-C6 and 11, to roots C5-C6-C7. The average time interval between injury and surgery was 7.5 months. Four patients had cervical fractures associated with brachial plexus injury. The postoperative follow-up was 15.7 months. RESULTS: Eight patients recovered elbow flexion strength MRC grade 4; two, MRC grade 3 and nine, MRC <3. There was no impairment of the previous ulnar nerve function. CONCLUSION: The surgical results of ulnar nerve neurotization at the motor branch of brachii biceps muscle are dependent on the interval between brachial plexus injury and surgical treatment, the presence of associated fractures of the cervical spine and occipital condyle, residual function of the C8-T1 roots after the injury and the involvement of the C7 root. Signs of reinnervation manifested up to 3 months after surgery showed better results in the long term. Level of Evidence: IV, Case Series. PMID:24453624

  9. Ulnar subluxation of the median nerve following carpal tunnel release: a case report.

    PubMed

    L'Heureux-Lebeau, B; Odobescu, A; Moser, T; Harris, P G; Danino, M A

    2012-04-01

    Complications of carpal tunnel release, while infrequent, include incomplete release resulting in persistent symptoms or recurrence due to postoperative scarring, as well as iatrogenic damage to nerves and vessels. We present the case of a patient who underwent carpal tunnel release with resolution of symptoms in the immediate postoperative period. At one and a half years post release he started to experience numbness and tingling in a median nerve distribution triggered by repetitive ulnar to radial deviation of the wrist, with no symptoms at rest. Dynamic ultrasound showed a subluxation of the median nerve from one side of the palmaris longus tendon to the other. The patient's symptoms were triggered as the median nerve squeezed in between the palmaris longus and flexor digitorum superficialis tendons. PMID:22227502

  10. Multiple point electrical stimulation of ulnar and median nerves

    Microsoft Academic Search

    H A Kadrie; S K Yates; H S Milner-Brown; W F Brown

    1976-01-01

    A computer-assisted method of isolating single motor units (MUs) by multiple point stimulation (MPS) of peripheral nerves is described. MPS was used to isolate 10-30 single MUs from thenar and hypothenar muscles of normal subjects and patients with entrapment neuropathies, with the original purpose of obtaining a more representative mean motor unit potential for estimating the number of MUs in

  11. Ulnar nerve compression at the elbow caused by the epitrochleoanconeus muscle: a case report and surgical approach.

    PubMed

    Uscetin, Ilker; Bingol, Derya; Ozkaya, Ozay; Orman, Cagdas; Akan, Mithat

    2014-01-01

    Cubital tunnel syndrome is the second most common peripheral nerve compression syndrome. It is the most common peripheral neuropathy of the ulnar nerve. The surgical treatment of the cubital tunnel syndrome is widely described in the literature, however the variations of the standard muscular anatomy in the medial humeral epicondyle region may create technical difficulties during surgical management. The epitrochleoanconeus muscle, which is an aberrant muscle of this region, is a rare cause of cubital tunnel syndrome. A case with ulnar nerve compression at the elbow caused by an uncommon etiological factor, hypertrophic epitrochleoanconeus muscle, and its surgical management is reported. PMID:24831373

  12. Acute ulnar nerve entrapment after closed reduction of a posterior fracture dislocation of the elbow: a case report.

    PubMed

    Reed, Maranda Walker; Reed, Dale Nicholas

    2012-06-01

    We present the case of a child who had a posterior-lateral elbow dislocation with an intact ulnar nerve documented before an attempted reduction, with subsequent loss of ulnar nerve function after the elbow was reduced.Dislocations of the elbow in children represent only 3% to 6% of all elbow injuries. Posterior elbow dislocations are the most common, with more than one half involving an associated fracture about the elbow. The most common associated fracture is the medial epicondyle. Even though it is known that injury to the ulnar nerve can occur in elbow dislocations, we found only 1 other case report describing intra-articular entrapment of the ulnar nerve after an elbow dislocation.This case demonstrates several important clinical issues. First, it highlights the potential risk of ulnar nerve entrapment after closed reduction of elbow dislocations in children. Second, it confirms the importance of careful prereduction and postreduction examinations in the pediatric patient presenting with a dislocated elbow. PMID:22668664

  13. Acute ulnar neuropathy at the wrist: a case report and review of the literature.

    PubMed

    Erkin, Gülten; Uysal, Hilmi; Kele?, I?ik; Aybay, Canan; Ozel, Sumru

    2006-12-01

    Acute ulnar neuropathy at the wrist is an extremely uncommon condition, at times requiring a high index of suspicion for the diagnosis. Clinical presentations of ulnar nerve lesions at the wrist and hand show variations due to the complex anatomic course of the nerve in distal sites. We report a case of acute ulnar neuropathy at the wrist caused by a ganglion in Guyon's canal, being initially misinterpreted as flexor tenosynovitis. The accurate diagnosis of selective distal motor neuropathy of ulnar nerve was made electrophysiologically. Magnetic resonance imaging revealed a well defined soft tissue mass consistent with a ganglion, compressing the ulnar nerve in Guyon's canal. Entrapment neuropathies are one of the common conditions handled by physiatrists. Ulnar nerve lesions at the wrist should be kept in mind in the differential diagnosis of patients with wrist or hand pain. Magnetic resonance imaging is a useful method in the anatomical evaluation of acute focal neuropathies. PMID:16896989

  14. Development and validation of the patient-rated ulnar nerve evaluation

    PubMed Central

    2013-01-01

    Background Compression neuropathy at the elbow causes substantial pain and disability. Clinical research on this disorder is hampered by the lack of a specific outcome measure for this problem. A patient-reported outcome measure, The Patient-Rated Ulnar Nerve Evaluation (PRUNE) was developed to assess pain, symptoms and functional disability in patients with ulnar nerve compression at the elbow. Methods An iterative process was used to develop and test items. Content validity was addressed using patient/expert interviews and review; linking of the scale items to International Classification of Functioning, Disability, and Health (ICF) codes; and cognitive coding of the items. Psychometric analysis of data collected from 89 patients was evaluated. Patients completed a longer version of the PRUNE at baseline. Item reduction was performed using statistical analyses and patient input to obtain the final 20 item version. Score distribution, reliability, exploratory factor analysis, correlational construct validity, discriminative known group construct validity, and responsiveness to change were evaluated. Results Content analysis indicated items were aligned with subscale concepts of pain and sensory/motor symptoms impairments; specific upper extremity-related tasks; and that the usual function subscale provided a broad view of self-care, household tasks, major life areas and recreation/ leisure. Four subscales were demonstrated by factor analysis (pain, sensory/motor symptoms impairments, specific activity limitations, and usual activity/role restrictions). The PRUNE and its subscales had high reliability coefficients (ICCs > 0.90; 0.98 for total score) and low absolute error. The minimal detectable change was 7.1 points. It was able to discriminate between clinically meaningful subgroups determined by an independent evaluation assessing work status, residual symptoms, motor recovery, sensory recovery and global improvement) p < 0.01. Responsiveness was excellent (SRM = 1.55). Conclusion The PRUNE is a brief, open-access, patient-reported outcome measure for patients with ulnar nerve compression that demonstrates strong measurement properties. PMID:23617407

  15. Minimal-incision in situ ulnar nerve decompression at the elbow.

    PubMed

    Adkinson, Joshua M; Chung, Kevin C

    2014-02-01

    With initiatives to decrease operative morbidity, complications, and associated costs, minimalincision techniques have found an expanding role within multiple specialties. Minimal-incision in situ open techniques for ulnar nerve release at the elbow provide adequate exposure and reproducible, satisfactory outcomes. Furthermore, there is no need for endoscopic equipment and the resultant dependence on staff adequately trained to operate and troubleshoot equipment. More robust research with a focus on complications and standard outcome measures will be required to further define the role of minimal-incision techniques. This technical modification, however, augments the increasing armamentarium of the hand surgeon. PMID:24286744

  16. Correlation between the lengths of the upper limb and cubital tunnel: potential use in patients with proximal ulnar nerve entrapment

    Microsoft Academic Search

    R. Shane Tubbs; Marios Loukas; Nihal Apaydin; Tiffany D. Cossey; Bulent Yalçin; Mohammadali M. Shoja; Aaron A. Cohen-Gadol

    2010-01-01

    Introduction  We hypothesized that a correlation may exist between the length of the upper limb and the length of the cubital tunnel, which\\u000a transmits the ulnar nerve from the arm to the forearm. If true, this association might aid in predicting individuals at greater\\u000a risk of developing ulnar nerve compression at this site.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  A total of 46 cadaveric upper

  17. Chiropractic management of a patient with ulnar nerve compression symptoms: a case report

    PubMed Central

    Illes, Jennifer D.; Johnson, Theodore L.

    2013-01-01

    Objective The purpose of this case report is to describe chiropractic management of a patient with arm and hand numbness and who was suspected to have ulnar nerve compression. Clinical Features A 41-year-old woman presented with hand weakness and numbness along the medial aspect of her right forearm and the 3 most medial fingers. The onset of symptoms presented suddenly, 3 weeks prior, when she woke up in the morning and assumed she had “slept wrong.” The patient’s posture showed protracted shoulders and moderate forward head carriage. Orthopedic assessment revealed symptomatic right elevated arm stress test, grip strength asymmetry, and a Tinel sign at the right cubital tunnel. Intervention and Outcome The patient was treated using chiropractic care, which consisted of manipulative therapy, myofascial therapy, and elastic therapeutic taping. Active home care included performing postural exercises and education about workstation ergonomics. She demonstrated immediate subjective improvement of her numbness and weakness after the first treatment. Over a series of 11 treatments, her symptoms resolved completely; and she was able to perform work tasks without dysfunction. Conclusion Chiropractic treatment consisting of manipulation, soft tissue mobilizations, exercise, and education of workstation ergonomics appeared to reduce the symptoms of ulnar nerve compression symptoms for this patient. PMID:24294148

  18. Ulnar nerve transposition using a mini-invasive approach: case series of 30 patients.

    PubMed

    Lequint, T; Naito, K; Awada, T; Facca, S; Liverneaux, P

    2013-06-01

    The treatment of ulnar nerve compression at the elbow remains controversial. No single technique has yet proven its superiority. We describe a technique combining the advantages of the mini-invasive approach with those of transposition. We present the results of 30 patients, of mean age 52 years, who underwent anterior subcutaneous transposition of the ulnar nerve using a mini-invasive approach with a follow-up of more than six months. The incision measures 3 cm. The results were evaluated by measuring pain intensity, quick disabilities of the arm shoulder and hand (DASH), grip strength and pinch, and McGowan score, pre- and post-operatively. All parameters were improved post-operative. The mean pain score went from 5.5 to 4, the quick DASH from 48 to 38, mean grip strength from 28 to 31 kg, and mean pinch strength from 4.7 to 6.4 kg. The McGowan score was also improved; pre-operatively, there were 16 patients at stage III, seven patients stage II, seven patients stage I, and post-operatively there was one patient stage III, three patients stage II, 16 patients stage I, and 10 patients stage 0. Analysis of our series shows that a 3 cm incision without endoscopy allows subcutanous transposition, with results at least as good as those with other techniques. The advantages of our technique are that it is easy, has a limited approach, preserves blood supply, allows placement of the nerve in a favourable environment, and decreases nerve stretching during elbow flexion. PMID:22869908

  19. Compression of the Deep Palmar Branch of the Ulnar Nerve by the Arch of the Adductor Pollicis

    Microsoft Academic Search

    J. J. COMTET; L. QUICOT; B. MOYEN

    1978-01-01

    A case of palsy of the distal part of the deep palmar branch of the ulnar nerve is described.The possibility of an entrapment by the arch of the adductor pollicis is discussedAnatomical features of this arch are reported.

  20. Establishment of a Method to Measure Length of the Ulnar Nerve and Standardize F-wave Values in Clinically Normal Beagles

    PubMed Central

    HIRASAWA, Shun; SHIMIZU, Miki; MARUI, Yuumi; KISHIMOTO, Miori; OKUNO, Seiichi

    2014-01-01

    We designed a new method of measuring the length of the ulnar nerve and determining standard values for F-wave parameters of the ulnar nerve in clinically normal beagles. Nerve length must be precisely measured to determine F-wave latency and conduction velocity. The length of the forelimb has served as the length of the ulnar nerve for F-wave assessments, but report indicates that F-wave latency is proportional to the length of the pathway traveled by nerve impulses. Therefore, we measured the surface distance from a stimulus point to the spinous process of the first thoracic vertebra (nerve length 1) and the anterior horn of the scapula (nerve length 2) as landmarks through the olecranon and the shoulder blade acromion. The correlation coefficients between the shortest F-wave latency and the length of nerves 1, 2 or the forelimb were 0.61, 0.7 and 0.58. Nerve length 2 generated the highest value. Furthermore, the anterior horn of the scapula was easily palpated in any dog regardless of well-fed body. We concluded that nerve length 2 was optimal for measuring the length of the ulnar nerve. PMID:25649942

  1. Field hockey players have different values of ulnar and tibial motor nerve conduction velocity than soccer and tennis players.

    PubMed

    Pawlak, Matthias; Kaczmarek, Dominik

    2010-12-01

    The aim of this study was to describe motor nerve conduction velocity in upper and lower extremities in sportsmen. Fifteen high-level field hockey players, seventeen soccer players and ten tennis players were recruited from the Polish National Field Hockey League, Polish Soccer League Clubs, and Polish Tennis Association clubs,respectively. The control group comprised of seventeen healthy, non-active young men. Nerve conduction velocities of ulnar and tibial nerve were assessed with NeuroScreen electromyograph (Toennies, Germany) equipped with standard techniques of supramaximal percutaneus stimulation with constant current and surface electrodes. No significant differences in motor nerve conduction velocities were found between dominant and non-dominant limbs in each studied group. Ulnar nerve conduction velocity measured from above elbow to below elbow was significantly lower only in the field hockey players' dominant limb. Tibial conduction velocity of the field hockey players' non-dominant lower limb was higher in comparison to the tennis players and the control group. There was no significant correlation between body mass and NCV as well as between height of subjects and NCV in both athletes or non-athletes. A slight trend towards a lower TCV values in athletes with longer duration of practicing sport was found. It was most pronounced in the non-dominant lower extremity of field hockey players. PMID:21308651

  2. [Idiopathic ulnar nerve entrapment at the elbow: report of 20 cases].

    PubMed

    Allagui, M; Hamdi, M F; Fekih, A; Koubaa, M; Aloui, I; Abid, A

    2013-04-01

    We report a retrospective study of 20 patients treated for idiopathic cubital tunnel syndrome in a period of 10 years (2002-2011). The average age was 46 years. A profession at risk was present in the majority of cases. The treatment was surgical in all the cases. The indication for surgery was related to the importance of sensory-motor deficit, the long duration of symptoms, and the failure of conservative treatment. Two surgical techniques were used in this work: isolated neurolysis and neurolysis with anterior transposition of the ulnar nerve. There were no complications or recurrence of symptoms. After a mean follow-up of 12 months, our results evaluated thanks to the classification of Bishop were considered as excellent or good in 85% of cases and fair in 15% of cases. Prognosis factors were advanced age (more than 60 years), severity of the disease, and duration of symptoms (more than one year). The management of this affection must go through a better knowledge of the disease, for early diagnosis and appropriate treatment, only guarantees for a good result. PMID:23499267

  3. Clinical features and electrodiagnosis of ulnar neuropathies.

    PubMed

    Landau, Mark E; Campbell, William W

    2013-02-01

    In this review, we delineate clinical, electrodiagnostic, and radiographic features of ulnar mononeuropathies. Ulnar neuropathy at the elbow (UNE) is most commonly due to lesions at the level of the retroepicondylar groove (RTC), with approximately 25% at the humeroulnar arcade (HUA). The term 'cubital tunnel syndrome' should be reserved for the latter. The diagnostic accuracy of nerve conduction studies is limited by biological (e.g. low elbow temperature) and technical factors. Across-elbow distance measurements greater than 10 cm improve diagnostic specificity at the expense of decreased sensitivity. Short-segment incremental studies can differentiate lesions at the HUA from those at the RTC. PMID:23177030

  4. Comparison of anterior subcutaneous and submuscular transposition of ulnar nerve in treatment of cubital tunnel syndrome: A prospective randomized trial

    PubMed Central

    Zarezadeh, Abolghassem; Shemshaki, Hamidreza; Nourbakhsh, Mohsen; Etemadifar, Mohammad R.; Moeini, Malihe; Mazoochian, Farhad

    2012-01-01

    Background: This study was designed to compare two methods of surgery, anterior subcutaneous transposition (ASCT) and anterior submuscular transposition (ASMT) of the ulnar nerve in treatment of cubital tunnel syndrome. Materials and Methods: This randomized trial study was conducted from October 2008 to March 2009 in the Department of Orthopedic Surgery at University Hospital. Forty-eight patients with confirmed cubital tunnel syndrome were randomized in two groups, and each patient received one of two different surgical treatment methods, either ASCT (n = 24) or ASMT (n = 24). In the ASCT technique, the ulnar nerve was transposed and retained in the subcutaneous bed, whereas in the ASMT, the nerve was retained deep in the transected muscular complex, near the median nerve. Patient outcomes, including pain, sensation, muscle strength, and muscle atrophy were compared between groups. Results: The two groups were similar in baseline characteristics. However, those treated with ASMT had a statistically significant reduction in their pain levels compared with ASCT (21 (87.5%) vs 8 (33.3%), P < 0.05). There were no statistically significant differences between the two groups relative to sensation (11 (45.8%) vs 12 (50%)), muscle strength (17 (70.8%) vs 15 (62.5%)), or muscle atrophy (15 (62.5%) vs 17 (70.8%)) (P > 0.05). Conclusions: Our results indicate that ASMT are more efficient than ASCT for managing cubital tunnel syndrome. In patients who had ASMT, there were significant reductions of pain compared with ASCT. PMID:23798941

  5. Bilateral intraneural perineurioma presenting as ulnar neuropathy at the elbow.

    PubMed

    Beekman, Roy; Slooff, Willem-Bart M; Van Oosterhout, Matthijs F M; Lammens, Martin; Van Den Berg, Leonard H

    2004-08-01

    We describe a 36-year-old woman with progressive bilateral ulnar neuropathy. Sonographic and magnetic resonance imaging studies revealed extensive focal ulnar nerve enlargement at the elbow. Histological studies gave evidence of an intraneural perineurioma. Because intraneural perineurioma usually appears as a single mass lesion at sites other than typical entrapment sites, this mode of presentation is unusual. We discuss the nature of this benign tumor and the differential diagnosis of nerve enlargement. Knowledge of possible causes of nerve thickening is crucial when performing imaging in patients with neuropathies. PMID:15266642

  6. Subclinical Ulnar Neuropathy at the Elbow in Diabetic Patients

    PubMed Central

    Jang, Ji Eun; Kim, Yun Tae; Park, Byung Kyu; Cheong, In Yae

    2014-01-01

    Objective To demonstrate the prevalence and characteristics of subclinical ulnar neuropathy at the elbow in diabetic patients. Methods One hundred and five patients with diabetes mellitus were recruited for the study of ulnar nerve conduction analysis. Clinical and demographic characteristics were assessed. Electrodiagnosis of ulnar neuropathy at the elbow was based on the criteria of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM1 and AANEM2). The inching test of the ulnar motor nerve was additionally performed to localize the lesion. Results The duration of diabetes, the existence of diabetic polyneuropathy (DPN) symptoms, the duration of symptoms, and HbA1C showed significantly larger values in the DPN group (p<0.05). Ulnar neuropathy at the elbow was more common in the DPN group. There was a statistically significant difference in the number of cases that met the three diagnostic criteria between the no DPN group and the DPN group. The most common location for ulnar mononeuropathy at the elbow was the retrocondylar groove. Conclusion Ulnar neuropathy at the elbow is more common in patients with DPN. If the conduction velocities of both the elbow and forearm segments are decreased to less than 50 m/s, it may be useful to apply the AANEM2 criteria and inching test to diagnose ulnar neuropathy. PMID:24639928

  7. The median nerve consistently drives flexion of the distal phalanx of the ring and little fingers: Interest in finger flexion reconstruction by nerve transfers.

    PubMed

    Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio; Tacca, Cristiano Paulo

    2015-03-01

    Surgeons believe that in high ulnar nerve lesion distal interphalangeal joint (DIP) flexion of the ring and little finger is abolished. In this article, we present the results of a study on innervation of the flexor digitorum profundus of the ring and little fingers in five patients with high ulnar nerve injury and in 19 patients with a brachial plexus, posterior cord, or radial nerve injury. Patients with ulnar nerve lesion were assessed clinically and during surgery for ulnar nerve repair we confirmed complete lesion of the ulnar nerve in all cases. In the remaining 19 patients, during surgery, either the median nerve (MN) or the anterior interosseous nerve (AIN) was stimulated electrically and DIP flexion of the ring and little fingers evaluated. All patients with high ulnar nerve lesions had active DIP flexion of the ring and little fingers. Strength scored M4 in the ring and M3-M4 in the little finger. Electrical stimulation of either the MN or AIN produced DIP flexion of the ring and little fingers. Contrary to common knowledge, we identified preserved flexion of the distal phalanx of the ring and little fingers in high ulnar nerve lesions. On the basis of these observations, nerve transfers to the AIN may provide flexion of all fingers. © 2014 Wiley Periodicals, Inc. Microsurgery 35:207-210, 2015. PMID:25256625

  8. MR Neurography in Ulnar Neuropathy as Surrogate Parameter for the Presence of Disseminated Neuropathy

    PubMed Central

    Bäumer, Philipp; Weiler, Markus; Ruetters, Maurice; Staub, Frank; Dombert, Thomas; Heiland, Sabine; Bendszus, Martin; Pham, Mirko

    2012-01-01

    Purpose Patients with ulnar neuropathy of unclear etiology occasionally present with lesion extension from elbow to upper arm level on MRI. This study investigated whether MRI thereby distinguishes multifocal neuropathy from focal-compressive neuropathy at the elbow. Methods This prospective study was approved by the institutional ethics committee and written informed consent was obtained from all participants. 122 patients with ulnar mononeuropathy of undetermined localization and etiology by clinical and electrophysiological examination were assessed by MRI at upper arm and elbow level using T2-weighted fat-saturated sequences at 3T. Twenty-one patients were identified with proximal ulnar nerve lesions and evaluated for findings suggestive of disseminated neuropathy (i) subclinical lesions in other nerves, (ii) unfavorable outcome after previous decompressive elbow surgery, and (iii) subsequent diagnosis of inflammatory or other disseminated neuropathy. Two groups served as controls for quantitative analysis of nerve-to-muscle signal intensity ratios: 20 subjects with typical focal ulnar neuropathy at the elbow and 20 healthy subjects. Results In the group of 21 patients with proximal ulnar nerve lesion extension, T2-w ulnar nerve signal was significantly (p<0.001) higher at upper arm level than in both control groups. A cut-off value of 1.92 for maximum nerve-to-muscle signal intensity ratio was found to be sensitive (86%) and specific (100%) to discriminate this group. Ten patients (48%) exhibited additional T2-w lesions in the median and/or radial nerve. Another ten (48%) had previously undergone elbow surgery without satisfying outcome. Clinical follow-up was available in 15 (71%) and revealed definitive diagnoses of multifocal neuropathy of various etiologies in four patients. In another eight, diagnoses could not yet be considered definitive but were consistent with multifocal neuropathy. Conclusion Proximal ulnar nerve T2 lesions at upper arm level are detected by MRI and indicate the presence of a non-focal disseminated neuropathy instead of a focal compressive neuropathy. PMID:23166762

  9. Giant solitary synovial osteochondromatosis of the elbow causing ulnar nerve neuropathy: a case report and review of literature

    PubMed Central

    2013-01-01

    Introduction Giant or solitary osteochondroma is part of a rare disorder known as synovial osteochondromatosis. It forms part of a spectrum of disease characterized by metaplastic changes within the joint synovium that are eventually extruded as loose bodies. It has been suggested that solitary synovial osteochondroma forms as progression of synovial osteochondromatosis through a process of either coalescence of multiple smaller bodies or the growth of a dominant synovial osteochondroma. Previous studies have shown that it occurs as a late phase of the disease. We report a rare case of giant synovial osteochondromatosis at the elbow causing ulnar nerve neuropathy and mechanical symptoms which has not been previously reported in the literature. Case report We report a case of a 56 year old Western European gentleman who presented with ulnar nerve neuropathy and swelling behind the elbow. The patient underwent MR imaging and subsequent biopsy that demonstrated synovial osteochondromatosis. Initially the patient declined surgery and opted for a watch and wait approach. Five years later he returned with worsening symptoms and underwent successful surgical resection of a giant solitary synovial osteochondroma. Conclusion The unique outcome in our patient despite the long interval between presentation and surgical treatment resulted in early full resolution of symptoms within a short period. It may suggest an improved prognosis as compared to multiple synovial osteochondromatosis in terms of mechanical and neurological outcomes. PMID:23351253

  10. Spinal accessory nerve schwannomas masquerading as a fourth ventricular lesion.

    PubMed

    Krishnan, Shyam Sundar; Bojja, Sivaram; Vasudevan, Madabhushi Chakravarthy

    2015-01-01

    Schwannomas are benign lesions that arise from the nerve sheath of cranial nerves. The most common schwannomas arise from the 8(th) cranial nerve (the vestibulo-cochlear nerve) followed by trigeminal and facial nerves and then from glossopharyngeal, vagus, and spinal accessory nerves. Schwannomas involving the oculomotor, trochlear, abducens and hypoglossal nerves are very rare. We report a very unusual spinal accessory nerve schwannoma which occupied the fourth ventricle and extended inferiorly to the upper cervical canal. The radiological features have been detailed. The diagnostic dilemma was due to its midline posterior location mimicking a fourth ventricular lesion like medulloblastoma and ependymoma. Total excision is the ideal treatment for these tumors. A brief review of literature with tabulations of the variants has been listed. PMID:25552867

  11. [Treatment with stellate ganglion block, continuous epidural block and ulnar nerve block of a patient with postherpetic neuralgia who developed complex regional pain syndrome (CRPS)].

    PubMed

    Mizuno, J; Sugimoto, S; Ikeda, M; Kamakura, T; Machida, K; Kusume, S

    2001-05-01

    We present a case of a 46-year-old female patient with systemic lupus erythematosus who developed herpes zoster of the right eighth cervical nerve. Her whole right forearm, hand and the first through fifth fingers were coated with some gel and protected against pain. She had been suffering from continuous and spasmodic burning pain, hyperalgesia, allodynia, drop in skin temperature, sudmotor disturbance, edema, constructure of the joints, muscle atrophy and bone atrophy of her right upper extremity probably due to postherpetic neuralgia (PHN) associated with complex regional pain syndrome (CRPS). She received right stellate ganglion block (SGB), continuous cervical epidural block and right ulnar nerve block. Reduction of pain and edema as well as improvement in mobility of each joint of her right upper extremity was observed. We suspect that SGB, continuous cervical epidural block and ulnar nerve block are effective and useful alternative treatments in a patient with PHN associated with CRPS of the eighth cervical nerve. PMID:11424478

  12. Anterior subcutaneous transposition of ulnar nerve with fascial flap and complete excision of medial intermuscular septum in cubital tunnel syndrome: A prospective patient cohort

    Microsoft Academic Search

    Aslani Hamidreza; Abrishami Saeid; Dehghanfard Mohammadreza; Zaferani Zohreh; Saeidpour Mehdi

    2011-01-01

    ObjectiveRegarding the frequency of cubital tunnel syndrome, varieties of treatment modalities, and ambiguity of anterior subcutaneous transposition of ulnar nerve method, we aimed to evaluate the efficacy of this procedure in patients with cubital tunnel syndrome referred to Taleghani hospital between 2006 and 2009.

  13. Symptomatic epineural ganglion cyst of the ulnar nerve in the cubital tunnel: a case report and brief review of the literature

    Microsoft Academic Search

    R. R. Sharma; S. J. Pawar; A. Delmendo; A. K. Mahapatra

    2000-01-01

    An unusual case of pain and weakness in the hand and forearm due to a ganglion cyst of the ulnar nerve at the elbow is presented. The patient was managed initially as a case of cervical disc disease and cervical spondylosis and later as a case of carpal tunnel syndrome at an another institution. Cervical radiography and cervical magnetic resonance

  14. Median nerve fascicle transfer versus ULNAR nerve fascicle transfer to the biceps motor branch in C5-C6 and C5-C7 brachial plexus injuries: nonrandomized prospective study of 23 consecutive patients.

    PubMed

    Cho, Alvaro Baik; Paulos, Renata Gregorio; de Resende, Marcelo Rosa; Kiyohara, Leandro Yoshinobu; Sorrenti, Luiz; Wei, Teng Hsiang; Bolliger Neto, Raul; Mattar Júnior, Rames

    2014-10-01

    The purpose of this study was to observe whether the results of the median nerve fascicle transfer to the biceps are equivalent to the classical ulnar nerve fascicle transfer, in terms of elbow flexion strength and donor nerve morbidity. Twenty-five consecutive patients were operated between March 2007 and July 2013. The patients were divided into two groups. In Group 1 (n?=?8), the patients received an ulnar nerve fascicle transfer to the biceps motor branch. In Group 2 (n?=?15), the patients received a median nerve fascicle transfer to the biceps motor branch. Two patients with follow-up less than six months were excluded. Both groups were similar regarding age (P?=?0.070), interval of injury (P?=?0.185), and follow-up period (P?=?0.477). Elbow flexion against gravity was achieved in 7 of 8 (87.5%) patients in Group 1, versus 14 of 15 (93.3%) patients in Group 2 (P?=?1.000). The level of injury (C5-C6 or C5-C7) did not affect anti-gravity elbow flexion recovery in both the groups (P?=?1.000). It was concluded that the median nerve fascicle transfer to the biceps is as good as the ulnar nerve fascicle transfer, even in C5-C7 injuries. PMID:24753064

  15. Simple Decompression or Subcutaneous Anterior Transposition of the Ulnar Nerve for Cubital tunnel Syndrome

    Microsoft Academic Search

    A. Nabhan; F. Ahlhelm; J. Kelm; W. Reith; K. Schwerdtfeger; W. I. Steudel

    2005-01-01

    The purpose of this prospective randomised study was to evaluate which operative technique for treatment of cubital tunnel syndrome is preferable: subcutaneous anterior transposition or nerve decompression without transposition. This study included 66 patients suffering from pain and\\/or neurological deficits with clinically and electromyographically proven cubital tunnel syndrome. Thirty-two patients underwent nerve decompression without transposition and 34 underwent subcutaneous transposition

  16. Ultrasonographic nerve enlargement of the median and ulnar nerves and the cervical nerve roots in patients with demyelinating Charcot-Marie-Tooth disease: distinction from patients with chronic inflammatory demyelinating polyneuropathy.

    PubMed

    Sugimoto, Takamichi; Ochi, Kazuhide; Hosomi, Naohisa; Takahashi, Tetsuya; Ueno, Hiroki; Nakamura, Takeshi; Nagano, Yoshito; Maruyama, Hirofumi; Kohriyama, Tatsuo; Matsumoto, Masayasu

    2013-10-01

    Demyelinating Charcot-Marie-Tooth disease (CMT) and chronic inflammatory demyelinating polyneuropathy (CIDP) are both demyelinating polyneuropathies. The differences in nerve enlargement degree and pattern at multiple evaluation sites/levels are not well known. We investigated the differences in nerve enlargement degree and the distribution pattern of nerve enlargement in patients with demyelinating CMT and CIDP, and verified the appropriate combination of sites/levels to differentiate between these diseases. Ten patients (aged 23-84 years, three females) with demyelinating CMT and 16 patients (aged 30-85 years, five females) with CIDP were evaluated in this study. The nerve sizes were measured at 24 predetermined sites/levels from the median and ulnar nerves and the cervical nerve roots (CNR) using ultrasonography. The evaluation sites/levels were classified into three regions: distal, intermediate and cervical. The number of sites/levels that exhibited nerve enlargement (enlargement site number, ESN) in each region was determined from the 24 sites/levels and from the selected eight screening sites/levels, respectively. The cross-sectional areas of the peripheral nerves were markedly larger at all evaluation sites in patients with demyelinating CMT than in patients with CIDP (p < 0.01). However, the nerve sizes of CNR were not significantly different between patients with either disease. When we evaluated ESN of four selected sites for screening from the intermediate region, the sensitivity and specificity to distinguish between demyelinating CMT and CIDP were 0.90 and 0.94, respectively, with the cut-off value set at four. Nerve ultrasonography is useful to detect nerve enlargement and can clarify morphological differences in nerves between patients with demyelinating CMT and CIDP. PMID:23821028

  17. Ulnar malignant peripheral nerve sheath tumour diagnosis in a mixed-breed dog as a model to study human: histologic, immunohistochemical, and clinicopathologic study

    PubMed Central

    2013-01-01

    Canine Malignant Peripheral Nerve Sheath Tumors (MPNSTs) are uncommonly reported in the ulnar, since they are underestimated relative to the more common spindle cell tumours of soft tissue. In dogs, MPNST accounts for 27% of nervous system tumours. In man, MPNST represents 5-10% of all soft tissue sarcomas and is often associated with neurofibromatosis type 1 (NF-1).An 8-year-old, 9 kg, female mixed-breed dog with a subcutaneous mass on the upper right side of the ulnar region was presented to the small animal research and teaching hospital of Tehran University. The dog was anorexic with general weakness. The mass (7 × 4 cm) was removed surgically and processed routinely. Microscopically, the mass was composed of highly cellular areas with a homogeneous population of round or spindle cells, high cellular pleomorphism, high mitotic index and various morphologic patterns. Furthermore, spindle cells arranged in densely or loosely sweeping fascicles, interlacing whorls, or storiform patterns together with wavy cytoplasm, nuclear palisades, and round cells were arranged in sheets or cords with a meshwork of intratumoral nerve fibers. In addition, in this case the presence of neoplastic cells within the blood vessels was observed. Immunohistochemically, tumor was positive for vimentin and S-100 protein. The histopathologic features coupled with the S-100 and vimentin immunoreactivity led to a diagnosis of malignant neurofibroma. To the best of our knowledge, primary ulnar MPNST has not been reported in animals. This is the first documentation of an ulnar malignant peripheral nerve sheath tumour in a dog. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1310907815984587 PMID:23688209

  18. Does Cervical Radiculopathy Have an Effect on Peripheral Nerve Conduction Studies? An Electrophysiological Evaluation

    Microsoft Academic Search

    Kemal Balci; Talip Asil; Ilkay Tekinaslan; Nasif Ir

    2011-01-01

    Background: Peripheral nerve neuropathies are more common in patients with cervical radiculopathy (CR) and a proximal lesion along an axon might predispose that nerve to injury at distal sites. To evaluate this hypothesis, the frequency of median nerve neuropathy at the wrist and the frequency of ulnar nerve neuropathy at the elbow were investigated in 80 patients with one-sided CR.

  19. Clinical and Electrodiagnostic Work-up of Peripheral Nerve Lesions

    Microsoft Academic Search

    Stefan Kiechl

    Diagnostic work-up of patients with peripheral nerve lesions includes a detailed evaluation of the clinical history, a thorough\\u000a search for predisposing factors and trigger events, palpation at the suspected lesion site, specific provocation maneuvers\\u000a and assessment of motor deficits (distribution, muscle power and atrophy), sensory disturbances (distribution and quality)\\u000a and autonomic impairment (sudomotor activity) — all embedded in a careful

  20. Occurrence of nerve entrapment lesion in chronic inflammatory demyelinating polyneuropathy

    Microsoft Academic Search

    L Padua; P Caliandro; I Aprile; M Sabatelli; F Madia; P Tonali

    2004-01-01

    Objective: To evaluate the occurrence of nerve entrapment syndrome in chronic inflammatory demyelinating polyneuropathy (CIDP).Methods: We retrospectively evaluated neurophysiologic results of 41 (25 male and 16 female, mean age 49.8, range 11–87) patients with CIDP. We evaluated the frequency of focal neurophysiologic lesion at entrapment site distinguishing two kinds of lesion: (a) true entrapment; and (b) false entrapment on the

  1. Posterior tibial nerve lesions in ankle arthroscopy.

    PubMed

    Cugat, Ramon; Ares, Oscar; Cuscó, Xavier; Garcia, Montserrat; Samitier, Gonzalo; Seijas, Roberto

    2008-05-01

    Ankle arthroscopy provides a minimally invasive approach to the diagnosis and treatment of certain ankle disorders. Neurological complications resulting from ankle arthroscopy have been well documented in orthopaedic and podiatric literature. Owing to the superficial location of the ankle joint and the abundance of overlying periarticular neurovascular structures, complications reported in ankle arthroscopy are greater than those reported for other joints. In particular, all reported neurovascular injuries following ankle arthroscopy have been the direct result of distractor pin or portal placement. The standard posteromedial portal has recognized risks because of the proximity of the posterior neurovascular structures. There can be considerable variability in the course of these portals and their proximity to the neurovascular structures. We found one report of intra-articular damage to the posterior tibial nerve as a result of ankle arthroscopy in the English-language literature and we report this paper as a second case described in the literature. PMID:17618442

  2. Endodontic periapical lesion-induced mental nerve paresthesia

    PubMed Central

    Shadmehr, Elham; Shekarchizade, Neda

    2015-01-01

    Paresthesia is a burning or prickling sensation or partial numbness, resulting from neural injury. The symptoms can vary from mild neurosensory dysfunction to total loss of sensation in the innervated area. Only a few cases have described apical periodontitis to be the etiological factor of impaired sensation in the area innervated by the inferior alveolar and mental nerves. The aim of the present paper is to report a case of periapical lesion-induced paresthesia in the innervation area of the mental nerve, which was successfully treated with endodontic retreatment.

  3. [Ulnar entrapment neuropathy].

    PubMed

    Blecher, Ronen; Loebenberg, Mark; Oron, Amir

    2010-02-01

    Ulnar nerve entrapment is one of the most common entrapment neuropathies in the upper limb. The most frequent location of this syndrome is behind the elbow. The clinical picture is associated with the localization of the entrapment but usually consists of an altered sensation at the fourth and fifth digits and a weakness of the intrinsic muscles of the palm. The most constructive tool in making the diagnosis and in assessing the treatment's efficacy is the physical examination. Treatment alternatives depend on entrapment location. Conservative treatment options such as rest, a change in the work environment and patterns as well as splints are all accepted modalities. A lack of improvement following conservative treatment or a deteriorating nerve function is an indication for surgical intervention. This includes procedures comprised of decompression of the ulnar nerve alone or those which combine its transposition. PMID:20549929

  4. Dermatological and immunological conditions due to nerve lesions

    PubMed Central

    Bove, Domenico; Lupoli, Amalia; Caccavale, Stefano; Piccolo, Vincenzo; Ruocco, Eleonora

    2013-01-01

    Summary Some syndromes are of interest to both neurologists and dermatologists, because cutaneous involvement may harbinger symptoms of a neurological disease. The aim of this review is to clarify this aspect. The skin, because of its relationships with the peripheral sensory nervous system, autonomic nervous system and central nervous system, constitutes a neuroimmunoendocrine organ. The skin contains numerous neuropeptides released from sensory nerves. Neuropeptides play a precise role in cutaneous physiology and pathophysiology, and in certain skin diseases. A complex dysregulation of neuropeptides is a feature of some diseases of both dermatological and neurological interest (e.g. cutaneous and nerve lesions following herpes zoster infection, cutaneous manifestations of carpal tunnel syndrome, trigeminal trophic syndrome). Dermatologists need to know when a patient should be referred to a neurologist and should consider this option in those presenting with syndromes of unclear etiology. PMID:24125557

  5. Clinical and neuropathological study about the neurotization of the suprascapular nerve in obstetric brachial plexus lesions

    Microsoft Academic Search

    Dominique Schaakxs; Jörg Bahm; Bernd Sellhaus; Joachim Weis

    2009-01-01

    BACKGROUND: The lack of recovery of active external rotation of the shoulder is an important problem in children suffering from brachial plexus lesions involving the suprascapular nerve. The accessory nerve neurotization to the suprascapular nerve is a standard procedure, performed to improve shoulder motion in patients with brachial plexus palsy. METHODS: We operated on 65 patients with obstetric brachial plexus

  6. Using multiple high-count electrode arrays in human median and ulnar nerves to restore sensorimotor function after previous transradial amputation of the hand.

    PubMed

    Clark, Gregory A; Wendelken, Suzanne; Page, David M; Davis, Tyler; Wark, Heather A C; Normann, Richard A; Warren, David J; Hutchinson, Douglas T

    2014-08-01

    Peripheral nerve interfaces that can record from and stimulate large numbers of different nerve fibers selectively and independently may help restore intuitive and effective motor and sensory function after hand amputation. To this end, and extending previous work in two subjects, two 100-electrode Utah Slanted Electrode Arrays (USEAs) were implanted for four weeks in the residual ulnar and median nerves of a 50-year-old male whose left, dominant hand had been amputated 21 years previously. Subsequent experiments involved 1) recording from USEAs for real-time control of a virtual prosthetic hand; 2) stimulation to evoke somatosensory percepts; and 3) closed-loop sensorimotor control. Overall, partial motor control and sensation were achieved using USEAs. 1) Isolated action potentials recorded from nerve motor fibers, although sparse at these distal implant sites, were activated during fictive movements of the phantom hand. Unlike in our previous two subjects, electromyographic (EMG) activity contributed to most online recordings and decodes, but was reduced in offline analyses using common average referencing. Online and offline Kalman-filter decodes of thresholded neural or EMG spikes independently controlled different digits of the virtual hand with one or two degrees of freedom. 2) Microstimulation through individual electrodes of the two USEAs evoked up to 106 different percepts, covering much of the phantom hand. The subject discriminated among five perceived stimulus locations, and between two somatosensory submodalities at a single location. 3) USEA-evoked percepts, mimicking contact with either a near or distal virtual target, were used to terminate movements of the virtual hand controlled with USEA recordings comprised wholly or mostly of EMG. These results further indicate that USEAs can help restore sensory and motor function after hand loss. PMID:25570369

  7. RETROGRADE TRANSPORT OF NERVE GROWTH FACTOR IN LESIONED GOLDFISH RETINAL GANGLION CELLS

    Microsoft Academic Search

    HENRY K. YIP; EUGENE M. JOHNSON

    1983-01-01

    Previous experiments have shown that nerve growth factor (NGF) enhances regeneration of goldfish optic nerve after local application of NGF at the site of the lesion. However, the site and mechanism of action of NGF are not yet known. One possibility is that NGF is taken up at the site of the lesion and retrogradely transported to the cell bodies

  8. Focal cranial nerve involvement in chronic inflammatory demyelinating polyneuropathy: clinical and MRI evidence of peripheral and central lesions

    Microsoft Academic Search

    H. M. Waddy; V. P. Misra; R. H. M. King; P. K. Thomas; L. Middleton; I. E. C. Ormerod

    1989-01-01

    Five cases of chronic inflammatory demyelinating polyneuropathy are described in which cranial nerve involvement accompanied a more generalized neuropathy. Clinical, electrophysiological, radiological and nerve biopsy findings are presented. Cranial nerve lesions in this form of polyneuropathy may be related to lesions of the peripheral nerves or of the central nervous system, when they may be accompanied by MRI evidence of

  9. Distribution of nerve lesions in serotonin-induced acute ischemic neuropathy.

    PubMed

    Korthals, J K; Korthals, M A

    1990-01-01

    We have developed a new model of an acute ischemic nerve injury in rat produced by the combined effects of right femoral artery ligation and intraperitoneal injection of serotonin. Light microscopic studies were performed on the right sciatic, tibial, plantar and sural nerves dissected from rats 7 days to 6 months after serotonin injection. Ischemic lesions occurred mostly in the middle tibial nerve and involved either a part or the whole transverse nerve section. Partial tibial nerve lesions appeared mainly as small subperineurial or large wedge-shaped areas of fiber loss or regeneration. No well-delineated central fascicular lesions were seen. Sural nerves were less damaged than tibial nerves. The predominantly subperineurial fascicular distribution of ischemic lesions seen in the present model differs from the central fascicular distribution found in previous experimental studies on nerve ischemia. The different distribution of lesions is probably related to the small fascicular size and local microvascular architecture of the affected nerve segment, as well as to the method of producing ischemia. PMID:2085092

  10. Low-power laser efficacy in peripheral nerve lesion treatment

    NASA Astrophysics Data System (ADS)

    Antipa, Ciprian; Nacu, Mihaela; Bruckner, Ion I.; Bunila, Daniela; Vlaiculescu, Mihaela; Pascu, Mihail-Lucian; Ionescu, Elena

    1998-07-01

    In order to establish the low energy laser (LEL) effects on nervous tissue regeneration in clinical practice, we evaluated in double blind, placebo controlled study, the efficacy of LEL in the functional recovery of 46 patients with distal forearm post- traumatic nerve lesion, after surgical suture. The patients were divided into two groups: A-26 patients were treated with LEL; B- 20 patients, as control, were treated with placebo lasers and classical medical and physical therapy. Lasers used were: HeNe, 632.5 nm wavelength, 2 mW power, and GaAlAs diode laser, 880 nm wavelength, pulsed emission with an output power about 3 mW. Before, during and after the treatment, electromyography (EMG) and electroneurography (ENG) were done in order to measure objectively the efficacy of the treatment. We obtained good results after 4 - 5 months at 80.7% patients from group A and about the same results at 70% patients from group B, but after at least 8 months. The good results were noticed concerning the improvement of EMG and ENG registrations and on the involution of pain, inflammations, movements and force of the fingers. Finally we can say that the favorable results were obtained in at least half the time with LEL treatment faster than with classical therapy.

  11. Cranial nerve lesions due to base of the skull metastases in prostate carcinoma.

    PubMed

    Ransom, D T; Dinapoli, R P; Richardson, R L

    1990-02-01

    We studied 11 patients with prostate cancer metastatic to the base of skull that caused cranial nerve deficits. Patients with occipital condyle, jugular foramen, middle fossa, parasellar, and orbital syndromes are described. Other patients had combinations of these syndromes or other cranial nerve involvements. Two patients had 6th nerve palsies secondary to prepontine cistern and clivus lesions. The median survival time from the diagnosis of cranial nerve involvement was 4 months. Two patients had cranial nerve involvement and, on subsequent investigation, were found to have carcinoma of the prostate. Interestingly, these patients are still alive at 42 and 84 months after diagnosis. PMID:2297648

  12. [Microneural reconstruction after iatrogenic lesions of the lingual nerve and the inferior alveolar nerve. Critical evaluation].

    PubMed

    Cornelius, C P; Roser, M; Ehrenfeld, M

    1997-07-01

    As microneural repair techniques of the sensory mandibular branches enter the third decade of their clinical use, there are but a few long-term investigations into the value of these procedures in the treatment of iatrogenic injury to the lingual (LN), inferior alveolar (IAN) or mental (MN) nerve. To establish the efficacy of microneural repair in lesions of the LN, IAN or MN with loss of continuity, the outcome of sensory recovery was evaluated in a series of 92 patients (LN: direct coaptation n = 39, coaptation + sural nerve grafting n = 23; IAN: direct coaptation n = 11 coaptation + sural nerve grafting n = 10; MN: direct coaptation n = 11). The minimum duration of follow-up was 14 months postoperatively. The persistent sensory deficit was assessed using standardized neurosensory testing and gustometric stimuli. In addition the patients answered a multiple-choice questionnaire containing a list of complaints. To obtain a numeric estimate for interindividual and intergroup comparison the information from clinical measurements and patient reports was condensed into a 'neurological score' and a 'complaint score', respectively. Furthermore, adequate items from both scores were combined to affirm or deny the return of sensory function in terms of protective and discriminative sensation. The overall results show a broad range of variation in the scores, sometimes reflecting severe degrees of persistent sensory impairment. The lowest scores, corresponding to the best regeneration, were found after direct coaptation of the LN, IAN and NM, but even the best results did not provide sensory recovery to a preinjury level. After direct coaptation of LN 69% of the patients exhibited protective sensation and 41% regained discriminative function. In contrast, LN grafting was ensued from restoration of protective function in 39% and discriminative function in 17% of the patients. More striking differences were found between coaptation and grafting of the IAN (IAN coaptation: 91% protective function; 18% discriminative function; IAN grafting: 60% protective function, 0% discriminative function). In the LN coaptation group low scores and improved taste perception were convincingly associated with short periods since injury (i.e. timing of repair). In conclusion, we feel there is sufficient justification to optimize the potential results of microneural repair by immediate (LN/MN) or early (IAN) reexposure of the injured site in order to clarify the precise nature of the underlying nerve damage and prevent delay, if patients present with complete loss of sensory function subsequent to dentoalveolar or oral surgery. However, clinical and electrophysiologic findings suggesting impairment or partial loss of sensory function are considered a contraindication to microneural intervention, in view of the limited prospects of sensory recovery after surgical repair. PMID:9410631

  13. Winged Scapula Caused by a Dorsal Scapular Nerve Lesion: A Case Report

    Microsoft Academic Search

    Kenan Akgun; Ilknur Aktas; Yeliz Terzi

    2008-01-01

    Akgun K, Aktas I, Terzi Y. Winged scapula caused by a dorsal scapular nerve lesion: a case report.Dorsal scapular nerve lesions are quite rare. A case of a 51-year-old man who had right shoulder pain, weakness of right arm elevation, and prominence of right scapula for 6 months is presented. The condition had been abruptly developed after lifting a heavy

  14. A Novel Technique for the Treatment of Recurrent Cubital Tunnel Syndrome: Ulnar Nerve Wrapping With a Tissue Engineered Bioscaffold

    Microsoft Academic Search

    B. N. Puckett; R. G. Gaston; G. M. Lourie

    2011-01-01

    The purpose of this study was to assess subjective and objective outcomes in treating recurrent cubital tunnel at secondary neurolysis by nerve wrapping with a tissue engineered three-dimensional biomatrix. Five patients with a mean age of 44.1 years and an average follow-up of 13.3 months were included in the study. All patients had improvement in visual analogue scales. Four patients

  15. Brain-derived neurotrophic factor (BDNF) prevents lesion-induced axonal die-back in young rat optic nerve

    Microsoft Academic Search

    Doris Weibel; Georg W. Kreutzberg; Martin E. Schwab

    1995-01-01

    Lesions of the optic nerve in young animals lead to rapid retrograde degeneration of the axon stumps and to death of retinal ganglion cells. We injected different neurotrophic factors into the eye at the time of an intracranial freeze-crush lesion of the optic nerve in 8 day old rats. Optic nerve axons were visualized by anterograde tracing with wheat germ

  16. Subclinical Ulnar Neuropathy in Carpal Tunnel Syndrome

    Microsoft Academic Search

    Joon-Shik Moon; Sung-Soo Lee; Ji-Yong Lee; Bum-Gi Han; Joon-Bum Kwon; Hyun-Duk Yang; Sung-Ik Lee

    B a c k g r o u n d : When performing routine diagnostic nerve conduction studies in patients with carpal tunnel syn- drome(CTS), we sometimes happen to be confronted with patients who have also ulnar nerve abnormality without any clinical symptoms or signs, although not so common. Anatomically, the borders of the carpal tunnel and the Guyon canal

  17. A neuromuscular platform to extract electrophysiological signals from lesioned nerves: a technical note.

    PubMed

    Wells, M R; Vaidya, U; Ricci, J L; Christie, C

    2001-01-01

    The volitional control of prosthetic devices could be greatly enhanced if the information formerly supplied by peripheral nerves to the amputated limb could be utilized. So that practical access to this information could be gained, a method was established to form a stable biological interface with fascicles of lesioned nerves. A small strip of an intact muscle was isolated in rats with the use of a silicone tube cuff electrode and innervated by the lesioned peroneal branch of the sciatic nerve. After 4 weeks survival, stimulation of the nerve fascicle produced reliable signals from the neuromuscular platform in the range of 0.5 to 2.0 mV. Histologically, myotubes remained intact and axons could be identified growing in and over the surfaces of the isolated muscle strips. These or similar interface techniques may supply electrophysiological signals of sufficient amplitude and reliability to provide peripheral nerve-based guidance information for prosthetic devices. PMID:11563491

  18. Rodent Facial Nerve Recovery After Selected Lesions and Repair Techniques

    PubMed Central

    Hadlock, Tessa A.; Kowaleski, Jeffrey; Lo, David; Mackinnon, Susan E.; Heaton, James T.

    2015-01-01

    Background Measuring rodent facial movements is a reliable method for studying recovery from facial nerve manipulation, and for examining the behavioral correlates of aberrant regeneration. We quantitatively compared recovery of vibrissal and ocular function following three types of clinically relevant nerve injury. Methods 178 adult rats underwent facial nerve manipulation and testing. In the experimental groups, the left facial nerve was either crushed, transected and repaired epineurially, or transected and the stumps suture-secured into a tube with a 2 mm gap between them. Facial recovery was measured for the ensuing 1–4 months. Data were analyzed for whisking recovery. Previously developed markers of co-contraction of the upper and midfacial zones (possible synkinesis markers) were also examined. Results Animals in the crush groups recovered nearly normal whisking parameters within 25 days. The distal branch crush group showed improved recovery over the main trunk crush group for several days during early recovery. By week 9, the transection/repair groups showed evidence of recovery that trended further upward throughout the study period. The entubulation groups followed a similar recovery pattern, though they did not maintain significant recovery levels by the study conclusion. Markers of potential synkinesis increased in selected groups following facial nerve injury. Conclusions Rodent vibrissial function recovers in a predictable fashion following manipulation. Generalized co-contraction of the upper and midfacial zones emerges following facial nerve manipulation, possibly related to aberrant regeneration, polyterminal axons, or hypersensitivity of the rodent to sensory stimuli following nerve manipulation. PMID:20048604

  19. After facial nerve damage, regenerating axons become aberrant throughout the length of the nerve and not only at the site of the lesion: an experimental study.

    PubMed

    Choi, D; Raisman, G

    2004-02-01

    After facial nerve trauma, aberrant regeneration is associated with synkinesis. Animal models of mechanical nerve guides or reparative cell transplants at the site of a lesion have not been shown to improve disorganized regeneration. We examined whether this is because regenerating axons become disorganized throughout the length of the nerve and not only at the site of the lesion. In rats (n = 12), retrograde fluorescent tracer techniques were used to establish that most of the temporal branch fibres were carried in the superior half of the facial nerve trunk. In two further groups of rats (n = 24) a complete proximal facial nerve lesion was made, and the nerve immediately repaired by suture. After 4 weeks, at a second operation, the superior half of the facial nerve trunk was cut, either proximal or distal to the original lesion, and retrograde tracers were applied to distal branches of the nerve. It was possible to localize the points at which regenerating fibres became aberrant in their course by studying the number of labelled motoneurons in the facial nucleus after application of the tracer to the temporal branch of the nerve: this was similar in the distal and proximal hemisection groups, suggesting that aberrant axonal development occurred throughout the length of the nerve. Future strategies aimed at improving the organization of regeneration need to provide guidance cues not only at the site of the lesion as previously thought, but also throughout the length of the nerve. PMID:15040714

  20. Cardiovascular responses to sciatic nerve stimulation are blocked by paratrigeminal nucleus lesion.

    PubMed

    Yu, Yun-Guo; Caous, Cristofer A; Balan, Antonio C; Rae, Giles A; Lindsey, Charles J

    2002-06-28

    The paratrigeminal nucleus (Pa5) receives primary sensory inputs from the vagus, glossopharyngeal, and trigeminal nerves and has efferent projections to the nucleus of the solitary tract (NTS), rostroventrolateral reticular nucleus (RVL), as well as to the nucleus ambiguus (Amb), lateral reticular (LRt), parabrachial (PB) and ventral posteromedial thalamic (VPM) nuclei, suggesting that it may play a significant role in cardiovascular responses to nociceptive stimuli. The aim of the present study was to evaluate the effects of unilateral lesions of the Pa5 on cardiovascular alterations induced by afferent somatic sensory nerve stimulation (SNS), also known as the somatosympathetic reflex (SSR). Cardiovascular responses were recorded in rats following either sham operation or unilateral lesions of the Pa5 with ibotenic acid. Mean arterial blood pressure (MAP) increased after SNS, which in sham-lesioned animals raised from 95 +/- 4 to 115 +/- 2 mmHg. Ipsilateral Pa5 lesion did not significantly reduce the pressor response to SNS (from 91 +/- 7 to 107 +/- 4 mmHg increase of baseline MAP). On the other hand, contralateral Pa5 lesion significantly reduced the response to SNS (from 99 +/- 5, to 104 +/- 2 mmHg). Sciatic nerve stimulation did not alter heart rate (HR) neither did ipsi- or contralateral Pa5 lesion HR baseline response level. These findings support a crucial role for the Pa5 in cardiovascular regulation, by relaying SSR input evoked by peripheral nerve stimulation. PMID:12144045

  1. Idiopathic peripheral neuropathy in the horse with knuckling: muscle and nerve lesions in additional cases

    Microsoft Academic Search

    H. Furuoka; R. Okamoto; S. Kitayama; S. Asou; T. Matsui; K. Miyahara

    1998-01-01

    We have previously reported a pathological investigation of peripheral neuropathy in a horse with knuckling. This report\\u000a describes details of the muscle and peripheral nerve lesions in two additional cases of light horse yearlings with knuckling.\\u000a The skeletal muscles showed neurogenic atrophy characterized by scattered single angular fibers, fiber grouping, and fiber-type\\u000a grouping. The severity of muscle lesions increased distally;

  2. Rat whisker movement after facial nerve lesion: evidence for autonomic contraction of skeletal muscle.

    PubMed

    Heaton, James T; Sheu, Shu Hsien; Hohman, Marc H; Knox, Christopher J; Weinberg, Julie S; Kleiss, Ingrid J; Hadlock, Tessa A

    2014-04-18

    Vibrissal whisking is often employed to track facial nerve regeneration in rats; however, we have observed similar degrees of whisking recovery after facial nerve transection with or without repair. We hypothesized that the source of non-facial nerve-mediated whisker movement after chronic denervation was from autonomic, cholinergic axons traveling within the infraorbital branch of the trigeminal nerve (ION). Rats underwent unilateral facial nerve transection with repair (N=7) or resection without repair (N=11). Post-operative whisking amplitude was measured weekly across 10weeks, and during intraoperative stimulation of the ION and facial nerves at ?18weeks. Whisking was also measured after subsequent ION transection (N=6) or pharmacologic blocking of the autonomic ganglia using hexamethonium (N=3), and after snout cooling intended to elicit a vasodilation reflex (N=3). Whisking recovered more quickly and with greater amplitude in rats that underwent facial nerve repair compared to resection (P<0.05), but individual rats overlapped in whisking amplitude across both groups. In the resected rats, non-facial-nerve-mediated whisking was elicited by electrical stimulation of the ION, temporarily diminished following hexamethonium injection, abolished by transection of the ION, and rapidly and significantly (P<0.05) increased by snout cooling. Moreover, fibrillation-related whisker movements decreased in all rats during the initial recovery period (indicative of reinnervation), but re-appeared in the resected rats after undergoing ION transection (indicative of motor denervation). Cholinergic, parasympathetic axons traveling within the ION innervate whisker pad vasculature, and immunohistochemistry for vasoactive intestinal peptide revealed these axons branching extensively over whisker pad muscles and contacting neuromuscular junctions after facial nerve resection. This study provides the first behavioral and anatomical evidence of spontaneous autonomic innervation of skeletal muscle after motor nerve lesion, which not only has implications for interpreting facial nerve reinnervation results, but also calls into question whether autonomic-mediated innervation of striated muscle occurs naturally in other forms of neuropathy. PMID:24480367

  3. Electrodiagnostic evaluation of carpal tunnel syndrome and ulnar neuropathies.

    PubMed

    Werner, Robert A

    2013-05-01

    Carpal tunnel syndrome (CTS) and ulnar mononeuropathies at the elbow and wrist are the most common nerve entrapments in the upper extremities. Electrodiagnostic studies are a valid and reliable means of confirming the clinical diagnosis. This review addresses various electrodiagnostic techniques to evaluate the median and ulnar nerves at the wrist and elbow. It also discusses the limitations of electrodiagnostic studies with regard to the sensitivity and specificity of such testing. PMID:23542773

  4. [Pathogenesis of lumbo-sacral nerve root lesion: from the view point of thermographic findings of the lower limbs].

    PubMed

    Igarashi, K

    1990-09-01

    Pathogenesis of the lumbo-sacral nerve roots lesion is discussed especially on the role of the sympathetic nerve using thermographic investigation of the lower limbs. 50 persons without any lumbar symptom were selected as control, and 97 patients with lumbo-sacral nerve roots lesion, including 64 with lumbar disc herniation (LDH) and 33 with lumbar canal stenosis (LCS), were the subjects of this study. In 33 patients group thermography was taken before and after selective nerve root block. The thermograms of the control group showed almost symmetrical thermatome. 49 (76.6%) of LDH group had hypothermal area on the affected limb, however, particularity of the hypothermal area did not define between L5 and S1 nerve root lesion. The patients with hypothermal area of the lower limb were characterised as having apparent neurological deficits and longer duration of the history from the onset, compared with the group without hypothermal area. 25 (75.8%) of LCS group showed not only hypothermal but also complicated thermographic findings. The patients with the complicated findings tended to have severer neurological deficits. Through thermographic findings after nerve root block, it is suggested that skin distribution of the particular nerve root, for example L5 or S1 nerve root distribution, exists in the lower limbs probably related to sympathetic nerve. This study concludes that thermograms of the lower limbs reflect pathogenesis of lumbo-sacral nerve root lesion in some extent, and probably indicate the prognosis of the lesion. PMID:1966740

  5. Ultrasound-guided Pulsed Radiofrequency Lesioning of the Phrenic Nerve in a Patient with Intractable Hiccup

    PubMed Central

    Kang, Keum Nae; Park, In Kyung; Suh, Jeong Hun; Leem, Jeong Gill

    2010-01-01

    Persistent and intractable hiccups (with respective durations of more than 48 hours and 1 month) can result in depression, fatigue, impaired sleep, dehydration, weight loss, malnutrition, and aspiration syndromes. The conventional treatments for hiccups are either non-pharmacological, pharmacological or a nerve block treatment. Pulsed radiofrequency lesioning (PRFL) has been proposed for the modulation of the excited nervous system pathway of pain as a safe and nondestructive treatment method. As placement of the electrode in close proximity to the targeted nerve is very important for the success of PRFL, ultrasound appears to be well suited for this technique. A 74-year-old man suffering from intractable hiccups that had developed after a coronary artery bypass graft and had continued for 7 years was referred to our pain clinic. He had not been treated with conventional methods or medications. We performed PRFL of the phrenic nerve guided by ultrasound and the hiccups disappeared. PMID:20830266

  6. Winged scapula caused by a dorsal scapular nerve lesion: a case report.

    PubMed

    Akgun, Kenan; Aktas, Ilknur; Terzi, Yeliz

    2008-10-01

    Dorsal scapular nerve lesions are quite rare. A case of a 51-year-old man who had right shoulder pain, weakness of right arm elevation, and prominence of right scapula for 6 months is presented. The condition had been abruptly developed after lifting a heavy box overhead on which he felt a sharp pain in the right shoulder. On clinical examination, there was a prominence of the lower medial border and inferior angle of the right scapula compared with the left. In addition, the right scapula was located more lateral. Magnetic resonance imaging of the thorax revealed the presence of a thinner rhomboid major muscle with a pathologic signal compared with the other side. Needle electromyography of the right rhomboid muscle revealed a long duration, polyphasic motor unit potential with reinnervation potentials, and spontaneous activity. According to these findings, the patient was diagnosed as having a winged scapula because of dorsal scapular nerve lesion. PMID:18929031

  7. Clinical utility of residual latency in ulnar neuropathy at elbow: Is there any correlation?

    PubMed Central

    Khosrawi, Saeid; Dehghan, Farnaz; Shaygannejad, Vahid

    2015-01-01

    Background: Residual latency is the time difference between measured and predicted distal conduction time. We investigated ulnar nerve residual latency in patients with ulnar neuropathy at elbow for the possibility of its clinical utility. Materials and Methods: In a cross-sectional study and based on the inclusion and exclusion criteria, ulnar nerve residual latency was calculated by using standard settings in 63 hands of patients who had signs and symptoms suggesting ulnar neuropathy at elbow and 94 healthy hands as the control group. Results: Mean ulnar nerve residual latency for case and control groups were 1.82 ± 0.45 and 1.59 ± 0.54 ms, respectively, which showed a statistically significant difference (P = 0.01). There was no significant difference in mean ulnar nerve residual latency between males and females and also between right and left hands (P > 0.05). By considering different cut-off points, the sensitivity and specificity of a residual latency of 2.86 ms were 70% and 56%, respectively. Conclusion: Ulnar nerve residual latency may reflect the effects of an axonal injury at elbow on distal ulnar motor fibers. So, its measurement may help in the diagnosis of ulnar neuropathy at elbow. PMID:25709986

  8. Differential patterns of local gene regulation in crush lesions of the rat optic and sciatic nerve: relevance to posttraumatic regeneration.

    PubMed

    Zickler, Philipp; Küry, Patrick; Gliem, Michael; Hartung, Hans-Peter; Jander, Sebastian

    2010-01-01

    Axon regrowth after nerve injury can occur in the peripheral but fails in the central nervous system. Cellular reactions at the lesion site affect axonal regrowth. We compared gene regulation in optic nerve (ON) and sciatic nerve (SN) crush lesions in adult rats by cDNA array analysis, quantitative RT-PCR and immunohistochemistry, focusing on the primary lesion site rather than the proximal or distal nerve stump. Four days after injury, identical gene regulation in ON and SN lesions was found for 19/1185 genes (15 up, 4 down). In contrast, tissue-specific regulations were identified for 48 genes in ON and 50 genes in SN crush lesions. Among these, in the ON many genes were downregulated (23 up, 25 down) whereas upregulation predominated in SN lesions (43 up, 7 down), especially for signaling, metabolism, and translation/transcription-related genes. In ON lesions aquaporin 4 downregulation corresponded to a transient loss of astrocytes. Tissue-type plasminogen activator was upregulated in the lesion and distal stump of SN while the urokinase-type plasminogen activator was upregulated only in the ON lesion indicating differences in local proteolysis between the systems. Typical neuronal genes were regulated at the crush site comprising neurotransmitter genes in ON and actin cytoskeleton-related genes in the SN. The differential orchestration of local gene regulation has implications for axonal regeneration in central nervous system lesions. PMID:20798533

  9. Ulnar tunnel syndrome.

    PubMed

    Chen, Shih-Heng; Tsai, Tsu-Min

    2014-03-01

    Ulnar neuropathy at or distal to the wrist, the so-called ulnar tunnel syndrome, is an uncommon but well-described condition. However, diagnosis of ulnar tunnel syndrome can be difficult. Paresthesias may be nonspecific or related to coexisting pathologies, such as carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, C8-T1 radiculopathy, or peripheral neuropathy, which makes accurate diagnosis challenging. The advances in electrodiagnosis, ultrasonography, computed tomography, and magnetic resonance imaging have improved the diagnostic accuracy. This article offers an updated view of ulnar tunnel syndrome as well as its etiologies, diagnoses, and treatments. PMID:24559635

  10. Acupuncture: a potential modality for the treatment of auricular pruritus in ramsay hunt syndrome with multiple cranial nerve lesions.

    PubMed

    Liu, Lan Ying; Wang, He Sheng; Sun, Jian Hua

    2015-03-01

    Auricular pruritus coexisted with multiple cranial nerve lesions in Ramsay Hunt syndrome has been rarely reported in the literature especially its treatment. However, auricular pruritus cannot be better improved along with the improvement of multiple cranial nerve lesions. We tried to solve the problem with acupuncture and got experience from it. The following 2 cases of Ramsay Hunt syndromeshow a potential modality for the treatment of auricular prurituswith acupuncture. PMID:25710744

  11. Synthesis and localization of ciliary neurotrophic factor in the sciatic nerve of the adult rat after lesion and during regeneration

    PubMed Central

    1992-01-01

    Ciliary neurotrophic factor (CNTF) is expressed in high quantities in Schwann cells of peripheral nerves during postnatal development of the rat. The absence of a hydrophobic leader sequence and the immunohistochemical localization of CNTF within the cytoplasm of these cells indicate that the factor might not be available to responsive neurons under physiological conditions. However, CNTF supports the survival of a variety of embryonic neurons, including spinal motoneurons in culture. Moreover we have recently demonstrated that the exogenous application of CNTF protein to the lesioned facial nerve of the newborn rat rescued these motoneurons from cell death. These results indicate that CNTF might indeed play a major role in assisting the survival of lesioned neurons in the adult peripheral nervous system. Here we demonstrate that the CNTF mRNA and protein levels and the manner in which they are regulated are compatible with such a function in lesioned peripheral neurons. In particular, immunohistochemical analysis showed significant quantities of CNTF at extracellular sites after sciatic nerve lesion. Western blots and determination of CNTF biological activity of the same nerve segments indicate that extracellular CNTF seems to be biologically active. After nerve lesion CNTF mRNA levels were reduced to less than 5% in distal regions of the sciatic nerve whereas CNTF bioactivity decreased to only one third of the original before-lesion levels. A gradual reincrease in Schwann cells occurred concomitant with regeneration. PMID:1618901

  12. Ulnar entrapment neuropathy along the medial intermuscular septum in the midarm.

    PubMed

    Nakajima, Masashi; Ono, Nobuko; Kojima, Tomoko; Kusunose, Koichi

    2009-05-01

    We report a patient with primary ulnar entrapment neuropathy in the midarm. Stimulation of multiple sites along the ulnar nerve showed a motor conduction block at a distance of 7.5-10 cm proximal to the medial epicondyle, where the nerve was compressed by the medial intermuscular septum. Anatomically, the possibility of ulnar nerve entrapment in this segment has long been suggested, and stimulation at least 10 cm above the medial epicondyle may reveal the entrapment. Muscle Nerve 39: 707-710, 2009. PMID:19347925

  13. ATP and NO Dually Control Migration of Microglia to Nerve Lesions

    PubMed Central

    Duan, Yuanli; Sahley, Christie L.; Muller, Kenneth J.

    2009-01-01

    Microglia migrate rapidly to lesions in the central nervous system (CNS), presumably in response to chemoattractants including ATP released directly or indirectly by the injury. Previous work on the leech has shown that nitric oxide (NO), generated at the lesion, is both a stop signal for microglia at the lesion and crucial for their directed migration from hundreds of micrometers away within the nerve cord, perhaps mediated by a soluble guanylate cyclase (sGC). In the present study, application of 100 ?M ATP caused maximal movement of microglia in leech nerve cords. The nucleotides ADP, UTP, and the non-hydrolyzable ATP analog AMP-PNP (adenyl-5?-yl imidodiphosphate) also caused movement, whereas AMP, cAMP and adenosine were without effect. Both movement in ATP and migration after injury were slowed by 50 ?M reactive blue 2 (RB2), an antagonist of purinergic receptors, without influencing the direction of movement. This contrasted with the effect of the NO scavenger cPTIO (2-(4-carboxyphenyl)-4,4,5,5-teramethylimidazoline-oxyl-3-oxide), which misdirected movement when applied at 1 mM. The cPTIO reduced cGMP immunoreactivity without changing immunoreactivity of eNOS (endothelial nitric oxide synthase), which accompanies increased NOS activity after nerve cord injury, consistent with involvement of sGC. Moreover, the sGC-specific inhibitor LY83583 applied at 50 ?M had a similar effect, in agreement with previous results with methylene blue. Taken together, the experiments support the hypothesis that ATP released directly or indirectly by injury activates microglia to move, while NO which activates sGC directs migration of microglia to CNS lesions. PMID:19025930

  14. ATP and NO dually control migration of microglia to nerve lesions.

    PubMed

    Duan, Yuanli; Sahley, Christie L; Muller, Kenneth J

    2009-01-01

    Microglia migrate rapidly to lesions in the central nervous system (CNS), presumably in response to chemoattractants including ATP released directly or indirectly by the injury. Previous work on the leech has shown that nitric oxide (NO), generated at the lesion, is both a stop signal for microglia at the lesion and crucial for their directed migration from hundreds of micrometers away within the nerve cord, perhaps mediated by a soluble guanylate cyclase (sGC). In this study, application of 100 microM ATP caused maximal movement of microglia in leech nerve cords. The nucleotides ADP, UTP, and the nonhydrolyzable ATP analog AMP-PNP (adenyl-5'-yl imidodiphosphate) also caused movement, whereas AMP, cAMP, and adenosine were without effect. Both movement in ATP and migration after injury were slowed by 50 microM reactive blue 2 (RB2), an antagonist of purinergic receptors, without influencing the direction of movement. This contrasted with the effect of the NO scavenger cPTIO (2-(4-carboxyphenyl)-4,4,5,5-teramethylimidazoline-oxyl-3-oxide), which misdirected movement when applied at 1 mM. The cPTIO reduced cGMP immunoreactivity without changing the immunoreactivity of eNOS (endothelial nitric oxide synthase), which accompanies increased NOS activity after nerve cord injury, consistent with involvement of sGC. Moreover, the sGC-specific inhibitor LY83583 applied at 50 microM had a similar effect, in agreement with previous results with methylene blue. Taken together, the experiments support the hypothesis that ATP released directly or indirectly by injury activates microglia to move, whereas NO that activates sGC directs migration of microglia to CNS lesions. PMID:19025930

  15. [The depiction of the cubital segment of the ulnar nerve by high resolution sonography--is it a helpful diagnostic tool for the assessment of the cubital tunnel syndrome?].

    PubMed

    Gruber, H; Peer, S

    2009-02-01

    During the last years sonographic assessment of pathologies of the peripheral nerves has not only become increasingly popular but has also proved to be a valid procedure. High-resolution ultrasonography (HRUS) is nowadays also performed with regard to the assessment of cubital tunnel syndrome (CuTS). Therefore, we now demonstrate special sonographic features of a rather frequent pathology of the peripheral nervous system that is often difficult to diagnose and treat--the primary and secondary forms of the cubital tunnel syndrome. Besides the mandatory technical requisites, a special focus is placed on anatomic-topographic peculiarities in the cubital segment of the ulnar nerve, its morphological characteristics and, especially, on changes in relation to other frequent pathologies: thus the typical sonographic findings of a proper primary compression syndrome, of traumatic impairment, and also those of inflammatory and neoplastic conditions are demonstrated. Especially in combination with electrophysiological tests, HRUS is a simple, radiation-free and hardly time-consuming method and a recommendable imaging procedure above all for the differentiation of the proper primary form from other forms of cubital tunnel syndrome. The results of HRUS examinations are not only of interest to clinical specialists but also save the patient from unnecessary follow-ups and ensure optimal prognosis and therapy. PMID:19224416

  16. Diagnostic Value of Ultrasonography and Magnetic Resonance Imaging in Ulnar Neuropathy at the Elbow

    PubMed Central

    Ayromlou, Hormoz; Tarzamni, Mohammad K.; Daghighi, Mohammad Hossein; Pezeshki, Mohammad Zakaria; Yazdchi, Mohammad; Sadeghi-Hokmabadi, Elyar; Sharifipour, Ehsan; Ghabili, Kamyar

    2012-01-01

    Aim. To evaluate the diagnostic value of ultrasonography and magnetic resonance imaging (MRI) in patients with ulnar neuropathy at the elbow (UNE). Methods. We prospectively performed electrodiagnostic, ultrasonographic, and MRI studies in UNE patients and healthy controls. Three cross-sectional area (CSA) measurements of the ulnar nerve at multiple levels along the arm and maximum CSA(-max) were recorded. Results. The ulnar nerve CSA measurements were different between the UNE severity grades (P < 0.05). CSA-max had the greatest sensitivity (93%) and specificity (68%). Moreover, CSA-max ?10?mm2 defined the severe UNE cases (sensitivity/specificity: 82%/72%). In MRI, ulnar nerve hyperintensity had the greatest sensitivity (90%) and specificity (80%). Conclusion. Ultrasonography using CSA-max is sensitive and specific in UNE diagnosis and discriminating the severe UNE cases. Furthermore, MRI particularly targeting at increased signal of the ulnar nerve can be a useful diagnostic test of UNE. PMID:22888452

  17. The Use of Patterned Neuromuscular Stimulation to Improve Hand Function Following Surgery for Ulnar Neuropathy

    Microsoft Academic Search

    T. PETTERSON; G. P. SMITH; J. A. OLDHAM; T. E. HOWE; R. C. TALLIS

    1994-01-01

    A 60-year-old man with wasting and weakness of the right hand following ulnar nerve entrapment at the elbow was referred for electrotherapy. An ulnar nerve transposition had been performed 2 years previously. This had produced some improvement in nerve conduction without significantly improving hand muscle function.The right first dorsal interosseous muscle (FDI) was stimulated for 4 hours per day over

  18. Clinical and neuropathological study about the neurotization of the suprascapular nerve in obstetric brachial plexus lesions

    PubMed Central

    2009-01-01

    Background The lack of recovery of active external rotation of the shoulder is an important problem in children suffering from brachial plexus lesions involving the suprascapular nerve. The accessory nerve neurotization to the suprascapular nerve is a standard procedure, performed to improve shoulder motion in patients with brachial plexus palsy. Methods We operated on 65 patients with obstetric brachial plexus palsy (OBPP), aged 5-35 months (average: 19 months). We assessed the recovery of passive and active external rotation with the arm in abduction and in adduction. We also looked at the influence of the restoration of the muscular balance between the internal and the external rotators on the development of a gleno-humeral joint dysplasia. Intraoperatively, suprascapular nerve samples were taken from 13 patients and were analyzed histologically. Results Most patients (71.5%) showed good recovery of the active external rotation in abduction (60°-90°). Better results were obtained for the external rotation with the arm in abduction compared to adduction, and for patients having only undergone the neurotization procedure compared to patients having had complete plexus reconstruction. The neurotization operation has a positive influence on the glenohumeral joint: 7 patients with clinical signs of dysplasia before the reconstructive operation did not show any sign of dysplasia in the postoperative follow-up. Conclusion The neurotization procedure helps to recover the active external rotation in the shoulder joint and has a good prevention influence on the dysplasia in our sample. The nerve quality measured using histopathology also seems to have a positive impact on the clinical results. PMID:19744351

  19. Muscle Ciliary Neurotrophic Factor Receptor ? Promotes Axonal Regeneration and Functional Recovery Following Peripheral Nerve Lesion

    PubMed Central

    Lee, Nancy; Spearry, Rachel P.; Leahy, Kendra M.; Robitz, Rachel; Trinh, Dennis S.; Mason, Carter O.; Zurbrugg, Rebekah J.; Batt, Myra K.; Paul, Richard J.; Maclennan, A. John

    2014-01-01

    Ciliary neurotrophic factor (CNTF) administration maintains, protects, and promotes the regeneration of both motor neurons (MNs) and skeletal muscle in a wide variety of models. Expression of CNTF receptor ? (CNTFR?), an essential CNTF receptor component, is greatly increased in skeletal muscle following neuromuscular insult. Together the data suggest that muscle CNTFR? may contribute to neuromuscular maintenance, protection, and/or regeneration in vivo. To directly address the role of muscle CNTFR?, we selectively-depleted it in vivo by using a “floxed” CNTFR? mouse line and a gene construct (mlc1f-Cre) that drives the expression of Cre specifically in skeletal muscle. The resulting mice were challenged with sciatic nerve crush. Counting of nerve axons and retrograde tracing of MNs indicated that muscle CNTFR? contributes to MN axonal regeneration across the lesion site. Walking track analysis indicated that muscle CNTFR? is also required for normal recovery of motor function. However, the same muscle CNTFR? depletion unexpectedly had no detected effect on the maintenance or regeneration of the muscle itself, even though exogenous CNTF has been shown to affect these functions. Similarly, MN survival and lesion-induced terminal sprouting were unaffected. Therefore, muscle CNTFR? is an interesting new example of a muscle growth factor receptor that, in vivo under physiological conditions, contributes much more to neuronal regeneration than to the maintenance or regeneration of the muscle itself. This novel form of muscle–neuron interaction also has implications in the therapeutic targeting of the neuromuscular system in MN disorders and following nerve injury. PMID:23504871

  20. Traumatic Distal Ulnar Artery Thrombosis

    PubMed Central

    Karaarslan, Ahmet A.; Karaka?l?, Ahmet; Mayda, Aslan; Karc?, Tolga; Aycan, Hakan; Kobak, ?enol

    2014-01-01

    This paper is about a posttraumatic distal ulnar artery thrombosis case that has occurred after a single blunt trauma. The ulnar artery thrombosis because of chronic trauma is a frequent condition (hypothenar hammer syndrome) but an ulnar artery thrombosis because of a single direct blunt trauma is rare. Our patient who has been affected by a single blunt trauma to his hand and developed ulnar artery thrombosis has been treated by resection of the thrombosed ulnar artery segment. This report shows that a single blunt trauma can cause distal ulnar artery thrombosis in the hand and it can be treated merely by thrombosed segment resection in suitable cases. PMID:25276455

  1. Axotomized and Intact Muscle Afferents But No Skin Afferents Develop Ongoing Discharges of Dorsal Root Ganglion Origin after Peripheral Nerve Lesion

    Microsoft Academic Search

    Martin Michaelis; Xianguo Liu; Wilfrid Janig

    2000-01-01

    After peripheral nerve lesions, some axotomized afferent neu- rons develop ongoing discharges that originate in the dorsal root ganglion (DRG). We investigated in vivo which functional types of afferent neurons contributed to this ectopic activity. Six to twelve days after the gastrocnemius soleus (GS) nerve sup- plying skeletal muscle and the sural (SU) nerve supplying skin had been transected (experimental

  2. Neuroprotective Activity of Thioctic Acid in Central Nervous System Lesions Consequent to Peripheral Nerve Injury

    PubMed Central

    Ghelardini, Carla; Nwankwo, Innocent E.; Pacini, Alessandra

    2013-01-01

    Peripheral neuropathies are heterogeneous disorders presenting often with hyperalgesia and allodynia. This study has assessed if chronic constriction injury (CCI) of sciatic nerve is accompanied by increased oxidative stress and central nervous system (CNS) changes and if these changes are sensitive to treatment with thioctic acid. Thioctic acid is a naturally occurring antioxidant existing in two optical isomers (+)- and (?)-thioctic acid and in the racemic form. It has been proposed for treating disorders associated with increased oxidative stress. Sciatic nerve CCI was made in spontaneously hypertensive rats (SHRs) and in normotensive reference cohorts. Rats were untreated or treated intraperitoneally for 14 days with (+/?)-, (+)-, or (?)-thioctic acid. Oxidative stress, astrogliosis, myelin sheets status, and neuronal injury in motor and sensory cerebrocortical areas were assessed. Increase of oxidative stress markers, astrogliosis, and neuronal damage accompanied by a decreased expression of neurofilament were observed in SHR. This phenomenon was more pronounced after CCI. Thioctic acid countered astrogliosis and neuronal damage, (+)-thioctic acid being more active than (+/?)- or (?)-enantiomers. These findings suggest a neuroprotective activity of thioctic acid on CNS lesions consequent to CCI and that the compound may represent a therapeutic option for entrapment neuropathies. PMID:24527432

  3. Brain-derived neurotrophic factor (BDNF) prevents lesion-induced axonal die-back in young rat optic nerve.

    PubMed

    Weibel, D; Kreutzberg, G W; Schwab, M E

    1995-05-15

    Lesions of the optic nerve in young animals lead to rapid retrograde degeneration of the axon stumps and to death of retinal ganglion cells. We injected different neurotrophic factors into the eye at the time of an intracranial freeze-crush lesion of the optic nerve in 8 day old rats. Optic nerve axons were visualized by anterograde tracing with wheat germ agglutinin-horseradish peroxidase (WGA-HRP) and by electron microscopy. The lesion induced a rapid die-back of the axons, which could be prevented by BDNF and to a lesser extent by neurotrophin-3 (NT-3) or ciliary neurotrophic factor (CNTF). No effect was seen in animals injected with nerve growth factor (NGF) or a mixture of acidic and basic fibroblast growth factor (FGF). In contrast to this effect on the axons, none of these factors was able to counteract the rapidly progressing degeneration of the retinal ganglion cells. These results suggest a selective influence of BDNF on the mechanisms responsible for the maintenance of optic nerve axons. PMID:7543356

  4. Importance of nitric oxide and capsaicin-sensitive afferent nerves in healing of stress lesions induced by epidermal growth factor.

    PubMed

    Brzozowski, T; Konturek, P C; Sliwowski, Z; Drozdowicz, D; Hahn, E G; Konturek, S J

    1997-01-01

    Epidermal growth factor (EGF) is a potent mitogen implicated in gastroprotection and ulcer healing, but its possible interaction with nitric oxide (NO) and sensory nerves on healing after acute gastric damage has not been assessed. We examined the effects of topical application of a small dose (0.5 mg/kg) of capsaicin to stimulate sensory nerves and a larger parenteral dose of capsaicin (125 mg/kg s.c.) to deactivate these neurons or the effect of systemic administration of NG-nitro-L-arginine methyl ester (L-NAME) (20 mg/kg i.v.) to suppress NO synthase on healing of gastric lesions induced by 3.5 h of water immersion and restraint stress (WRS) in rats without or with EGF administration. Rats were sacrificed at 0, 6, 12, or 24 h after WRS and the gastric blood flow (GBF) was measured by the H2 gas clearance technique. Exposure to WRS produced many gastric lesions, with a marked decrease in GBF, but at 12 h these lesions started to heal and the lesion number was reduced by 75% after 24 h. This was accompanied by progressive increase in the GBF and an increase in expression of EGF mRNA in gastric mucosa, as detected by RT-PCR. Pretreatment with L-NAME or functional ablation of sensory nerves by capsaicin significantly delayed the healing of WRS lesions and accompanying hyperemia. In contrast, pretreatment with EGF (100 micrograms/kg s.c.) or glyceryl trinitrate (10 mg/kg i.g.), a donor of NO, or stimulation of sensory nerves by topical capsaicin significantly enhanced the healing of these lesions and increased the GBF. The acceleration of the healing and accompanying hyperemia induced by EGF at 12 h after WRS were completely reversed in rats pretreated with L-NAME or in those with capsaicin denervation. Addition of L-arginine but not D-arginine to L-NAME restored the healing of stress lesions and gastric hyperemia induced by this peptide. Removal of salivary glands, which reduced luminal content of EGF and DNA synthesis by about fourfold compared to rats with intact glands, produced a significant delay in healing, and this was further aggravated by capsaicin denervation. We conclude that EGF, sensory nerves, and NO play an important role in the healing of gastric mucosa from lesions induced by stress and that sensory nerves and NO appear to interact with EGF in the mechanism of mucosal recovery from stress lesions. PMID:9479624

  5. Sensory deficits of a nerve root lesion can be objectively documented by somatosensory evoked potentials elicited by painful infrared laser stimulations: a case study.

    PubMed Central

    Lorenz, J; Hansen, H C; Kunze, K; Bromm, B

    1996-01-01

    Somatosensory evoked potentials (SEPs) in response to painful laser stimuli were measured in a patient with a unilateral sensory deficit due to radiculopathy at cervical levels C7 and C8. Laser evoked potentials (LEPs) were compared with SEPs using standard electrical stimulation of median and ulnar nerves at the wrist and mechanical stimulation of the fingertips by means of a mechanical stimulator. Early and late ulnar and median nerve SEPs were normal. Mechanical stimulation resulted in w shaped early SEPs from all five fingertips with some degree of abnormality at the fourth and fifth digits of the affected hand. Late LEPs were completely absent for stimulations at affected dermatomes and normal in the unaffected control dermatomes. The border between skin areas with normal or absent LEPs was very sharp and fitted the dermatomes of intact C6 and damaged C7 and C8 nerve roots. It is suggested that pain dermatomes are narrower than tactile dermatomes because thin fibres of the nociceptive system, activated by laser stimuli, probably do not overlap between adjacent spinal segments to the same extent as thick fibres of the mechanoreceptive system, activated by standard electrical or mechanical stimulation. Images PMID:8676136

  6. Usefulness of Ultrasound for Detecting Suspected Peripheral Nerve Lesions in Diagnosis of Peripheral Neuropathy : Case Report and Brief Review of the Literature

    PubMed Central

    Kim, Kwang-Hai; Choi, Soon-Kyoo; Shim, Jae-Hyun

    2013-01-01

    Ultrasound scanning of a peripheral nerve along its expected course is a simple and useful method for determining the cause of peripheral neuropathy. We present 3 cases of peripheral neuropathy in which the pathology was detected by simple ultrasound scanning of the affected nerve. There were 2 cases of entrapment neuropathy due to mucoid cyst and 1 case of nerve sheath tumor. All lesions were visualized by simple ultrasound scanning of the involved peripheral nerve. Our results suggest that if a lesion affecting the peripheral nerve is suspected after history and physical examination or electrophysiologic studies, ultrasound scanning of the peripheral nerve of interest throughout its course is very helpful for identifying the causative lesion. PMID:23560182

  7. Axonal Regeneration after Sciatic Nerve Lesion Is Delayed but Complete in GFAP- and Vimentin-Deficient Mice

    PubMed Central

    Berg, Alexander; Zelano, Johan; Pekna, Marcela; Wilhelmsson, Ulrika; Pekny, Milos; Cullheim, Staffan

    2013-01-01

    Peripheral axotomy of motoneurons triggers Wallerian degeneration of injured axons distal to the lesion, followed by axon regeneration. Centrally, axotomy induces loss of synapses (synaptic stripping) from the surface of lesioned motoneurons in the spinal cord. At the lesion site, reactive Schwann cells provide trophic support and guidance for outgrowing axons. The mechanisms of synaptic stripping remain elusive, but reactive astrocytes and microglia appear to be important in this process. We studied axonal regeneration and synaptic stripping of motoneurons after a sciatic nerve lesion in mice lacking the intermediate filament (nanofilament) proteins glial fibrillary acidic protein (GFAP) and vimentin, which are upregulated in reactive astrocytes and Schwann cells. Seven days after sciatic nerve transection, ultrastructural analysis of synaptic density on the somata of injured motoneurons revealed more remaining boutons covering injured somata in GFAP–/–Vim–/– mice. After sciatic nerve crush in GFAP–/–Vim–/– mice, the fraction of reinnervated motor endplates on muscle fibers of the gastrocnemius muscle was reduced 13 days after the injury, and axonal regeneration and functional recovery were delayed but complete. Thus, the absence of GFAP and vimentin in glial cells does not seem to affect the outcome after peripheral motoneuron injury but may have an important effect on the response dynamics. PMID:24223940

  8. Differentiating c8-t1 radiculopathy from ulnar neuropathy: a survey of 24 spine surgeons.

    PubMed

    Stoker, Geoffrey E; Kim, Han Jo; Riew, K Daniel

    2014-02-01

    Study Design?Questionnaire. Objective?To evaluate the ability of spine surgeons to distinguish C8-T1 radiculopathies from ulnar neuropathy. Methods?Twenty-four self-rated "experienced" cervical spine surgeons completed a questionnaire with the following items. (1) If the ulnar nerve is cut at the elbow, which of the following would be numb: ulnar forearm, small and ring fingers; only the ulnar forearm; only the small and ring fingers; or none of the above? (2) Which of the following muscles are weak with C8-T1 radiculopathies but intact with ulnar neuropathy at the elbow: flexor digiti minimi brevis, flexor pollicis brevis, abductor digiti minimi, abductor pollicis brevis, adductor pollicis, opponens digiti minimi, opponens pollicis, medial lumbricals, lateral lumbricals, dorsal interossei, palmar interossei? Results?Fifteen of 24 surgeons (63%) correctly answered the first question-that severing the ulnar nerve results in numbness of the fifth and fourth fingers. None correctly identified all four nonulnar, C8-T1-innervated options in the second question without naming additional muscles. Conclusion?The ulnar nerve provides sensation to the fourth and fifth fingers and medial border of the hand. The medial antebrachial cutaneous nerve provides sensation to the medial forearm. The ulnar nerve innervates all intrinsic hand muscles, except the abductor and flexor pollicis brevis, opponens pollicis, and lateral two lumbricals, which are innervated by C8 and T1 via the median nerve. By examining these five muscles, one can clinically differentiate cubital tunnel syndrome from C8-T1 radiculopathies. Although all participants considered themselves to be experienced cervical spine surgeons, this study reveals inadequate knowledge regarding the clinical manifestations of C8-T1 radiculopathies and cubital tunnel syndrome. PMID:24494175

  9. Differentiating C8–T1 Radiculopathy from Ulnar Neuropathy: A Survey of 24 Spine Surgeons

    PubMed Central

    Stoker, Geoffrey E.; Kim, Han Jo; Riew, K. Daniel

    2013-01-01

    Study Design?Questionnaire. Objective?To evaluate the ability of spine surgeons to distinguish C8–T1 radiculopathies from ulnar neuropathy. Methods?Twenty-four self-rated “experienced” cervical spine surgeons completed a questionnaire with the following items. (1) If the ulnar nerve is cut at the elbow, which of the following would be numb: ulnar forearm, small and ring fingers; only the ulnar forearm; only the small and ring fingers; or none of the above? (2) Which of the following muscles are weak with C8–T1 radiculopathies but intact with ulnar neuropathy at the elbow: flexor digiti minimi brevis, flexor pollicis brevis, abductor digiti minimi, abductor pollicis brevis, adductor pollicis, opponens digiti minimi, opponens pollicis, medial lumbricals, lateral lumbricals, dorsal interossei, palmar interossei? Results?Fifteen of 24 surgeons (63%) correctly answered the first question—that severing the ulnar nerve results in numbness of the fifth and fourth fingers. None correctly identified all four nonulnar, C8–T1-innervated options in the second question without naming additional muscles. Conclusion?The ulnar nerve provides sensation to the fourth and fifth fingers and medial border of the hand. The medial antebrachial cutaneous nerve provides sensation to the medial forearm. The ulnar nerve innervates all intrinsic hand muscles, except the abductor and flexor pollicis brevis, opponens pollicis, and lateral two lumbricals, which are innervated by C8 and T1 via the median nerve. By examining these five muscles, one can clinically differentiate cubital tunnel syndrome from C8–T1 radiculopathies. Although all participants considered themselves to be experienced cervical spine surgeons, this study reveals inadequate knowledge regarding the clinical manifestations of C8–T1 radiculopathies and cubital tunnel syndrome. PMID:24494175

  10. [Peripheral nerve lesions of experimental leprosy in monkeys. V. Histopathological finding of cutaneous nerves and cutaneous sensory organs].

    PubMed

    Fukunishi, Y

    1989-01-01

    The skin samples of each palm side and dorsum side of finger, nose and peripheral nerves running under the finger skin at the area between proximal phalanx and distal phalanx of mangabey monkey A022 and rhesus monkey A125 were studied by histopathological methods (semithin section and light microscopic findings). Results found about this study were as follows. 1. In spite of the existence of a large amount of leprosy bacilli at the areas of corium and subcutis, some of Meissner's corpuscles, Vater-Pacinian corpuscles (or Golgi-Mazzoni's corpuscles) and Krauze's end bulbs-like structures were observed. 2. Occasionally, several intracytoplasmic foamy structures containing a large amount of leprosy bacilli were observed at the shallow and deep layers of stratum papillare of corium, where leprosy bacilli were not so remarkable as shown on Figure 4. So, it was thought that the affinity of leprosy bacilli to free nerve endings should be exist there. 3. Some of M. arrector pili were kept in good condition in spite of the existence of multiplying leprosy bacilli around the hair follicles. 4. It was thought that the histopathological findings of the fascicles of cutaneous nerves were classified to 4 patterns. The first pattern of histopathological finding of the cutaneous nerve was shown as A on Figure 25. In this pattern observed in almost of all the fascicles locating at the subcutis, no leprosy bacillus was observed inside the fascicles, and the nerve fibers were kept in good condition. The second pattern observed in almost of all the fascicles located at the corium, was shown as B on Figure 25. In this pattern, a large amount of leprosy bacilli were observed inside the fascicles, and the nerve fibers were often kept in good condition. The third pattern observed in almost of all the fascicles located at the deep layer of corium and subcutis, was shown as C on Figure 25. In this pattern, not only multiplying leprosy bacilli but also remarkable fibrosis were found inside one fascicle, and many nerve fibers disappeared by the existence of the bacilli and fibrosis. The final pattern observed in almost of all the fascicles located at the deep layer of corium and subcutis, was shown as D on Figure 25. In this pattern, remarkable fibrosis was observed inside the fascicles, and the nerve fibers often disappeared by the existence of fibrosis.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2697712

  11. A biohybrid system to interface peripheral nerves after traumatic lesions: design of a high channel sieve electrode.

    PubMed

    Stieglitz, T; Ruf, H H; Gross, M; Schuettler, M; Meyer, J-U

    2002-08-01

    Peripheral nerve lesions lead to nerve degeneration and flaccid paralysis. The first objective in functional rehabilitation of these diseases should be the preservation of the neuro-muscular junction by biological means and following functional electrical stimulation (FES) may restore some function of the paralyzed limb. The combination of biological cells and technical microdevices to biohybrid systems might become a new approach in neural prosthetics research to preserve skeletal muscle function. In this paper, a microdevice for a biohybrid system to interface peripheral nerves after traumatic lesions is presented. The development of the microprobe design and the fabrication technology is described and first experimental results are given and afterwards discussed. The technical microprobe is designed in a way that meets the most important technical requirements: adaptation to the distal nerve stump, suitability to combine the microstructure with a containment for cells, and integrated microelectrodes as information transducers for cell stimulation and monitoring. Micromachining technologies were applied to fabricate a polyimide-based sieve-like microprobe with 19 substrate-integrated ring electrodes and a distributed counter electrode. Monolithic integration of fixation flaps and a three-dimensional shaping technology led to a device that might be adapted to nerve stumps with neurosurgical sutures in the epineurium. First experimental results of the durability of the shaping technology and electrochemical electrode properties were investigated. The three-dimensional shape remained quite stable after sterilization in an autoclave and chronic implantation. Electrode impedance was below 200 kOmega at 1 kHz which ought to permit recording of signals from nerves sprouting through the sieve holes. PMID:12052354

  12. Relation between the neuronal and hemodynamic response in the lesioned rat spinal cord following peripheral nerve stimulation

    NASA Astrophysics Data System (ADS)

    Dubeau, S.; Beaumont, E.; Lesage, F.

    2009-02-01

    In this study, we explore the hemodynamic response in the lesioned rat spinal cord following peripheral nerve stimulation. Oxy and deoxy hemoglobin were measured (using a four color LED multispectral intrinsic optical imaging system) simultaneously with blood flow (laser speckle measurement). Both optical and electrophysiological data are compared spatially and against stimulation strength. When compared with non-lesioned animals, the hemodynamic response is seen to display significant differences exhibiting increased initial dip and decreased blood drain following stimulation. The origin of the difference is observed to be due to the vascular nature of the injury. The distinct hemodynamic responses may have a strong impact on General Linear Model based fMRI studies of spinal cord lesions due to the difficulty in separating vascular effects from neuronal plasticity following injury.

  13. Hypertrophic ancenous epitrochlearis muscle as a cause of ulnar neuropathy at elbow.

    PubMed

    Yalcin, Elif; Demir, Sibel Ozbudak; Dizdar, Dilek; Buyukvural, S?d?ka; Akyuz, Mufit

    2013-01-01

    We report herein a 35-year-old man who suffered from pain at his left elbow and numbness in his left hand. Electromyographic studies demonstrated a localized nerve conduction block in the left elbow region. Ultrasonographic evaluation revealed enlargement of the ulnar nerve at the level of the medial epicondyle as well as bilateral anconeus epitrochlearis muscles, one of which was hypertrophic, causing the ulnar neuropathy at the symptomatic site. We emphasize with this case report the complementary role of ultrasound in peripheral nerve pathologies, as it confirmed the entrapment and determined the underlying cause. PMID:23629545

  14. Effects of Distal Nerve Injuries on Dorsal-Horn Neurons and Glia: Relationships Between Lesion Size and Mechanical Hyperalgesia

    PubMed Central

    Lee, J. W.; Siegel, S. M.; Oaklander, A. L.

    2008-01-01

    Penetrating limb injuries are common and usually heal without long-lasting effects, even when nerves are cut. However, rare nerve-injury patients develop prolonged and disabling chronic pain (neuralgia). When pain severity is disproportionate to severity of the inciting injury, physicians and insurers may suspect exaggeration and limit care or benefits, although the nature of the relationship between lesion-size and the development and persistence of neuralgia remains largely unknown. We compared cellular changes in the spinal dorsal-horn (the initial CNS pain-processing area) after partial or total tibial-nerve axotomies in male Sprague–Dawley rats to determine if these changes are proportional to the numbers of peripheral axons cut. Unoperated rats provided controls. Plantar hind-paw responses to touch, pin, and cold were quantitated bilaterally to identify hyperalgesic rats. We also compared data from nerve-injured rats with or without hyperalgesic responses to mechanical hind-paw stimulation to evaluate concordance between pain behaviors and dorsal-horn cellular changes. Hyperalgesia was no less prevalent or severe after partial than after total axotomy. L5 spinal-cord sections from rats killed 7 days postoperatively were labeled for markers of primary afferents (substance P calcitonin gene-related peptide isolectin B4, gamma aminobutyric acid, and glial fibrillary acidic protein), then labeled cells were stereologically quantitated in somatotopically defined dorsal-horn regions. Total axotomy reduced markers of primary afferents more than partial axotomy. In contrast, GABA-immunoreactive profiles were similarly reduced after both lesions, and in rats with sensory loss versus hyperalgesia. Numbers of GFAP-immunoreactive astrocytes increased independently of lesion size and pain status. Small nerve injuries can thus have magnified and disproportionate effects on dorsal-horn neurons and glia, perhaps providing a biological correlate for the disproportionate pain of post-traumatic neuralgias (including complex regional pain syndrome-I) that follow seemingly minor nerve injuries. However, the presence of similar dorsal-horn changes in rats without pain behaviors suggests that not all transcellular responses to axotomy are pain-specific. PMID:18992304

  15. Biphasic reorganization of somatotopy in the primary motor cortex follows facial nerve lesions in adult rats

    Microsoft Academic Search

    Jozsef Toldia; Rainer Laskawi; Michael Landgrebe; Joachim R. Wolff

    1996-01-01

    Effects of facial nerve transection were studied on muscle responses evoked by electrical stimulation in the primary motor cortex (MI) of adult rats. In intact animals, activated muscles varied according to the somatotopic representation map, and responses were restricted to the contralateral side. Unilateral transection of the facial nerve extinguished contralateral vibrissae responses, while ipsilateral vibrissae began to respond within

  16. Diffusion tensor imaging for anatomical localization of cranial nerves and cranial nerve nuclei in pontine lesions: initial experiences with 3T-MRI.

    PubMed

    Ulrich, Nils H; Ahmadli, Uzeyir; Woernle, Christoph M; Alzarhani, Yahea A; Bertalanffy, Helmut; Kollias, Spyros S

    2014-11-01

    With continuous refinement of neurosurgical techniques and higher resolution in neuroimaging, the management of pontine lesions is constantly improving. Among pontine structures with vital functions that are at risk of being damaged by surgical manipulation, cranial nerves (CN) and cranial nerve nuclei (CNN) such as CN V, VI, and VII are critical. Pre-operative localization of the intrapontine course of CN and CNN should be beneficial for surgical outcomes. Our objective was to accurately localize CN and CNN in patients with intra-axial lesions in the pons using diffusion tensor imaging (DTI) and estimate its input in surgical planning for avoiding unintended loss of their function during surgery. DTI of the pons obtained pre-operatively on a 3Tesla MR scanner was analyzed prospectively for the accurate localization of CN and CNN V, VI and VII in seven patients with intra-axial lesions in the pons. Anatomical sections in the pons were used to estimate abnormalities on color-coded fractional anisotropy maps. Imaging abnormalities were correlated with CN symptoms before and after surgery. The course of CN and the area of CNN were identified using DTI pre- and post-operatively. Clinical associations between post-operative improvements and the corresponding CN area of the pons were demonstrated. Our results suggest that pre- and post-operative DTI allows identification of key anatomical structures in the pons and enables estimation of their involvement by pathology. It may predict clinical outcome and help us to better understand the involvement of the intrinsic anatomy by pathological processes. PMID:24998855

  17. Unilateral Superior Laryngeal Nerve Lesion in an Animal Model of Dysphagia and Its Effect on Sucking and Swallowing

    PubMed Central

    Campbell-Malone, Regina; Holman, Shaina D.; Lukasik, Stacey L.; Fukuhara, Takako; Gierbolini-Norat, Estela M.; Thexton, Allan J.; German, Rebecca Z.

    2013-01-01

    We tested two hypotheses relating to the sensory deficit that follows a unilateral superior laryngeal nerve (SLN) lesion in an infant animal model. We hypothesized that it would result in (1) a higher incidence of aspiration and (2) temporal changes in sucking and swallowing. We ligated the right-side SLN in six 2–3-week-old female pigs. Using videofluoroscopy, we recorded swallows in the same pre- and post-lesion infant pigs. We analyzed the incidence of aspiration and the duration and latency of suck and swallow cycles. After unilateral SLN lesioning, the incidence of silent aspiration during swallowing increased from 0.7 to 41.5 %. The durations of the suck containing the swallow, the suck immediately following the swallow, and the swallow itself were significantly longer in the post-lesion swallows, although the suck prior to the swallow was not different. The interval between the start of the suck containing a swallow and the subsequent epiglottal movement was longer in the post-lesion swallows. The number of sucks between swallows was significantly greater in post-lesion swallows compared to pre-lesion swallows. Unilateral SLN lesion increased the incidence of aspiration and changed the temporal relationships between sucking and swallowing. The longer transit time and the temporal coordinative dysfunction between suck and swallow cycles may contribute to aspiration. These results suggest that swallow dysfunction and silent aspiration are common and potentially overlooked sequelae of unilateral SLN injury. This validated animal model of aspiration has the potential for further dysphagia studies. PMID:23417250

  18. Ulnar-sided wrist pain. II. Clinical imaging and treatment

    PubMed Central

    Watanabe, Atsuya; Souza, Felipe; Vezeridis, Peter S.; Blazar, Philip

    2009-01-01

    Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed. PMID:20012039

  19. Use of ultrasound and fluoroscopy guidance in percutaneous radiofrequency lesioning of the sensory branches of the femoral and obturator nerves.

    PubMed

    Chaiban, Gassan; Paradis, Tyler; Atallah, Joseph

    2014-04-01

    Hip pain is a common condition that is often seen in patients with multiple comorbidities. Often surgery is not an option due to these comorbidities. Percutaneous radiofrequency lesioning of the articular branches of the obturator and femoral nerves is an alternative treatment for hip pain. Traditionally, fluoroscopy is used to guide needle placement. We report a case where a novel approach was used with ultrasound guidance to visualize vascular and soft tissue structures in real time. The use of ultrasound might help to guide the needle to avoid vascular complications due to anatomical variation between patients. PMID:23656575

  20. Imaging the cranial nerves: Part I: Methodology, infectious and inflammatory, traumatic and congenital lesions

    Microsoft Academic Search

    Alexandra Borges; Jan Casselman

    2007-01-01

    Many disease processes manifest either primarily or secondarily by cranial nerve deficits. Neurologists, ENT surgeons, ophthalmologists\\u000a and maxillo-facial surgeons are often confronted with patients with symptoms and signs of cranial nerve dysfunction. Seeking\\u000a the cause of this dysfunction is a common indication for imaging. In recent decades we have witnessed an unprecedented improvement\\u000a in imaging techniques, allowing direct visualization of

  1. Ulnar variance and scaphoid fracture.

    PubMed

    Ramos-Escalona, J; García-Bordes, L; Martínez-Galarza, P; Yunta-Gallo, A

    2010-03-01

    Between 1997 and 2006, radiographs of 66 scaphoid fractures were retrospectively reviewed to evaluate ulnar variance. Twenty-one (31.8%) patients had an 'ulna neutral' wrist, six (9.1%) had an 'ulna plus' and 39 (59.1%) had an 'ulna minus' wrist. The mean ulnar variance was -1.3 (SD 1.8) mm (range -5.5, 2.5). We observed a significant difference in the distribution of ulnar variance (P < 0.00001) and in the proportion of cases with ulna minus (OR = 5.0; 95% CI: 2.7, 9.3) compared to previous publications. PMID:20007423

  2. Sindrome compressiva del nervo ulnare al gomito e al polso

    Microsoft Academic Search

    A. Leti Acciaro; A. Russomando; L. Pegoli; G. Pajardi; A. Landi

    2011-01-01

    \\u000a Abstract  The aim of this article is to underline the main anatomic, aetiopatogenetic, diagnostic and surgical aspects of ulnar nerve\\u000a compression syndrome at the elbow and wrist level. Knowledge of these aspects provides useful guidelines for a prompt diagnosis,\\u000a choosing the most appropriate surgical procedure for treatment.\\u000a \\u000a \\u000a A good clinical examination is the only and most relevant tool for reaching a

  3. Modified Quad surgery significantly improves the median nerve conduction and functional outcomes in obstetric brachial plexus nerve injury

    PubMed Central

    2013-01-01

    Background Nerve conduction studies or somatosensory evoked potentials (SSEPs) have become an important tool in the investigation of peripheral nerve lesions, and is sensitive in detecting brachial plexus nerve injury, and other nerve injuries. To investigate whether the modified Quad surgical procedure improves nerve conductivity and functional outcomes in obstetric brachial plexus nerve injury (OBPI) patients. Methods All nerves were tested with direct functional electrical stimulation. A Prass probe was used to stimulate the nerves, and recording the response, the compound motor action potential (CMAP) in the muscle. SSEP monitoring was performed pre- and post modified Quad surgery, stimulating the median and ulnar nerves at the wrist, the radial nerve over the dorsum of the hand, recording the peripheral, cervical and cortical responses. All patients have had the modified Quad surgery (n?=?19). The modified Quad surgery is a muscle release and transfer surgery with nerve decompressions. All patients were assessed preoperatively and postoperatively by evaluating video recordings of standardized movements, the modified Mallet scale to index active shoulder movements. Results The cervical responses were significantly lower in amplitude in the affected arm than the un-affected arm. The median nerve conduction was significantly improved from 8.04 to 9.26 (P?nerve conduction, and shoulder abduction were significantly improved in OBPI children, who have undergone the modified Quad procedure with neuroplasty, internal microneurolysis and tetanic stimulation of the median nerve. PMID:23714699

  4. Ulnar neuropathy as a result of anconeus epitrochlearis.

    PubMed

    Nellans, Kate; Galdi, Balazs; Kim, H Mike; Levine, William N

    2014-08-01

    After carpal tunnel syndrome, cubital tunnel syndrome is the second most common compression neuropathy in the upper extremity. Various sites of ulnar nerve compression at the elbow exist, with the most common being between the 2 heads of the flexor carpi ulnaris. Other potential sites include the arcade of Struthers, the space between Osborne's ligament and the medial ulnar collateral ligament, the medial epicondyle, the medial head of the triceps, and the medial intermuscular septum. The anconeus epitrochlearis, an anomalous muscle that runs between the medial aspect of the olecranon and the medial epicondyle, is found in up to 28% of cadavers. Although it is far less common, it must be considered when evaluating a patient with cubital tunnel syndrome. The authors report a 19-year-old man with a 2-month history of atraumatic left elbow pain accompanied by distal motor and sensory symptoms that significantly affected his activities of daily living and quality of life. After a short course of conservative management, surgical excision of the anomalous muscle, along with decompression of the ulnar nerve, was performed because of progression of symptoms. The patient had immediate improvement in subjective symptoms and strength on removal of the anconeus epitrochlearis. As shown in this case report, recovery of both motor and sensory nerve function can be achieved if the source of compression is an anomalous muscle and is treated with early surgical removal. PMID:25102512

  5. Role of magnetic resonance imaging in entrapment and compressive neuropathy--what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity.

    PubMed

    Kim, Sungjun; Choi, Jin-Young; Huh, Yong-Min; Song, Ho-Taek; Lee, Sung-Ah; Kim, Seung Min; Suh, Jin-Suck

    2007-02-01

    The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon's canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging. PMID:16572333

  6. Effects of histidine and n-acetylcysteine on experimental lesions induced by doxorubicin in sciatic nerve of rats.

    PubMed

    Farshid, Amir Abbas; Tamaddonfard, Esmaeal; Najafi, Sima

    2014-11-27

    Abstract In this study, the effect of separate and combined intraperitoneal (i.p.) injections of histidine and n-acetylcysteine were investigated on experimental damage induced by doxorubicin (DOX) in sciatic nerve of rats. DOX was i.p. injected at a dose of 4?mg/kg once weekly for four weeks. Histidine and n-acetylcysteine were i.p. injected at a same dose of 20?mg/kg. Cold and mechanical allodynia were recorded using acetone spray and von Frey filaments tests, respectively. The sciatic nerve damage was evaluated by light microscopy. Plasma levels of malondialdehyde (MDA) and total antioxidant capacity (TAC) were measured. Histidine and especially n-acetylcysteine at a same dose of 20?mg/kg suppressed cold and mechanical allodynia, improved sciatic nerve lesions and reversed MDA and TAC levels in DOX-treated groups. Combination treatment with histidine and n-acetylcysteine showed better responses when compared with them used alone. The results of the present study showed peripheral neuroprotective effects for histidine and n-acetylcysteine. Reduction of free radical-induced toxic effects may have a role in neuroprotective properties of histidine and n-acetylcysteine. PMID:25427688

  7. MR demonstration of an anomalous muscle in a patient with coexistent carpal and ulnar tunnel syndrome case report and literature summary

    Microsoft Academic Search

    Jacob Zeiss; Emery Jakab

    1995-01-01

    An aberrant muscle is demonstrated by magnetic resonance (MR) imaging in a patient presenting with focal wrist swelling and compression neuropathy of median and ulnar nerves following 4 months of carpentry work. The muscle originated from the palmaris longus tendon and ulnar antebrachial fascia at the lower half of the forearm as a single belly, then diverged medially from palmaris

  8. Isolated Peripheral Nerve Lesions of the Brachial Plexus Affecting the Shoulder Joint

    Microsoft Academic Search

    ERNEST J. GENTCHOS

    Shoulder pain, weakness, and instability are common findings of nerve entrapment and traumatic and inflammatory le- sions of the brachial plexus. These disorders can be properly di- agnosed with careful clinical examination and electrophysiologic testing. An understanding of the kinesiology of muscles acting on the scapula aids in the diagnosis of patients presenting with muscle atrophy and scapular winging. This

  9. Clinical study of dorsal ulnar artery flap in hand reconstruction

    PubMed Central

    Khan, Manal M.; Yaseen, Mohd.; Bariar, L. M.; Khan, Sheeraz M.

    2009-01-01

    Soft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft. PMID:19881021

  10. Spectrum of Suprascapular Nerve Lesions: Normal and Abnormal Neuromuscular Imaging Appearances on 3-T MR Neurography.

    PubMed

    Ahlawat, Shivani; Wadhwa, Vibhor; Belzberg, Allan J; Batra, Kiran; Chhabra, Avneesh

    2015-03-01

    OBJECTIVE. In this article, we will review the normal anatomy and imaging features of various neuromuscular abnormalities related to suprascapular neuropathy. CONCLUSION. Suprascapular neuropathy can be difficult to distinguish from rotator cuff pathology, plexopathy, and radiculopathy. Electrodiagnostic studies are considered the reference standard for diagnosis; however, high-resolution 3-T MR neurography (MRN) can play an important role. MRN enables direct visualization of the nerve and simultaneous assessment of the cervical spine, brachial plexus, and rotator cuff. PMID:25714290

  11. Expression of major histocompatibility complex antigens on inflammatory peripheral nerve lesions.

    PubMed

    Yu, L T; Rostami, A; Silvers, W K; Larossa, D; Hickey, W F

    1990-12-01

    The expression of major histocompatibility complex (MHC) antigens by cells of the rat peripheral nervous system (PNS) was studied using a model of peripheral nerve transplantation. Monoclonal antibodies to polymorphic determinants of MHC class I and class II (Ia) molecules were used to determine donor or recipient origin of MHC antigen-bearing cells in nerve allografts. The expression of class I and class II antigens by PNS parenchymal cells was modified during varying alloimmune conditions. Baseline, constitutive expression of class I antigens on endothelial and perivascular cells and class II antigens on interstitial cells were identified. Decreased MHC antigen expression was noted following in vitro culture of nerve allografts prior to implantation. After transplantation, enhanced donor-derived MHC antigen expression was demonstrated by both cultured and untreated allograft endothelial, perivascular and interstitial cells in a pattern which was distinct from isografts. This data supports a concept of perivascular monocytic and/or parenchymal cell (Schwann cell or resident macrophage-like cell) activity as the resident antigen-presenting cell for PNS immune processes. PMID:2172305

  12. Overexpression of nerve growth factor in peritoneal fluid from women with endometriosis may promote neurite outgrowth in endometriotic lesions.

    PubMed

    Barcena de Arellano, Maria Luisa; Arnold, Julia; Vercellino, Filiberto; Chiantera, Vito; Schneider, Achim; Mechsner, Sylvia

    2011-03-01

    To investigate the role of the nerve growth factor (NGF) in the endometriosis-associated innervation in the development of endometriosis-associated symptoms, 41 peritoneal fluid samples (PF) from patients with surgically and histologically proven endometriosis and 20 PF from patients with other gynecologic conditions were analyzed with Western blot and a novel in vitro model using dorsal root ganglia (DRG) to show neuronal outgrowth; endometrial cells also were analyzed. The results suggest that the PF of endometriosis patients and endometriotic lesions have neurotropic properties, because the Western blot analysis and the cell culture stainings showed NGF expression, and the neurite outgrowth of DRG treated with PF of patients with endometriosis was significantly higher than when treated with PF of patients without endometriosis. Furthermore, blocking NGF with both anti-NGF and K252a leads to a significant decrease in neurite outgrowth. PMID:21047631

  13. Facial nerve lesion response; strain differences but no involvement of IFN-gamma, STAT4 or STAT6.

    PubMed

    Lidman, Olle; Fraidakis, Matt; Lycke, Nils; Olson, Lars; Olsson, Tomas; Piehl, Fredrik

    2002-09-16

    Facial nerve lesions lead to a retrograde response characterized by activation of glia surrounding axotomized motoneurons and up-regulation of immunological cell surface molecules such as major histocompatibility complex (MHC) antigens. Cytokines, in particular interferon-gamma, are potent inducers of MHC expression and glial activation. We have here tested whether axotomy-induced activation is changed in transgenic mouse strains lacking components of the IFN-gamma signaling pathway, STAT4 or STAT6. No differences regarding astrocyte activation, ss2-microglobulin or MHC class I expression were discernible as compared to wild type controls. In contrast, there were conspicuous differences in the reaction between the examined wild type strains (C57BL/6J, BALB/c and 129/SvJ), suggesting considerable polymorphisms in the genetic regulation of these events, however, not involving IFN-gamma, STAT4 or STAT6. PMID:12352607

  14. Entrapment of motor nerves in motor neuron disease: does double crush occur?

    PubMed Central

    Chaudhry, V; Clawson, L L

    1997-01-01

    OBJECTIVE: To investigate whether "diseased nerves" are more prone to entrapment neuropathy than normal nerves. Nerve conduction studies of human neuropathies have shown that electrophysiological abnormalities are often most prominent at potential sites of nerve entrapment, and entrapments are more common in patients with radiculopathies--a concept designated as "double crush". As entrapment neuropathies commonly occur in otherwise healthy subjects, it is unclear whether this relation is coincidental or whether peripheral nerves affected by disease are rendered more susceptible to effects of repeated minor trauma, traction, or mechanical compression. METHODS: Sequential ulnar nerve conduction studies were prospectively performed at baseline and at four, eight, and 12 month intervals in 16 patients with amyotrophic lateral sclerosis. Ulnar nerve entrapment was defined as a focal reduction (> 10 m/s) in conduction velocity in the across-elbow segment. RESULTS: Ulnar sensory and motor nerve fibres showed similar findings of ulnar nerve entrapment at baseline and at follow up over the period of the study. Nerves with ulnar nerve entrapment showed a significantly greater reduction in distal motor amplitudes than nerves without entrapment, even though distal ulnar sensory amplitudes remained unchanged. CONCLUSIONS: Motor nerves in motor neuron disease do not seem to be more susceptible to entrapment at the elbow than do healthy sensory nerves, thus casting doubt on the double crush hypothesis. Nerves with double pathology (amyotrophic lateral sclerosis and ulnar nerve entrapment), however, seem to undergo more rapid axonal loss than do nerves with single pathology (amyotrophic lateral sclerosis or ulnar nerve entrapment alone). Images PMID:9010403

  15. Volumetric and Horseradish Peroxidase Tracing Analysis of Rat Olfactory Bulb Following Reversible Olfactory Nerve Lesions

    Microsoft Academic Search

    Robert G. Struble; Shari L. Beckman; Elizabeth Fesser; Britto P. Nathan

    2001-01-01

    Olfactory receptor neurons can regenerate from basal stem cells. Receptor neuron lesion causes degenerative changes in the olfactory bulb followed by regeneration as new olfactory receptor axons innervate the olfactory bulb. To our knowledge, parametric analyses of morphometric changes in the olfactory bulb during degeneration and regeneration do not exist except in abstract form. To better characterize olfactory bulb response,

  16. Superficial ulnar artery perforator flap.

    PubMed

    Schonauer, Fabrizio; Marlino, Sergio; Turrà, Francesco; Graziano, Pasquale; Dell'Aversana Orabona, Giovanni

    2014-09-01

    Superficial ulnar artery is a rare finding but shows significant surgical implications. Its thinness and pliability make this flap an excellent solution for soft tissue reconstruction, especially in the head and neck region. We hereby report a successful free superficial ulnar artery perforator forearm flap transfer for tongue reconstruction. A 64-year-old man presenting with a squamous cell carcinoma of the left tongue underwent a wide resection of the tumor, left radical neck dissection, and reconstruction of the tongue and the left tonsillar pillar with the mentioned flap. No complications were observed postoperatively. The flap survived completely; no recurrence at 6 months of follow-up was detected. Superficial ulnar artery perforator flap has shown to be a safe alternative to other free tissue flaps in specific forearm anatomic conditions. PMID:25102397

  17. Dynamic organization of primary motor cortex output to target muscles in adult rats I. Long-term patterns of reorganization following motor or mixed peripheral nerve lesions

    Microsoft Academic Search

    J. N. Sanes; S. Suner; J. P. Donoghue

    1990-01-01

    These experiments examined the ability of the adult motor cortex to reorganize its relationship with somatic musculature following nerve lesions. Cortical motor output organization was assessed by mapping the areal extent of movements evoked by intracortical electrical stimulation in anesthetized rats. Output patterns of the motor cortex of normal rats were compared with those of adult rats that had received

  18. Effect of change in macular birefringence imaging protocol on retinal nerve fiber layer thickness parameters using GDx VCC in eyes with macular lesions.

    PubMed

    Dada, Tanuj; Tinwala, Sana I; Dave, Vivek; Agarwal, Anand; Sharma, Reetika; Wadhwani, Meenakshi

    2014-08-01

    This study evaluates the effect of two macular birefringence protocols (bow-tie retardation and irregular macular scan) using GDx VCC on the retinal nerve fiber layer (RNFL) thickness parameters in normal eyes and eyes with macular lesions. In eyes with macular lesions, the standard protocol led to significant overestimation of RNFL thickness which was normalized using the irregular macular pattern protocol. In eyes with normal macula, absolute RNFL thickness values were higher in irregular macular pattern protocols with the difference being statistically significant for all parameters except for inferior average thickness. This has implications for monitoring glaucoma patients who develop macular lesions during the course of their follow-up. PMID:24469116

  19. Perioperative lesions of the facial nerve: follow-up investigations using transcranial magnetic stimulation

    Microsoft Academic Search

    S. Kotterba; M. Tegenthoff; J.-P. Malin

    1997-01-01

    Peripheral facial palsy can occur after aural surgery and neurosurgery. Routine neurophysiological investigation (utilizing\\u000a electrical stimulation and the blink reflex) does not allow the direct assessment of the site of a lesion. In the present\\u000a study transcranial magnetic stimulation (TMS) was applied in order to evaluate the usefulness of this method for prognosis.\\u000a Twenty-three patients with postoperative facial pareses (after

  20. Slowed motor conduction in lumbosacral nerve roots in cauda equina lesions: a new diagnostic technique

    Microsoft Academic Search

    M Swash; S J Snooks

    1986-01-01

    New techniques have been developed for the electrophysiological assessment of patients with suspected cauda equina lesions using transcutaneous spinal stimulation (500-1500 V: time constant 50 microseconds) to measure motor latencies to the external and sphincter and puborectalis muscles from L1 and L4 vertebral levels. These latencies represent motor conduction in the S3 and S4 motor roots of the cauda equina

  1. Endogenous Prostaglandins and Afferent Sensory Nerves in Gastroprotective Effect of Hydrogen Sulfide against Stress-Induced Gastric Lesions

    PubMed Central

    Magierowski, Marcin; Jasnos, Katarzyna; Kwiecien, Slawomir; Drozdowicz, Danuta; Surmiak, Marcin; Strzalka, Malgorzata; Ptak-Belowska, Agata; Wallace, John L.; Brzozowski, Tomasz

    2015-01-01

    Hydrogen sulfide (H2S) plays an important role in human physiology, exerting vasodilatory, neuromodulatory and anti-inflammatory effects. H2S has been implicated in the mechanism of gastrointestinal integrity but whether this gaseous mediator can affect hemorrhagic lesions induced by stress has been little elucidated. We studied the effect of the H2S precursor L-cysteine, H2S-donor NaHS, the H2S synthesizing enzyme (CSE) activity inhibitor- D,L-propargylglycine (PAG) and the gastric H2S production by CSE/CBS/3-MST activity in water immersion and restraint stress (WRS) ulcerogenesis and the accompanying changes in gastric blood flow (GBF). The role of endogenous prostaglandins (PGs) and sensory afferent nerves releasing calcitonin gene-related peptide (CGRP) in the mechanism of gastroprotection induced by H2S was examined in capsaicin-denervated rats and those pretreated with capsazepine to inhibit activity of vanilloid receptors (VR-1). Rats were pretreated with vehicle, NaHS, the donor of H2S and or L-cysteine, the H2S precursor, with or without the concurrent treatment with 1) nonselective (indomethacin) and selective cyclooxygenase (COX)-1 (SC-560) or COX-2 (rofecoxib) inhibitors. The expression of mRNA and protein for COX-1 and COX-2 were analyzed in gastric mucosa pretreated with NaHS with or without PAG. Both NaHS and L-cysteine dose-dependently attenuated severity of WRS-induced gastric lesions and significantly increased GBF. These effects were significantly reduced by pretreatment with PAG and capsaicin denervation. NaHS increased gastric H2S production via CSE/CBS but not 3-MST activity. Inhibition of COX-1 and COX-2 activity significantly diminished NaHS- and L-cysteine-induced protection and hyperemia. NaHS increased expression of COX-1, COX-2 mRNAs and proteins and raised CGRP mRNA expression. These effects of NaHS on COX-1 and COX-2 protein contents were reversed by PAG and capsaicin denervation. We conclude that H2S exerts gastroprotection against WRS-induced gastric lesions by the mechanism involving enhancement in gastric microcirculation mediated by endogenous PGs, sensory afferent nerves releasing CGRP and the activation of VR-1 receptors. PMID:25774496

  2. Endogenous Prostaglandins and Afferent Sensory Nerves in Gastroprotective Effect of Hydrogen Sulfide against Stress-Induced Gastric Lesions.

    PubMed

    Magierowski, Marcin; Jasnos, Katarzyna; Kwiecien, Slawomir; Drozdowicz, Danuta; Surmiak, Marcin; Strzalka, Malgorzata; Ptak-Belowska, Agata; Wallace, John L; Brzozowski, Tomasz

    2015-01-01

    Hydrogen sulfide (H2S) plays an important role in human physiology, exerting vasodilatory, neuromodulatory and anti-inflammatory effects. H2S has been implicated in the mechanism of gastrointestinal integrity but whether this gaseous mediator can affect hemorrhagic lesions induced by stress has been little elucidated. We studied the effect of the H2S precursor L-cysteine, H2S-donor NaHS, the H2S synthesizing enzyme (CSE) activity inhibitor- D,L-propargylglycine (PAG) and the gastric H2S production by CSE/CBS/3-MST activity in water immersion and restraint stress (WRS) ulcerogenesis and the accompanying changes in gastric blood flow (GBF). The role of endogenous prostaglandins (PGs) and sensory afferent nerves releasing calcitonin gene-related peptide (CGRP) in the mechanism of gastroprotection induced by H2S was examined in capsaicin-denervated rats and those pretreated with capsazepine to inhibit activity of vanilloid receptors (VR-1). Rats were pretreated with vehicle, NaHS, the donor of H2S and or L-cysteine, the H2S precursor, with or without the concurrent treatment with 1) nonselective (indomethacin) and selective cyclooxygenase (COX)-1 (SC-560) or COX-2 (rofecoxib) inhibitors. The expression of mRNA and protein for COX-1 and COX-2 were analyzed in gastric mucosa pretreated with NaHS with or without PAG. Both NaHS and L-cysteine dose-dependently attenuated severity of WRS-induced gastric lesions and significantly increased GBF. These effects were significantly reduced by pretreatment with PAG and capsaicin denervation. NaHS increased gastric H2S production via CSE/CBS but not 3-MST activity. Inhibition of COX-1 and COX-2 activity significantly diminished NaHS- and L-cysteine-induced protection and hyperemia. NaHS increased expression of COX-1, COX-2 mRNAs and proteins and raised CGRP mRNA expression. These effects of NaHS on COX-1 and COX-2 protein contents were reversed by PAG and capsaicin denervation. We conclude that H2S exerts gastroprotection against WRS-induced gastric lesions by the mechanism involving enhancement in gastric microcirculation mediated by endogenous PGs, sensory afferent nerves releasing CGRP and the activation of VR-1 receptors. PMID:25774496

  3. Posttraumatic ulnar neuropathy versus non-traumatic cubital tunnel syndrome: Clinical features and response to surgery

    Microsoft Academic Search

    C. Barrios; C. Ganoza; J. de Pablos; J. Cafiadell

    1991-01-01

    Summary The outcome of 53 patients operated on either for posttraumatic ulnar neuropathy (PUN) or non-traumatic cubital tunnel syndrome (CTS) was reviewed after 3 years follow-up. Results were analyzed and compared considering the surgical technique used (neurolysis versus anterior transposition or combined) and a variety of clinical features that could influence outcome after nerve release. In the whole series, excellent

  4. Unusual presentation of multiple nerve entrapment: a case report

    PubMed Central

    Citisli, Veli; Kocaoglu, Murat; Göcmen, Selcuk; Korucu, Mustafa

    2014-01-01

    Cubital tunnel syndrome is the most common form of ulnar nerve entrapment and the second most common entrapment neuropathy of the upper extremity after carpal tunnel syndrome. However, bilateral compressive ulnar neuropathy is a rare condition. Electro diagnostic studies are a valid and reliable means of confirming the diagnosis.

  5. Lesion-induced increase in nerve growth factor mRNA is mediated by c-fos

    SciTech Connect

    Hengerer, B.; Lindholm, D.; Heumann, R.; Thoenen, H. (Max Planck Institute for Psychiatry, Munich (West Germany)); Ruether, U. (European Molecular Biology Laboratory, Heidelberg (West Germany)); Wagner, E.F. (Research Institute of Molecular Pathology, Vienna (Austria))

    1990-05-01

    Lesion of the sciatic nerve caused a rapid increase in c-fos and c-jun mRNA that was followed about 2 hr later by an increase in nerve growth factor (NGF) mRNA. To evaluate whether the initial increase in c-fos mRNA is casually related to the subsequent increase in NGF mRNA, the authors performed experiments with fibroblasts of transgenic mice carrying an exogenous c-fos gene under the control of a metallothionein promoter. In primary cultures of these fibroblasts, CdCl{sub 2} evoked a rapid increase in exogenous c-fos mRNA, followed immediately by an increase in endogenous c-jun mRNA and with a slight delay by an increase in NGF mRNA. In fibroblasts of C3H control mice, CdCl{sub 2} had no effect on the mRNA levels of the protooncogenes c-fos and c-jun or of NGF. Additional evidence for a casual relationship between c-fos induction and the subsequent increase in NGF mRNA was obtained in cotransfection experiments. DNase I footprint experiments demonstrated that a binding site for transcription factor AP-1 in the first intron of the NGF gene was protected following c-fos induction. That this protected AP-1 site indeed was functional in the regulation of NGF expression was verified by deletion experiments and by a point mutation in the corresponding AP-1 binding region in the NGF promoter-chloramphenicol acetyltransferase reporter construct.

  6. Restoring penis sensation in patients with low spinal cord lesions: The role of the remaining function of the dorsal nerve in a unilateral or bilateral TOMAX procedure.

    PubMed

    Overgoor, Max L E; Braakhekke, Jan P; Kon, Moshe; De Jong, Tom P V M

    2014-01-30

    Aims: The recently developed TOMAX-procedure restores unilateral genital sensation, improving sexual health in men with a low spinal lesion (LSL). It connects one dorsal nerve of the penis (DNP) to the intact ipsilateral ilioinguinal nerve. We proposed bilateral neurotization for full sensation of the glans but this entails cutting both DNPs, risking patients' erection/ejaculation ability. The objective was to select patients for a bilateral TOMAX-procedure by measuring remaining DNP function, and perform the first bilateral cases. PMID:24481885

  7. Low-energy laser action on median and radial nerve post-traumatic lesion after surgical suture

    NASA Astrophysics Data System (ADS)

    Antipa, Ciprian; Bunila, Daniela; Crangulescu, Nicolae; Nacu, Mihaela; Podoleanu, Adrian Gh.; Stanciulescu, Viorica; Vasiliu, Virgil V.

    1996-01-01

    The low energy laser (LEL) biostimulatory effects on nervous tissue regeneration are well known. Thirty two patients with medial and/or radial nerve traumatic forearm lesion after surgical suture were divided into two groups: A-18 patients were treated with LEL; B-14 patients, witness, were treated with placebo lasers and classical medical and physical therapy. Lasers used were: HeNe, 632.5 nm wavelength, 2 mW power, and GaAlAs diode laser, 880 nm wavelength, pulsed emission with an output power 2 mW. Before, during, and after treatment EMG was done in order to measure objectively the efficiency of the treatment. We obtained good results after 4 - 5 months at 14 patients (77.7%) from group A and about the same results at 10 patients (71.3%) from group B, but after at least 8 months the good results were noticed concerning the improvements of EMG registration and on movements and force of the fingers. Finally we can say that the favorable results were obtained in at least twice shorter time with LEL treatment than with classical therapy.

  8. Surgical management of painful peripheral nerves.

    PubMed

    Elliot, David

    2014-07-01

    This article deals with the classification, assessment, and management of painful nerves of the distal upper limb. The author's preferred surgical and rehabilitation techniques in managing these conditions are discussed in detail and include (1) relocation of end-neuromas to specific sites, (2) division and relocation of painful nerves in continuity (neuromas-in-continuity and scar-tethered nerves) involving small nerves to the same sites, and (3) fascial wrapping of painful nerves in continuity involving larger nerves such as the median and ulnar nerves. The results of these treatments are presented as justification for current use of these techniques. PMID:24996473

  9. Cellular lesions in the central nervous system of Periplaneta americana following insecticide treatment in vitro and in vivo. I. Nerve cell bodies and the neuropile.

    PubMed

    Singh, G J; Singh, B

    1984-01-01

    Cellular lesions in the metathoracic ganglion of P. americana following insecticide treatment have been examined. Treatment of the isolated ganglia with dieldrin (10 microM) and bioresmethrin (5 microM) induced mitochondrial damage in the neuropile and nerve cell bodies. The mitochondria in treated nerve cells were swollen with broken cristae and devoid of normal morphological appearance. Following in vivo treatment of cockroaches with these insecticides, this type of mitochondrial damage was observed even at the onset of poisoning. In the prostrate cockroaches, however, the mitochondrial swelling was accompanied by the accumulation of electron dense granules. In addition, the neuropiles of insecticide-treated ganglia contained secondary lysosomes which increased in size and number with the progress of poisoning and showed signs of depletion of synaptic vesicles. The action of dieldrin upon the ultrastructure was completely abolished by pretreatment of ganglia with 10 mM Mg2+. On the other hand, pretreatment of ganglia with tetrodotoxin and pentobarbital-sodium had very little effect on the action of dieldrin though these compounds blocked the action of bioresmethrin. The results of this study suggest that cellular lesions in the insect CNS, caused by dieldrin, are due to an enhanced uptake of calcium into nerve terminals which may occur independent of membrane depolarization. The effects of bioresmethrin upon the ultrastructure of the CNS are apparently mediated by nerve excitation and membrane depolarization. It is concluded that treatment of intact cockroaches with dieldrin and bioresmethrin initiates catabolic processes in the nerve cells leading to cellular lesions which are indicative of neuronal degeneration. PMID:6493424

  10. Ultrasonographic swelling ratio in the diagnosis of ulnar neuropathy at the elbow.

    PubMed

    Yoon, Joon Shik; Walker, Francis O; Cartwright, Michael S

    2008-10-01

    High-resolution ultrasound can demonstrate focal nerve enlargement in entrapment neuropathies. We hypothesized that a ratio between the nerve cross-sectional area at the site of maximal enlargement and at an unaffected site may improve diagnostic accuracy in ulnar neuropathy at the elbow (UNE), when compared to a single measurement at the site of maximal enlargement. Ultrasound was used to measure the cross-sectional area of the ulnar nerve at three sites in 30 normal, healthy controls and 26 individuals with UNE. In individuals with UNE, the ratio was 2.9:1 when the site of maximal swelling was compared with a distal ulnar nerve site and 2.8:1 when compared with a proximal site. This represented a significant increase compared with the ratio of 1.1:1 for both comparisons in controls (P < 0.0001). This type of ratio may be particularly useful for assessing entrapment in those with polyneuropathy or obesity, both of which can cause diffuse nerve enlargement. PMID:18785184

  11. Arthroscopic wafer procedure for ulnar impaction syndrome.

    PubMed

    Colantoni, Julie; Chadderdon, Christopher; Gaston, R Glenn

    2014-02-01

    Ulnar impaction syndrome is abutment of the ulna on the lunate and triquetrum that increases stress and load, causing ulnar-sided wrist pain. Typically, ulnar-positive or -neutral variance is seen on a posteroanterior radiograph of the wrist. The management of ulnar impaction syndrome varies from conservative, symptomatic treatment to open procedures to shorten the ulna. Arthroscopic management has become increasingly popular for management of ulnar impaction with ulnar-positive variance of less than 3 mm and concomitant central triangular fibrocartilage complex tears. This method avoids complications associated with open procedures, such as nonunion and symptomatic hardware. The arthroscopic wafer procedure involves debridement of the central triangular fibrocartilage complex tear, along with debridement of the distal pole of the ulna causing the impaction. Debridement of the ulna arthroscopically is taken down to a level at which the patient is ulnar neutral or slightly ulnar negative. Previous studies have shown good results with relief of patient symptoms while avoiding complications seen with open procedures. PMID:24749031

  12. Granulocyte colony-stimulating factor (G-CSF) positive effects on muscle fiber degeneration and gait recovery after nerve lesion in MDX mice

    PubMed Central

    Simões, Gustavo F; Benitez, Suzana U; Oliveira, Alexandre L R

    2014-01-01

    Background G-CSF has been shown to decrease inflammatory processes and to act positively on the process of peripheral nerve regeneration during the course of muscular dystrophy. Aims The aims of this study were to investigate the effects of treatment of G-CSF during sciatic nerve regeneration and histological analysis in the soleus muscle in MDX mice. Methods Six-week-old male MDX mice underwent left sciatic nerve crush and were G-CSF treated at 7 days prior to and 21 days after crush. Ten and twenty-one days after surgery, the mice were euthanized, and the sciatic nerves were processed for immunohistochemistry (anti-p75NTR and anti-neurofilament) and transmission electron microscopy. The soleus muscles were dissected out and processed for H&E staining and subsequent morphologic analysis. Motor function analyses were performed at 7 days prior to and 21 days after sciatic crush using the CatWalk system and the sciatic nerve index. Results Both groups treated with G-CSF showed increased p75NTR and neurofilament expression after sciatic crush. G-CSF treatment decreased the number of degenerated and regenerated muscle fibers, thereby increasing the number of normal muscle fibers. Conclusions The reduction in p75NTR and neurofilament indicates a decreased regenerative capacity in MDX mice following a lesion to a peripheral nerve. The reduction in motor function in the crushed group compared with the control groups may reflect the cycles of muscle degeneration/regeneration that occur postnatally. Thus, G-CSF treatment increases motor function in MDX mice. Nevertheless, the decrease in baseline motor function in these mice is not reversed completely by G-CSF. PMID:25328849

  13. Injury to ulnar collateral ligament of thumb.

    PubMed

    Madan, Simerjit Singh; Pai, Dinker R; Kaur, Avneet; Dixit, Ruchita

    2014-02-01

    Injury of the ulnar collateral ligament (UCL) of thumb can be incapacitating if untreated or not treated properly. This injury is notorious for frequently being missed by inexperienced health care personnel in emergency departments. It has frequently been described in skiers, but also occurs in other sports such as rugby, soccer, handball, basketball, volleyball and even after a handshake. The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Many treatment options exist, surgical treatment being offered depending on various factors, including timing of presentation (acute or chronic), grade (severity of injury), displacement (Stener lesion), location of tear (mid-substance or peripheral), associated or concomitant surrounding tissue injury (bone, volar plate, etc.), and patient-related factors (occupational demands, etc.). This review aims to identify the optimal diagnostic techniques and management options for UCL injury available thus far. PMID:24590986

  14. Ulnar Neuropathy Around the Mid-Arm Combined with Martin-Gruber Anastomosis

    PubMed Central

    Kim, Bong Joo

    2012-01-01

    This study reports a rare case of ulnar neuropathy around the arm with Martin-Gruber anastomosis of a moderate conduction block in the forearm segment and a severe conduction block in the arm segment. Inching tests and ultrasonography showed a lesion between 12 and 14 cm from the medial epicondyle. It is concluded that axilla stimulation may provide diagnostic clues, and inching tests and ultrasonography may be helpful for localizing a lesion. PMID:23185739

  15. Interaction between selective cyclooxygenase inhibitors and capsaicin-sensitive afferent sensory nerves in pathogenesis of stress-induced gastric lesions. Role of oxidative stress.

    PubMed

    Kwiecien, S; Konturek, P C; Sliwowski, Z; Mitis-Musiol, M; Pawlik, M W; Brzozowski, B; Jasnos, K; Magierowski, M; Konturek, S J; Brzozowski, T

    2012-04-01

    Gastric microcirculation plays an important role in the maintenance of the mucosal gastric integrity and the mechanism of injury as well as providing protection to the gastric mucosa. Disturbances in the blood perfusion, through the microcapillaries within the gastric mucosa may result in the formation of mucosal damage. Acute gastric mucosal lesions constitute an important clinical problem. Originally, one of the essential component of maintaining the gastric mucosal integrity was the biosynthesis of prostaglandins (PGs), an issue that has captured the attention of numerous investigations. PGs form due to the activity of cyclooxygenase (COX), an enzyme which is divided into 2 isoforms: constitutive (COX-1) and inducible (COX-2) ones. The inhibition of COX-1 by SC-560, or COX-2 by rofecoxib, reduces gastric blood flow (GBF) and impairs gastric mucosal integrity. Another detrimental effect on the gastric mucosal barrier results from the ablation of sensory afferent nerves by neurotoxic doses of capsaicin. Functional ablation of the sensory afferent nerves by capsaicin attenuates GBF and also renders the gastric mucosa more susceptible to gastric mucosal damage induced by ethanol, aspirin and stress. However, the role of reactive oxygen species (ROS) in the interaction between COX specific inhibitors and afferent sensory nerves has not been extensively studied. The aim of our present study was to determine the participation of ROS in pathogenesis of stress-induced gastric lesions in rats administered with SC-560 or rofecoxib, with or without ablation of the sensory afferent nerves. ROS were estimated by measuring the gastric mucosal tissue level of MDA and 4-HNE, the products of lipid peroxidation by ROS as well as the SOD activity and reduced glutathione (GSH) levels, both considered to be scavengers of ROS. It was demonstrated that exposure to 3.5 h of WRS resulted in gastric lesions, causing a significant increase of MDA and 4-HNE in the gastric mucosa, accompanied by a decrease of SOD activity and mucosal GSH level. Pretreatment with COX-1 and COX-2 inhibitors (SC-560 and rofecoxib, respectively) aggravated the number of gastric lesions, decreased GBF, attenuated GSH level without further significant changes in MDA and 4-HNE tissue levels and SOD activity. Furthermore, the capsaicin--nactivation of sensory nerves resulted in exaggeration of gastric mucosal damage induced by WRS and this was further augmented by rofecoxib. We conclude that oxidative stress, as reflected by an increase of MDA and 4-HNE tissue concentrations (an index of lipid peroxidation), as well as decrease of SOD activity and the fall in GSH tissue level, may play an important role in the mechanism of interaction between the inhibition of COX activity and afferent sensory nerves releasing vasoactive neuropeptides. This is supported by the fact that the addition of specific COX-1 or COX-2 inhibitors to animals with capsaicin denervation led to exacerbation of gastric lesions, and further fall in the antioxidizing status of gastric mucosa exposed to stress. PMID:22653901

  16. Grapefruit-seed extract attenuates ethanol-and stress-induced gastric lesions via activation of prostaglandin, nitric oxide and sensory nerve pathways

    PubMed Central

    Brzozowski, Tomasz; Konturek, Peter C; Drozdowicz, Danuta; Konturek, Stanislaw J; Zayachivska, Oxana; Pajdo, Robert; Kwiecien, Slawomir; Pawlik, Wieslaw W; Hahn, Eckhart G

    2005-01-01

    AIM: Grapefruit-seed extract (GSE) containing flavonoids, possesses antibacterial and antioxidative properties but whether it influences the gastric defense mechanism and gastroprotection against ethanol- and stress-induced gastric lesions remains unknown. METHODS: We compared the effects of GSE on gastric mucosal lesions induced in rats by topical application of 100% ethanol or 3.5 h of water immersion and restraint stress (WRS) with or without (A) inhibition of cyclooxygenase (COX)-1 activity by indomethacin and rofecoxib, the selective COX-2 inhibitor, (B) suppression of NO-synthase with L-NNA (20 mg/kg ip), and (C) inactivation by capsaicin (125 mg/kg sc) of sensory nerves with or without intragastric (ig) pretreatment with GSE applied 30 min prior to ethanol or WRS. One hour after ethanol and 3.5 h after the end of WRS, the number and area of gastric lesions were measured by planimetry, the gastric blood flow (GBF) was assessed by H2-gas clearance technique and plasma gastrin levels and the gastric mucosal generation of PGE2, superoxide dismutase (SOD) activity and malonyldialdehyde (MDA) concentration, as an index of lipid peroxidation were determined. RESULTS: Ethanol and WRS caused gastric lesions accompanied by the significant fall in the GBF and SOD activity and the rise in the mucosal MDA content. Pretreatment with GSE (8-64 mg/kg i g) dose-dependently attenuated gastric lesions induced by 100% ethanol and WRS; the dose reducing these lesions by 50% (ID50) was 25 and 36 mg/kg, respectively, and this protective effect was similar to that obtained with methyl PGE2 analog (5 ?g/kg i g). GSE significantly raised the GBF, mucosal generation of PGE2, SOD activity and plasma gastrin levels while attenuating MDA content. Inhibition of PGE2 generation with indomethacin or rofecoxib and suppression of NO synthase by L-NNA or capsaicin denervation reversed the GSE-induced protection and the accompanying hyperemia. Co-treatment of exogenous calcitonine gene-related peptide (CGRP) with GSE restored the protection and accompanying hyperemic effects of GSE in rats with capsaicin denervation. CONCLUSION: GSE exerts a potent gastroprotective activity against ethanol and WRS-induced gastric lesions via an increase in endogenous PG generation, suppression of lipid peroxidation and hyperemia possibly mediated by NO and CGRP released from sensory nerves. PMID:16425415

  17. Peripheral Nerve Entrapment Syndromes in Chronic Hemodialysis Patients

    Microsoft Academic Search

    James A. Delmez; Barbel Holtmann; Gregorio A. Sicard; Andrew P. Goldberg; Herschel R. Harter

    1982-01-01

    15 of 271 patients (6%) treated with chronic hemodialysis developed peripheral nerve entrapment syndrome of the median or the ulnar nerve. The majority of these patients were female (p < 0.03). Fistulas located in arms with nerve entrapment tended to have higher flow rates than fistulas located in arms without nerve entrapment (57% vs. 4.4%, p < 0.001). There was

  18. Nerve entrapment syndromes in musicians.

    PubMed

    Wilson, Robert J; Watson, Jeffry T; Lee, Donald H

    2014-09-01

    Nerve entrapment syndromes are common in instrumental musicians. Carpal tunnel syndrome, ulnar neuropathy at the elbow, and thoracic outlet syndrome appear to be the most common. While electrodiagnostic studies may confirm the diagnosis of nerve entrapment, they may be falsely normal in musicians. Non-operative treatment with instrument and technique modification may help. Involvement with the musician's teacher to implement appropriate treatment is recommended. Outcomes for both non-operative and operative treatment for various nerve entrapment syndromes have yielded mostly good to excellent results, similar to the general population. PMID:24644143

  19. Synthesis and localization of ciliary neurotrophic factor in the sciatic nerve of the adult rat after lesion and during regeneration

    Microsoft Academic Search

    M. Sendtner; K. A. Stiickli; H. Thoenen

    1992-01-01

    Ciliary neurotrophic factor (CNTF) is ex- pressed in high quantifies in Schwann cells of periph- eral nerves during postnatal development of the rat. The absence of a hydrophobic leader sequence and the immunohistochemical localization of CNTF within the cytoplasm of these cells indicate that the factor might not be available to responsive neurons under physio- logical conditions. However, CNTF supports

  20. The Effect of Bilateral Superior Laryngeal Nerve Lesion on Swallowing – A Novel Method to Quantitate Aspirated Volume and Pharyngeal Threshold in Videofluoroscopy

    PubMed Central

    DING, Peng; FUNG, George Shiu-Kai; LIN, Ming De; HOLMAN, Shaina D.; GERMAN, Rebecca Z.

    2015-01-01

    Purpose To determine the effect of bilateral superior laryngeal nerve (SLN) lesion on swallowing threshold volume and the occurrence of aspiration, using a novel measurement technique for videofluorscopic swallowing studies (VFSS). Methods and Materials We used a novel radiographic phantom to assess volume of the milk containing barium from fluoroscopy. The custom made phantom was firstly calibrated by comparing image intensity of the phantom with known cylinder depths. Secondly, known volume pouches of milk in a pig cadaver were compared to volumes calculated with the phantom. Using these standards, we calculated the volume of milk in the valleculae, esophagus and larynx, for 205 feeding sequences from four infant pigs feeding before and after had bilateral SLN lesions. Swallow safety was assessed using the IMPAS scale. Results The log-linear correlation between image intensity values from the phantom filled with barium milk and the known phantom cylinder depths was strong (R2>0.95), as was the calculated volumes of the barium milk pouches. The threshold volume of bolus in the valleculae during feeding was significantly larger after bilateral SLN lesion than in control swallows (p<0.001). The IMPAS score increased in the lesioned swallows relative to the controls (p<0.001). Conclusion Bilateral SLN lesion dramatically increased the aspiration incidence and the threshold volume of bolus in valleculae. The use of this phantom permits quantification of the aspirated volume of fluid. The custom made phantom and calibration allow for more accurate 3D volume estimation from 2D x-ray in VFSS. PMID:25270532

  1. Diagnostic specificity of sensory and motor nerve conduction variables in early detection of carpal tunnel syndrome

    Microsoft Academic Search

    R. Cioni; S. Passero; C. Paradiso; F. Giannini; N. Battistini; G. Rushworth

    1989-01-01

    In the carpal tunnel syndrome (CTS) sensory nerve conduction is more sensitive than motor conduction. However, 8%–25% of the sensory distal latencies in symptomatic hands may still be normal. A systematic study was made of the median, ulnar and radial orthodromic nerve conduction velocities (SNCV) stimulating each of the fingers separately. Four SNCVs from the median nerve, two SNCVs from

  2. Complication avoidance in peripheral nerve surgery: injuries, entrapments, and tumors of the extremities--part 2.

    PubMed

    Russell, Stephen M; Kline, David G

    2006-10-01

    The goal of this two-part review is to discuss peripheral nerve surgery complications, along with the techniques and principles used to prevent them. In this second article, we concentrate on injuries, tumors, and entrapment of nerves in the extremities, including carpal tunnel syndrome and ulnar nerve compression at the elbow. PMID:17041516

  3. Acute Grade III ulnar collateral ligament rupturesA new surgical and rehabilitation protocol

    Microsoft Academic Search

    1991-01-01

    A review is presented here of 36 cases, seen since 1980, of acute Grade III (unstable) sports-related sprains of the thumb metacarpophalangeal joint. In all cases, the injury involved the ulnar collateral ligament. A Stener lesion was present in 97% of cases. Followup was from 2.0 to 8.5 years, the average being 3.9 years. All of the patients underwent repeat

  4. Silicone rubber distal ulnar replacement arthroplasty.

    PubMed

    Sagerman, S D; Seiler, J G; Fleming, L L; Lockerman, E

    1992-12-01

    We retrospectively reviewed 42 patients who underwent resection of the distal ulna with implantation of a silicone rubber ulnar head prosthesis (45 wrists). Two prostheses were used: the original Swanson prosthesis, and a prosthesis of our own design. Follow-up X-rays showed migration or breakage of 63% of the prostheses. No statistically significant correlation existed between the quality of functional outcome and the integrity of the prostheses. There was no significant difference between pre-operative and post-operative range of motion for the entire group or between patients with broken or intact prostheses. Histological confirmation of silicone synovitis was documented in one patient who required implant removal. We suggest that destabilization and breakage of prostheses result from fatigue failure secondary to the torque generated at the distal radio-ulnar joint during repeated pronation and supination. Use of a silicone rubber ulnar head prosthesis following distal ulna resection is not recommended. PMID:1484256

  5. Nerve sheath ganglion of the tibial nerve presenting as a Baker's cyst: a case report.

    PubMed

    Tseng, Kuo-Fung; Hsu, Horng-Chaung; Wang, Fu-Cheng; Fong, Yi-Chin

    2006-09-01

    Nerve sheath ganglion is a relatively rare clinical entity commonly found in the peroneal nerve in the lower limb or the ulnar nerve in the upper extremity. It is rarely found in the tibial nerve. The occurrence of a nerve sheath ganglion in a patient's tibial nerve has been identified. The initial presentation of the tumor mass has been very similar to that of a Baker's cyst, namely a soft undulating popliteal mass. Yet, the case also presented symptoms and signs of tibial nerve compressive neuropathy. We present here a rare case of nerve sheath ganglion of the tibial nerve. Clinical courses of the patient were reviewed, and relevant issues were discussed with a thorough literature review. PMID:16570194

  6. [Ulnar dimelia: Management of a rare malformation].

    PubMed

    Irani, Y; Salazard, B; Jouve, J-L

    2007-12-01

    Mirror hand is a rare congenital deformity of the upper limb which is characterized by duplication of the ulna (ulnar dimelia), absence of the radius and polydactyly. The authors report a case of ulnar dimelia with treatment of the of the elbow stiffness by surgery and splinting, and the flexed radial club hand deformity of the wrist solely by early splinting. This treatment was performed both before and after pollicization which was performed at 12 months. The stiffness of the elbow and wrist is very difficult to treat and remains a major problem whereas pollicization is now an established and successful means of treating the hand deformity. PMID:18032085

  7. Infraclavicular Ulnar Nerve Entrapment Due to a Chondroepitrochlearis Muscle

    Microsoft Academic Search

    R. J. SPINNER; S. W. CARMICHAEL; M. SPINNER

    1991-01-01

    The chondroepitrochlearis muscle is an extremely rare muscle, arising from the pectoralis major, crossing over the neurovascular bundle in the axilla and inserting into the brachial fascia and medial epicondyle of the humerus. This paper presents the first known neurological complication due to the chondroepitrochlearis muscle.

  8. Anterior interosseous nerve syndrome

    PubMed Central

    Bäumer, Philipp; Meinck, Hans-Michael; Schiefer, Johannes; Weiler, Markus; Bendszus, Martin; Kele, Henrich

    2014-01-01

    Objective: We sought to determine lesion sites and spatial lesion patterns in spontaneous anterior interosseous nerve syndrome (AINS) with high-resolution magnetic resonance neurography (MRN). Methods: In 20 patients with AINS and 20 age- and sex-matched controls, MRN of median nerve fascicles was performed at 3T with large longitudinal anatomical coverage (upper arm/elbow/forearm): 135 contiguous axial slices (T2-weighted: echo time/repetition time 52/7,020 ms, time of acquisition: 15 minutes 48 seconds, in-plane resolution: 0.25 × 0.25 mm). Lesion classification was performed by visual inspection and by quantitative analysis of normalized T2 signal after segmentation of median nerve voxels. Results: In all patients and no controls, T2 lesions of individual fascicles were observed within upper arm median nerve trunk and strictly followed a somatotopic/internal topography: affected were those motor fascicles that will form the anterior interosseous nerve further distally while other fascicles were spared. Predominant lesion focus was at a mean distance of 14.6 ± 5.4 cm proximal to the humeroradial joint. Discriminative power of quantitative T2 signal analysis and of qualitative lesion rating was high, with 100% sensitivity and 100% specificity (p < 0.0001). Fascicular T2 lesion patterns were rated as multifocal (n = 17), monofocal (n = 2), or indeterminate (n = 1) by 2 independent observers with strong agreement (kappa = 0.83). Conclusion: It has been difficult to prove the existence of fascicular/partial nerve lesions in spontaneous neuropathies using clinical and electrophysiologic findings. With MRN, fascicular lesions with strict somatotopic organization were observed in upper arm median nerve trunks of patients with AINS. Our data strongly support that AINS in the majority of cases is not a surgically treatable entrapment neuropathy but a multifocal mononeuropathy selectively involving, within the main trunk of the median nerve, the motor fascicles that continue distally to form the anterior interosseous nerve. PMID:24415574

  9. Osteotomy for sigmoid notch obliquity and ulnar positive variance.

    PubMed

    Dickson, Lisa M; Tham, Stephen K Y

    2014-02-01

    Background?Several causes of ulnar wrist pain have been described. One uncommon cause is ulnar carpal abutment associated with a notable distally facing sigmoid notch (reverse obliquity). Such an abnormality cannot be treated with ulnar shortening alone because it will result in incongruity of the distal radioulnar joint (DRUJ). Case Description?A 23-year-old woman presented with ulnar wrist pain aggravated by forearm rotation. Ten years earlier she had sustained a distal radius fracture that was conservatively treated. Examination revealed mild tenderness at the DRUJ and decreased wrist flexion and grip strength on the affected side. Radiographic examination demonstrated 1 cm ulnar positive variance, ulnar styloid nonunion, and a 37° reverse obliquity of the sigmoid notch. The patient was treated with ulnar shortening and rotation sigmoid notch osteotomy to realign the sigmoid notch with the ulnar head. Literature Review?Sigmoid notch incongruity is one of several causes of wrist pain after distal radius fracture. Traditional salvage options for DRUJ arthritis may result in loss of grip strength, painful ulnar shaft instability, or reossification and are not acceptable options in the young patient. Sigmoid notch osteotomy or osteoplasty have been described to correct the shape of the sigmoid notch in the axial plane. Clinical Relevance?We report a coronal plane osteotomy of the sigmoid notch to treat reverse obliquity of the sigmoid notch associated with ulnar carpal abutment. The rotation osteotomy described is particularly useful for patients in whom a salvage procedure is not warranted. PMID:24533247

  10. Osteotomy for Sigmoid Notch Obliquity and Ulnar Positive Variance

    PubMed Central

    Dickson, Lisa M.; Tham, Stephen K. Y.

    2014-01-01

    Background?Several causes of ulnar wrist pain have been described. One uncommon cause is ulnar carpal abutment associated with a notable distally facing sigmoid notch (reverse obliquity). Such an abnormality cannot be treated with ulnar shortening alone because it will result in incongruity of the distal radioulnar joint (DRUJ). Case Description?A 23-year-old woman presented with ulnar wrist pain aggravated by forearm rotation. Ten years earlier she had sustained a distal radius fracture that was conservatively treated. Examination revealed mild tenderness at the DRUJ and decreased wrist flexion and grip strength on the affected side. Radiographic examination demonstrated 1 cm ulnar positive variance, ulnar styloid nonunion, and a 37° reverse obliquity of the sigmoid notch. The patient was treated with ulnar shortening and rotation sigmoid notch osteotomy to realign the sigmoid notch with the ulnar head. Literature Review?Sigmoid notch incongruity is one of several causes of wrist pain after distal radius fracture. Traditional salvage options for DRUJ arthritis may result in loss of grip strength, painful ulnar shaft instability, or reossification and are not acceptable options in the young patient. Sigmoid notch osteotomy or osteoplasty have been described to correct the shape of the sigmoid notch in the axial plane. Clinical Relevance?We report a coronal plane osteotomy of the sigmoid notch to treat reverse obliquity of the sigmoid notch associated with ulnar carpal abutment. The rotation osteotomy described is particularly useful for patients in whom a salvage procedure is not warranted. PMID:24533247

  11. A sensitive new median-ulnar technique for diagnosing mild Carpal Tunnel Syndrome.

    PubMed

    Bodofsky, E B; Wu, K D; Campellone, J V; Greenberg, W M; Tomaio, A C

    2005-01-01

    Carpal Tunnel Syndrome (CTS) is easily the most common focal peripheral nerve compression. The primary diagnostic tool is electrodiagnosis, although 13-27% of patients with symptoms and signs of CTS have normal electrodiagnostic results. The goal of this study was to create a more sensitive and specific latency difference criteria without any additional testing beyond the minimum. Statistical theory indicates that this would occur by comparing the latency most sensitive to CTS to the least sensitive latency. Data was evaluated from 68 normal hands, 23 hands of patients with symptoms and signs of CTS but normal standard results, and 88 hands of patients with CTS symptoms and signs of CTS with the diagnosis confirmed with standard criteria. The Median Sensory latency was the most sensitive parameter, while the Ulnar Motor Latency varied least in the presence of CTS, making the (Median Sensory-Ulnar Motor) latency difference the criteria of choice. Setting a cutoff value of 0.8 msecs for this difference correctly classified all normals, and all hands with CTS by standard criteria, and classified as abnormal 19/23 (82%) of hands with symptoms and signs of CTS but negative results by standard criteria. Overall the (Median Sensory-Ulnar Motor) Latency difference is a simple, easy, sensitive and specific test for CTS. PMID:15981684

  12. Clinical strategies to enhance nerve regeneration in composite tissue allotransplantation.

    PubMed

    Glaus, Simone W; Johnson, Philip J; Mackinnon, Susan E

    2011-11-01

    Reinnervation of a hand transplant ultimately dictates functional recovery but provides a significant regenerative challenge. This article highlights interventions to enhance nerve regeneration through acceleration of axonal regeneration or augmentation of Schwann cell support and discuss their relevance to composite tissue allotransplantation. Surgical techniques that may be performed at the time of transplantation to optimize intrinsic muscle recovery--including appropriate alignment of ulnar nerve motor and sensory components, transfer of the distal anterior interosseous nerve to the recurrent motor branch of the median nerve, and prophylactic release of potential nerve entrapment points--are also presented. PMID:22051390

  13. Nerve injuries in the throwing elbow.

    PubMed

    Keefe, Daniel T; Lintner, David M

    2004-10-01

    The unique anatomy of the elbow combined with the angular velocity and stresses placed across this hinge joint while throwing can cause a large number of pathologic changes associated with nerves. Although the ulnar nerve is the most commonly injured, neuropathies are also seen with the branches of the median and radial nerves. These neuropathies are typically responsive to rest, activity modification, ice, splinting, and anti-inflammatories. A graduated return to throwing is then needed before returning to play. When conservative measures fail, surgical decompression is warranted, but results have been less than perfect. PMID:15474232

  14. Repeatability of Nerve conduction Measurements using Automation

    Microsoft Academic Search

    Xuan Kong; Eugene A. Lesser; J. Thomas Megerian; Shai N. Gozani

    2006-01-01

    Objective  To quantify nerve conduction study (NCS) reproducibility utilizing an automated NCS system (NC-stat®, NeuroMetrix, Inc.).\\u000a \\u000a \\u000a \\u000a Method  Healthy volunteers without neuropathic symptoms participated in the study. Their median, ulnar, peroneal, and tibial nerves\\u000a were tested twice (7 days apart) by the same technician with an NC-stat® instrument. Pre-fabricated electrode arrays specific to each nerve were used. Both motor responses (compound motor action\\u000a potential

  15. 21 CFR 888.3810 - Wrist joint ulnar (hemi-wrist) polymer prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...Wrist joint ulnar (hemi-wrist) polymer prosthesis. 888.3810 Section...Wrist joint ulnar (hemi-wrist) polymer prosthesis. (a) Identification...wrist joint ulnar (hemi-wrist) polymer prosthesis is a...

  16. Natural history of ulnar entrapment at elbow

    Microsoft Academic Search

    L. Padua; I. Aprile; P. Caliandro; M. Foschini; S. Mazza; P. Tonali

    2002-01-01

    Objective: No clinical–neurophysiological data on natural history of ulnar neuropathy at elbow (UNE) are reported. The aim of the current study is to assess the course of untreated UNE.Methods: We performed a follow-up at 1 year of 30 neurophysiologically positive UNE, 24 were untreated and 6 were operated on. The evaluation was based on a phone interview and sometimes on

  17. Cubital Tunnel Syndrome: Anterior Transposition as a Logical Approach to Complete Nerve Decompression

    Microsoft Academic Search

    William B. Kleinman

    1999-01-01

    In it's native position, deep to Osborne's ligament, within the retrocondylar groove of the elbow, the ulnar nerve courses with a significant lever distance posterior to the elbow axis of rotation. In this position, flexion of the elbow places longitudinal traction and local compression forces on the nerve. This biomechanical consideration, as well as variations in anatomy, may potentially contribute

  18. Electrophysiological findings in entrapment of the median nerve at wrist and elbow

    Microsoft Academic Search

    Fritz Buchthal; Annelise Rosenfalck; Werner Trojaborg

    1974-01-01

    In 117 consecutive patients with carpal tunnel syndrome and 11 patients with a compression syndrome of the median nerve at elbow, motor and sensory conduction along the median and ulnar nerves and quantitative electromyography were compared with findings in 190 normal controls of the same age. In 25% of patients with carpal tunnel syndrome in whom motor conduction and EMG

  19. Upper extremity peripheral nerve entrapments among wheelchair athletes: prevalence, location, and risk factors.

    PubMed

    Burnham, R S; Steadward, R D

    1994-05-01

    Wheelchair athletes commonly experience hand pain and numbness. This investigation studied the prevalence, location, and risk factors of upper extremity peripheral nerve entrapment among wheelchair athletes. Clinical and electrodiagnostic assessments were performed on both upper extremities of 28 wheelchair athletes and 30 able-bodied controls. Included in the assessment were short-segment stimulation techniques of the median nerve across the carpal tunnel and the ulnar nerve across the elbow. By clinical criteria, the prevalence of nerve entrapment among the wheelchair athletes was 23%, whereas it was 64% electrodiagnostically. The most common electrodiagnostic dysfunction was of the median nerve at the carpal tunnel (46%), and the portion of the nerve within the proximal carpal tunnel was most frequently affected. Ulnar neuropathy was the second most common entrapment electrodiagnostically (39%) and occurred at the wrist and forearm segments. Disability duration correlated significantly with electrophysiologic median nerve dysfunction. PMID:8185443

  20. [Nerve injuries in children].

    PubMed

    Legré, R; Iniesta, A; Toméi, F; Gay, A

    2013-09-01

    Management of peripheral nerve lesions in children does not differ fundamentally from that in adults. Nevertheless, difficulty to perform an extensive clinical examination can explain initial misdiagnosis and postoperative follow up can be tricky. The poor compliance of the children in the postoperative care makes a postoperative immobilization mandatory. If the peripheral nerve injuries involving children have a better prognosis reputation than in adults, fundamental studies results do not comfort this conventional wisdom, but rather claim for a better adaptability of the child to the relapses left by the peripheral nerves lesions. PMID:23751426

  1. The impact and specificity of nerve perturbation on novel vibrotactile sensory letter learning.

    PubMed

    Passmore, Steven R; Bosse, Jessica; Murphy, Bernadette; Lee, Timothy D

    2014-12-01

    The purposes of this study were to determine if induced radiating paresthesia interferes with (a) acquisition and/or (b) utilization of complex tactile information, and (c) identify whether interference reflects tactile masking or response competition. Radiating ulnar (experiment 1) and median (experiment 2) nerve paresthesia was quantified on ulnar innervated vibrotactile Morse code letter acquisition and recollection tasks. Induced paresthesia differentially impacted letter acquisition and recollection, but only when presented to the same anatomical spatial location. PMID:24844345

  2. Diffusion tensor imaging of peripheral nerves

    Microsoft Academic Search

    Sachin Jambawalikar; Jeremy Baum; Terry Button; Haifang Li; Veronica Geronimo; Elaine S. Gould

    2010-01-01

    Magnetic resonance diffusion tensor imaging (DTI) allows the directional dependence of water diffusion to be studied. Analysis\\u000a of the resulting image data allows for the determination of fractional anisotropy (FA), apparent diffusion coefficient (ADC),\\u000a as well as allowing three-dimensional visualization of the fiber tract (tractography). We visualized the ulnar nerve of ten\\u000a healthy volunteers with DTI. We found FA to

  3. Techniques of peripheral nerve repair.

    PubMed

    Dahlin, L B

    2008-01-01

    Nerve injuries extend from simple nerve compression lesions to complete nerve injuries and severe lacerations of the nerve trunks. A specific problem is brachial plexus injuries where nerve roots can be ruptured, or even avulsed from the spinal cord, by traction. An early and correct diagnosis of a nerve injury is important. A thorough knowledge of the anatomy of the peripheral nerve trunk as well as of basic neurobiological alterations in neurons and Schwann cells induced by the injury are crucial for the surgeon in making adequate decisions on how to repair and reconstruct nerves. The technique of peripheral nerve repair includes four important steps (preparation of nerve end, approximation, coaptation and maintenance). Nerves are usually repaired primarily with sutures applied in the different tissue components, but various tubes are available. Nerve grafts and nerve transfers are alternatives when the injury induces a nerve defect. Timing of nerve repair is essential. An early repair is preferable since it is advantageous for neurobiological reasons. Postoperative rehabilitation, utilising the patients' own coping strategies, with evaluation of outcome are additional important steps in treatment of peripheral nerve injuries. in the rehabilitation phase adequate handling of pain, allodynia and cold intolerance are emphasised. PMID:19211385

  4. Massive peripheral nerve hypertrophy in a patient with chronic inflammatory demyelinating polyradiculoneuropathy.

    PubMed

    Albini Riccioli, L; D'Agostino, V; Marliani, A F; Leonardi, M

    2008-02-18

    We describe a male patient with chronic inflammatory demyelinating polyradiculoneuropathy presenting extensive diffuse hypertrophy of the nerve roots of peripheral nerves. Since adolescence the patient has had a slow and progressive mainly distal loss of sensitivity and muscle weakness in all four limbs. He presented with diffuse muscle atrophy with enlarged palpable nerve trunks. Electromyography disclosed impaired sensory and motor responses in the bilateral median nerves and the right ulnar nerve. CSF examination showed elevated protein content, while MR scans depicted extensive hypertrophy of the spinal nerve roots. The patient benefitted from corticosteroid treatment. PMID:24256758

  5. Nerve conduction studies in early tuberculoid leprosy

    PubMed Central

    Vashisht, Deepak; Das, Arjun Lal; Vaishampayan, Sanjeev S; Vashisht, Surbhi; Joshi, Rajneesh

    2014-01-01

    Context: Hansen's disease is a chronic illness; besides involving skin and peripheral nerves, it affects multiple organs. Nerve involvement is always present in leprosy, and it may be present much before the patient manifests clinically. Aims: To assess nerve conduction parameters in thickened and contralateral non-thickened nerves in early tuberculoid leprosy Materials and Methods: Fifty new untreated male patients with tuberculoid and borderline tuberculoid leprosy in the age group of 15-50 years with thickened peripheral nerves on one side were included in the study. Nerve conduction studies consisting of sensory and motor velocity (NCV), distal latencies, and amplitude were carried out on thickened ulnar, common peroneal, and posterior tibial nerves and contralateral normal nerves. Statistical Analysis Used: Mean values along with coefficient of variation were obtained for various parameters. These were compared with normal values of the control population. P value was used to verify statistical significance. Results: Nerve conduction parameters were deranged in most of the thickened nerves. Sensory parameters were affected early in the disease process. Conclusion: Additional parameters are required to assess nerve damage in early cases, where it is more in slow conducting fibers (average velocity fibers). Change in conduction velocity may not be marked; this calls for the measurement of fast fibers separately because potentials recorded are mainly from myelinated fibers. PMID:25593812

  6. Peripheral nerve lengthening as a regenerative strategy

    PubMed Central

    Vaz, Kenneth M.; Brown, Justin M.; Shah, Sameer B.

    2014-01-01

    Peripheral nerve injury impairs motor, sensory, and autonomic function, incurring substantial financial costs and diminished quality of life. For large nerve gaps, proximal lesions, or chronic nerve injury, the prognosis for recovery is particularly poor, even with autografts, the current gold standard for treating small to moderate nerve gaps. In vivo elongation of intact proximal stumps towards the injured distal stumps of severed peripheral nerves may offer a promising new strategy to treat nerve injury. This review describes several nerve lengthening strategies, including a novel internal fixator device that enables rapid and distal reconnection of proximal and distal nerve stumps. PMID:25317163

  7. Functional outcome of nerve transfer for restoration of shoulder and elbow function in upper brachial plexus injury

    Microsoft Academic Search

    Hari Venkatramani; Praveen Bhardwaj; Sajedur Reza Faruquee; S Raja Sabapathy

    2008-01-01

    BACKGROUND: Purpose of this study was to evaluate the functional outcome of spinal accessory to suprascapular nerve transfer (XI-SSN) done for restoration of shoulder function and partial transfer of ulnar nerve to the motor branch to the biceps muscle for the recovery of elbow flexion (Oberlin transfer). METHODS: This is a prospective study involving 15 consecutive cases of upper plexus

  8. Variation in the hypothenar muscles and its impact on ulnar tunnel syndrome.

    PubMed

    Claassen, Horst; Schmitt, Oliver; Schulze, Marko; Wree, Andreas

    2013-12-01

    Compression of the ulnar nerve at Guyon's canal can be caused not only by tumor-like structures, a fibrotic arch, a ganglion, lipoma, aneurysm or thrombosis but also by anomalous hypothenar muscles which are reviewed here. For the search of relevant papers, PubMed and crucial anatomical textbooks were consulted. The abductor digiti minimi is the most variable hypothenar muscle. It can possess one to three muscle bellies. Additional heads can arise from the flexor retinaculum, the palmaris longus tendon, the pronator quadratus tendon or the deep fascia of the palmar side of the forearm. Our own case of an aberrant abductor digiti minimi appearing like connective tissue and originating in the antebrachial fascia is included here. Hematoxylin and eosin staining revealed that macroscopically non-muscle-like tissue contained skeletal muscle tissue. The muscle itself resembled other described cases. In addition, at the flexor digiti minimi accessory heads with origin from the flexor retinaculum, the antebrachial fascia or the long flexor muscles of the forearm can be detected. By contrast, the opponens digiti minimi mostly lacks variations and is sometimes missing. In our opinion, this is due to its hidden location. However, in few cases an additional head can arise from the lower arm aponeurosis. Furthermore, additional (fourth) hypothenar muscles might be expressed. These muscles are characterized by origins in the forearm and insertions on the head of the 5th metacarpal bone or on the 5th proximal phalanx. It must be noted that accessory hypothenar muscles might look like connective tissue at first glance. Often their origin extends to the antebrachial fascia. This can be explained by the phylogenetic fact that all intrinsic muscles of the hand are derived from muscle masses that originated in the forearm. In the opinion of several authors, ulnar nerve compression mostly is evoked by hyper trophied variant hypothenar muscles due to overuse as for example in carpenters. In some rare cases, an aberrant hypothenar muscle can also evoke median nerve compression. PMID:23558800

  9. Differential effects of distal and proximal nerve lesions on carbonic anhydrase activity in rat primary sensory neurons, ventral and dorsal root axons

    Microsoft Academic Search

    J. M. Peyronnard; L. F. Charron; J. P. Messier; J. Lavoie

    1988-01-01

    The effect of proximal and distal peripheral nerve injuries on the histochemistry of carbonic anhydrase (CA) in rat dorsal root ganglion (DRG) neurons, and myelinated (MyF) dorsal and ventral root fibers was studied. Sciatic neurectomy induced no change. Contrariwise, 7 days after lumbar spinal nerve section the numbers of CA-stained ventral root MyF and DRG cells at the L4 and

  10. Cranial Nerves IX, X, XI, and XII

    PubMed Central

    Sanders, Richard D.

    2010-01-01

    This article concludes the series on cranial nerves, with review of the final four (IX–XII). To summarize briefly, the most important and common syndrome caused by a disorder of the glossopharyngeal nerve (craniel nerve IX) is glossopharyngeal neuralgia. Also, swallowing function occasionally is compromised in a rare but disabling form of tardive dyskinesia called tardive dystonia, because the upper motor portion of the glossopharyngel nerve projects to the basal ganglia and can be affected by lesions in the basal ganglia. Vagus nerve funtion (craniel nerve X) can be compromised in schizophrenia, bulimia, obesity, and major depression. A cervical lesion to the nerve roots of the spinal accessory nerve (craniel nerve XI) can cause a cervical dystonia, which sometimes is misdiagnosed as a dyskinesia related to neuroleptic use. Finally, unilateral hypoglossal (craniel nerve XII) nerve palsy is one of the most common mononeuropathies caused by brain metastases. Supranuclear lesions of cranial nerve XII are involved in pseudobulbar palsy and ALS, and lower motor neuron lesions of cranial nerve XII can also be present in bulbar palsy and in ALS patients who also have lower motor neuron involvement. This article reviews these and other syndromes related to cranial nerves IX through XII that might be seen by psychiatry. PMID:20532157

  11. Injury to the Ulnar Collateral Ligament of the Thumb

    PubMed Central

    Hayton, Michael J.; Baratz, Mark

    2008-01-01

    Injury to the ulnar collateral ligament of the thumb is very common and can be disabling when missed or left untreated. We present a review of literature and our preferred way of management. PMID:18975032

  12. Ulnar tunnel syndrome due to an aberrant muscle.

    PubMed

    Afshar, Ahmadreza

    2015-01-01

    This report presents a case of dynamic ulnar tunnel syndrome due to an additional origin of abductor digiti minimi muscle (ADMM) from the palmaris longus tendon. Patient's symptoms resolved after excision of the aberrant muscle. PMID:25556388

  13. Evolution of the treatment options of ulnar collateral ligament injuries of the elbow

    PubMed Central

    Langer, P; Fadale, P; Hulstyn, M

    2006-01-01

    Ulnar collateral ligament (UCL) insufficiency is potentially a career threatening, or even a career ending, injury, particularly in overhead throwing athletes. The evolution of treating modalities provides afflicted athletes with the opportunity to avoid premature retirement. There have been several clinical and basic science research efforts which have investigated the pathophysiology of UCL disruption, the biomechanics specific to overhead throwing, and the various types of treatment modalities. UCL reconstruction is currently the most commonly performed surgical treatment option. An in depth analysis of the present treatment options, both non?operative and operative, as well as their respective results and biomechanical evaluation, is lacking in the literature to date. This article provides a comprehensive current review and comparative analysis of these modalities. Over the last 30 years there has been an evolution of the original UCL reconstruction. Yet, despite the variability in modifications, such as the docking technique, interference screw fixation, and use of suture anchors, the unifying concepts of UCL reconstruction are that decreased dissection of the flexor?pronator mass and decreased handling of the ulnar nerve leads to improved outcomes. PMID:16488902

  14. Transverse Ultrasound Assessment of Median Nerve Deformation and Displacement in the Human Carpal Tunnel during Wrist Movements

    PubMed Central

    Wang, Yuexiang; Zhao, Chunfeng; Passe, Sandra M.; Filius, Anika; Thoreson, Andrew R.; An, Kai-Nan; Amadio, Peter C.

    2013-01-01

    The symptoms of carpal tunnel syndrome, a compression neuropathy of the median nerve at the wrist, are aggravated by wrist motion, but the effect of these motions on median nerve motion are unknown. In order to better understand the biomechanics of the abnormal nerve, it is first necessary to understand normal nerve movement. The purpose of this study was to evaluate the deformation and displacement of the normal median nerve at the proximal carpal tunnel level on transverse ultrasound images during different wrist movements, in order to have a baseline for comparison with abnormal movements. Dynamic ultrasound images were obtained in both wrists of 10 asymptomatic volunteers during wrist maximal flexion, extension and ulnar deviation. In order to simplify the analysis, the initial and final shape and position of the median nerve were measured and analyzed. The circularity of the median nerve was significantly increased and the aspect ratio and perimeter were significantly decreased in the final image compared to that in the first image during wrist flexion with finger extension, wrist flexion with finger flexion and wrist ulnar deviation with finger extension (p<0.01). There were significant differences in median nerve displacement vector between finger flexion, wrist flexion with finger extension and wrist ulnar deviation with finger extension (all p<0.001). The mean amplitudes of the median nerve motion in wrist flexion with finger extension (2.36±0.79 NU), wrist flexion with finger flexion (2.46±0.84 NU) and wrist ulnar deviation with finger extension (2.86±0.51 NU) were higher than those in finger flexion (0.82±0.33 NU), wrist extension with finger extension (0.77±0.46 NU) and wrist extension with finger flexion (0.81±0.58 NU) (p<0.0001). In the normal carpal tunnel, wrist flexion and ulnar deviation could induce significant transverse displacement and deformation of the median nerve. PMID:24210862

  15. Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction Techniques

    Microsoft Academic Search

    Robert T. Ruland; Christopher J. Hogan; Craig J. Randall; Andrew Richards; Stephen M. Belkoff

    2008-01-01

    Background: Incompetence of the ulnar collateral ligament (UCL) of the elbow is career-threatening for high-performance throwing athletes. Although multiple reconstructions have been described, a procedure that combines a larger graft with improved fixation may demonstrate more favorable loading characteristics than current techniques.Hypothesis: Ulnar collateral ligament reconstructions utilizing a semitendinosus graft and interference knot fixation will be bio-mechanically superior to previously

  16. The effects of picric acid (2,4,6-trinitrophenol) and a bite-deterrent chemical (denatonium benzoate) on autotomy in rats after peripheral nerve lesion.

    PubMed

    Firouzi, Matin Sadat; Firouzi, Masoumeh; Nabian, Mohammad Hossein; Zanjani, Leila Oryadi; Zadegan, Shayan Abdollah; Kamrani, Reza Shahryar; Rahimi-Movaghar, Vafa

    2015-03-20

    Denervation of the hind limb is a technique used to study peripheral nerve regeneration. Autotomy or autophagia is an undesirable response to denervation in such studies. Application of a commercially available lotion used to deter nail biting in humans reduced autotomy in rats after denervation but did not completely prevent it. In this study, this authors evaluated the application of picric acid to prevent autotomy in rats in peripheral nerve experiments. They carried out sciatic nerve transection in 41 adult female Wistar rats and then applied either bite-deterrent lotion (n = 26) or saturated picric acid solution (n = 15) topically to the affected hind limb immediately after surgery and every day for 1 month. Autotomy scores were lower for rats treated with picric acid than for rats treated with bite-deterrent lotion 1 week and 2 weeks after surgery but were not different between the two groups 4 weeks after surgery. The authors conclude that application of picric acid could be used as an alternative strategy to prevent autotomy in peripheral nerve studies. PMID:25793680

  17. Effect of low-level laser therapy (685 nm, 3 J/cm(2)) on functional recovery of the sciatic nerve in rats following crushing lesion.

    PubMed

    Takhtfooladi, Mohammad Ashrafzadeh; Jahanbakhsh, Fatemeh; Takhtfooladi, Hamed Ashrafzadeh; Yousefi, Kambiz; Allahverdi, Amin

    2015-04-01

    Previous studies have shown that low-level laser therapy (LLLT) promotes posttraumatic nerve regeneration. The objective of the present study was to assess the efficacy of 685-nm LLLT at the dosage of 3 J/cm(2) in the functional recovery of the sciatic nerve in rats following crushing injury. The left sciatic nerves of 20 male Wistar rats were subjected to controlled crush injury by a hemostatic tweezers, and the rats were randomly allocated into two experimental groups as follows: control group and laser group. Laser irradiation (685 nm wavelength; 15 mW, CW, 3 J/cm(2), spot of 0.028 cm(2)) was started on the postsurgical first day, above the site of injury, and was continued for 21 consecutive days. Functional recovery was evaluated at 3 weeks postoperatively by measuring the sciatic functional index (SFI) and sciatic static index (SSI) at weekly intervals. The treated rats showed improvement in motion pattern. The SFI and SSI results were significant when comparing two groups on the 14th and 21st postoperative days (p?nerve function in rats after crushing injury. PMID:25595127

  18. Analysis of 22 Posterior Ulnar Recurrent Artery Perforator Flaps: A Type of Proximal Ulnar Perforator Flap

    PubMed Central

    Mateev, Musa A.; Trunov, Leonid; Hyakusoku, Hiko; Ogawa, Rei

    2010-01-01

    Background: The proximal ulnar artery has several branches, including perforators that are directly derived from the ulnar artery and anterior/posterior recurrent arteries. There are only a few reports of flaps that use the anterior/posterior recurrent arteries, and flaps employing their perforators as a main pedicle are yet to be reported. In this study, posterior ulnar recurrent artery perforator (PURAP) flaps were employed for elbow and forearm reconstruction. Methods: The 22 cases of reconstruction by PURAP flaps were analyzed in terms of the cause of injury, the recipient site, the vascular pedicle of the flap, flap size and survival, and the quality of the outcome. Donor-site morbidity, including the development of scars and numbness, was also evaluated. Results: All flaps were vascular pedicled island flaps. The perforator used was the medial and posterior perforator in 14 (63.6%) and 8 (36.4%) cases, respectively. The average flap size was 10 × 5 cm. Six months after the operation, the outcomes were judged to be excellent in 15 cases (68.2%), good in 6 cases (27.3%), and poor in 1 case (4.5%) because of partial necrosis of the distal part of the flap. Conclusions: PURAP flaps can be harvested with 2 types of perforator pedicles (the medial or posterior perforator) and offer greater safety and flexibility, and less donor-site morbidity, than existing flaps used for elbow and forearm reconstruction. The ability to close the donor site primarily is a significant benefit of this flap. PMID:20076784

  19. Evaluation of Nerve Conduction Studies in Obese Children With Insulin Resistance or Impaired Glucose Tolerance.

    PubMed

    Ince, Hülya; Ta?demir, Haydar Ali; Aydin, Murat; Ozyürek, Hamit; Tilki, Hacer Erdem

    2014-10-23

    The aim of the study was to investigate nerve conduction studies in terms of neuropathic characteristics in obese patients who were in prediabetes stage and also to determine the abnormal findings. The study included 69 obese adolescent patients between April 2009 and December 2010. All patients and control group underwent motor (median, ulnar, tibial, and peroneal) and sensory (median, ulnar, sural, and medial plantar) nerve conduction studies and sympathetic skin response test. Sensory response amplitude of the medial plantar nerve was significantly lower in the patients with impaired glucose tolerance and insulin resistance. To our knowledge, the present study is the first study demonstrating the development of sensory and autonomic neuropathy due to metabolic complications of obesity in adolescent children even in the period without development of diabetes mellitus. We recommend that routine electrophysiological examinations be performed, using medial plantar nerve conduction studies and sympathetic skin response test. PMID:25342307

  20. Comparison between open and arthroscopic-assisted foveal triangular fibrocartilage complex repair for post-traumatic distal radio-ulnar joint instability.

    PubMed

    Luchetti, R; Atzei, A; Cozzolino, R; Fairplay, T; Badur, N

    2014-10-01

    The aim of this study was to assess the objective and subjective functional outcomes after foveal reattachment of proximal or complete ulnar-sided triangular fibrocartilage complex lesions by two surgical procedures: an open technique or an arthroscopically assisted repair. The study was done prospectively on 49 wrists affected by post-traumatic distal radio-ulnar joint instability. Twenty-four patients were treated with the open technique (Group 1) and 25 by the arthroscopically assisted technique (Group 2). Magnetic resonance imaging demonstrated a clear foveal detachment of the triangular fibrocartilage complex in 67% of the cases. Arthroscopy showed a positive ulnar-sided detachment of the triangular fibrocartilage complex (positive hook test) in all cases. Distal radio-ulnar joint stability was obtained in all but five patients at a mean follow-up of 6 months. Both groups had improvement of all parameters with significant differences in wrist pain scores, Mayo wrist score, Disability of the Arm, Shoulder and Hand questionnaire and Patient-Rated Wrist/Hand Evaluation questionnaire scores. There were no significant post-operative differences between the two groups in the outcome parameters except for the Disability of the Arm Shoulder and Hand questionnaire score, which was significantly better in Group 2 (p < 0.001). PMID:23962870

  1. Intraosseous radial nerve entrapment complicating total elbow revision

    Microsoft Academic Search

    Jason Zook; William G Ward

    2001-01-01

    A 43-year-old man underwent revision of a loose total elbow arthroplasty in 1995. The arthroplasty had been implanted 20 years previously for post-traumatic osteoarthritis after a gunshot wound complicated by permanent ulnar nerve palsy. The patient suffered a minimally displaced periprosthetic fracture 4 years after implantation that was treated closed. The patient subsequently developed severe loosening with bony dilation. During

  2. An audit of peripheral nerve blocks for hand surgery.

    PubMed Central

    Porter, J. M.; Inglefield, C. J.

    1993-01-01

    A prospective audit of 140 median, radial and ulnar blocks, given for 70 hand operations is described. The surgery was completed successfully in every patient. A further injection of local anaesthetic was required in 13 operations. Four patients experienced severe tourniquet pain. The results of the audit have shown that if a careful technique is used, a wide range of minor hand operations can be performed under regional nerve block. PMID:8215147

  3. The Minimal Clinically Important Difference after Simple Decompression for Ulnar Neuropathy at the Elbow

    PubMed Central

    Malay, Sunitha; Chung, Kevin C.; Gaston, Glenn; Haase, R. Steven C.; Hammert, Warren C.; Lawton, Jeff; Merrell, Greg A.; Nassab, Paul F.; Song, Jae W.; Yang, Lynda J.S.

    2013-01-01

    Purpose Establishing minimally clinically important difference (MCID) for patient-reported outcomes questionnaires is an important component of outcomes research to understand treatment effectiveness from the patient’s perspective. For patients with ulnar neuropathy at the elbow (UNE), these assessments are vital to examine how much change in the questionnaire scores equate to patient satisfaction. Methods We calculated the change in scores of Michigan Hand Outcomes Questionnaire (MHQ), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and Carpal Tunnel Questionnaire (CTQ) from preoperative to 3,6 and 12 months postoperatively after ulnar nerve simple decompression procedure. We used the anchor based approach of receiver operating characteristic curves to determine the MCID. Results On average, MCID of 10, 12, and 7 points were identified for pain, function, and ADL domains of MHQ. Similarly, DASH, CTQ-symptom severity scale, and CTQ-function severity scale had an average MCID of 7, 0.7, and 0.3 points respectively. At the 3, 6, and 12 months’ time-points, an MCID of 9, 8, and 13 points for pain, 12, 12, and 12 points for function, and 6, 8, and 6 points for ADL domains of the MHQ were identified; similarly an MCID of 8, 7, and 7 points for DASH; 0.4, 0.7, and 0.7 points for CTQ- symptom severity scale; and 0.3, 0.3, and 0.4 points for CTQ-function severity scale were established. Conclusion The smaller MCIDs of MHQ, DASH, and even smaller MCIDs of CTQ found in our study indicate that a small change in the scores identified satisfied patients. Simple decompression surgery for UNE produced patient satisfaction with only a small change in their questionnaire scores. The implications of this finding are that simple decompression surgery for UNE is a highly effective procedure and the outcomes questionnaires used are highly responsive, which minimizes sample size requirements for future research studies relating to UNE. PMID:23474160

  4. Development of an in vivo rabbit ulnar loading model.

    PubMed

    Baumann, Andrew P; Aref, Mohammad W; Turnbull, Travis L; Robling, Alex G; Niebur, Glen L; Allen, Matthew R; Roeder, Ryan K

    2015-06-01

    Ulnar and tibial cyclic compression in rats and mice have become the preferred animal models for investigating the effects of mechanical loading on bone modeling/remodeling. Unlike rodents, rabbits provide a larger bone volume and normally exhibit intracortical Haversian remodeling, which may be advantageous for investigating mechanobiology and pharmaceutical interventions in cortical bone. Therefore, the objective of this study was to develop and validate an in vivo rabbit ulnar loading model. Ulnar tissue strains during loading of intact forelimbs were characterized and calibrated to applied loads using strain gauge measurements and specimen-specific finite element models. Periosteal bone formation in response to varying strain levels was measured by dynamic histomorphometry at the location of maximum strain in the ulnar diaphysis. Ulnae loaded at 3000 microstrain did not exhibit periosteal bone formation greater than the contralateral controls. Ulnae loaded at 3500, 4000, and 4500 microstrain exhibited a dose-dependent increase in periosteal mineralizing surface (MS/BS) compared with contralateral controls during the second week of loading. Ulnae loaded at 4500 microstrain exhibited the most robust response with significantly increased MS/BS at multiple time points extending at least 2weeks after loading was ceased. Ulnae loaded at 5250 microstrain exhibited significant woven bone formation. Rabbits required greater strain levels to produce lamellar and woven bone on periosteal surfaces compared with rats and mice, perhaps due to lower basal levels of MS/BS. In summary, bone adaptation during rabbit ulnar loading was tightly controlled and may provide a translatable model for human bone biology in preclinical investigations of metabolic bone disease and pharmacological treatments. PMID:25683214

  5. Use of intercostal nerves for different target neurotization in brachial plexus reconstruction

    PubMed Central

    Lykissas, Marios G; Kostas-Agnantis, Ioannis P; Korompilias, Ananstasios V; Vekris, Marios D; Beris, Alexandros E

    2013-01-01

    Intercostal nerve transfer is a valuable procedure in devastating plexopathies. Intercostal nerves are a very good choice for elbow flexion or extension and shoulder abduction when the intraplexus donor nerves are not available. The best results are obtained in obstetric brachial plexus palsy patients, when direct nerve transfer is performed within six months from the injury. Unlike the adult posttraumatic patients after median and ulnar nerve neurotization with intercostal nerves, almost all obstetric brachial plexus palsy patients achieve protective sensation in the hand and some of them achieve active wrist and finger flexion. Use in combination with proper muscles, intercostal nerve transfer can yield adequate power to the paretic upper limb. Reinnervation of native muscles (i.e., latissimus dorsi) should always be sought as they can successfully be transferred later on for further functional restoration. PMID:23878776

  6. Nerve and Nerve Root Biomechanics

    Microsoft Academic Search

    Kristen J. Nicholson; Beth A. Winkelstein

    \\u000a Together, the relationship between the mechanical response of neural tissues and the related mechanisms of injury provide\\u000a a foundation for defining relevant thresholds for injury. The nerves and nerve roots are biologic structures with specific\\u000a and important functions, and whose response to mechanical loading can have immediate, long-lasting and widespread consequences.\\u000a In particular, when nerves or nerve roots are mechanically

  7. Role of intra-operative neurophysiologic monitoring during decompression and neurolysis after peripheral nerve injury: case report.

    PubMed

    Nazzi, Vittoria; Cordella, Roberto; Messina, Giuseppe; Dones, Ivano; Franzini, Angelo

    2012-01-01

    This paper reports the case of a patient presenting motor and sensitive deficits of the left forearm and hand after a traumatic injury of the median, ulnar, and radial nerves. Decompression and neurolysis of the three nerves was performed. Spontaneous electromyographic activity and the amplitude of compound muscle action potentials (CMAPs) were monitored. Surgery led to an increased amplitude of the aforesaid parameters and a long-term clinical improvement. PMID:23030364

  8. Ultrasonographic reference values for assessing normal radial nerve ultrasonography in the normal population.

    PubMed

    Chen, Jun; Wu, Shan; Ren, Jun

    2014-10-15

    High-resolution ultrasound has been used recently to characterize median and ulnar nerves, but is seldom used to characterize radial nerves. The radial nerve is more frequently involved in entrapment syndromes than the ulnar and median nerves. However, the reference standard for normal radial nerves has not been established. Thus, this study measured the cross-sectional areas of radial nerves of 200 healthy male or female volunteers, aged 18 to 75, using high-resolution ultrasound. The results showed that mean cross-sectional areas of radial nerves at 4 cm upon the lateral epicondyle of the humerus and mid-humerus (midpoint between the elbow crease and axilla) were 5.14 ± 1.24 and 5.08 ± 1.23 mm(2), respectively. The age and the dominant side did not affect the results, but the above-mentioned cross-sectional areas were larger in males (5.31 ± 1.25 and 5.19 ± 1.23 mm(2)) than in females (4.93 ± 1.21 and 4.93 ± 1.23 mm(2), respectively). In addition, the cross-sectional areas of radial nerves were positively correlated with height and weight (r = 0.38, 0.36, respectively, both P < 0.05). These data provide basic clinical data for the use of high-resolution ultrasound for the future diagnosis, treatment, and prognostic evaluation of peripheral neuropathies. PMID:25422648

  9. Ultrasonographic reference values for assessing normal radial nerve ultrasonography in the normal population

    PubMed Central

    Chen, Jun; Wu, Shan; Ren, Jun

    2014-01-01

    High-resolution ultrasound has been used recently to characterize median and ulnar nerves, but is seldom used to characterize radial nerves. The radial nerve is more frequently involved in entrapment syndromes than the ulnar and median nerves. However, the reference standard for normal radial nerves has not been established. Thus, this study measured the cross-sectional areas of radial nerves of 200 healthy male or female volunteers, aged 18 to 75, using high-resolution ultrasound. The results showed that mean cross-sectional areas of radial nerves at 4 cm upon the lateral epicondyle of the humerus and mid-humerus (midpoint between the elbow crease and axilla) were 5.14 ± 1.24 and 5.08 ± 1.23 mm2, respectively. The age and the dominant side did not affect the results, but the above-mentioned cross-sectional areas were larger in males (5.31 ± 1.25 and 5.19 ± 1.23 mm2) than in females (4.93 ± 1.21 and 4.93 ± 1.23 mm2, respectively). In addition, the cross-sectional areas of radial nerves were positively correlated with height and weight (r = 0.38, 0.36, respectively, both P < 0.05). These data provide basic clinical data for the use of high-resolution ultrasound for the future diagnosis, treatment, and prognostic evaluation of peripheral neuropathies. PMID:25422648

  10. Nerve conduction studies of upper extremities in tennis players

    PubMed Central

    Colak, T; Bamac, B; Ozbek, A; Budak, F; Bamac, Y

    2004-01-01

    Objectives: The influence of regular and intense practice of an asymmetric sport such as tennis on nerves in the elbow region was examined. Methods: The study included 21 male elite tennis players with a mean (SD) age of 27.5 (1.7) years and 21 male non-active controls aged 26.4 (1.9) years. Anthropometric measurements (height, weight, limb length, and perimeters of arm and forearm) were determined for each subject, and range of motion assessment and radiographic examination carried out. Standard nerve conduction techniques using constant measured distances were applied to evaluate the median, ulnar, and radial nerves in the dominant and non-dominant limb of each individual. Results: The sensory and motor conduction velocities of the radial nerve and the sensory conduction velocity of the ulnar nerve were significantly delayed in the dominant arms of tennis players compared with their non-dominant arms and normal subjects. There were no statistical differences in the latencies, conduction velocities, or amplitudes of the median motor and sensory nerves between controls and tennis players in either the dominant or non-dominant arms. However, the range of motion of the upper extremity was significantly increased in tennis players when compared with control subjects. Tennis players were taller and heavier than control subjects and their dominant upper limb lengths were longer, and arm and forearm circumferences greater, than those of the control subjects. Conclusions: Many of the asymptomatic tennis players with abnormal nerve conduction tests in the present study may have presymptomatic or asymptomatic neuropathy similar to subclinical entrapment nerve neuropathy. PMID:15388554

  11. Neuropathies compressives du nerf ulnaire au poignet (et dans la main) et du nerf fibulaire commun. Données récentes

    Microsoft Academic Search

    P. Bouche; R. Séror; D. Psimaras; P. Séror; M. Ebelin

    2008-01-01

    We report our experience with patients who underwent surgery for entrapment neuropathies involving the ulnar nerve at the wrist and into the hand and the peroneal nerve. For the ulnar nerve, the cause of the lesion was identified in all patients, generally a cyst which had developed in the Guyon canal. The patients usually recovered completely. For the peroneal nerve,

  12. Cortical plasticity induced by different degrees of peripheral nerve injuries: a rat functional magnetic resonance imaging study under 9.4 Tesla

    PubMed Central

    2013-01-01

    Background Major peripheral nerve injuries not only result in local deficits but may also cause distal atrophy of target muscles or permanent loss of sensation. Likewise, these injuries have been shown to instigate long-lasting central cortical reorganization. Methods Cortical plasticity changes induced after various types of major peripheral nerve injury using an electrical stimulation technique to the rat upper extremity and functional magnetic resonance imaging (fMRI) were examined. Studies were completed out immediately after injury (acute stage) and at two weeks (subacute stage) to evaluate time affect on plasticity. Results After right-side median nerve transection, cortical representation of activation of the right-side ulnar nerve expanded intra-hemispherically into the cortical region that had been occupied by the median nerve representation After unilateral transection of both median and ulnar nerves, cortical representation of activation of the radial nerve on the same side of the body also demonstrated intra-hemispheric expansion. However, simultaneous electrical stimulation of the contralateral uninjured median and ulnar nerves resulted in a representation that had expanded both intra- and inter-hemispherically into the cortical region previously occupied by the two transected nerve representations. Conclusions After major peripheral nerve injury, an adjacent nerve, with similar function to the injured nerve, may become significantly over-activated in the cortex when stimulated. This results in intra-hemispheric cortical expansion as the only component of cortical plasticity. When all nerves responsible for a certain function are injured, the same nerves on the contralateral side of the body are affected and become significantly over-activated during a task. Both intra- and inter-hemispheric cortical expansion exist, while the latter dominates cortical plasticity. PMID:23659705

  13. Reconstructed animation from four-phase grip MRI of the wrist with ulnar-sided pain.

    PubMed

    Oda, T; Wada, T; Iba, K; Aoki, M; Tamakawa, M; Yamashita, T

    2013-09-01

    In order to visualize dynamic variations related to ulnar-sided wrist pain, animation was reconstructed from T2* coronal-sectioned magnetic resonance imaging in each of the four phases of grip motion for nine wrists in patients with ulnar pain. Eight of the nine wrists showed a positive ulnar variance of less than 2 mm. Ulnocarpal impaction and triangular fibrocartilage complex injury were assessed on the basis of animation and arthroscopy, respectively. Animation revealed ulnocarpal impaction in four wrists. In one of the four wrists, the torn portion of the articular disc was impinged between the ulnar head and ulnar proximal side of the lunate. In another wrist, the ulnar head impacted the lunate directly through the defect in the articular disc that had previously been excised. An ulnar shortening osteotomy successfully relieved ulnar wrist pain in all four cases with both ulnocarpal impaction and Palmer's Class II triangular fibrocartilage complex tears. This method demonstrated impairment of the articular disc and longitudinal instability of the distal radioulnar joint simultaneously and should be of value in investigating dynamic pathophysiology causing ulnar wrist pain. PMID:23390153

  14. Ulnar-sided wrist pain. Part I: anatomy and physical examination

    PubMed Central

    Vezeridis, Peter S.; Han, Roger; Blazar, Philip

    2009-01-01

    Ulnar-sided wrist pain is a common complaint, and it presents a diagnostic challenge for hand surgeons and radiologists. The complex anatomy of this region, combined with the small size of structures and subtle imaging findings, compound this problem. A thorough understanding of ulnar-sided wrist anatomy and a systematic clinical examination of this region are essential in arriving at an accurate diagnosis. In part I of this review, ulnar-sided wrist anatomy and clinical examination are discussed for a more comprehensive understanding of ulnar-sided wrist pain. PMID:19722104

  15. In vivo nerve-macrophage interactions following peripheral nerve injury

    PubMed Central

    Rosenberg, Allison; Wolman, Marc A.; Franzini-Armstrong, Clara; Granato, Michael

    2012-01-01

    In vertebrates, the peripheral nervous system has retained its regenerative capacity, enabling severed axons to reconnect with their original synaptic targets. While it is well documented that a favorable environment is critical for nerve regeneration, the complex cellular interactions between injured nerves with cells in their environment, as well as the functional significance of these interactions, have not been determined in vivo and in real time. Here we provide the first minute-by-minute account of cellular interactions between laser transected motor nerves and macrophages in live intact zebrafish. We show that macrophages arrive at the lesion site long before axon fragmentation, much earlier than previously thought. Moreover, we find that axon fragmentation triggers macrophage invasion into the nerve to engulf axonal debris, and that delaying nerve fragmentation in a Wlds model does not alter macrophage recruitment but induces a previously unknown ‘nerve scanning’ behavior, suggesting that macrophage recruitment and subsequent nerve invasion are controlled by separate mechanisms. Finally, we demonstrate that macrophage recruitment, thought to be dependent on Schwann cell derived signals, occurs independently of Schwann cells. Thus, live cell imaging defines novel cellular and functional interactions between injured nerves and immune cells. PMID:22423110

  16. MEDIAN NERVE LIPOMA IN THE HAND

    Microsoft Academic Search

    I. K. MIKHAIL

    Tumours and tumour-like lesions of the major peripheral nerve trunks are not common and the two cases reported here are to be regarded as medical curiosities. In a review of the medical literature since 1930 no report of fibrolipomas arising in peripheral nerves was found. Straus in 1931 published a paper on deep lipomas of the hand but none arose

  17. Abnormalities of nerve conduction studies in myotonic dystrophy type 1: primary involvement of nerves or incidental coexistence?

    PubMed

    Bae, Jong Seok; Kim, Oeung-Kyu; Kim, Sang-Jin; Kim, Byoung Joon

    2008-10-01

    The involvement of peripheral nerves in myotonic dystrophy type 1 (DM1) is controversial and the features of peripheral neuropathy (PN) are not well known. The aim of this study was to assess the frequency of abnormal nerve conduction findings and the electrophysiological characteristics of PN in DM1. We analyzed medical records, data from nerve conduction studies (NCS), and the results of genetic analysis of 18 patients with DM1 and 30 healthy individuals. The early changes identified in NCS were determined using the sural/ulnar sensory nerve action potential amplitude ratio (SUAR). To correlate the neuropathic changes with cardiac abnormality, we compared the corrected Q-wave/T-wave interval (QTc) with the NCS parameters. Eight of 18 patients had abnormal NCS findings. Of these, abnormal peroneal motor nerve conduction and H-reflex abnormalities were most common. Only one patient complained of sensory symptoms and had abnormal sensory and motor nerve conduction compatible with sensorimotor axonal polyneuropathy. There were no significant correlations between SUAR and disease duration, age, gene CTG repeats, or the QTc. The presence of diabetes was not related to abnormal nerve conduction or SUAR. The frequency of PN or abnormal NCS results was lower in our patients with DM1 than in previous studies. Our findings suggest that most abnormal NCS results in DM1 patients are more likely to result from myopathic changes, coincidental neuropathies, or radiculopathies than from primary involvement of the nerve. PMID:18657426

  18. LUSSAZIONE PALMARE ISOLATA DELL'ARTICOLAZIONE RADIO ULNARE DISTALE: PRESENTAZIONE DI UN CASO CLINICO

    Microsoft Academic Search

    M. CALCAGNI; T. GIESEN; R. LUCHETTI; U. MARTORANA; G. PAJARDI

    Isolated volar distal radio-ulnar joint dislocation: case report SUMMARY Palmar distal radio-ulnar joint (DRUJ) dislocation is a rare injury that may occur isolated from other injuries but, most frequently occurs in association with a distal radius fracture. In the literature, no more than 20 cases of pa- tients with isolated DRUJ dislocation were found. The diagnosis of this injury is

  19. Biomechanical Evaluation of 2 Techniques for Ulnar Collateral Ligament Reconstruction of the Elbow

    Microsoft Academic Search

    George A. Paletta; Steven J. Klepps; Gregory S. Difelice; Tracy Allen; Michael D. Brodt; Meghan E. Burns; Matthew J. Silva; Rick W. Wright

    2006-01-01

    Background:Elbow medial ulnar collateral ligament tears often result in pain and instability that may be career threatening in overhead-throwing athletes. Surgical reconstruction is frequently chosen to treat this injury. Ulnar collateral ligament reconstruction as described by Jobe is the most commonly used technique. Testing of this construct has not demonstrated that the biomechanical parameters of the native ligament are restored.

  20. Ulnar Impaction Syndrome: A case series investigating the appropriate diagnosis, management, and post-operative considerations.

    PubMed

    Woitzik, Erin; deGraauw, Chris; Easter, Brock

    2014-12-01

    Ulnar sided wrist pain is a common site for upper extremity disability. Ulnar impaction syndrome results in a spectrum of triangular fibrocartilage complex (TFCC) injuries and associated lunate, triquetrum, and ligamentous damage. Patients commonly present with insidious ulnar sided wrist pain and clicking, and a history of trauma or repetitive axial loading and rotation. In this case series, three patients presented to a sports chiropractor for evaluation and were subsequently diagnosed with ulnar impaction syndrome. Treatment strategies consist of conservative management, arthroscopic debridement or repair, arthroscopic wafer procedure, or ulnar shortening osteotomy. For the athlete, intervention should be individualized and sport-specific, considering athletic priorities, healing potential, return to play, and long-term health concerns. PMID:25550665

  1. The Practical Uses of Ultrasound in a Clinical Setting to Diagnose Thrombosis of the Ulnar Artery

    PubMed Central

    Serafine, Matthew S.; Peterson, Charles S.

    2013-01-01

    A 43-year-old professional skateboarder presented to the sports medicine clinic with complaints of left wrist pain to the ulnar aspect. Two weeks prior to presentation, his wrist became suddenly painful with no specific trauma. He reported a history of falls over the years while skateboarding but none directly correlated to his onset of wrist pain. Radiographic results were negative for wrist or hand fracture. Physical examination yielded tenderness and mild swelling to the ulnar aspect of the wrist. Musculoskeletal ultrasound was used to assess tendon and ligament integrity, all of which was intact. Both radial and ulnar arteries were visualized, and ulnar artery thrombosis was incidentally diagnosed. He was advised to immediately proceed to the hospital, where an open arthrectomy was performed to the ulnar artery the following day. The patient was released from the hospital 2 days later and subsequently made a full recovery. PMID:24459558

  2. Ulnar Impaction Syndrome: A case series investigating the appropriate diagnosis, management, and post-operative considerations

    PubMed Central

    Woitzik, Erin; deGraauw, Chris; Easter, Brock

    2014-01-01

    Ulnar sided wrist pain is a common site for upper extremity disability. Ulnar impaction syndrome results in a spectrum of triangular fibrocartilage complex (TFCC) injuries and associated lunate, triquetrum, and ligamentous damage. Patients commonly present with insidious ulnar sided wrist pain and clicking, and a history of trauma or repetitive axial loading and rotation. In this case series, three patients presented to a sports chiropractor for evaluation and were subsequently diagnosed with ulnar impaction syndrome. Treatment strategies consist of conservative management, arthroscopic debridement or repair, arthroscopic wafer procedure, or ulnar shortening osteotomy. For the athlete, intervention should be individualized and sport-specific, considering athletic priorities, healing potential, return to play, and long-term health concerns. PMID:25550665

  3. Eight nerve, root nucleus Dolores E. Lpez

    E-print Network

    Oliver, Douglas L.

    Reticulospinal bundle Trapezoid body Pn Dorsal acoustic stria #12;Labeled PnC reticulospinal neurons (in brown- cochlear nucleus response) Kainic acid lesion in the VIII nerve abolish the startle Mean startle amplitude elicited by three different noise burst intensities before and after bilateral Kainic acid lesioning

  4. Ulnar neuropathy at the elbow: an evidence-based algorithm.

    PubMed

    Chimenti, Peter C; Hammert, Warren C

    2013-08-01

    Ulnar neuropathy at the elbow is the second most common compression neuropathy of the upper extremity and poses a challenge for treating physicians. Lack of a standardized grading system, outcome measures, or surgical indications can make treatment decisions difficult to justify. Conclusions drawn from the available literature include similar rates of good to excellent outcomes for in situ decompression; transposition in the subcutaneous, submuscular, or intramuscular planes; and endoscopic decompression. Outcomes for revision surgery are generally less favorable. Development of standardized outcomes measures will be important in improving the quality and comparability of the literature on this subject. PMID:23895724

  5. [False traumatic aneurysm of the ulnar artery in a teenager].

    PubMed

    Nour, M; Talha, H; El Idrissi, R; Lahraoui, Y; Ouazzani, L; Oubejja, H; Erraji, M; Zerhouni, H; Ettayebi, F

    2014-12-01

    Most aneurysms of hand arteries are traumatic. It is a generally rare unrecognized pathology. Complications are serious (embolism and thromboses of interdigital arteries). Two main causes can be recalled: acute trauma, with development of a false aneurysm; repeated microtrauma (hand hammer syndrome), with occurrence of an arterial dysplasic aneurysm. The diagnosis is based on the presence of a pulsatile mass, with finger dysesthesia, unilateral Raynaud's phenomenon. It is confirmed by duplex Doppler. Arteriography is necessary but can be replaced by an angio-MR. We report a case of false traumatic aneurysm of the ulnar artery in a teenager. This case illustrates this rare condition and opens discussion on therapeutic options. PMID:24970785

  6. [The ulnar longitudinal deficiency: proposition of a descriptive classification].

    PubMed

    Loréa, P; Pajardi, G; Medina, J; Szabo, Z; Foucher, G

    2004-12-01

    Ulnar longitudinal deficiency is an extended malformation sometimes involving the whole upper extremity, even including sometimes the opposite side. The clinical and radiological aspects are variable and none of the existing classifications takes into account all the possible deformities. Multiple decisive factors in the surgical indications are missing such as shoulder stability, elbow position (extension or flexion with or without pterygium), orientation of the hand (internal rotation), wrist inclination and number of digits. Based on a review of our 46 clinical cases as well as the published cases in the literature we have developed a simple way to describe each level. PMID:15651244

  7. Nerve Blocks

    MedlinePLUS

    ... doctor. By performing a nerve block and then monitoring how the patient responds to the injection, the ... and/or imaging guidance. He or she will clean the area with antiseptic solution, and then the ...

  8. Inflammatory Mediators Sensitize Acutely Axotomized Nerve Fibers to Mechanical Stimulation in the Rat

    Microsoft Academic Search

    Martin Michaelis; Carola Vogel; Karl-Heinz Blenk; Adalsteinn Arnarson; Wilfrid Janig

    1998-01-01

    Many axotomized myelinated as well as unmyelinated cutane- ous nerve fibers are sensitive to mechanical stimuli applied to the cut nerve end within a few hours after nerve lesion. Here we investigated the influence of inflammatory mediators on this ectopic mechanosensitivity after cutting and ligating the sural nerve in anesthetized rats. Neural activity was recorded from single axons in filaments

  9. Spinal Cord and Nerve Root Decompression

    Microsoft Academic Search

    Keith R. Lodhia; Paul Park; Gregory P. Graziano

    Tumors of the vertebral column include both primary and metastatic lesions. These tumors can cause significant morbidity consisting\\u000a of lesional pain and pain from deformity. Compression of the spinal cord and spinal nerve roots can also cause radicular pain\\u000a as well as neurologial deterioration including sensory deficits, weakness, paralysis, and\\/or sexual\\/bowel\\/ bladder dysfunction.\\u000a In cases of metastatic lesions, the spine

  10. Ultrasound of tendons and nerves.

    PubMed

    Martinoli, Carlo; Bianchi, Stefano; Dahmane, M'Hamed; Pugliese, Francesca; Bianchi-Zamorani, Maria Pia; Valle, Maura

    2002-01-01

    Tendons and nerves represent probably one of the best application of musculoskeletal US due to the high lesion detection rate and accuracy of US combined with its low cost, wide availability, and ease of use. The refinement of high-frequency broadband linear-array transducers, and sensitive color and power Doppler technology, have improved the ability of US to detect fine textural abnormalities of these structures as well as to identify a variety of pathological conditions. Characteristic echotextural patterns, closely resembling the histological ones, are typically depicted in these structures using high US frequencies. In tendon imaging, US can assess dislocations, degenerative changes and tendon tears, including intrasubstance tears, longitudinal splits, partial and complete rupture, inflammatory conditions and tendon tumors, as well as postoperative findings. In nerve imaging, US can support clinical and electrophysiological testing for detection of compressing lesions caused by nerve entrapment in a variety of osteofibrous tunnels of the limbs and extremities. Congenital anomalies, nerve tears, and neurogenic tumors can also be diagnosed. Overall, US is an effective technique for imaging tendons and nerves. In most cases, a focused US examination can be performed more rapidly and efficiently than MR imaging. PMID:11868073

  11. Regional Anesthesia Does Not Increase the Risk of Postoperative Neuropathy in Patients Undergoing Ulnar Nerve Transposition

    Microsoft Academic Search

    James R. Hebl; Terese T. Horlocker; Eric J. Sorenson; Darrell R. Schroeder

    2001-01-01

    The use of regional anesthetic techniques in patients with preexisting neuropathies has been widely debated. The possibility of needle- or catheter-induced trauma, local anesthetic toxicity, or neural ischemia during regional blockade may place patients with underlying mechanical, ischemic, or metabolic neurologic derangements at in- creased risk of progressive neural injury. We evaluated the safety of regional versus general anesthesia in

  12. Ulnar nerve compression possibly due to aberrant veins: sonography is elucidatory for idiopathic cubital tunnel syndrome

    Microsoft Academic Search

    Erkan K?l?ç; Levent Özçakar

    2011-01-01

    Springer-Verlag 2010 To the Editor, A 38-year-old man (waiter) was seen due to right elbow pain for the last 6 months. He declared that the pain was mainly localized on the medial side of the joint and sometimes radiated to the right fifth finger (worse with physical activity especially after carrying trays for long duration). The patient had been given

  13. New sonographic measures of peripheral nerves: a tool for the diagnosis of peripheral nerve involvement in leprosy

    PubMed Central

    Frade, Marco Andrey Cipriani; Nogueira-Barbosa, Marcello Henrique; Lugão, Helena Barbosa; Furini, Renata Bazan; Marques, Wilson; Foss, Norma Tiraboschi

    2013-01-01

    To evaluate ultrasonographic (US) cross-sectional areas (CSAs) of peripheral nerves, indexes of the differences between CSAs at the same point (?CSAs) and between tunnel (T) and pre-tunnel (PT) ulnar CSAs (?TPTs) in leprosy patients (LPs) and healthy volunteers (HVs). Seventy-seven LPs and 49 HVs underwent bilateral US at PT and T ulnar points, as well as along the median (M) and common fibular (CF) nerves, to calculate the CSAs, ?CSAs and ?TPTs. The CSA values in HVs were lower than those in LPs (p < 0.0001) at the PT (5.67/9.78 mm2) and T (6.50/10.94 mm2) points, as well as at the M (5.85/8.48 mm2) and CF (8.17/14.14 mm2) nerves. The optimum CSA- receiver operating characteristic (ROC) points and sensitivities/specificities were, respectively, 6.85 mm2 and 68-85% for the PT point, 7.35 mm2 and 71-78% for the T point, 6.75 mm2 and 62-75% for the M nerve and 9.55 mm2 and 81-72% for the CF nerve. The ?CSAs of the LPs were greater than those of the HVs at the PT point (4.02/0.85; p = 0.007), T point (3.71/0.98; p = 0.0005) and CF nerve (2.93/1.14; p = 0.015), with no difference found for the M nerve (1.41/0.95; p = 0.17). The optimum ?CSA-ROC points, sensitivities, specificities and p-values were, respectively, 1.35, 49%, 80% and 0.003 at the PT point, 1.55, 55-85% and 0.0006 at the T point, 0.70, 58-50% and 0.73 for the M nerve and 1.25, 54-67% and 0.022 for the CF nerve. The ?TPT in the LPs was greater than that in the HVs (4.43/1.44; p <0.0001). The optimum ?TPT-ROC point was 2.65 (90% sensitivity/41% specificity, p < 0.0001). The ROC analysis of CSAs showed the highest specificity and sensitivity at the PT point and CF nerve, respectively. The PT and T ?CSAs had high specificities (> 80%) and ?TPT had the highest specificity (> 90%). New sonographic peripheral nerve measurements (?CSAs and ?TPT) provide an important methodological improvement in the detection of leprosy neuropathy. PMID:23778664

  14. Nerve conduction in relation to vibration exposure - a non-positive cohort study

    PubMed Central

    2010-01-01

    Background Peripheral neuropathy is one of the principal clinical disorders in workers with hand-arm vibration syndrome. Electrophysiological studies aimed at defining the nature of the injury have provided conflicting results. One reason for this lack of consistency might be the sparsity of published longitudinal etiological studies with both good assessment of exposure and a well-defined measure of disease. Against this background we measured conduction velocities in the hand after having assessed vibration exposure over 21 years in a cohort of manual workers. Methods The study group consisted of 155 male office and manual workers at an engineering plant that manufactured pulp and paper machinery. The study has a longitudinal design regarding exposure assessment and a cross-sectional design regarding the outcome of nerve conduction. Hand-arm vibration dose was calculated as the product of self-reported occupational exposure, collected by questionnaire and interviews, and the measured or estimated hand-arm vibration exposure in 1987, 1992, 1997, 2002, and 2008. Distal motor latencies in median and ulnar nerves and sensory nerve conduction over the carpal tunnel and the finger-palm segments in the median nerve were measured in 2008. Before the nerve conduction measurement, the subjects were systemically warmed by a bicycle ergometer test. Results There were no differences in distal latencies between subjects exposed to hand-arm vibration and unexposed subjects, neither in the sensory conduction latencies of the median nerve, nor in the motor conduction latencies of the median and ulnar nerves. Seven subjects (9%) in the exposed group and three subjects (12%) in the unexposed group had both pathological sensory nerve conduction at the wrist and symptoms suggestive of carpal tunnel syndrome. Conclusion Nerve conduction measurements of peripheral hand nerves revealed no exposure-response association between hand-arm vibration exposure and distal neuropathy of the large myelinated fibers in a cohort of male office and manual workers. PMID:20642848

  15. Monteggia lesion in an Asian small-clawed otter (Aonyx cinerea).

    PubMed

    Peters, Holly J; Hettlich, Bianca F; Barrie, Michael T

    2013-12-01

    A 10-yr-old female Asian small-clawed otter (Aonyx cinerea) presented with a history of right forelimb lameness. Antebrachial radiographs revealed a Monteggia lesion, classified by cranial radial head luxation and distal diaphyseal ulnar fracture. Open reduction with placement of an ulnar-radial positional screw was performed. The lateral collateral ligament was reconstructed using suture anchored by a condylar screw and bone tunnel in the radius. Reduction and proper implant placement was confirmed on postoperative radiographs. The ulnar-radial positional screw was removed 6 wk postoperatively to allow proper supination and pronation. Limb function was greatly improved at this time; however, a mild lameness was still observed. At 7 mo postoperatively, the otter was ambulating lameness-free. Radiographs documented proper joint reduction and stable condylar screw. At 32 mo postoperatively, the otter continued to exhibit normal ambulation. PMID:24450070

  16. A simple model of radial nerve injury in the rhesus monkey to evaluate peripheral nerve repair

    PubMed Central

    Wang, Dong; Huang, Xijun; Fu, Guo; Gu, Liqiang; Liu, Xiaolin; Wang, Honggang; Hu, Jun; Yi, Jianhua; Niu, Xiaofeng; Zhu, Qingtang

    2014-01-01

    Current research on bone marrow stem cell transplantation and autologous or xenogenic nerve transplantation for peripheral nerve regeneration has mainly focused on the repair of peripheral nerve defects in rodents. In this study, we established a standardized experimental model of radial nerve defects in primates and evaluated the effect of repair on peripheral nerve injury. We repaired 2.5-cm lesions in the radial nerve of rhesus monkeys by transplantation of autografts, acellular allografts, or acellular allografts seeded with autologous bone marrow stem cells. Five months after surgery, regenerated nerve tissue was assessed for function, electrophysiology, and histomorphometry. Postoperative functional recovery was evaluated by the wrist-extension test. Compared with the simple autografts, the acellular allografts and allografts seeded with bone marrow stem cells facilitated remarkable recovery of the wrist-extension functions in the rhesus monkeys. This functional improvement was coupled with radial nerve distal axon growth, a higher percentage of neuron survival, increased nerve fiber density and diameter, increased myelin sheath thickness, and increased nerve conduction velocities and peak amplitudes of compound motor action potentials. Furthermore, the quality of nerve regeneration in the bone marrow stem cells-laden allografts group was comparable to that achieved with autografts. The wrist-extension test is a simple behavioral method for objective quantification of peripheral nerve regeneration. PMID:25206757

  17. Vascular lesions induced by renal nerve ablation as assessed by optical coherence tomography: pre- and post-procedural comparison with the Simplicity® catheter system and the EnligHTN™ multi-electrode renal denervation catheter

    PubMed Central

    Templin, Christian; Jaguszewski, Milosz; Ghadri, Jelena R.; Sudano, Isabella; Gaehwiler, Roman; Hellermann, Jens P.; Schoenenberger-Berzins, Renate; Landmesser, Ulf; Erne, Paul; Noll, Georg; Lüscher, Thomas F.

    2013-01-01

    Aims Catheter-based renal nerve ablation (RNA) using radiofrequency energy is a novel treatment for drug-resistant essential hypertension. However, the local endothelial and vascular injury induced by RNA has not been characterized, although this importantly determines the long-term safety of the procedure. Optical coherence tomography (OCT) enables in vivo visualization of morphologic features with a high resolution of 10–15 µm. The objective of this study was to assess the morphological features of the endothelial and vascular injury induced by RNA using OCT. Methods and results In a prospective observational study, 32 renal arteries of patients with treatment-resistant hypertension underwent OCT before and after RNA. All pre- and post-procedural OCT pullbacks were evaluated regarding vascular changes such as vasospasm, oedema (notches), dissection, and thrombus formation. Thirty-two renal arteries were evaluated, in which automatic pullbacks were obtained before and after RNA. Vasospasm was observed more often after RNA then before the procedure (0 vs. 42%, P < 0.001). A significant decrease in mean renal artery diameter after RNA was documented both with the EnligHTN™ (4.69 ± 0.73 vs. 4.21 ± 0.87 mm; P < 0.001) and with the Simplicity® catheter (5.04 ± 0.66 vs. 4.57 ± 0.88 mm; P < 0.001). Endothelial-intimal oedema was noted in 96% of cases after RNA. The presence of thrombus formations was significantly higher after the RNA then before ablation (67 vs. 18%, P < 0.001). There was one evidence of arterial dissection after RNA with the Simplicity® catheter, while endothelial and intimal disruptions were noted in two patients with the EnligHTN™ catheter. Conclusion Here we show that diffuse renal artery constriction and local tissue damage at the ablation site with oedema and thrombus formation occur after RNA and that OCT visualizes vascular lesions not apparent on angiography. This suggests that dual antiplatelet therapy may be required during RNA. PMID:23620498

  18. Quantitative determination of proximal radial and ulnar growth rates in foals using orthopedic markers

    E-print Network

    Smith, Barbara Lynn

    1988-01-01

    OF PROXIMAL RADIAL AND ULNAR GROWTH RATES IN FOALS USING ORTHOPEDIC MARKERS Literature Review 1-5 Ulnar fractures are common injuries in the horse. The incidence reported was 1 in 100 fractures, 5 out of 5 12, 536 horses, 3 in 99 fractures, 4 cases in 3... returned to pasture. Dehiscence occurred in one or both ulnar incisions of all foals from 2 to 5 days after surgery. All wounds healed within 2 weeks with stall rest, daily cleansing, and systemic antibiotics (procaine penicillin G, 22, 000 U/kg BID...

  19. Superficial ulnar artery: Clinical recommendations to avoid iatrogenic complications due to variation in arterial system

    PubMed Central

    Salunke, Abhijeet Ashok; Nambi, Gurunathampalayam Ilango; Dhanwate, Anant Dattatray; Siriwardana, Hettige Amila Ruwan Prasad

    2014-01-01

    Superficial ulnar artery is an uncommon variation in which the ulnar artery is having its course superficial to the flexors of the forearm and may arise directly from axillary or brachial arteries. The proper understanding and knowledge of variation of arterial systems is helpful for judicious planning of various reconstructive procedures in oncological, orthopaedic and reconstructive surgeries. We present a case of variant course of ulnar artery which was noted during exploration of a right distal forearm wound. We suggest few clinical recommendations to avoid iatrogenic complications due to variation in arterial system. PMID:25013265

  20. Peripheral Nerve Disorders

    MedlinePLUS

    ... spinal cord. Like static on a telephone line, peripheral nerve disorders distort or interrupt the messages between the brain ... body. There are more than 100 kinds of peripheral nerve disorders. They can affect one nerve or many nerves. ...

  1. Reflections on the contributions of Harvey Cushing to the surgery of peripheral nerves.

    PubMed

    Tubbs, R Shane; Patel, Neal; Nahed, Brian Vala; Cohen-Gadol, Aaron A; Spinner, Robert J

    2011-05-01

    By the time Harvey Cushing entered medical school, nerve reconstruction techniques had been developed, but peripheral nerve surgery was still in its infancy. As an assistant surgical resident influenced by Dr. William Halsted, Cushing wrote a series of reports on the use of cocaine for nerve blocks. Following his residency training and a hiatus to further his clinical interests and intellectual curiosity, he traveled to Europe and met with a variety of surgeons, physiologists, and scientists, who likely laid the groundwork for Cushing's increased interest in peripheral nerve surgery. Returning to The Johns Hopkins Hospital in 1901, he began documenting these surgeries. Patient records preserved at Yale's Cushing Brain Tumor Registry describe Cushing's repair of ulnar and radial nerves, as well as his exploration of the brachial plexus for nerve repair or reconstruction. The authors reviewed Harvey Cushing's cases and provide 3 case illustrations not previously reported by Cushing involving neurolysis, nerve repair, and neurotization. Additionally, Cushing's experience with facial nerve neurotization is reviewed. The history, physical examination, and operative notes shed light on Cushing's diagnosis, strategy, technique, and hence, his surgery on peripheral nerve injury. These contributions complement others he made to surgery of the peripheral nervous system dealing with nerve pain, entrapment, and tumor. PMID:21214330

  2. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs.

    PubMed

    Martinoli, C; Bianchi, S; Gandolfo, N; Valle, M; Simonetti, S; Derchi, L E

    2000-10-01

    The diagnosis of nerve entrapment at osteofibrous tunnels relies primarily on clinical and electrodiagnostic findings. Recently, the refinement of high-frequency broadband transducers with a range of 5-15 MHz, sophisticated focusing in the near field, and sensitive color and power Doppler technology have improved the ability to evaluate peripheral nerve entrapment in osteofibrous tunnels with ultrasonography (US). In the upper limb, osteofibrous tunnels amenable to US examination include the carpal tunnel for the median nerve and the cubital and Guyon tunnels for the ulnar nerve. In the lower limb, these tunnels include the fibular neck for the common peroneal nerve, the tarsal tunnel for the posterior tibial nerve, and the intermetatarsal spaces for the interdigital nerves. High-resolution US allows direct imaging of the involved nerves, as well as documentation of changes in nerve shape and echotexture that occur in compressive syndromes. A spectrum of extrinsic causes of entrapment, such as tenosynovitis, ganglia, soft-tissue tumors, bone and joint abnormalities, and anomalous muscles, can also be diagnosed with US. With continued experience, it is likely that this technique will be increasingly used to evaluate nerve entrapment syndromes. PMID:11046171

  3. Ulnar collateral ligament in the overhead athlete: a current review.

    PubMed

    Dugas, Jeffrey; Chronister, Justin; Cain, E Lyle; Andrews, James R

    2014-09-01

    Ulnar collateral ligament (UCL) injuries are most commonly reported in baseball players (particularly in pitchers) but have also been observed in other overhead athletes including javelin, softball, tennis, volleyball, water polo, and gymnastics. Partial injuries have been successfully treated with appropriate nonoperative measures but complete tears and chronic injuries have shown less benefit from conservative measures. In these cases, surgical reconstruction has become the treatment modality for overhead athlete who wishes to continue to play. This article discusses the functional anatomy and biomechanics of the UCL as related to the pathophysiology of overhead throwing, as well as the important clinical methods needed to make accurate and timely diagnosis. It also gives an updated review of the current clinical outcomes and complications of surgical reconstruction. PMID:25077747

  4. Nerve Racking

    NSDL National Science Digital Library

    Integrated Teaching and Learning Program,

    This lesson describes the function and components of the human nervous system. It helps students understand the purpose of our brain, spinal cord, nerves and the five senses. How the nervous system is affected during spaceflight is also discussed in this lesson.

  5. Factors predicting sensory and motor recovery after the repair of upper limb peripheral nerve injuries

    PubMed Central

    He, Bo; Zhu, Zhaowei; Zhu, Qingtang; Zhou, Xiang; Zheng, Canbin; Li, Pengliang; Zhu, Shuang; Liu, Xiaolin; Zhu, Jiakai

    2014-01-01

    OBJECTIVE: To investigate the factors associated with sensory and motor recovery after the repair of upper limb peripheral nerve injuries. DATA SOURCES: The online PubMed database was searched for English articles describing outcomes after the repair of median, ulnar, radial, and digital nerve injuries in humans with a publication date between 1 January 1990 and 16 February 2011. STUDY SELECTION: The following types of article were selected: (1) clinical trials describing the repair of median, ulnar, radial, and digital nerve injuries published in English; and (2) studies that reported sufficient patient information, including age, mechanism of injury, nerve injured, injury location, defect length, repair time, repair method, and repair materials. SPSS 13.0 software was used to perform univariate and multivariate logistic regression analyses and to investigate the patient and intervention factors associated with outcomes. MAIN OUTCOME MEASURES: Sensory function was assessed using the Mackinnon-Dellon scale and motor function was assessed using the manual muscle test. Satisfactory motor recovery was defined as grade M4 or M5, and satisfactory sensory recovery was defined as grade S3+ or S4. RESULTS: Seventy-one articles were included in this study. Univariate and multivariate logistic regression analyses showed that repair time, repair materials, and nerve injured were independent predictors of outcome after the repair of nerve injuries (P < 0.05), and that the nerve injured was the main factor affecting the rate of good to excellent recovery. CONCLUSION: Predictors of outcome after the repair of peripheral nerve injuries include age, gender, repair time, repair materials, nerve injured, defect length, and duration of follow-up. PMID:25206870

  6. Nerve regeneration and reinnervation after limb amputation and replantation: clinical and physiological findings.

    PubMed

    Krarup, C; Upton, J; Creager, M A

    1990-04-01

    A 22-year-old male was studied 3 1/2-4 1/2 years after a traumatic section-avulsion amputation of the left upper extremity at the level of the distal humerus. The arm was reattached after a cold ischemia time of 4-5 hours and good vascularization was obtained. The ulnar nerve was repaired early with an end-to-end juncture while the median and radial nerves were repaired after seven months delay using a combination of vascularized radial nerve and nonvascularized sural nerve grafts. Some intrinsic hand muscle function had recovered. Pin-prick and touch sensation was present in all digits, although localization of touch stimulation was poor. Evoked motor responses had recovered by 25-50% of control amplitude in ulnar-innervated and by 10-25% in median-innervated muscles. Amplitudes of sensory responses from digit V had recovered by 25% and from digits I and III by 1-5%. Fast-adapting touch receptors had become reinnervated. There was electrophysiological evidence of aberrant sensory regeneration and of abnormal connections between sensory and motor fibers. Digital blood flow measurements suggested the presence of vascular obstruction in vessels of the replanted upper extremity. However, the digital vasoconstriction during cold exposure indicated regeneration of sympathetic nerve fibers. PMID:2355942

  7. 21 CFR 888.3810 - Wrist joint ulnar (hemi-wrist) polymer prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3810 Wrist joint ulnar (hemi-wrist) polymer prosthesis. (a) Identification. A...

  8. 21 CFR 888.3810 - Wrist joint ulnar (hemi-wrist) polymer prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3810 Wrist joint ulnar (hemi-wrist) polymer prosthesis. (a) Identification. A...

  9. Ultrasonography in patients with ulnar neuropathy at the elbow: comparison of cross-sectional area and swelling ratio with electrophysiological severity.

    PubMed

    Bayrak, Ayse Oytun; Bayrak, Ilkay Koray; Turker, Hande; Elmali, Muzaffer; Nural, Mehmet Selim

    2010-05-01

    The aim of this study was to determine the diagnostic value of ultrasonographic measurements in ulnar neuropathy at the elbow (UNE) and to assess the relationship between the measurements and the electrophysiological severity. The largest anteroposterior diameter (LAPD) and cross-sectional area (CSA) measurements of the ulnar nerve were noted at multiple levels along the arm, and the distal-to-proximal ratios were calculated. Almost all of the measurements and swelling ratios between patients and controls showed statistically significant differences. The largest CSA, distal/largest CSA ratio, CSA at the epicondyle, and proximal LAPD had larger areas under the curve than other measurements. The sensitivity and specificity in diagnosing UNE were 95% and 71% for the largest CSA, 83% and 85% for the distal/largest CSA ratio, 83% and 81% for the CSA at the epicondyle, and 93% and 43% for the proximal LAPD, respectively. There was a statistically significant correlation between the electrophysiological severity scale score (ESSS) and the largest CSA, the CSA at the epicondyle and 2 cm proximal to the epicondyle, and the LAPD at the level of the epicondyle (P < 0.05). None of the swelling ratios showed a significant correlation with the ESSS. The largest CSA measurement is the most valuable ultrasonographic measurement both for diagnosis and determining the severity of UNE. PMID:19941341

  10. The Proximal Medial Sural Nerve Biopsy Model: A Standardised and Reproducible Baseline Clinical Model for the Translational Evaluation of Bioengineered Nerve Guides

    PubMed Central

    van Neerven, Sabien G. A.; Claeys, Kristl G.; O'Dey, Dan mon; Brook, Gary A.; Sellhaus, Bernd; Schulz, Jörg B.; Weis, Joachim; Pallua, Norbert

    2014-01-01

    Autologous nerve transplantation (ANT) is the clinical gold standard for the reconstruction of peripheral nerve defects. A large number of bioengineered nerve guides have been tested under laboratory conditions as an alternative to the ANT. The step from experimental studies to the implementation of the device in the clinical setting is often substantial and the outcome is unpredictable. This is mainly linked to the heterogeneity of clinical peripheral nerve injuries, which is very different from standardized animal studies. In search of a reproducible human model for the implantation of bioengineered nerve guides, we propose the reconstruction of sural nerve defects after routine nerve biopsy as a first or baseline study. Our concept uses the medial sural nerve of patients undergoing diagnostic nerve biopsy (?2?cm). The biopsy-induced nerve gap was immediately reconstructed by implantation of the novel microstructured nerve guide, Neuromaix, as part of an ongoing first-in-human study. Here we present (i) a detailed list of inclusion and exclusion criteria, (ii) a detailed description of the surgical procedure, and (iii) a follow-up concept with multimodal sensory evaluation techniques. The proximal medial sural nerve biopsy model can serve as a preliminarynature of the injuries or baseline nerve lesion model. In a subsequent step, newly developed nerve guides could be tested in more unpredictable and challenging clinical peripheral nerve lesions (e.g., following trauma) which have reduced comparability due to the different nature of the injuries (e.g., site of injury and length of nerve gap). PMID:25006574

  11. Simultaneous dislocation of the radial head and distal radio-ulnar joint. A case report

    PubMed Central

    Verettas, D-A.J.; Drosos, G.I.; Xarchas, K.C.; Chatzipapas, C.N.; Staikos, C.

    2008-01-01

    Isolated dislocation of the distal radio-ulnar joint and isolated dislocation of the radial head in adults are not common injuries. A simultaneous dislocation of the radial head and distal radio-ulnar joint with no other injury seems to be extremely rare since only one report was found in the English literature. A similar case, but with some differences in presentation and treatment is reported. PMID:18825278

  12. Ulnar Collateral Ligament Reconstruction in High School Baseball PlayersClinical Results and Injury Risk Factors

    Microsoft Academic Search

    Damon H. Petty; James R. Andrews; Glenn S. Fleisig; E. Lyle Cain

    2004-01-01

    Background: The incidence of ulnar collateral ligament injury has increased in baseball, especially at the high school level.Hypothesis: Ulnar collateral ligament injury in high school baseball players is associated with overuse, high-velocity throwing, early throwing of breaking pitches, and improper warm-ups.Study Design: Retrospective cohort study.Methods: Follow-up physical examination and questionnaire data were collected at an average of 35 months after

  13. Other Optic Nerve Maladies in Cancer Patients

    Microsoft Academic Search

    Jade S. Schiffman; Anitha Raghunath; Rosa Ana Tang

    \\u000a Many optic neuropathies in cancer patients are related to the direct effect of cancer on the optic nerve (e.g., orbital and\\u000a parasellar skull base compressive lesions or infiltration of the optic nerve with leptomeningeal disease). However, a number\\u000a of optic neuropathies occur unrelated to those mechanisms. Other mechanisms of optic neuropathy in cancer patients include\\u000a those caused by raised intracranial

  14. Primary malignant melanoma of the optic nerve simulating a melanocytoma.

    PubMed

    Erzurum, S A; Jampol, L M; Territo, C; O'Grady, R

    1992-05-01

    Primary malignant melanoma of the optic nerve head is an extremely rare tumor. We describe a patient with a pigmented optic nerve lesion that simulated a growing melanocytoma. The pigmented tumor slowly infiltrated the optic nerve causing disc edema, retinal venous congestion, progressive visual field loss, and eventually, loss of central acuity. Following enucleation of the eye, and later resections of the optic nerve to the chiasm, histopathologic examination of the optic nerve, disc, and peripapillary region demonstrated a primary malignant melanoma of the optic nerve without choroidal involvement. Involvement of the optic nerve extended 26 mm beyond the lamina cribrosa. Malignant melanoma of the optic nerve is a real entity and may clinically simulate a melanocytoma. PMID:1580845

  15. [Carpal tunnel syndrome and other nerve entrapment syndromes].

    PubMed

    Gouzou, Stéphanie; Liverneaux, Philippe

    2013-11-01

    The carpal tunnel syndrome is the most common entrapment syndrome of the upper limb. Compression of the median nerve is most often idiopathic and typically occurs in women aged 50. The diagnosis is clinical and must look for signs of gravity (hypoesthesia, thenar atrophy). The electromyogram is not required but recommended for surgical indication, It assesses the severity of the disease and identifies other injury. Conservative treatment is available in the beginner to moderate forms. In case of failure of this treatment or with severe objective signs, treatment is surgical. The ulnar nerve at the elbow comes in the second position of the upper limb entrapment syndromes. Clinical examination looks for signs of serious problems with objectives symptoms. Treatment is usually surgical. PMID:24422297

  16. Methods to evaluate functional nerve recovery in adult rats: walking track analysis, video analysis and the withdrawal reflex

    Microsoft Academic Search

    Jeroen R. Dijkstra; Marcel F. Meek; Peter H. Robinson; Albert Gramsbergen

    2000-01-01

    The aim of this study was to compare different methods for the evaluation of functional nerve recovery. Three groups of adult male Wistar rats were studied. In group A, a 12-mm gap between nerve ends was bridged by an autologous nerve graft; in rats of group B we performed a crush lesion of the sciatic nerve and group C consisted

  17. High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma.

    PubMed

    Koenig, Ralph W; Pedro, Maria T; Heinen, Christian P G; Schmidt, Thomas; Richter, Hans-Peter; Antoniadis, Gregor; Kretschmer, Thomas

    2009-02-01

    High-resolution ultrasonography is a noninvasive, readily applicable imaging modality, capable of depicting real-time static and dynamic morphological information concerning the peripheral nerves and their surrounding tissues. Continuous progress in ultrasonographic technology results in highly improved spatial and contrast resolution. Therefore, nerve imaging is possible to a fascicular level, and most peripheral nerves can now be depicted along their entire anatomical course. An increasing number of publications have evaluated the role of high-resolution ultrasonography in peripheral nerve diseases, especially in peripheral nerve entrapment. Ultrasonography has been shown to be a precious complementary tool for assessing peripheral nerve lesions with respect to their exact location, course, continuity, and extent in traumatic nerve lesions, and for assessing nerve entrapment and tumors. In this article, the authors discuss the basic technical considerations for using ultrasonography in peripheral nerve assessment, and some of the clinical applications are illustrated. PMID:19435442

  18. Etifoxine improves peripheral nerve regeneration and functional recovery

    Microsoft Academic Search

    Christelle Girard; Song Liu; Françoise Cadepond; David Adams; Catherine Lacroix; Marc Verleye; Jean-Marie Gillardin; Etienne-Emile Baulieu; Michael Schumacher; Ghislaine Schweizer-Groyer

    2008-01-01

    Peripheral nerves show spontaneous regenerative responses, but recovery after injury or peripheral neuropathies (toxic, diabetic, or chronic inflammatory demyelinating polyneuropathy syndromes) is slow and often incomplete, and at present no efficient treatment is available. Using well-defined peripheral nerve lesion paradigms, we assessed the therapeutic usefulness of etifoxine, recently identified as a ligand of the translocator protein (18 kDa) (TSPO), to

  19. Computer Simulation of Antidromic Facial Nerve Response Waveform

    Microsoft Academic Search

    Mitsuru Iwai; Taizo Takeda; Hiroaki Nakatani; Akinobu Kakigi

    2009-01-01

    Conclusion: An assessment of facial nerve (FN) damage on the basis of antidromic facial nerve response (AFNR) was established by computer simulation analysis. Computer simulation has the advantage of being able to assume any type of lesion. In the near future, computer analysis should provide another experimental method which displaces animal experiments, thus circumventing the ethical dilemma associated with animal

  20. Intraparotid facial nerve schwannoma: A case report

    PubMed Central

    Jaiswal, Abhishek; Mridha, Asit Ranjan; Nath, Devajit; Bhalla, Ashu Seith; Thakkar, Alok

    2015-01-01

    Facial nerve schwannoma occurring within the parotid gland is a rare tumour. We report a case of schwannoma within the parotid gland in a young female patient, who underwent ultrasound and magnetic resonance imaging (MRI) and subsequent surgical excision of the lesion. The lesion showed hyperintensity on T2-weighted and diffusion-weighted MRI. There was no adjacent lymphadenopathy. Although hyperintensity on diffusion-weighted MRI could suggest malignant tumours, the characteristic “string sign” provided the clue for the diagnosis of schwannoma.

  1. Treatment of ulnar shaft fractures: a prospective, randomized study.

    PubMed

    Atkin, D M; Bohay, D R; Slabaugh, P; Smith, B W

    1995-06-01

    The treatment of isolated ulnar shaft fractures is controversial. Previous studies comparing treatment options have been largely retrospective and nonrandomized. In this study, consecutive patients were randomized into treatment groups of long arm plaster immobilization, short arm plaster immobilization, or Ace Wrap bandage, based on the order of hospital admission. Thirty-one patients were followed until radiographic or clinical union, with no significant difference in time to union between groups. Age, sex, fracture pattern, and displacement did not significantly influence time to union or final angulation. Two patients in both the long arm cast group and the short arm cast group lost significant motion at final follow up. Seventy percent of patients in the Ace Wrap group failed treatment secondary to pain and were converted to plaster immobilization. Furthermore, patients in this group demonstrated significantly greater angulation than those treated in a long arm cast. Our results demonstrate that above-elbow plaster immobilization offers no advantage over below-elbow immobilization. We recommend short arm casting for a period of 8 weeks. PMID:7675718

  2. Electrophysiologicalproperties were monitored in detail in chronically con-stricted peripheral nerves by implanted, multicontact nerve cuff electrodes

    E-print Network

    Loeb, Gerald E.

    similar but less pronounced changes than larger diameter fibers. Recordings from ventral and dorsal roots * "dying-back'' degeneration * secondary demyelination MUSCLE & NERVE 12~915-928 1989 CONDUCTION STUDIES in peripheral nerve fiber caliber occur as a consequence of traumatic lesions. Retrograde atrophy of mature

  3. Ulnar styloid fracture in distal radius fractures managed with volar locking plates: to fix or not?

    PubMed

    Gogna, Paritosh; Selhi, Harpal Singh; Mohindra, Mukul; Singla, Rohit; Thora, Ankit; Yamin, Mohammad

    2014-12-01

    Distal radius fracture is usually associated with ulnar styloid fracture. Whether to fix the ulnar styloid or not remains a surgical dilemma as some surgeons believe that their repair is imperative while others feel that they should be managed conservatively. This prospective study involved 47 patients with unilateral fracture of the distal radius who met the inclusion criterion and underwent open reduction and internal fixation with volar locking plates; 28 patients (12 males and females?=?16) had an associated ulnar styloid fracture (Group A) while 19 (7 males; 12 females) did not have any ulnar styloid fracture (Group B). At the time of final evaluation both the groups were compared clinically by measuring the grip strength and range of motion around the wrist and the radiologically by measuring radial angle, radial length, volar angle and ulnar variance. Subjective assessment was done using DASH score and final assessment using Demerit point system of Saito. In Group A, average time for consolidation was 9.4 weeks, 17 patients developed non-union of the ulnar styloid, average DASH scores was 4.4 and according to Demerit point system of Saito, there were 78.5 % excellent, 17.9 % good and 3.6 % fair results; there were 2 cases of loss of reduction out of which one had persistent ulnar sided wrist pain. In Group B the average time for consolidation was 10.2 weeks, average DASH score was 3.8.and Demerit point system of Saito yielded 78.9 % excellent, 15.8 % good and 5.3 % fair results. There was one case of loss of reduction and one case of carpal tunnel syndrome which was managed conservatively. Both groups attained excellent range of motion, grip strength and well maintained the post operative radiological parameters. The comparison of clinico-radiological parameters in both groups was found to be statistically insignificant. To conclude, ulnar styloid fracture or its non union does not affect the outcome of an adequately fixed distal end radius fracture. We urge caution in electing operative treatment of non-united fracture of the ulnar styloid until better scientific report for treatment of pain associated with these fracture is available. PMID:25414551

  4. Hamartomatous tongue lesions in children.

    PubMed

    Kreiger, Portia A; Ernst, Linda M; Elden, Lisa M; Kazahaya, Ken; Alawi, Faizan; Russo, Pierre A

    2007-08-01

    The incidence and spectrum of tongue lesions in children, in particular tongue hamartomas, is relatively unknown. We report a retrospective review of all tongue lesions seen at a major tertiary care children's hospital over an 18-year period with an emphasis on describing tongue hamartomas. A total of 135 tongue lesions were identified. Vascular/lymphatic lesions (36/135) were the most common followed by mucus extravasation phenomenon (22/135). Interestingly, hamartomatous lesions (18/135) were the third most common lesion category identified. Lingual hamartomas were predominantly submucosal in location and were classified histologically by tissue composition as follows: neurovascular (2/18), smooth muscle predominant (5/18), fat predominant (1/18), and smooth muscle and fat containing (10/18). All 5 smooth muscle predominant hamartomas also contained vasculature, and 1 case additionally contained salivary gland tissue. The single fat predominant hamartoma additionally contained vessels and salivary gland. The final 10 hamartomas contained varying amounts of both smooth muscle and fat, and also admixed combinations of vessels, nerves, and salivary glands. Two of these 10 cases additionally contained foci of choristomatous elements, including cutaneous adnexal structures and cartilage. Most patients with hamartomatous lesions were young, 2 years or less. Eight cases were congenital in origin. Females outnumbered males by 2:1. The majority of lesions (16/18) were dorsal in location, and 4 patients had a syndromic association, all oral-facial-digital syndrome. PMID:17667541

  5. Nerve Impulses in Plants

    ERIC Educational Resources Information Center

    Blatt, F. J.

    1974-01-01

    Summarizes research done on the resting and action potential of nerve impulses, electrical excitation of nerve cells, electrical properties of Nitella, and temperature effects on action potential. (GS)

  6. Ulnar aplasia, dysplastic radius and preaxial oligodactyly: Rare longitudinal limb defect in a sporadic male child

    PubMed Central

    Malik, Sajid; Afzal, Muhammad

    2013-01-01

    Ulnar hypoplasia is a rare longitudinal limb deficiency in which the ulna shows various degrees of deficiency. The condition is normally associated with radial defects, and in severe cases there is a reduction of postaxial/ulnar digits. Ulnar deficiency is an integral part of several syndromic malformations like Weyer's oligodactyly syndrome, limb/pelvis hypoplasia/aplasia syndrome, and ulnar-mammary syndrome. Here, we report an isolated unilateral ulnar deficiency in a boy who was a product of a consanguineous marriage. The subject demonstrated mesomelic shortening of the left arm with reduced zeugopod and autopod, and preaxial absence of two fingers. Additional findings in the affected limb were severe flexion contracture at the elbow joint, reduced and narrow palm, hypoplastic digits, and clinodactyly. Roentgenographic study revealed rudimentary ulna, dysplastic and posteriorly dislocated radius, crowding of carpals, and complete absence of digit rays of the thumb and index finger. Despite this anomaly, the subject could manage his daily life activities well. We present detailed clinical features and differential diagnosis of this rare limb malformation. PMID:24381628

  7. Ulnar aplasia, dysplastic radius and preaxial oligodactyly: Rare longitudinal limb defect in a sporadic male child.

    PubMed

    Malik, Sajid; Afzal, Muhammad

    2013-09-01

    Ulnar hypoplasia is a rare longitudinal limb deficiency in which the ulna shows various degrees of deficiency. The condition is normally associated with radial defects, and in severe cases there is a reduction of postaxial/ulnar digits. Ulnar deficiency is an integral part of several syndromic malformations like Weyer's oligodactyly syndrome, limb/pelvis hypoplasia/aplasia syndrome, and ulnar-mammary syndrome. Here, we report an isolated unilateral ulnar deficiency in a boy who was a product of a consanguineous marriage. The subject demonstrated mesomelic shortening of the left arm with reduced zeugopod and autopod, and preaxial absence of two fingers. Additional findings in the affected limb were severe flexion contracture at the elbow joint, reduced and narrow palm, hypoplastic digits, and clinodactyly. Roentgenographic study revealed rudimentary ulna, dysplastic and posteriorly dislocated radius, crowding of carpals, and complete absence of digit rays of the thumb and index finger. Despite this anomaly, the subject could manage his daily life activities well. We present detailed clinical features and differential diagnosis of this rare limb malformation. PMID:24381628

  8. Collagen nerve wrap for median nerve scarring.

    PubMed

    Kokkalis, Zinon T; Mavrogenis, Andreas F; Ballas, Efstathios G; Papagelopoulos, Panayiotis J; Soucacos, Panayotis N

    2015-02-01

    Nerve wrapping materials have been manufactured to inhibit nerve tissue adhesions and diminish inflammatory and immunologic reactions in nerve surgery. Collagen nerve wrap is a biodegradable type I collagen material that acts as an interface between the nerve and the surrounding tissues. Its main advantage is that it stays in place during the period of tissue healing and is then gradually absorbed once tissue healing is completed. This article presents a surgical technique that used a collagen nerve wrap for the management of median nerve tissue adhesions in 2 patients with advanced carpal tunnel syndrome due to median nerve scarring and adhesions. At last follow-up, both patients had complete resolution with no recurrence of their symptoms. Complications related to the biodegradable material were not observed. PMID:25665110

  9. Hypertrophic nerve roots in a case of Roussy-Lévy syndrome.

    PubMed

    Haubrich, C; Krings, T; Senderek, J; Züchner, S; Schröder, J M; Noth, J; Töpper, R

    2002-11-01

    Hypertrophic radiculopathy is a rare feature of neuropathies. Single cases of enlarged nerve roots have been described in hereditary motor sensory neuropathies (HMSN) and chronic inflammatory demyelinating diseases (CIDP). This is the first description of hypertrophied nerve roots in a patient with Roussy-Lévy syndrome. MRI did not show contrast enhancement of the enlarged nerve roots or nodular lesions. PMID:12428130

  10. Malignant schwannoma of the obturator nerve.

    PubMed

    Kanta, M; Petera, J; Ehler, E; Prochazka, E; Lastovicka, D; Habalova, J; Valis, M; Rehak, S

    2013-01-01

    Lesions of obturator nerve are rare. Tumours and mainly malignant schwannoma of this nerve are extremely rare. The authors describe an unusual case of a gigantic schwannoma of the obturator nerve in 69 year old woman. Due to tumour expansion in the proximal part of the thigh MRI was performed and demonstrated extensive tumour originating most probably from the obturator nerve. The patient had no neurological symptoms. Biopsy from the lesion was taken at the Department of Orthopaedics with the following conclusion: malignant schwannoma. The patient received neoadjuvant chemotherapy due to diffuse metastatic spread on the chest X ray, after which metastatic spread subsided. The main lesion reduced its size by 1 cm. In 4 months after biopsy the patient was referred for operation to neurosurgery. The tumour was removed along its borders and except of minimal weakness of adduction of the right thigh there was no neurological deterioration. She was subsequently referred for further care to oncology and radiotherapy.The goal of this work is to emphasize the extremely rare occurrence of tumours of this nerve and suggest therapeutic options (Fig. 4, Ref. 11). PMID:24156686

  11. Peripheral nerve stimulation in neurological rehabilitation

    Microsoft Academic Search

    T. Sinkjaer; D. Popovic

    2003-01-01

    An injury to the central nervous system can result in a permanent loss of the voluntary motor function and sensation. However, the peripheral motor and sensory nerves below the level of lesion often remain intact, and so do the muscles. Functional Electrical Stimulation (FES) is a technique to restore motor and sensory functions after such injuries. The forces generated in

  12. Angiolymphoid hyperplasia with eosinophilia involving the cubital nerve.

    PubMed

    Martorell, Miguel; Pérez-Vallés, Ana; García-García, Jose Angel; Calabuig, Consuelo; Aguilella, Luis

    2004-04-01

    A tumor involving cubital nerve was resected and studied; it was classified as an angiolymphoid hyperplasia with eosinophilia (ALHE). Immunohistochemical and molecular study was done both to confirm the reactive nature of the process and rule out the presence of clonal T or B cell rearrangement. This lesion has been designated as epitheloid hemangioma [Coindre (1994) Ann Pathol 14:426]. Typically, ALHE occurs in the skin and the subcutaneous tissue, and extracutaneous involvement is rare. No cases of ALHE affecting a nerve have been described, but a case of Kimura's disease, the lesions of which have repeatedly been confused with ALHE, has been reported involving median nerve. PMID:14762674

  13. The usefulness of nocturnal resting splints in the treatment of ulnar deviation of the rheumatoid hand.

    PubMed

    Malcus Johnson, P; Sandkvist, G; Eberhardt, K; Liang, B; Herrlin, K

    1992-03-01

    Seven patients with definite RA and bilateral ulnar deviation of Fearnley grade I were included in a study of the usefulness of nocturnal resting splints. Each patient used the splint on average 17 months on one hand, randomly chosen, with the free hand as control. Joint mobility, grip strength, pain and radiographic findings were recorded at start and finish of the study. Splint treatment influenced grip strength positively, and most patients stated pain relief during the night. However, all but one patient showed progression of ulnar deviation in both hands, and there was no significant difference in progression between treated and nontreated hands. This study thus supported the use of resting splints at night for pain relief but not for prevention of ulnar deviation. PMID:1582123

  14. Exploring the anatomy of dorsal radiocarpal ligament of the wrist and its ulnar part: a cadaveric study.

    PubMed

    Jariwala, A; Khurjekar, K; Whiton, S; Wigderowitz, C A

    2012-01-01

    The current study aimed to explore the anatomy of the dorsal radio-carpal ligament (DRC ligament) and to investigate the presence and histological structure of ulnar part of the DRC ligament. Twenty cadaveric wrist joints were dissected and attachments of the DRC ligament and the newly described ulnar part of the DRC ligament were identified and noted. Samples of both ligaments were sent for histological examination. The DRC ligament was identified in all 20 specimens with type I Mizuseki arrangement of fibres seen in 60% of wrists. The ulnar part of the DRC ligament was successfully identified in 18 of the 20 wrists. The histological observation of the ulnar part of the DRC ligament showed the highly uniform arrangement of collagen bundles typical of ligaments. This study explores the anatomy of the DRC ligament and confirms the presence of the ulnar part of DRC ligament through histological analysis not undertaken in previous studies. PMID:23061937

  15. Effects of 940 nm light-emitting diode (led) on sciatic nerve regeneration in rats

    Microsoft Academic Search

    Karla Guivernau Gaudens Serafim; Solange de Paula Ramos; Franciele Mendes de Lima; Marcelo Carandina; Osny Ferrari; Ivan Frederico Lupiano Dias; Dari de Oliveira Toginho Filho; Cláudia Patrícia Cardoso Martins Siqueira

    The objective of the present study was to evaluate the effect of 940 nm wavelength light emitting diode (LED) phototherapy\\u000a on nerve regeneration in rats. Forty male Wistar rats weighing approximately 300 g each were divided into four groups: control\\u000a (C); control submitted to LED phototherapy (CLed); Sciatic Nerve Lesion without LED phototherapy (L); Sciatic Nerve Lesion\\u000a with LED phototherapy (LLed). The

  16. Patient-related factors influencing ulnar-shortening osteotomy outcomes using the trimed dynamic compression plate.

    PubMed

    Viswanath, Purab; Monaco, Nathan A; Lubahn, John D

    2015-02-01

    Ulnocarpal impingement can be surgically managed with various shortening osteotomy techniques. The purpose of this study was to retrospectively examine the outcomes of the ulnar-shortening osteotomy technique using the Trimed dynamic compression plate (Valencia, California) and to determine whether results vary among patient-related factors, including smoking status, occupation, preoperative diagnosis, and workers' compensation status. Twenty-seven patients (28 wrists) operated by a single surgeon underwent ulnar shortening over a 4-year span. Radiographic analysis was obtained preoperatively and at an average 24-month follow-up. A subset of 12 patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) inventory; the Patient-Rated Wrist Evaluation (PRWE); and the visual analog scale for pain and underwent clinical evaluation for range of motion and strength. Ulnar variance improved in all cases between pre- and postoperative imaging (P<.05). Grip strength and range of motion were found to be 79% and 90% of the contralateral extremity, respectively. Among the examined patient-related factors, patients involved in a workers' compensation claim demonstrated significantly different DASH (average, 56.8 claim vs 26.8 no claim; P=.037) and PRWE (average, 66.0 claim vs 32.8 no claim; P=.008) scores while also showing a trend toward nonunion (3/10 claim vs 1/18 no claim; P=.105). Results of ulnar-shortening osteotomy using the Trimed system at 2-year follow-up show consistent objective improvements in radiographic ulnar variance. Workers' compensation claims may negatively influence outcomes of ulnar shortening, and this factor should be considered in preoperative patient selection and counseling. [Orthopedics. 2015; 38(2):e106-e111.]. PMID:25665114

  17. Influence of recreational activity and muscle strength on ulnar bending stiffness in men

    NASA Technical Reports Server (NTRS)

    Myburgh, K. H.; Charette, S.; Zhou, L.; Steele, C. R.; Arnaud, S.; Marcus, R.

    1993-01-01

    Bone bending stiffness (modulus of elasticity [E] x moment of inertia [I]), a measure of bone strength, is related to its mineral content (BMC) and geometry and may be influenced by exercise. We evaluated the relationship of habitual recreational exercise and muscle strength to ulnar EI, width, and BMC in 51 healthy men, 28-61 yr of age. BMC and width were measured by single photon absorptiometry and EI by mechanical resistance tissue analysis. Maximum biceps strength was determined dynamically (1-RM) and grip strength isometrically. Subjects were classified as sedentary (S) (N = 13), moderately (M) (N = 18), or highly active (H) (N = 20) and exercised 0.2 +/- 0.2; 2.2 +/- 1.3; and 6.8 +/- 2.3 h.wk-1 (P < 0.001). H had greater biceps (P < 0.0005) and grip strength (P < 0.05), ulnar BMC (P < 0.05), and ulnar EI (P = 0.01) than M or S, who were similar. Amount of activity correlated with grip and biceps strength (r = 0.47 and 0.49; P < 0.001), but not with bone measurements, whereas muscle strength correlated with both EI and BMC (r = 0.40-0.52, P < 0.005). EI also correlated significantly with both BMC and ulnar width (P < 0.0001). Ulnar width and biceps strength were the only independent predictors of EI (r2 = 0.67, P < 0.0001). We conclude that levels of physical activity sufficient to increase arm strength influence ulnar bending stiffness.

  18. Vascular lesions.

    PubMed

    Ting, Patricia T; Rao, Jaggi

    2011-01-01

    Advances in laser and light-based technology have increased their potential applications, safety and efficacy for the management of vascular lesions in dermatology. Light devices for vascular lesions include the variable-pulse 532 nm potassium titanyl phosphate laser, 577 to 595 nm pulsed dye laser, intense pulsed light devices, and 800 to 940 nm diode, long-pulse 755 nm alexandrite and 1,064 nm Nd:YAG lasers. This review will discuss the various different laser and light-based devices, and provide a focused treatment approach for the management of common congenital and acquired vascular lesions. PMID:21865800

  19. Regeneration of Dorsal Column Fibers into and beyond the Lesion Site following Adult Spinal Cord Injury

    Microsoft Academic Search

    Simona Neumann; Clifford J Woolf

    1999-01-01

    Regeneration is abortive following adult mammalian CNS injury. We have investigated whether increasing the intrinsic growth state of primary sensory neurons by a conditioning peripheral nerve lesion increases regrowth of their central axons. After dorsal column lesions, all fibers stop at the injury site. Animals with a peripheral axotomy concomitant with the central lesion show axonal growth into the lesion

  20. Myelinated sensory and alpha motor axon regeneration in peripheral nerve neuromas

    NASA Technical Reports Server (NTRS)

    Macias, M. Y.; Lehman, C. T.; Sanger, J. R.; Riley, D. A.

    1998-01-01

    Histochemical staining for carbonic anhydrase and cholinesterase (CE) activities was used to analyze sensory and motor axon regeneration, respectively, during neuroma formation in transected and tube-encapsulated peripheral nerves. Median-ulnar and sciatic nerves in the rodent model permitted testing whether a 4 cm greater distance of the motor neuron soma from axotomy site or intrinsic differences between motor and sensory neurons influenced regeneration and neuroma formation 10, 30, and 90 days later. Ventral root radiculotomy confirmed that CE-stained axons were 97% alpha motor axons. Distance significantly delayed axon regeneration. When distance was negligible, sensory axons grew out sooner than motor axons, but motor axons regenerated to a greater quantity. These results indicate regeneration differences between axon subtypes and suggest more extensive branching of motor axons within the neuroma. Thus, both distance from injury site to soma and inherent motor and sensory differences should be considered in peripheral nerve repair strategies.

  1. Imaging features on sonography and MRI in a case of lipofibromatous hamartoma of the median nerve

    PubMed Central

    Arora, Abhishek J.

    2014-01-01

    Lipofibromatous hamartomas are rare benign tumours of Peripheral nerves. Median nerve is most common affected nerve involved in about 80 percent of the cases. Approximately 92 cases have been reported so far. We present a case of lipofibromatous hamartoma of median nerve diagnosed on sonography and magnetic resonance imaging (MRI). These rare lesions are an important entity to be known to radiologists because their imaging features are quite pathognomonic and allow for confident diagnosis negating the need for biopsy. PMID:24914422

  2. Parenchymal Anaplastic Astrocytoma presenting with Visual Symptoms due to Bilateral Optic Nerve Sheath Involvement

    PubMed Central

    Bui, Kelly M; Farooq, Asim V; Valyi-Nagy, Tibor; Villano, J. Lee; Moss, Heather E

    2013-01-01

    A 23 year old man presented with transient visual obscurations and was found to have optic nerve edema and a thalamic lesion that did not enhance on magnetic resonance imaging. Lumbar puncture opening pressure was normal. Subsequent magnetic resonance images demonstrated optic nerve sheath enhancement. Pathological diagnosis of the thalamic mass was anaplastic astrocytoma (WHO grade III). Visual symptoms were attributed to spread of high grade parenchymal glioma to the optic nerve sheaths causing intraorbital optic nerve compression. PMID:23838764

  3. Peripheral nerve regeneration after experimental section in ovine radial and tibial nerves using synthetic nerve grafts, including expanded bone marrow mesenchymal cells: morphological and neurophysiological results.

    PubMed

    Casañas, Joaquim; de la Torre, Jaime; Soler, Francesc; García, Felix; Rodellar, Clementina; Pumarola, Martí; Climent, Jana; Soler, Robert; Orozco, Lluís

    2014-10-01

    The standard treatment of peripherical nerve injuries with substance gap is to introduce the nerve free extremes in a biodegradable tube which, as a biocamera, allows the continuity of the nerve, promote the neuroconduction and save the lesion from the surrounding fibrosis. However, this procedure has not any direct effect on the neuroregeneration nor to resolve high severe lesions. The mesenchymal stem cells (MSC) can derivate "in vitro" in different lineages, including Schwann cells. Different studies have shown MSC can promote the nerve regeneration in rodents, dogs and primates. Moving to the human clinical application requires the procedure standardization, including the optimal cell dose which we have to use. In the sheep model animal we performed a study of 1 cm. nerve section-ressection and repair with a Neurolac™ biocamera, in whose gap we applied between 30 to 50×10(6) MSC from cancellous bone, all of them selected and cultured with GMP procedures. The results were compared with controls (saline serum ± platelet-rich plasma). We used radial nerve (sensitive) and tibial nerve (motor) from 7 sheep. In the first step we performed the surgical lesion and bone marrow aspiration, and in 3 weeks we performed the surgical repair. 3 sheep were sacrificed in 3 months, and 4 sheep in 6 months. In all surgeries we performed a neurophysiological register. When we obtained the tissue samples, we performed an histological, immunohistiquimical and morphometrical study. The recovery percentage was defined comparing the axonal density from the proximal and distal lesion margins. The 3 months samples results were wrong. In 6 months samples results we observed a significative myelined nervous fibers and conduction increasing, in front of controls, both radial and tibial nerves. These results suggest the MSC application in biodegradable scaffold in nerve injuries promotes good results in terms of regeneration and functional recovery. PMID:25384470

  4. Peripheral nerve size in normals and patients with polyneuropathy: an ultrasound study.

    PubMed

    Zaidman, Craig M; Al-Lozi, Mohammed; Pestronk, Alan

    2009-12-01

    Ultrasound has been used for visualizing peripheral nerve pathology. Our goal was to use ultrasound to quantitate the sizes of upper extremity nerves along their length in control subjects and patients with neuropathy. We measured median and ulnar nerve cross-sectional areas (NCSA) in the arms of 190 subjects, including 100 with neuropathies and 90 controls. We found that NCSAs in healthy child and adult controls were greater with increasing height, at proximal sites, and at sites of entrapment. Nerves were enlarged in all Charcot-Marie-Tooth 1A (CMT-1A) (11 of 11; 100%), most chronic inflammatory demyelinating polyneuropathy (CIDP) (31 of 36; 86%), half of Guillain-Barré syndrome (GBS) (8 of 17; 47%), but few axonal neuropathy (7 of 36, 19%) subjects. In GBS, nerve enlargement occurred early and with minimal electrodiagnostic abnormalities in some patients. We conclude that NCSA measured by ultrasound is a quantifiable marker of nerve features that should be corrected for patient characteristics and nerve site. NCSA is generally larger in demyelinating than it is in axonal polyneuropathies. PMID:19697380

  5. Amplitude of sensory nerve action potential in early stage diabetic peripheral neuropathy: an analysis of 500 cases

    PubMed Central

    Zhang, Yunqian; Li, Jintao; Wang, Tingjuan; Wang, Jianlin

    2014-01-01

    Early diagnosis of diabetic peripheral neuropathy is important for the successful treatment of diabetes mellitus. In the present study, we recruited 500 diabetic patients from the Fourth Affiliated Hospital of Kunming Medical University in China from June 2008 to September 2013: 221 cases showed symptoms of peripheral neuropathy (symptomatic group) and 279 cases had no symptoms of peripheral impairment (asymptomatic group). One hundred healthy control subjects were also recruited. Nerve conduction studies revealed that distal motor latency was longer, sensory nerve conduction velocity was slower, and sensory nerve action potential and amplitude of compound muscle action potential were significantly lower in the median, ulnar, posterior tibial and common peroneal nerve in the diabetic groups compared with control subjects. Moreover, the alterations were more obvious in patients with symptoms of peripheral neuropathy. Of the 500 diabetic patients, neural conduction abnormalities were detected in 358 cases (71.6%), among which impairment of the common peroneal nerve was most prominent. Sensory nerve abnormality was more obvious than motor nerve abnormality in the diabetic groups. The amplitude of sensory nerve action potential was the most sensitive measure of peripheral neuropathy. Our results reveal that varying degrees of nerve conduction changes are present in the early, asymptomatic stage of diabetic peripheral neuropathy. PMID:25221597

  6. Sensory nerve action potentials and sensory perception in women with arthritis of the hand

    PubMed Central

    2012-01-01

    Background Arthritis of the hand can limit a person’s ability to perform daily activities. Whether or not sensory deficits contribute to the disability in this population remains unknown. The primary purpose of this study was to determine if women with osteoarthritis (OA) or rheumatoid arthritis (RA) of the hand have sensory impairments. Methods Sensory function in the dominant hand of women with hand OA or RA and healthy women was evaluated by measuring sensory nerve action potentials (SNAPs) from the median, ulnar and radial nerves, sensory mapping (SM), and vibratory and current perception thresholds (VPT and CPT, respectively) of the second and fifth digits. Results All SNAP amplitudes were significantly lower for the hand OA and hand RA groups compared with the healthy group (p?ulnar and radial nerves. Less apparent were losses in conduction speed or sensory perception. PMID:22575001

  7. Applied anatomy of the superficial branch of the radial nerve.

    PubMed

    Robson, A J; See, M S; Ellis, H

    2008-01-01

    The superficial branch of the radial nerve (SBRN) is highly vulnerable to trauma and iatrogenic injury. This study aimed to map the course of the SBRN in the context of surgical approaches and identify a safe area of incision for de Quervain's tenosynovitis. Twenty-five forearms were dissected. The SBRN emerged from under brachioradialis by a mean of 8.31 cm proximal to the radial styloid (RS), and remained radial to the dorsal tubercle of the radius by a mean of 1.49 cm. The nerve divided into a median of four branches. The first branch arose a mean of 4.92 cm proximal to the RS, traveling 0.49 cm radial to the first compartment of the extensor retinaculum, while the main nerve remained ulnar to it by 0.64 cm. All specimens had branches underlying the traditional transverse incision for de Quervain's release. A 2.5-cm longitudinal incision proximal from the RS avoided the SBRN in 17/25 cases (68%). In 20/25 specimens (80%), the SBRN underlay the cephalic vein. In 18/25 (72%), the radial artery was closely associated with a sensory nerve branch near the level of the RS (SBRN 12/25, lateral cutaneous nerve of the forearm (LCNF) 6/25.) A longitudinal incision in de Quervain's surgery may be preferable. Cannulation of the cephalic vein in the distal third of the forearm is best avoided. The close association between the radial artery and first branch of the SBRN or the LCNF may explain the pain often experienced during arterial puncture. Particular care should be taken during radial artery harvest to avoid nerve injury. PMID:18092362

  8. Evaluation of Tookad-mediated photodynamic effect on peripheral nerve and pelvic nerve in a canine model

    NASA Astrophysics Data System (ADS)

    Hetzel, Fred W.; Chen, Qun; Dole, Kenneth C.; Blanc, Dominique; Whalen, Lawrence R.; Gould, Daniel H.; Huang, Zheng

    2006-02-01

    Photodynamic therapy (PDT) mediated with a novel vascular targeting photosensitizer pd-bacteriopheophorbide (Tookad) has been investigated as an alternative modality for the treatment of prostate cancer and other diseases. This study investigated, for the first time, the vascular photodynamic effects of Tookad-PDT on nerve tissues. We established an in situ canine model using the cutaneous branches of the saphenous nerve to evaluate the effect of Tookad-PDT secondary to vascular damage on compound-action potentials. With Tookad dose of 2 mg/kg, treatment with 50 J/cm2 induced little change in nerve conduction. However, treatment with 100 J/cm2 resulted in decreases in nerve conduction velocities, and treatment with 200 J/cm2 caused a total loss of nerve conduction. Vasculature surrounding the saphenous nerve appeared irritated. The nerve itself looked swollen and individual fibers were not as distinct as they were before PDT treatment. Epineurium had mild hemorrhage, leukocyte infiltration, fibroplasias and vascular hypertrophy. However, the nerve fascicles and nerve fibers were free of lesions. We also studied the effect of Tookad-PDT secondary to vascular damage on the pelvic nerve in the immediate vicinity of the prostate gland. The pelvic nerve and saphenous nerve showed different sensitivity and histopathological responses to Tookad-PDT. Degeneration nerve fibers and necrotic neurons were seen in the pelvic nerve at a dose level of 1 mg/kg and 50 J/cm2. Adjacent connective tissue showed areas of hemorrhage, fibrosis and inflammation. Our preliminary results suggest that possible side effects of interstitial PDT on prostate nerve tissues need to be further investigated.

  9. Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain.

    PubMed

    Moraux, A; Lefebvre, G; Pansini, V; Aucourt, J; Vandenbussche, L; Demondion, X; Cotten, A

    2014-06-01

    Pisotriquetral joint disorders are often under-recognized in routine clinical practice. They nevertheless represent a significant cause of ulnar side wrist pain. The aim of this article is to present the main disorders of this joint and discuss the different imaging modalities that can be useful for its assessment. PMID:24687844

  10. Compartment syndrome resulting from undetected ulnar artery injury in the absence of a forearm fracture.

    PubMed

    Chadha, Priyanka; Lloyd-Hughes, Hawys; Halsey, Timothy

    2014-01-01

    A 6-year-old boy presented following a transient crush injury to his forearm. He displayed mild abrasions but no laceration or associated fractures. The injury resulted in traumatic rupture of the ulnar artery, which caused a large forearm haematoma and an acute forearm compartment syndrome. Prompt clinical diagnosis and operative intervention were required to prevent disastrous consequences. PMID:25538213

  11. Sciatic Nerve Injury Related to Hip Replacement Surgery: Imaging Detection by MR Neurography Despite Susceptibility Artifacts

    PubMed Central

    Wolf, Marcel; Bäumer, Philipp; Pedro, Maria; Dombert, Thomas; Staub, Frank; Heiland, Sabine; Bendszus, Martin; Pham, Mirko

    2014-01-01

    Sciatic nerve palsy related to hip replacement surgery (HRS) is among the most common causes of sciatic neuropathies. The sciatic nerve may be injured by various different periprocedural mechanisms. The precise localization and extension of the nerve lesion, the determination of nerve continuity, lesion severity, and fascicular lesion distribution are essential for assessing the potential of spontaneous recovery and thereby avoiding delayed or inappropriate therapy. Adequate therapy is in many cases limited to conservative management, but in certain cases early surgical exploration and release of the nerve is indicated. Nerve-conduction-studies and electromyography are essential in the diagnosis of nerve injuries. In postsurgical nerve injuries, additional diagnostic imaging is important as well, in particular to detect or rule out direct mechanical compromise. Especially in the presence of metallic implants, commonly applied diagnostic imaging tests generally fail to adequately visualize nervous tissue. MRI has been deemed problematic due to implant-related artifacts after HRS. In this study, we describe for the first time the spectrum of imaging findings of Magnetic Resonance neurography (MRN) employing pulse sequences relatively insensitive to susceptibility artifacts (susceptibility insensitive MRN, siMRN) in a series of 9 patients with HRS procedure related sciatic nerve palsy. We were able to determine the localization and fascicular distribution of the sciatic nerve lesion in all 9 patients, which clearly showed on imaging predominant involvement of the peroneal more than the tibial division of the sciatic nerve. In 2 patients siMRN revealed direct mechanical compromise of the nerve by surgical material, and in one of these cases indication for surgical release of the sciatic nerve was based on siMRN. Thus, in selected cases of HRS related neuropathies, especially when surgical exploration of the nerve is considered, siMRN, with its potential to largely overcome implant related artifacts, is a useful diagnostic addition to nerve-conduction-studies and electromyography. PMID:24558483

  12. Hypoglossal nerve monitoring, a potential application of intraoperative nerve monitoring in head and neck surgery

    PubMed Central

    2013-01-01

    Background Intraoperative nerve monitoring (IONM) has many applications in different surgical fields. In head and neck surgery, IONM has been used to perform surgery of the parotid, thyroid and parathyroid glands, preserving the facial and recurrent nerves. However, hypoglossal nerve neuromonitoring has not been addressed with such relevance. Material and methods A retrospective review of surgeries performed on patients with special tongue and floor of mouth conditions was undertaken to examine the indications that prompted its use. Particular attention was given to the pathology, intraoperative findings and the final outcome of each patient. Results Four patients, aged between 6 years and 68 years, with complex oral tongue and floor of mouth lesions were reviewed. Three patients were male, aged 22 years and younger, and two of these patients had oral tongue cancers with previous surgery. Oral tongue and neck conditions are challenging since the functions of the hypoglossal nerve are put at risk. The use of IONM technology allowed us to preserve nerve functions, speech and swallowing. Conclusions Although IONM of the hypoglossal nerve is not a common indication in tongue and floor of mouth lesions, under special conditions its application can be extrapolated to challenging surgical cases, like the ones described. PMID:24028712

  13. Peripheral facial nerve dysfunction: CT evaluation

    SciTech Connect

    Disbro, M.A.; Harnsberger, H.R.; Osborn, A.G.

    1985-06-01

    Peripheral facial nerve dysfunction may have a clinically apparent or occult cause. The authors reviewed the clinical and radiographic records of 36 patients with peripheral facial nerve dysfunction to obtain information on the location of the suspected lesion and the number, sequence, and type of radiographic evaluations performed. Inadequate clinical evaluations before computed tomography (CT) was done and unnecessary CT examinations were also noted. They have suggested a practical clinical and radiographic scheme to evaluate progressive peripheral facial dysfunction with no apparent cause. If this scheme is applied, unnecessary radiologic tests and delays in diagnosis and treatment may be avoided.

  14. New treatment alternatives in the ulnar neuropathy at the elbow: ultrasound and low-level laser therapy.

    PubMed

    Ozkan, Feyza Unlu; Sayg?, Evrim Karada?; Senol, Selcen; Kapc?, Serap; Aydeniz, Banu; Akta?, Ilknur; Gozke, Eren

    2014-10-16

    Ulnar nerve entrapment at the elbow (UNE) is the second most common entrapment neuropathy of the arm. Conservative treatment is the treatment of choice in mild to moderate cases. Elbow splints and avoiding flexion of the involved elbow constitute majority of the conservative treatment; indeed, there is no other non-invasive treatment modality. The aim of this study was to investigate the efficacy of ultrasound (US) and low-level laser therapy (LLLT) in the treatment of UNE to provide an alternative conservative treatment method. A randomized single-blind study was carried out in 32 patients diagnosed with UNE. Short-segment conduction study (SSCS) was performed for the localization of the entrapment site. Patients were randomized into US treatment (frequency of 1 MHz, intensity of 1.5 W/cm(2), continuous mode) and LLLT (0.8 J/cm(2) with 905 nm wavelength), both applied five times a week for 2 weeks. Assessments were performed at baseline, at the end of the treatment, and at the first and third months by visual analog scale, hand grip strength, semmes weinstein monofilament test, latency change at SSCS, and patient satisfaction scale. Both treatment groups had significant improvements on clinical and electrophysiological parameters (p < 0.05) at first month with no statistically significant difference between them. Improvements in all parameters were sustained at the third month for the US group, while only changes in grip strength and latency were significant for the LLLT group at third month. The present study demonstrated that both US and LLLT provided improvements in clinical and electrophysiological parameters and have a satisfying short-term effectiveness in the treatment of UNE. PMID:25319131

  15. Electromechanical Nerve Stimulator

    NASA Technical Reports Server (NTRS)

    Tcheng, Ping; Supplee, Frank H., Jr.; Prass, Richard L.

    1993-01-01

    Nerve stimulator applies and/or measures precisely controlled force and/or displacement to nerve so response of nerve measured. Consists of three major components connected in tandem: miniature probe with spherical tip; transducer; and actuator. Probe applies force to nerve, transducer measures force and sends feedback signal to control circuitry, and actuator positions force transducer and probe. Separate box houses control circuits and panel. Operator uses panel to select operating mode and parameters. Stimulator used in research to characterize behavior of nerve under various conditions of temperature, anesthesia, ventilation, and prior damage to nerve. Also used clinically to assess damage to nerve from disease or accident and to monitor response of nerve during surgery.

  16. Nerve conduction velocity

    MedlinePLUS

    ... to determine the speed of the nerve signals. Electromyography (recording from needles placed into the muscles) is ... Often, the nerve conduction test is followed by electromyography (EMG). In this test, needles are placed into ...

  17. Distal median nerve dysfunction

    MedlinePLUS

    ... is necessary to look for an underlying medical problem that can affect nerves. Medical conditions such as diabetes and kidney disease can damage nerves. In these cases, treatment is directed at the underlying medical condition. Physical ...

  18. Nerve Injuries in Athletes.

    ERIC Educational Resources Information Center

    Collins, Kathryn; And Others

    1988-01-01

    Over a two-year period this study evaluated the condition of 65 athletes with nerve injuries. These injuries represent the spectrum of nerve injuries likely to be encountered in sports medicine clinics. (Author/MT)

  19. A rare type of peripheral nerve sheath tumor: radial nerve schwannoma.

    PubMed

    Senol, Nilgun; Yilmaz, Omer

    2015-01-01

    Schwannomas, also known as neurilemmomas, are generally benign peripheral nerve sheath tumors developing from Schwann cells. Peripheral nerve sheath tumors account for less than 8% of soft tissue neoplasms. Schwannomas are characterized by a slow-growing and non-infiltrating pattern. We report a 21-year-old, right-handed male, with a mass at his right elbow anterolateral region, that was slowly enlarging and became more painful over time. Magnetic resonance imaging of the right upper extremity revealed a 2.5x2 cm mass with heterogeneous contrast enhancement. The patient underwent complete removal of the lesion. The histopathological diagnosis was schwannoma. The postoperative course was uneventful. Clinically, these tumors may be misdiagnosed as other benign tumors, such as lipomas, synovial cysts or hemangiomas. During surgery, care should be taken to protect the nerve. Schwannomas in the upper extremities can be excised completely with preservation of nerve function and total removal lowers the risk of recurrence. PMID:25640559

  20. Etifoxine improves peripheral nerve regeneration and functional recovery

    PubMed Central

    Girard, Christelle; Liu, Song; Cadepond, Françoise; Adams, David; Lacroix, Catherine; Verleye, Marc; Gillardin, Jean-Marie; Baulieu, Etienne-Emile; Schumacher, Michael; Schweizer-Groyer, Ghislaine

    2008-01-01

    Peripheral nerves show spontaneous regenerative responses, but recovery after injury or peripheral neuropathies (toxic, diabetic, or chronic inflammatory demyelinating polyneuropathy syndromes) is slow and often incomplete, and at present no efficient treatment is available. Using well-defined peripheral nerve lesion paradigms, we assessed the therapeutic usefulness of etifoxine, recently identified as a ligand of the translocator protein (18 kDa) (TSPO), to promote axonal regeneration, modulate inflammatory responses, and improve functional recovery. We found by histologic analysis that etifoxine therapy promoted the regeneration of axons in and downstream of the lesion after freeze injury and increased axonal growth into a silicone guide tube by a factor of 2 after nerve transection. Etifoxine also stimulated neurite outgrowth in PC12 cells, and the effect was even stronger than for specific TSPO ligands. Etifoxine treatment caused a marked reduction in the number of macrophages after cryolesion within the nerve stumps, which was rapid in the proximal and delayed in the distal nerve stumps. Functional tests revealed accelerated and improved recovery of locomotion, motor coordination, and sensory functions in response to etifoxine. This work demonstrates that etifoxine, a clinically approved drug already used for the treatment of anxiety disorders, is remarkably efficient in promoting acceleration of peripheral nerve regeneration and functional recovery. Its possible mechanism of action is discussed, with reference to the neurosteroid concept. This molecule, which easily enters nerve tissues and regulates multiple functions in a concerted manner, offers promise for the treatment of peripheral nerve injuries and axonal neuropathies. PMID:19075249

  1. Etifoxine improves peripheral nerve regeneration and functional recovery.

    PubMed

    Girard, Christelle; Liu, Song; Cadepond, Françoise; Adams, David; Lacroix, Catherine; Verleye, Marc; Gillardin, Jean-Marie; Baulieu, Etienne-Emile; Schumacher, Michael; Schweizer-Groyer, Ghislaine

    2008-12-23

    Peripheral nerves show spontaneous regenerative responses, but recovery after injury or peripheral neuropathies (toxic, diabetic, or chronic inflammatory demyelinating polyneuropathy syndromes) is slow and often incomplete, and at present no efficient treatment is available. Using well-defined peripheral nerve lesion paradigms, we assessed the therapeutic usefulness of etifoxine, recently identified as a ligand of the translocator protein (18 kDa) (TSPO), to promote axonal regeneration, modulate inflammatory responses, and improve functional recovery. We found by histologic analysis that etifoxine therapy promoted the regeneration of axons in and downstream of the lesion after freeze injury and increased axonal growth into a silicone guide tube by a factor of 2 after nerve transection. Etifoxine also stimulated neurite outgrowth in PC12 cells, and the effect was even stronger than for specific TSPO ligands. Etifoxine treatment caused a marked reduction in the number of macrophages after cryolesion within the nerve stumps, which was rapid in the proximal and delayed in the distal nerve stumps. Functional tests revealed accelerated and improved recovery of locomotion, motor coordination, and sensory functions in response to etifoxine. This work demonstrates that etifoxine, a clinically approved drug already used for the treatment of anxiety disorders, is remarkably efficient in promoting acceleration of peripheral nerve regeneration and functional recovery. Its possible mechanism of action is discussed, with reference to the neurosteroid concept. This molecule, which easily enters nerve tissues and regulates multiple functions in a concerted manner, offers promise for the treatment of peripheral nerve injuries and axonal neuropathies. PMID:19075249

  2. Cortical Brain Mapping of Peripheral Nerves Using Functional Magnetic Resonance Imaging in a Rodent Model

    PubMed Central

    Cho, Younghoon R.; Jones, Seth R.; Pawela, Christopher P.; Li, Rupeng; Kao, Dennis S.; Schulte, Marie L.; Runquist, Matthew L.; Yan, Ji-Geng; Hudetz, Anthony G.; Jaradeh, Safwan S.; Hyde, James S.; Matloub, Hani S.

    2008-01-01

    The regions of the body have cortical and subcortical representation in proportion to their degree of innervation. The rat forepaw has been studied extensively in recent years using functional magnetic resonance imaging (fMRI)—typically by stimulation using electrodes directly inserted into the skin of the forepaw. Here, we stimulate using surgically implanted electrodes. A major distinction is that stimulation of the skin of the forepaw is mostly sensory, whereas direct nerve stimulation reveals not only the sensory system but also deep brain structures associated with motor activity. In this paper, we seek to define both the motor and sensory cortical and subcortical representations associated with the four major nerves of the rodent upper extremity. We electrically stimulated each nerve (median, ulnar, radial, and musculocutaneous) during fMRI acquisition using a 9.4T Bruker scanner. A current level of 0.5-1.0 mA and a frequency of 5 Hz were used while keeping the duration constant. A distinct pattern of cortical activation was found for each nerve that can be correlated with known sensorimotor afferent and efferent pathways to the rat forepaw. This direct nerve stimulation rat model can provide insight into peripheral nerve injury. PMID:18924070

  3. Cranial Nerves Model

    NSDL National Science Digital Library

    Juliann Garza (University of Texas-Pan American Physician Assistant Studies)

    2010-08-16

    Lesson is designed to introduce students to cranial nerves through the use of an introductory lecture. Students will then create a three-dimensional model of the cranial nerves. An information sheet will accompany the model in order to help students learn crucial aspects of the cranial nerves.

  4. Radiofrequency Lesioning

    Microsoft Academic Search

    Michael Petr; John M. Tew

    Radiofrequency lesioning (RFL) is a time-proven, safe method of long-term pain relief. It provides successful treatment for\\u000a trigeminal neuralgia and has been explored as a tool for symptomatic relief of many other neurologic conditions including\\u000a Parkinson’s disease, oncologic pain, spinal pain syndromes, facial spasm, facial pain of multiple sclerosis, vagoglossopharyngeal\\u000a neuralgia, and (rarely) atypical facial pain (1–5). Originally the RFL

  5. Ultrasonography of peripheral nerves.

    PubMed

    Martinoli, C; Bianchi, S; Derchi, L E

    2000-06-01

    With recent improvements in ultrasound (US) imaging equipment and refinements in scanning technique, an increasing number of peripheral nerves and related pathologic conditions can be identified. US imaging can support clinical and electrophysiologic testing for detection of nerve abnormalities caused by trauma, tumors, and a variety of nonneoplastic conditions, including entrapment neuropathies. This article addresses the normal US appearance of peripheral nerves and discusses the potential role of US nerve imaging in specific clinical settings. A series of US images of diverse pathologic processes involving peripheral nerves is presented. PMID:10994689

  6. Ultrasound-guided pulse-dose radiofrequency: treatment of neuropathic pain after brachial plexus lesion and arm revascularization.

    PubMed

    Magistroni, Ernesta; Ciclamini, Davide; Panero, Bernardino; Verna, Valter

    2014-01-01

    Neuropathic pain following brachial plexus injury is a severe sequela that is difficult to treat. Pulsed radiofrequency (PRF) has been proved to reduce neuropathic pain after nerve injury, even though the underlying mechanism remains unclear. This case report describes the use of ultrasound-guided PRF to reduce neuropathic pain in a double-level upper extremity nerve injury. A 25-year-old man who sustained a complete left brachial plexus injury with cervical root avulsion came to our attention. Since 2007 the patient has suffered from neuropathic pain (NP) involving the ulnar side of the forearm, the proximal third of the forearm, and the thumb. No pain relief was obtained by means of surgery, rehabilitation, and medications. Ultrasound-guided PRF was performed on the ulnar nerve at the elbow level. The median nerve received a PRF treatment at wrist level. After the treatment, the patient reported a consistent reduction of pain in his hand. We measured a 70% reduction of pain on the VAS scale. PRF treatment allowed our patient to return to work after a period of absence enforced by severe pain. This case showed that PRF is a useful tool when pharmacological therapy is inadequate for pain control in posttraumatic neuropathic pain. PMID:25525439

  7. Ultrasound-Guided Pulse-Dose Radiofrequency: Treatment of Neuropathic Pain after Brachial Plexus Lesion and Arm Revascularization

    PubMed Central

    Magistroni, Ernesta; Panero, Bernardino; Verna, Valter

    2014-01-01

    Neuropathic pain following brachial plexus injury is a severe sequela that is difficult to treat. Pulsed radiofrequency (PRF) has been proved to reduce neuropathic pain after nerve injury, even though the underlying mechanism remains unclear. This case report describes the use of ultrasound-guided PRF to reduce neuropathic pain in a double-level upper extremity nerve injury. A 25-year-old man who sustained a complete left brachial plexus injury with cervical root avulsion came to our attention. Since 2007 the patient has suffered from neuropathic pain (NP) involving the ulnar side of the forearm, the proximal third of the forearm, and the thumb. No pain relief was obtained by means of surgery, rehabilitation, and medications. Ultrasound-guided PRF was performed on the ulnar nerve at the elbow level. The median nerve received a PRF treatment at wrist level. After the treatment, the patient reported a consistent reduction of pain in his hand. We measured a 70% reduction of pain on the VAS scale. PRF treatment allowed our patient to return to work after a period of absence enforced by severe pain. This case showed that PRF is a useful tool when pharmacological therapy is inadequate for pain control in posttraumatic neuropathic pain. PMID:25525439

  8. Optic Nerve Elongation

    PubMed Central

    Alvi, Aijaz; Janecka, Ivo P.; Kapadia, Silloo; Johnson, Bruce L.; McVay, William

    1996-01-01

    The length of the optic nerves is a reflection of normal postnatal cranio-orbital development. Unilateral elongation of an optic nerve has been observed in two patients with orbital and skull base neoplasms. In the first case as compared to the patient's opposite, normal optic nerve, an elongated length of the involved optic nerve of 45 mm was present. The involved optic nerve in the second patient was 10 mm longer than the normal opposite optic nerve. The visual and extraocular function was preserved in the second patient. The first patient had only light perception in the affected eye. In this paper, the embryology, anatomy, and physiology of the optic nerve and its mechanisms of stretch and repair are discussed. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9Figure 10Figure 11Figure 13 PMID:17170975

  9. Laryngeal zoster with multiple cranial nerve palsies

    Microsoft Academic Search

    Paul Van Den Bossche; Karolien Van Den Bossche; Hilde Vanpoucke

    2008-01-01

    A young immunocompetent patient is presented with a very rare presentation of a common viral illness: herpes zoster of the\\u000a left hemilarynx with sensorial and motoric neuropathy of three ipsilateral lower cranial nerves: IX, X and XI. The mucosal\\u000a lesions were discovered during upper gastrointestinal endoscopy. PCR of erosional exsudate confirmed the clinical diagnosis.\\u000a Antiviral therapy and corticosteroids possibly contributed

  10. [Common and not so common nerve entrapment syndromes: diagnostics, clinical aspects and therapy].

    PubMed

    Schulte-Mattler, W J; Grimm, T

    2015-02-01

    Altogether, nerve entrapment syndromes have a very high incidence. Neurological deficits attributable to a focal peripheral nerve lesion lead to the clinical diagnosis. Frequently, pain is the dominant symptom but is often not confined to the nerve supply area. Electroneurography, electromyography, and more recently also neurosonography are the most important diagnostic tools. In most patients surgical therapy is necessary, which should be carried out in a timely manner. The entrapment syndromes discussed are suprascapular nerve entrapment, carpal tunnel syndrome, cubital tunnel syndrome, meralgia paraesthetica, thoracic outlet syndrome and anterior interosseous nerve syndrome. PMID:25526716

  11. Septo-optic dysplasia in combination with a pigmented skin lesion: a case report with nosological discussion

    Microsoft Academic Search

    Stefan De Smedt; Philippe Demaerel; Paul Casaer; Ingele Casteels

    2000-01-01

    In this case report a patient with bilateral optic nerve hypoplasia, schizencephaly and a pigmented skin lesion is described. The diagnosis of de Morsier syndrome or septo-optic dysplasia is put forward on the basis of the diagnosis of optic nerve hypoplasia. The differential diagnosis with Jadassohn's naevus phakomatosis is discussed. The importance of direct ophthalmoscopy of optic nerve abnormalities is

  12. Occurrence of epidermal nerve endings in glabrous and hairy skin of the rat foot after sciatic nerve regeneration

    Microsoft Academic Search

    N. Stankovic; O. Johansson; C. Hildebrand

    1996-01-01

    The occurrence and distribution of intraepidermal nerve endings in hairy and glabrous skin of the rat foot was examined in normal cases and three months after sciatic neurotomy\\/suture or a crush lesion. The nerve endings were visualized in cryostate sections with antibodies against protein gene product 9.5. Normal glabrous skin exhibited 23.3 endings\\/mm length. Neurotomy\\/suture cases had 6.1 endings\\/mm. In

  13. Hyperbaric oxygenation in peripheral nerve repair and regeneration.

    PubMed

    Sanchez, E Cuauhtemoc

    2007-03-01

    Peripheral nerves are essential connections between the central nervous system and muscles, autonomic structures and sensory organs. Their injury is one of the major causes for severe and longstanding impairment in limb function. Acute peripheral nerve lesion has an important inflammatory component and is considered as ischemia-reperfusion (IR) injury. Surgical repair has been the standard of care in peripheral nerve lesion. It has reached optimal technical development but the end results still remain unpredictable and complete functional recovery is rare. Nevertheless, nerve repair is not primarily a mechanical problem and microsurgery is not the only key to success. Lately, there have been efforts to develop alternatives to nerve graft. Work has been carried out in basal lamina scaffolds, biologic and non-biologic structures in combination with neurotrophic factors and/or Schwann cells, tissues, immunosuppressive agents, growth factors, cell transplantation, principles of artificial sensory function, gene technology, gangliosides, implantation of microchips, hormones, electromagnetic fields and hyperbaric oxygenation (HBO). HBO appears to be a beneficial adjunctive treatment for surgical repair in the acute peripheral nerve lesion, when used at lower pressures and in a timely fashion (<6 hours). PMID:17439703

  14. Infra-orbital nerve schwannoma: Report and review

    PubMed Central

    Kumar, Nilesh

    2015-01-01

    Extra-cranial schwannomas although common in head and neck region are very rarely seen originating from the infra-orbital nerve. We report a case of schwannoma arising from infra-orbital nerve in a 40-year-old male patient. The case presented as an isolated, asymptomatic, slow growing sub-cutaneous nodular swelling over left side of mid-face. On ultrasonography, a localized lesion within the sub-cutaneous tissue of cheek was observed, without involvement of orbital, maxillary sinus or underlying bone. Aspiration biopsy of the lesion showed spindle shaped cells predominantly arranged in Antoni A pattern around verocay bodies, with less organized Antoni B tissue in few places. Diagnosis of schwannoma, probably arising from terminal branch of infra-orbital nerve was established. The tumor was approached through skin incision. At the time of exploration, the lesion was found to emanate from the nerve trunk of peripheral branch of infra-orbital nerve, which was dissected and preserved. We correlate our experience with previously reported cases of infra-orbital nerve schwannoma.

  15. Acute isolated volar dislocation of the distal radio-ulnar joint: case report and literature review.

    PubMed

    Werthel, J-D; Masmejean, E; Silvera, J; Boyer, P; Schlur, C

    2014-10-01

    The acute isolated distal radio-ulnar (DRU) dislocation is a rare traumatic pathology and no consensus concerning its management has been established. This case report describes an acute isolated volar DRU dislocation in a 26-year-old patient. The authors propose, based on this case and after an exhaustive review of the literature, a non-operative management for these isolated and non-complicated dislocations. PMID:24981576

  16. Simple Cannulation Procedure for Serial Blood Sampling Through Cutaneous Ulnar Vein in Chickens

    Microsoft Academic Search

    Darmel M. Bayer; K. Mohan; K. Jayakumar; Milad Manafi; B. H. Pavithra

    2012-01-01

    The objective of the study was to collect repeated, low-stress blood samples from the ulnar vein of chickens required for pharmacokinetic studies or hormonal assays. The study used 5 apparently healthy, unsexed, commercial broiler chickens about 6 weeks old and weighing 1.7–1.9 kg for serial sampling of blood. The study prepared the birds prior to cannulation and penetrated the catheter

  17. The reverse ulnar artery forearm island flap in hand surgery: 54 cases.

    PubMed

    Guimberteau, J C; Goin, J L; Panconi, B; Schuhmacher, B

    1988-06-01

    The authors discuss their experience with the ulnar artery forearm island flap in 54 cases of hand surgery. They discuss its advantages over the radial island forearm flap and examine further technical possibilities in hand reconstruction, such as the compound flap. Although these reconstructive techniques do not have any sequelae, they involve the sacrifice of a major artery and should thus be used only in complex cases with very clear indications and as a last resort. PMID:3375354

  18. Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves.

    PubMed

    Kijowski, Richard; Tuite, Michael; Sanford, Matthew

    2005-01-01

    Part II of this comprehensive review on magnetic resonance imaging of the elbow discusses the role of magnetic resonance imaging in evaluating patients with abnormalities of the ligaments, tendons, and nerves of the elbow. Magnetic resonance imaging can yield high-quality multiplanar images which are useful in evaluating the soft tissue structures of the elbow. Magnetic resonance imaging can detect tears of the ulnar collateral ligament and lateral collateral ligament of the elbow with high sensitivity and specificity. Magnetic resonance imaging can determine the extent of tendon pathology in patients with medial epicondylitis and lateral epicondylitis. Magnetic resonance imaging can detect tears of the biceps tendon and triceps tendon and can distinguishing between partial and complete tendon rupture. Magnetic resonance imaging is also helpful in evaluating patients with nerve disorders at the elbow. PMID:15480640

  19. A (heat) shock to the system promotes peripheral nerve regeneration

    PubMed Central

    Höke, Ahmet

    2011-01-01

    Peripheral nerves are easily damaged, resulting in loss of motor and sensory function. Recovery of motor and sensory function after peripheral nerve injury is suboptimal, even after appropriate surgical repair. This is due to the slow rate of axonal elongation during regeneration and atrophic changes that occur in denervated Schwann cells and target muscle with proximal lesions. One way to solve this problem is to accelerate the rate at which the axons regenerate. In this issue of the JCI, Ma and colleagues show that this can be achieved in mice by overexpression of heat shock protein 27, providing hope for enhanced functional recovery in patients after peripheral nerve damage. PMID:21965324

  20. Unusual branching pattern of axillary artery associated with the high origin of ulnar artery.

    PubMed

    Swamy, Rs; Rao, Mkg; Kumar, N; Sirasanagandla, S; Nelluri, Vm

    2013-04-01

    Axillary artery is a continuation of subclavian artery, extending from the outer border of first rib to the lower border of teres major muscle. During routine dissection for the undergraduate medical students, a rare variations was seen in an approximately 55-year-old male cadaver. This case showed a variation in branching pattern of right axillary and subscapular arteries. The subscapular artery originated from 2(nd) part of axillary artery, gave origin to posterior circumflex humeral and lateral thoracic arteries in addition to its normal branches. The ulnar artery originated from the 3(rd) part of the axillary artery, just above the lower border of teres major muscle. The variant ulnar artery passed deep to the median cubital vein, bicipital aponeurosis, and tendon of palmaris longus muscle. Then, it passed superficial to flexor digitorum superficialis muscle and flexor retinaculum to enter the palm. In the palm, it formed the superficial palmar arch. This variant ulnar artery was much smaller in caliber than the radial artery. PMID:23919202

  1. Malignant peripheral nerve sheath tumor of the cauda equina.

    PubMed

    Acharya, R; Bhalla, S; Sehgal, A D

    2001-06-01

    Only one case of malignant peripheral nerve sheath tumor (MPNST) affecting the cauda equina region has been reported earlier. A 32-year-old male with congenital multiple subcutaneous swellings presented with low back pain, progressive paraparesis and bladder-bowel dysfunction. Magnetic resonance imaging (MRI) demonstrated a heterogeneously enhancing intradural lesion at L2-L4. At operation, on opening the dura, multiple nodular, firm matted masses attached to the lumbosacral nerve roots were encountered. Peripheral lesions were partially excised. Histopathological exam revealed varied cellularity with necrosis and pleomorphic nuclei suggestive of MPNST. MRI features, pathophysiological characteristics and the literature are reviewed. PMID:11731882

  2. Are Human Peripheral Nerves Sensitive to X-Ray Imaging?

    PubMed Central

    Scopel, Jonas Francisco; de Souza Queiroz, Luciano; O’Dowd, Francis Pierce; Júnior, Marcondes Cavalcante França; Nucci, Anamarli; Hönnicke, Marcelo Gonçalves

    2015-01-01

    Diagnostic imaging techniques play an important role in assessing the exact location, cause, and extent of a nerve lesion, thus allowing clinicians to diagnose and manage more effectively a variety of pathological conditions, such as entrapment syndromes, traumatic injuries, and space-occupying lesions. Ultrasound and nuclear magnetic resonance imaging are becoming useful methods for this purpose, but they still lack spatial resolution. In this regard, recent phase contrast x-ray imaging experiments of peripheral nerve allowed the visualization of each nerve fiber surrounded by its myelin sheath as clearly as optical microscopy. In the present study, we attempted to produce high-resolution x-ray phase contrast images of a human sciatic nerve by using synchrotron radiation propagation-based imaging. The images showed high contrast and high spatial resolution, allowing clear identification of each fascicle structure and surrounding connective tissue. The outstanding result is the detection of such structures by phase contrast x-ray tomography of a thick human sciatic nerve section. This may further enable the identification of diverse pathological patterns, such as Wallerian degeneration, hypertrophic neuropathy, inflammatory infiltration, leprosy neuropathy and amyloid deposits. To the best of our knowledge, this is the first successful phase contrast x-ray imaging experiment of a human peripheral nerve sample. Our long-term goal is to develop peripheral nerve imaging methods that could supersede biopsy procedures. PMID:25757086

  3. Painful legs and moving toes: evidence on the site of the lesion.

    PubMed Central

    Nathan, P W

    1978-01-01

    A condition of painful legs with moving toes was described in 1971. Further examples of this condition are now reported, showing lesions in the posterior root ganglion, cauda equina, nerve roots, or a peripheral nerve of the lower limb. It is concluded that this syndrome is caused by a lesion of the afferent fibres of the posterior nerve roots. It is likely that this lesion causes frequent spontaneous impulses in the posterior roots which activate local circuits of interneurones and motoneurones and result in co-ordinated movements involving local muscles. Images PMID:215727

  4. A rare vasoproliferative lesion: angiolymphoid hyperplasia with eosinophilia of the hand.

    PubMed

    Krapohl, B D; Machens, H-G; Reichert, B; Mailänder, P

    2003-03-01

    Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vasoproliferative lesion of uncertain aetiology, involving the skin and subcutaneous tissue. The predilection of the tumour-like lesion is for the head and neck region. Radical surgical excision is still regarded as the most effective treatment. We present the case of a 33-year-old female with ALHE of the right hand. Preoperative MRI and angiography demonstrated involvement of the fourth and fifth rays, with complete occlusion of the ulnar artery, and a small lesion at the level of the metacarpophalangeal joint of the index finger. Complete tumour excision could not be achieved without resection of the fourth and fifth rays. One year postoperatively, there were no clinical signs of recurrence. The patient refused any further invasive diagnostic and follow-up examinations. Angiolymphoid hyperplasia of the hand is a rare disease, and patients should undergo early surgical treatment to achieve complete excision of the lesion. PMID:12791366

  5. The Furcal Nerve Revisited

    PubMed Central

    Dabke, Harshad V.

    2014-01-01

    Atypical sciatica and discrepancy between clinical presentation and imaging findings is a dilemma for treating surgeon in management of lumbar disc herniation. It also constitutes ground for failed back surgery and potential litigations thereof. Furcal nerve (Furcal = forked) is an independent nerve with its own ventral and dorsal branches (rootlets) and forms a link nerve that connects lumbar and sacral plexus. Its fibers branch out to be part of femoral and obturator nerves in-addition to the lumbosacral trunk. It is most commonly found at L4 level and is the most common cause of atypical presentation of radiculopathy/sciatica. Very little is published about the furcal nerve and many are unaware of its existence. This article summarizes all the existing evidence about furcal nerve in English literature in an attempt to create awareness and offer insight about this unique entity to fellow colleagues/professionals involved in spine care. PMID:25317309

  6. The furcal nerve revisited.

    PubMed

    Harshavardhana, Nanjundappa S; Dabke, Harshad V

    2014-08-01

    Atypical sciatica and discrepancy between clinical presentation and imaging findings is a dilemma for treating surgeon in management of lumbar disc herniation. It also constitutes ground for failed back surgery and potential litigations thereof. Furcal nerve (Furcal = forked) is an independent nerve with its own ventral and dorsal branches (rootlets) and forms a link nerve that connects lumbar and sacral plexus. Its fibers branch out to be part of femoral and obturator nerves in-addition to the lumbosacral trunk. It is most commonly found at L4 level and is the most common cause of atypical presentation of radiculopathy/sciatica. Very little is published about the furcal nerve and many are unaware of its existence. This article summarizes all the existing evidence about furcal nerve in English literature in an attempt to create awareness and offer insight about this unique entity to fellow colleagues/professionals involved in spine care. PMID:25317309

  7. Injection of the sciatic nerve with TMEV: a new model for peripheral nerve demyelination.

    PubMed

    Drescher, Kristen M; Tracy, Steven M

    2007-03-01

    Demyelination of the human peripheral nervous system (PNS) can be caused by diverse mechanisms including viral infection. Despite association of several viruses with the development of peripheral demyelination, animal models of the condition have been limited to disease that is either autoimmune or genetic in origin. We describe here a model of PNS demyelination based on direct injection of sciatic nerves of mice with the cardiovirus, Theiler's murine encephalomyelitis virus (TMEV). Sciatic nerves of FVB mice develop inflammatory cell infiltration following TMEV injection. Schwann cells and macrophages are infected with TMEV. Viral replication is observed initially in the sciatic nerves and subsequently the spinal cord. Sciatic nerves are demyelinated by day 5 post-inoculation (p.i.). Injecting sciatic nerves of scid mice resulted in increased levels of virus recovered from the sciatic nerve and spinal cord relative to FVB mice. Demyelination also occurred in scid mice and by 12 days p.i., hindlimbs were paralyzed. This new model of virus-induced peripheral demyelination may be used to dissect processes involved in protection of the PNS from viral insult and to study the early phases of lesion development. PMID:17028060

  8. Overview of the Cranial Nerves

    MedlinePLUS

    ... nerves—the cranial nerves—lead directly from the brain to various parts of the head, neck, and trunk. Some of the cranial nerves are ... cranial nerves emerge from the underside of the brain, pass through ... to parts of the head, neck, and trunk. The nerves are named and numbered, ...

  9. Protecting the genitofemoral nerve during direct/extreme lateral interbody fusion (DLIF/XLIF) procedures.

    PubMed

    Jahangiri, Faisal R; Sherman, Jonathan H; Holmberg, Andrea; Louis, Robert; Elias, Jeff; Vega-Bermudez, Francisco

    2010-12-01

    A 77-year-old male presented with a history of severe lower back pain for 10 years with radiculopathy, positive claudication type symptoms in his calf with walking, and severe "burning" in his legs bilaterally with walking. Magnetic resonance imaging (MRI) revealed lumbar stenosis at the L3-L4 and L4-L5 levels. During the direct or extreme lateral interbody fusion (DLIF/XLIF) procedure, bilateral posterior tibial, femoral, and ulnar nerve somatosensory evoked potentials (SSEPs) were recorded with good morphology of waveforms observed. Spontaneous electromyography (S-EMG) and triggered electromyography (T-EMG) were recorded from cremaster and ipsilateral leg muscles. A left lateral retroperitoneal transpsoas approach was used to access the anterior disc space for complete discectomy, distraction, and interbody fusion. T-EMG ranging from 0.05 to 55.0 mA with duration of 200 microsec was used for identification of the genitofemoral nerve using a monopolar stimulator during the approach. The genitofemoral nerve (L1-L2) was identified, and the guidewire was redirected away from the nerve. Post-operatively, the patient reported complete pain relief and displayed no complications from the procedure. Intraoperative SSEPs, S-EMG, and T-EMG were utilized effectively to guide the surgeon's approach in this DLIF thereby preventing any post-operative neurological deficits such as damage to the genitofemoral nerve that could lead to groin pain. PMID:21313792

  10. Nerve and Blood Vessels

    Microsoft Academic Search

    Maura Valle; Maria Pia Zamorani

    From the histologic point of view, nerves are round or flattened cords, with a complex internal structure made of myelinated\\u000a and unmyelinated nerve fibers, containing axons and Schwann cells grouped in fascicles (Fig. 4.1a) (Erickson 1997). Along the course of the nerve, fibers can traverse from one fascicle to another and fascicles can split and merge. Based\\u000a on the fascicular

  11. Nerves as Embodied Metaphor in the Canada\\/Mexico Seasonal Agricultural Workers Program

    Microsoft Academic Search

    Avis Mysyk; Margaret England; Juan Arturo Avila Gallegos

    2008-01-01

    This article examines nerves among participants in the Canada\\/Mexico Seasonal Agricultural Workers Program (C\\/MSAWP). Based on in-depth interviews with 30 Mexican farm workers in southwestern Ontario, we demonstrate that nerves embodies the distress of economic need, relative powerlessness, and the contradictions inherent in the C\\/MSAWP that result in various life's lesions. We also explore their use of the nerves idiom

  12. Microglia in tadpoles of Xenopus laevis : Normal distribution and the response to optic nerve injury

    Microsoft Academic Search

    I. A. Goodbrand; R. M. Gaze

    1991-01-01

    Summary We have studied the distribution of microglia in normalXenopus tadpoles and after an optic nerve lesion, using a monoclonal antibody (5F4) raised againstXenopus retinas of which the optic nerves had been cut 10 days previously. The antibody 5F4 selectively recognizes macrophages and microglia inXenopus. In normal animals microglia are sparsely but widely distributed throughout the retina, optic nerve, diencephalon

  13. The femoral nerve in the repair of inguinal hernia: well worth remembering

    Microsoft Academic Search

    M. A. García-Ureña; V. Vega; G. Rubio; M. A. Velasco

    2005-01-01

    Injury to the nerves after inguinal hernia surgery is uncommon. The femoral nerve may be damaged by suture or staples, tissue\\u000a scar entrapment, local anesthesia blockade or direct compression. We present a case of a transient lesion of the femoral nerve\\u000a after mesh hernioplasty for a re-recurrent inguinal hernia, confirmed by radiological studies, electrophysiology and clinical\\u000a recovery. The diagnosis, mechanism

  14. Effects of Electrical Stimulation and Testosterone in Translational Models of Facial Nerve Injury

    Microsoft Academic Search

    Nijee Sharma

    2011-01-01

    Among the various peripheral nervous system injuries seen clinically, facial nerve lesions are prevalent and have significant functional and emotional impact on patients. As injuries can occur in different segments of the facial nerve and lead to different pathophysiological outcomes, animal models that mimic the common sites of injury need to be developed so that potential therapies can be appropriately

  15. Selective Reactions of Cutaneous and Muscle Afferent Neurons to Peripheral Nerve Transection in Rats

    Microsoft Academic Search

    Ping Hu; Elspeth M. McLachlan

    2003-01-01

    To determine whether peripheral nerve injury has similar effects on all functional types of afferent neuron, we retrogradely labeled populations of neurons projecting to skin and to muscle with FluoroGold and lesioned various peripheral nerves in the rat. Labeled neurons were counted after different periods and related to immunohistochemically identified ectopic terminals and satellite cells in lumbar dorsal root ganglia.

  16. Ultrasound Neurography in the Evaluation of Sciatic Nerve Injuries

    PubMed Central

    Bilgici, Ayhan; Çokluk, Cengiz; Ayd?n, Keramettin

    2013-01-01

    [Purpose] The aim of this clinical study was to investigate the benefits and the basic principles of ultrasonographic examination in the evaluation of sciatic nerve injuries. [Subjects and Methods] Patients with sciatic nerve injury were evaluated using a real-time utrasonographic examination. The capabilty of ultrasonography in terms of determination of the type and the localization of injury, the position of the proximal and distal nerve segments, the presence or absence of a neuroma, and perilesional scar tissue were evaluated in all cases. [Results] Ten cases with sciatic nerve injury were evaluated with real time sonography. Perilesional scar tissue formation was found in 4 (40%) cases. Two (20%) cases had stump neuroma diagnosed by sonographic examination. The capability of ultrasonographic examination was satisfactory for all evaluation parameters. [Conclusion] Ultrasonographic examination of sciatic nerve lesions may be used for the description of the degree of injury, determination of complete or incomplete nerve sectioning, the presence of hematoma and foreign body, the continuity of nerve, determination of nerve stumps, formation of perilesional scar tissue, and the presence of neuroma. PMID:24259759

  17. Parkinson Disease Affects Peripheral Sensory Nerves in the Pharynx

    PubMed Central

    Mu, Liancai; Sobotka, Stanislaw; Chen, Jingming; Su, Hungxi; Sanders, Ira; Nyirenda, Themba; Adler, Charles H.; Shill, Holly A.; Caviness, John N.; Samanta, Johan E.; Sue, Lucia I.; Beach, Thomas G.

    2013-01-01

    Dysphagia is very common in patients with Parkinson’s disease (PD) and often leads to aspiration pneumonia, the most common cause of death in PD. Unfortunately, current therapies are largely ineffective for dysphagia. As pharyngeal sensation normally triggers the swallowing reflex, we examined pharyngeal sensory nerves in PD for Lewy pathology. Sensory nerves supplying the pharynx were excised from autopsied pharynges obtained from patients with clinically diagnosed and neuropathologically confirmed PD (n = 10) and healthy age-matched controls (n = 4). We examined: the glossopharyngeal nerve (IX); the pharyngeal sensory branch of the vagus nerve (PSB-X); and the internal superior laryngeal nerve (ISLN) innervating the laryngopharynx. Immunohistochemistry for phosphorylated ?-synuclein was used to detect potential Lewy pathology. Axonal ?-synuclein aggregates in the pharyngeal sensory nerves were identified in all of the PD subjects but not in the controls. The density of ?-synuclein-positive lesions was significantly greater in PD subjects with documented dysphagia compared to those without dysphagia. In addition, ?-synuclein-immunoreactive nerve fibers in the ISLN were much more abundant than those in the IX and PSBX. These findings suggest that pharyngeal sensory nerves are directly affected by the pathologic process of PD. This anatomic pathology may decrease pharyngeal sensation impairing swallowing and airway protective reflexes, thereby contributing to dysphagia and aspiration. PMID:23771215

  18. High-Frequency Transcutaneous Peripheral Nerve Stimulation Induces a Higher Increase of Heat Pain Threshold in the Cutaneous Area of the Stimulated Nerve When Confronted to the Neighbouring Areas

    PubMed Central

    Buonocore, M.; Camuzzini, N.; Cecini, M.; Dalla Toffola, E.

    2013-01-01

    Background. TENS (transcutaneous electrical nerve stimulation) is probably the most diffused physical therapy used for antalgic purposes. Although it continues to be used by trial and error, correct targeting of paresthesias evoked by the electrical stimulation on the painful area is diffusely considered very important for pain relief. Aim. To investigate if TENS antalgic effect is higher in the cutaneous area of the stimulated nerve when confronted to neighbouring areas. Methods. 10 volunteers (4 males, 6 females) underwent three different sessions: in two, heat pain thresholds (HPTs) were measured on the dorsal hand skin before, during and after electrical stimulation (100?Hz, 0.1?msec) of superficial radial nerve; in the third session HPTs, were measured without any stimulation. Results. Radial nerve stimulation induced an increase of HPT significantly higher in its cutaneous territory when confronted to the neighbouring ulnar nerve territory, and antalgic effect persisted beyond the stimulation time. Conclusions. The location of TENS electrodes is crucial for obtaining the strongest pain relief, and peripheral nerve trunk stimulation is advised whenever possible. Moreover, the present study indicates that continuous stimulation could be unnecessary, suggesting a strategy for avoiding the well-known tolerance-like effect of prolonged TENS application. PMID:24027756

  19. Outcome of Ulnar Collateral Ligament Reconstruction of the Elbow in 1281 AthletesResults in 743 Athletes With Minimum 2Year Follow-up

    Microsoft Academic Search

    E. Lyle Cain; James R. Andrews; Jeffrey R. Dugas; Kevin E. Wilk; Christopher S. McMichael; James C. Walter; Renee S. Riley; Scott T. Arthur

    2010-01-01

    Background: The anterior bundle of the ulnar collateral ligament (UCL) is the primary anatomical structure providing elbow stability in overhead sports, particularly baseball. Injury to the UCL in overhead athletes often leads to symptomatic valgus instability that requires surgical treatment.Hypothesis: Ulnar collateral ligament reconstruction with a free tendon graft, known as Tommy John surgery , will allow return to the

  20. Alagille's syndrome associated with proximal radio-ulnar synostosis: Clinical case and a literature review.

    PubMed

    Couceiro, J; Gómez, B; Sanmartín, M

    2014-07-15

    Alagille's syndrome is an infrequent genetic condition with autosomal inheritance and variable expression. The complete form exhibits 5 clinical signs, chronic intrahepatic cholestasis, characteristic facies, cardiovascular anomalies, posterior embryotoxon, and vertebral defects. If only 3 or 4 of these are present the case is considered as an incomplete form. The association of Alagille's syndrome with radio-ulnar synostosis is extremely rare. There is only one case described in the indexed literature. A case is presented of Alagille's syndrome with bilateral proximal radioulnar synostosis. To the best of our knowledge this is the second reported case of this association. PMID:25037110

  1. Electrophysiological properties were monitored in detail in chronically con-stricted peripheral nerves by implanted, multicontact nerve cuff electrodes

    E-print Network

    Loeb, Gerald E.

    similar but less pronounced changes than larger diameter fibers. Recordings from ventral and dorsal roots * "dying-back" degeneration * secondary demyelination MUSCLE & NERVE 12:915-928 1989 CONDUCTION STUDIES of traumatic lesions. Retrograde rofilament transport from the cell-body in re- atrophy of mature peripheral

  2. Advances in nerve repair.

    PubMed

    Khuong, Helene T; Midha, Rajiv

    2013-01-01

    Patients with peripheral nerve injuries face unpredictable and often suboptimal functional outcome, even following standard microsurgical nerve repair. The challenge of improving such outcomes following nerve surgical procedures has interested many research teams, in both clinical and fundamental fields. Some innovative treatments are presently being applied to a widening range of patients, whereas others will require further development before translation to human subjects. This article presents several recent advances in emerging therapies at various stages of clinical application. Nerve transfers have been successfully used in clinical settings, but new indications are being described, enlarging the range of patients who might benefit from them. Brief direct nerve electrical stimulation has been shown to improve nerve regeneration and outcome in animal models and in a small cohort of patients. Further clinical trials are warranted to prove the efficacy of this exciting and easily applicable approach. Animal studies also suggest a tremendous potential for stem and precursor cell therapy. Further studies will lead to a better understanding of their mechanisms of action in nerve repair and potential applications for human patients. PMID:23250767

  3. Changes in nerve microcirculation following peripheral nerve compression?

    PubMed Central

    Gao, Yueming; Weng, Changshui; Wang, Xinglin

    2013-01-01

    Following peripheral nerve compression, peripheral nerve microcirculation plays important roles in regulating the nerve microenvironment and neurotrophic substances, supplying blood and oxygen and maintaining neural conduction and axonal transport. This paper has retrospectively analyzed the articles published in the past 10 years that addressed the relationship between peripheral nerve compression and changes in intraneural microcirculation. In addition, we describe changes in different peripheral nerves, with the aim of providing help for further studies in peripheral nerve microcirculation and understanding its protective mechanism, and exploring new clinical methods for treating peripheral nerve compression from the perspective of neural microcirculation. PMID:25206398

  4. Cyclic AMP Signaling: A Molecular Determinant of Peripheral Nerve Regeneration

    PubMed Central

    Knott, Eric P.; Assi, Mazen; Pearse, Damien D.

    2014-01-01

    Disruption of axonal integrity during injury to the peripheral nerve system (PNS) sets into motion a cascade of responses that includes inflammation, Schwann cell mobilization, and the degeneration of the nerve fibers distal to the injury site. Yet, the injured PNS differentiates itself from the injured central nervous system (CNS) in its remarkable capacity for self-recovery, which, depending upon the length and type of nerve injury, involves a series of molecular events in both the injured neuron and associated Schwann cells that leads to axon regeneration, remyelination repair, and functional restitution. Herein we discuss the essential function of the second messenger, cyclic adenosine monophosphate (cyclic AMP), in the PNS repair process, highlighting the important role the conditioning lesion paradigm has played in understanding the mechanism(s) by which cyclic AMP exerts its proregenerative action. Furthermore, we review the studies that have therapeutically targeted cyclic AMP to enhance endogenous nerve repair. PMID:25177696

  5. Delayed diagnosed posterior interosseous nerve palsy due to intramuscular myxoma

    PubMed Central

    Kursumovic, A; Mattiassich, G; Rath, S

    2013-01-01

    We present a case of posterior interosseous nerve palsy after bowel surgery associated with intramuscular myxoma of the supinator muscle. The initial symptoms of swelling of the forearm made it difficult to distinguish the condition from extravasations after intravenous cannulation. The diagnosis was finally established with nerve conduction studies and MRI 3?months after symptom onset. The patient underwent surgery for removal of the tumour and decompression of the posterior interosseous nerve. The histological examination identified the tumour as intramuscular myxoma and the patient made a full recovery with no recurrence of the lesion until present. Every swelling on the forearm causing neurological disorders is tumour suspected and should be examined clinically as well as electrophysically and radiographically. Early surgery and nerve decompression should follow immediately after the diagnosis. In case of intramuscular myxoma, good recovery of function after surgery with low recurrence risk may be expected. PMID:23576649

  6. Rat Schwann cells in bioresorbable nerve guides to promote and accelerate axonal regeneration.

    PubMed

    Schlosshauer, Burkhard; Müller, Erhard; Schröder, Bernhard; Planck, Heinrich; Müller, Hans-Werner

    2003-02-14

    A micro-structured, biodegradable, semipermeable hollow nerve guide implant was developed to bridge nerve lesions. Quantitative comparison of cell migration and axonal growth using time lapse video recording in vitro revealed that axons grow eight times faster than neuritotrophic Schwann cells migrate. To accelerate regeneration, purified Schwann cells are best injected into nerve guides before implantation. Nerve guides made from resorbable poly-lactide-co-glycolide support Schwann cell attachment, cell survival, and axonal outgrowth in vitro. The therapeutic concept aims at the development of an 'intelligent neuroprosthesis' that first mediates regeneration and then disappears. PMID:12560139

  7. The femoral nerve in the repair of inguinal hernia: well worth remembering.

    PubMed

    García-Ureña, M A; Vega, V; Rubio, G; Velasco, M A

    2005-12-01

    Injury to the nerves after inguinal hernia surgery is uncommon. The femoral nerve may be damaged by suture or staples, tissue scar entrapment, local anesthesia blockade or direct compression. We present a case of a transient lesion of the femoral nerve after mesh hernioplasty for a re-recurrent inguinal hernia, confirmed by radiological studies, electrophysiology and clinical recovery. The diagnosis, mechanism of injury and surgical approach are reviewed. Surgery to a recurrent hernia may be underestimated. The role of electromyography nerve conducting studies is emphasized insisting on the importance of clinical evolution for the successful management of these infrequent injuries. PMID:15999220

  8. Degenerative Nerve Diseases

    MedlinePLUS

    Degenerative nerve diseases affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Many of these diseases are genetic. Sometimes the cause is a medical ...

  9. Diabetic Nerve Problems

    MedlinePLUS

    ... the wrong times. This damage is called diabetic neuropathy. Over half of people with diabetes get it. ... change positions quickly Your doctor will diagnose diabetic neuropathy with a physical exam and nerve tests. Controlling ...

  10. Common peroneal nerve dysfunction

    MedlinePLUS

    ... people: Who are very thin (for example, from anorexia nervosa ) Who have conditions such as diabetic neuropathy or ... other tests are done depend on the suspected cause of nerve dysfunction, and the person's symptoms and ...

  11. Vagus Nerve Stimulation.

    PubMed

    Howland, Robert H

    2014-06-01

    The vagus nerve is a major component of the autonomic nervous system, has an important role in the regulation of metabolic homeostasis, and plays a key role in the neuroendocrine-immune axis to maintain homeostasis through its afferent and efferent pathways. Vagus nerve stimulation (VNS) refers to any technique that stimulates the vagus nerve, including manual or electrical stimulation. Left cervical VNS is an approved therapy for refractory epilepsy and for treatment resistant depression. Right cervical VNS is effective for treating heart failure in preclinical studies and a phase II clinical trial. The effectiveness of various forms of non-invasive transcutaneous VNS for epilepsy, depression, primary headaches, and other conditions has not been investigated beyond small pilot studies. The relationship between depression, inflammation, metabolic syndrome, and heart disease might be mediated by the vagus nerve. VNS deserves further study for its potentially favorable effects on cardiovascular, cerebrovascular, metabolic, and other physiological biomarkers associated with depression morbidity and mortality. PMID:24834378

  12. Optic Nerve Decompression

    MedlinePLUS

    ... sinuses directly beside the eye. In particular, the ethmoid and sphenoid sinuses are directly adjacent to the ... double vision, inadequate decompression of the optic nerve, bleeding around the eye, carotid artery injury, leakage of ...

  13. Extratemporal facial nerve injury.

    PubMed

    Sternbach, G L; Rosen, P; Meislin, H W

    1976-04-01

    Isolated traumatic facial nerve injury, frequently seen in wartime combat, may also be encountered among civilians. The clinical picture occurring as a result of such injury may be confusing because partial, or incomplete, damage to the peripheral nerve may mimic impairment of the central facial motor mechanism. In treating the patient with facial injury, life-threatening aspects of the injury must be assessed and stabilized first. Then, attention may be focused on the injured facial nerve, for which prompt surgical repair is the treatment of choice. Prior to surgery, the assessment of taste and hearing, as well as mastoid and skull x-ray films and electrodiagnostic tests are helpful in localizing the facial nerve injury. PMID:933404

  14. Tibial nerve dysfunction

    MedlinePLUS

    Katitji B, Koontz D. Disorders of the peripheral nerves. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 76. ...

  15. Axillary nerve dysfunction

    MedlinePLUS

    ... Body-wide (systemic) disorders that cause nerve inflammation Deep infection Fracture of the upper arm bone (humerus) Pressure from casts or splints Improper use of crutches Shoulder dislocation In some cases, no cause can be found.

  16. Histopathology of idiopathic lesions in the eyes of Homarus americanus from Long Island Sound.

    PubMed

    Maniscalco, Andrea M; Shields, Jeffrey D

    2006-02-01

    In 1999, American lobsters, Homarus americanus, from western Long Island Sound (WLIS) experienced a significant mortality. In 2001 and 2004, the eyes and eyestalks of lobsters from WLIS and central LIS were examined for histopathological changes. Idiopathic lesions were identified in the ommatidia and optic nerve fibers proximal to the ommatidia in 29 (56%) of the lobsters from LIS. Lesions were categorized as either moderate or severe. Moderate lesions had altered rhabdoms, clumped pigment, and altered optic nerve fibers. Severe lesions were marked by absent rhabdoms, clumped pigment in both the ommatidial region and in the optic nerve region; and optic nerve fibers that had been completely destroyed and were replaced by vascular tissue. Idiopathic lesions occurred primarily in the central and ventral regions of the eye, and with much less frequency in the dorsal region. In addition, damage to the dorsal area tended to occur only when the severity of lesions was high, indicating a spatially progressive pattern to the lesion development. The lesions occurred in both western and central Long Island Sound, with no significant differences in severity between locations. The prevalence of lesions did not vary between years, but in 2004, several eyes had less severe pathology than those from 2001. These data indicate that the etiological agent is present throughout a large portion of the Sound, and that lobsters are probably continually exposed to it. PMID:16376928

  17. Dentoalveolar nerve injury.

    PubMed

    Auyong, Thomas G; Le, Anh

    2011-08-01

    Nerve injury associated with dentoalveolar surgery is a complication contributing to the altered sensation of the lower lip, chin, buccal gingivae, and tongue. This surgery-related sensory defect is a morbid postoperative outcome. Several risk factors have been proposed. This article reviews the incidence of trigeminal nerve injury, presurgical risk assessment, classification, and surgical coronectomy versus conventional extraction as an approach to prevent neurosensory damage associated with dentoalveolar surgery. PMID:21798439

  18. Nerve conduction study of the medial and lateral plantar nerves.

    PubMed

    Antunes, A C; Nobrega, J A; Manzano, G M

    2000-01-01

    The medial and lateral plantar nerves may be evaluated through the recordings of the compound sensory nerve action potentials (CSNAP), compound mixed nerve action potentials (CMNAP) and compound muscular action potentials (CMAP). As some of these potentials are not easily and always obtainable in normal individuals, our purpose was to verify the consistency of these potentials for the study of these nerves. Fifty-one normal adult volunteers were examined. The CSNAP, CMNAP and CMAP, related to the medial and lateral plantar nerves were evaluated bilaterally. CSNAP were not obtained in 7.8% and in 17.6% from the medial and lateral plantar nerves respectively. CMNAP from the lateral plantar nerve were not obtained in 15.6%. CMNAP from the medial plantar nerves and CMAPs from the abductor hallucis and abductor digiti quinti were obtained for all nerves tested. Our results, therefore, suggest that these last 3 parameters are the ones more reliable for clinical application. PMID:10812535

  19. Fibrolipomatous Hamartoma of the Nerve Arising in the Neck: A Case Report With Review of the Literature and Differential Diagnosis.

    PubMed

    Philp, Lauren; Naert, Karen A; Ghazarian, Danny

    2014-07-15

    : We report an unusual case of a fibrolipomatous hamartoma that arose in a nuchal nerve. Typically, fibrolipomatous hamartoma, otherwise known as a neural fibrolipoma or lipomatosis of nerve, arises in the median nerve, brachial plexus, cranial nerves, or plantar nerves. The differential diagnosis is broad and includes benign and malignant spindle cell lesions, such as spindle cell lipoma, perineurioma, and myxoid liposarcoma. We were able to identify the lesion based on the typical histology, including triphasic composition with spindle cell, neural, and adipocytic components and whorled architecture. Because of the atypical location in the neck, detailed immunohistochemical staining was performed. The lesional spindle cells were negative for SMA, CD10, CD68, EMA, S100, PGP9.5, CD34, CD56, and beta-catenin. Colloidal iron stain highlighted marked intralesional mucin deposition. This detailed immunohistochemical profile is a useful diagnostic aid and to our knowledge has not been previously described. PMID:25033011

  20. Cranial Nerves III, IV, and VI

    PubMed Central

    Sanders, Richard D.

    2009-01-01

    Motor activity affecting the direction of gaze, the position of the eyelids, and the size of the pupils are served by cranial nerves III, IV, and VI. Unusual oculomotor activity is often encountered in psychiatric patients and can be quite informative. Evaluation techniques include casual observation and simple tests that require no equipment in addition to the sophisticated methods used in specialty clinics and research labs. This article reviews pupil size, extraocular movements, nystagmus, lid retraction, lid lag, and ptosis. Beyond screening for diseases and localizing lesions, these tests yield useful information about the individual’s higher cortical function, extrapyramidal motor functioning, and toxic/pharmacologic state. PMID:20049149

  1. LASER DOPPLER IMAGING OF FINGER SKIN BLOOD FLOW IN PATIENTS AFTER MICROVASCULAR REPAIR OF THE ULNAR ARTERY AT THE WRIST

    Microsoft Academic Search

    S. BORNMYR; M. ARNER; H. SVENSSON

    1994-01-01

    Laser Doppler imaging is a new, non-invasive technique allowing the spatial distribution and the temporal variation of the skin blood flow to be monitored. A mean blood flow value over an area, such as the finger-tip in the present study, can also be calculated. Recordings from 12 patients with a sutured ulnar artery following trauma did not significantly differ from

  2. Refining the Sensory and Motor Ratunculus of the Rat Upper Extremity Using fMRI and Direct Nerve Stimulation

    PubMed Central

    Cho, Younghoon R.; Pawela, Christopher P.; Li, Rupeng; Kao, Dennis; Schulte, Marie L.; Runquist, Matthew L.; Yan, Ji-Geng; Matloub, Hani S.; Jaradeh, Safwan S.; Hudetz, Anthony G.; Hyde, James S.

    2008-01-01

    It is well understood that the different regions of the body have cortical representations in proportion to the degree of innervation. Our current understanding of the rat upper extremity has been enhanced using functional MRI (fMRI), but these studies are often limited to the rat forepaw. The purpose of this study is to describe a new technique that allows us to refine the sensory and motor representations in the cerebral cortex by surgically implanting electrodes on the major nerves of the rat upper extremity and providing direct electrical nerve stimulation while acquiring fMRI images. This technique was used to stimulate the ulnar, median, radial, and musculocutaneous nerves in the rat upper extremity using four different stimulation sequences that varied in frequency (5 Hz vs. 10 Hz) and current (0.5 mA vs. 1.0 mA). A distinct pattern of cortical activation was found for each nerve. The higher stimulation current resulted in a dramatic increase in the level of cortical activation. The higher stimulation frequency resulted in both increases and attenuation of cortical activation in different regions of the brain, depending on which nerve was stimulated. PMID:17969116

  3. Acellular Nerve Allografts in Peripheral Nerve Regeneration: A Comparative Study

    PubMed Central

    Moore, Amy M.; MacEwan, Matthew; Santosa, Katherine B.; Chenard, Kristofer E.; Ray, Wilson Z.; Hunter, Daniel A.; Mackinnon, Susan E.; Johnson, Philip J.

    2011-01-01

    Background Processed nerve allografts offer a promising alternative to nerve autografts in the surgical management of peripheral nerve injuries where short deficits exist. Methods Three established models of acellular nerve allograft (cold-preserved, detergent-processed, and AxoGen® -processed nerve allografts) were compared to nerve isografts and silicone nerve guidance conduits in a 14 mm rat sciatic nerve defect. Results All acellular nerve grafts were superior to silicone nerve conduits in support of nerve regeneration. Detergent-processed allografts were similar to isografts at 6 weeks post-operatively, while AxoGen®-processed and cold-preserved allografts supported significantly fewer regenerating nerve fibers. Measurement of muscle force confirmed that detergent-processed allografts promoted isograft-equivalent levels of motor recovery 16 weeks post-operatively. All acellular allografts promoted greater amounts of motor recovery compared to silicone conduits. Conclusions These findings provide evidence that differential processing for removal of cellular constituents in preparing acellular nerve allografts affects recovery in vivo. PMID:21660979

  4. Repair of sciatic nerve defects using tissue engineered nerves.

    PubMed

    Zhang, Caishun; Lv, Gang

    2013-07-25

    In this study, we constructed tissue-engineered nerves with acellular nerve allografts in Sprague-Dawley rats, which were prepared using chemical detergents-enzymatic digestion and mechanical methods, in combination with bone marrow mesenchymal stem cells of Wistar rats cultured in vitro, to repair 15 mm sciatic bone defects in Wistar rats. At postoperative 12 weeks, electrophysiological detection results showed that the conduction velocity of regenerated nerve after repair with tissue-engineered nerves was similar to that after autologous nerve grafting, and was higher than that after repair with acellular nerve allografts. Immunohistochemical staining revealed that motor endplates with acetylcholinesterase-positive nerve fibers were orderly arranged in the middle and superior parts of the gastrocnemius muscle; regenerated nerve tracts and sprouted branches were connected with motor endplates, as shown by acetylcholinesterase histochemistry combined with silver staining. The wet weight ratio of the tibialis anterior muscle at the affected contralateral hind limb was similar to the sciatic nerve after repair with autologous nerve grafts, and higher than that after repair with acellular nerve allografts. The hind limb motor function at the affected side was significantly improved, indicating that acellular nerve allografts combined with bone marrow mesenchymal stem cell bridging could promote functional recovery of rats with sciatic nerve defects. PMID:25206507

  5. Stretch-induced nerve injury: a proposed technique for the study of nerve regeneration and evaluation of the influence of gabapentin on this model

    PubMed Central

    Machado, J.A.; Ghizoni, M.F.; Bertelli, J.; Teske, Gabriel C.; Teske, Guilherme C.; Martins, D.F.; Mazzardo-Martins, L.; Cargnin-Ferreira, E.; Santos, A.R.S.; Piovezan, A.P.

    2013-01-01

    The rat models currently employed for studies of nerve regeneration present distinct disadvantages. We propose a new technique of stretch-induced nerve injury, used here to evaluate the influence of gabapentin (GBP) on nerve regeneration. Male Wistar rats (300 g; n=36) underwent surgery and exposure of the median nerve in the right forelimbs, either with or without nerve injury. The technique was performed using distal and proximal clamps separated by a distance of 2 cm and a sliding distance of 3 mm. The nerve was compressed and stretched for 5 s until the bands of Fontana disappeared. The animals were evaluated in relation to functional, biochemical and histological parameters. Stretching of the median nerve led to complete loss of motor function up to 12 days after the lesion (P<0.001), compared to non-injured nerves, as assessed in the grasping test. Grasping force in the nerve-injured animals did not return to control values up to 30 days after surgery (P<0.05). Nerve injury also caused an increase in the time of sensory recovery, as well as in the electrical and mechanical stimulation tests. Treatment of the animals with GBP promoted an improvement in the morphometric analysis of median nerve cross-sections compared with the operated vehicle group, as observed in the area of myelinated fibers or connective tissue (P<0.001), in the density of myelinated fibers/mm2 (P<0.05) and in the degeneration fragments (P<0.01). Stretch-induced nerve injury seems to be a simple and relevant model for evaluating nerve regeneration. PMID:24270909

  6. Treatment of neurogenic torticollis by microvascular lysis of the accessory nerve roots — indication, technique, and first results

    Microsoft Academic Search

    N. Freckmann; R. Hagenah; H.-D. Herrmann; D. Müller

    1981-01-01

    Summary For treatment of spasmodic torticollis (s.T.) microsurgical decompression of the intraspinal-intracranial portion of the accessory nerve (a.N.) has been performed in 11 patients with proved neurogenic lesions of the accessory nerve-dependent muscles. Neurogenic lesions were discovered by meticulous electromyographic (EMG) examination in 26 out of 32 patients with s.T. Based on the EMG findings the a.N. roots were exposed,

  7. A novel and robust conditioning lesion induced by ethidium bromide.

    PubMed

    Hollis, Edmund R; Ishiko, Nao; Tolentino, Kristine; Doherty, Ernest; Rodriguez, Maria J; Calcutt, Nigel A; Zou, Yimin

    2015-03-01

    Molecular and cellular mechanisms underlying the peripheral conditioning lesion remain unsolved. We show here that injection of a chemical demyelinating agent, ethidium bromide, into the sciatic nerve induces a similar set of regeneration-associated genes and promotes a 2.7-fold greater extent of sensory axon regeneration in the spinal cord than sciatic nerve crush. We found that more severe peripheral demyelination correlates with more severe functional and electrophysiological deficits, but more robust central regeneration. Ethidium bromide injection does not activate macrophages at the demyelinated sciatic nerve site, as observed after nerve crush, but briefly activates macrophages in the dorsal root ganglion. This study provides a new method for investigating the underlying mechanisms of the conditioning response and suggests that loss of the peripheral myelin may be a major signal to change the intrinsic growth state of adult sensory neurons and promote regeneration. PMID:25541322

  8. Using intact nerve to bridge peripheral nerve defects: an alternative to the use of nerve grafts.

    PubMed

    McCallister, W V; Cober, S R; Norman, A; Trumble, T E

    2001-03-01

    This preliminary study was conducted to determine whether a regenerating peripheral nerve in a rat model can use the epineurium of an intact nerve to bridge a nerve gap defect. To create the intact nerve bridge a 1-cm segment of the peroneal nerve is resected leaving a gap defect. The proximal and distal peroneal nerve stumps are sutured 1-cm apart, in an end-to-side fashion, to the epineurium of the intact tibial nerve. The following experimental groups were used (n = 12): group A, immediate primary repair of resected segment; group B, intact nerve bridge technique; group C, nerve autograft; and group D, gap in situ control. Evaluation 12 weeks after surgery included measurement of the tibialis anterior muscle contraction force, axonal counting, wet weight of the tibialis anterior muscle, and histologic examination. The results of this animal study support 3 main conclusions: regenerating axons can use the epineurium of an intact nerve to bridge a gap in nerve continuity; when using functional recovery to assess regeneration, there is no significant difference between standard nerve autografts and the intact nerve bridge technique; and based on histologic examination, the intact nerve bridge technique does not injure the intact tibial nerve used to bridge the gap defect. Taken together, the results of this preliminary animal study suggest that the intact nerve bridge technique may be a potential alternative to standard nerve autografts in appropriate circumstances. Further investigation in a higher animal model is warranted before considering clinical application of the intact nerve bridge technique. PMID:11279579

  9. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve cuff is a tubular silicone rubber sheath used to encase a nerve for aid in repairing the nerve (e.g., to prevent ingrowth of scar tissue)...

  10. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve cuff is a tubular silicone rubber sheath used to encase a nerve for aid in repairing the nerve (e.g., to prevent ingrowth of scar tissue)...

  11. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve cuff is a tubular silicone rubber sheath used to encase a nerve for aid in repairing the nerve (e.g., to prevent ingrowth of scar tissue)...

  12. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve cuff is a tubular silicone rubber sheath used to encase a nerve for aid in repairing the nerve (e.g., to prevent ingrowth of scar tissue)...

  13. 21 CFR 882.5275 - Nerve cuff.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...Neurological Therapeutic Devices § 882.5275 Nerve cuff. (a) Identification. A nerve cuff is a tubular silicone rubber sheath used to encase a nerve for aid in repairing the nerve (e.g., to prevent ingrowth of scar tissue)...

  14. The ulnar digital artery perforator flap: A new flap for little finger reconstruction - A preliminary report

    PubMed Central

    Panse, Nikhil; Sahasrabudhe, Parag

    2010-01-01

    An ulnar digital artery perforator flap was used for little finger reconstruction. The flap has a reliable blood supply, being perfused by a constant sizeable perforator. This paper describes a study of a cadaveric dissection with methylene blue dye that was conducted to prove the rationality and reliability of the blood supply. The position of the perforator is confirmed intraoperatively by an exploratory incision before committing to the distal incision. The flap used to cover the flexor aspect of the little finger in three cases yielded positive results. To our knowledge, a digital artery perforator flap of this nature is unprecedented. We propose to call this flap the B.J. Flap after our institute. PMID:21217979

  15. Laryngeal nerve monitoring.

    PubMed

    Kartush, Jack M; Naumann, Ilka

    2014-09-01

    Intraoperative neurophysiological monitoring of the vagus and recurrent laryngeal nerves is increasingly used during thyroidectomy, parathyroidectomy, skull base surgery, and cervical discectomy with fusion. Monitoring can assist in nerve localization and in reducing the incidence of neural trauma. To be effective, however, monitoring must be correctly implemented and the results interpreted based on an in-depth understanding of technique and the surgical structures at risk. Because "poor monitoring is worse than no monitoring" all members of the surgical monitoring team must have training specific to laryngeal recording to maximize its benefit and minimize pitfalls. This publication will review pertinent anatomy and neurophysiology as well as technical and interpretative factors. PMID:25351033

  16. Dexamethasone Enhanced Functional Recovery after Sciatic Nerve Crush Injury in Rats

    PubMed Central

    Feng, Xinhong; Yuan, Wei

    2015-01-01

    Dexamethasone is currently used for the treatment of peripheral nerve injury, but its mechanisms of action are not completely understood. Inflammation/immune response at the site of nerve lesion is known to be an essential trigger of the pathological changes that have a critical impact on nerve repair and regeneration. In this study, we observed the effects of various doses of dexamethasone on the functional recovery after sciatic nerve crush injury in a rat model. Motor functional recovery was monitored by walking track analysis and gastrocnemius muscle mass ratio. The myelinated axon number was counted by morphometric analysis. Rats administered dexamethasone by local intramuscular injection had a higher nerve function index value, increased gastrocnemius muscle mass ratio, reduced Wallerian degeneration severity, and enhanced regenerated myelinated nerve fibers. Immunohistochemical analysis was performed for CD3 expression, which is a marker for T-cell activation, and infiltration in the sciatic nerve. Dexamethasone-injected rats had fewer CD3-positive cells compared to controls. Furthermore, we found increased expression of GAP-43, which is a factor associated with development and plasticity of the nervous system, in rat nerves receiving dexamethasone. These results provide strong evidence that dexamethasone enhances sciatic nerve regeneration and function recovery in a rat model of sciatic nerve injury through immunosuppressive and potential neurotrophic effects.

  17. Wide resection and stabilization of ulnar stump by extensor carpi ulnaris for giant cell tumor of distal ulna: two case reports

    PubMed Central

    Singh, Manjeet; Peshin, Chetan; Wani, Iftikhar H; Tikoo, Agnivesh; Gupta, Sanjeev K; Singh, Dara

    2009-01-01

    The distal end of ulna is an extremely uncommon site for primary bone tumors in general and giant cell tumor in particular. Wide resection is usually indicated in such cases and at times it may be necessary to remove of a long segment of the distal ulna. Any ulnar resection proximal to the insertion of pronator quadratus can lead to instability in the form of radio-ulnar convergence and dorsal displacement (winging) of the ulnar stump. This can result in diminution of forearm rotation and weakness with grasp. Stabilization of the ulnar stump after resection for a giant cell tumor was described by Kayias & Drosos. We are adding two more cases to the literature. Both patients had excellent functional outcome and there were no instances of recurrence at three years of follow-up. PMID:19830093

  18. Comparison of the Effects of Flexion and Extension of the Thumb and Fingers on the Position and Cross-Sectional Area of the Median Nerve

    PubMed Central

    Toge, Yasushi; Nishimura, Yukihide; Basford, Jeffrey R.; Nogawa, Takako; Yamanaka, Midori; Nakamura, Takeshi; Yoshida, Munehito; Nagano, Akira; Tajima, Fumihiro

    2013-01-01

    Objective To assess the separate effects of thumb and finger extension/flexion on median nerve position and cross-sectional area. Methods Ultrasonography was used to assess median nerve transverse position and cross-sectional area within the carpal tunnel at rest and its movement during volitional flexion of the individual digits of the hand. Both wrists of 165 normal subjects (11 men, 4 women, mean age, 28.6, range, 22 to 38) were studied. Results Thumb flexion resulted in transverse movement of the median nerve in radial direction (1.2±0.6 mm), whereas flexion of the fingers produced transverse movement in ulnar direction, which was most pronounced during flexion of the index and middle fingers (3.2±0.9 and 3.1±1.0 mm, respectively). Lesser but still statistically significant movements were noted with flexion of the ring finger (2.0±0.8 mm) and little finger (1.2±0.5 mm). Flexion of the thumb or individual fingers did not change median nerve cross-sectional area (8.5±1.1 mm2). Conclusions Volitional flexion of the thumb and individual fingers, particularly the index and middle fingers, produced significant transverse movement of the median nerve within the carpal tunnel but did not alter the cross-sectional area of the nerve. The importance of these findings on the understanding of the pathogenesis of the carpal tunnel syndrome and its treatment remains to be investigated. PMID:24367601

  19. Use of screening nerve conduction studies for predicting future carpal tunnel syndrome.

    PubMed Central

    Werner, R A; Franzblau, A; Albers, J W; Buchele, H; Armstrong, T J

    1997-01-01

    OBJECTIVE: To determine if an abnormal sensory nerve conduction study consistent with median mononeuropathy in asymptomatic workers was predictive of future complaints of the hand or finger suggestive of carpal tunnel syndrome. METHODS: This was a case-control study of over 700 active workers at five different work sites: four sites involved manufacturing workers and one site represented clerical workers. Patients' reports of symptoms of pain, numbness, tingling, or burning in the hand or finger that lasted more than one week or occurred three or more times after the initial screening were investigated. 77 cases were defined as asymptomatic workers with electrodiagnostic findings of median mononeuropathy in either hand based on a comparison of median and ulnar sensory evoked peak latencies. A difference > or = 0.5 ms was defined as abnormal; a normal difference was < or = 0.2 ms. Controls were asymptomatic age, and sex matched workers with normal nerve conduction studies in both hands. Follow up questionnaires were completed 17 (SD 6) months later. RESULTS: The follow up participation rate was 72%. Cases had a 12% risk of developing symptoms during the follow up period compared with 10% in the control group, chi 2 = 0.12, P = 0.73. CONCLUSIONS: Abnormal median sensory nerve conduction studies in asymptomatic workers were not predictive of future hand or fingers complaints and if used for preplacement screening among active workers this should be done with caution. PMID:9072016

  20. Vestibular nerve section.

    PubMed

    Silverstein, Herbert; Jackson, Lance E

    2002-06-01

    When the vertigo of Meniere's disease becomes refractory to medical management, a variety of surgical options are available. If intratympanic gentamicin has failed or is not recommended and serviceable hearing is present, sectioning the vestibular nerve is an excellent option in terms of vertigo control, hearing preservation, and postoperative quality of life. Transection of the vestibular nerve has gone through a metamorphosis since attempted by Krause over a century ago. The microsurgical posterior fossa vestibular neurectomy has undergone an evolution, resulting in the combined RRVN. This is essentially a retrosigmoid approach with exposure of the lateral venous sinus to allow forward retraction of the sinus and better exposure. This technique has the advantages of minimization of required mastoid and suboccipital bone work, elimination of the need for cerebellar retraction, improved exposure, ability to achieve watertight dural closure to minimize incidence of CSF leakage, low incidence of postoperative headache, and low overall complication rate. If a cleavage plain cannot be readily identified, then the superior half of the eighth nerve is sectioned near the brainstem. The results are essentially the same whether the vestibular nerve is cut in the IAC or the posterior fossa. Vertigo has been completely controlled in 85% and hearing has been preserved at the preoperative level in 80% of patients. Combined RRVN is a direct and safe technique, with high success in properly selected patients. PMID:12486846

  1. Ischemic Nerve Block.

    ERIC Educational Resources Information Center

    Williams, Ian D.

    This experiment investigated the capability for movement and muscle spindle function at successive stages during the development of ischemic nerve block (INB) by pressure cuff. Two male subjects were observed under six randomly ordered conditions. The duration of index finger oscillation to exhaustion, paced at 1.2Hz., was observed on separate…

  2. Cervical Radiculopathy (Pinched Nerve)

    MedlinePLUS

    ... sometimes referred to as a “pinched” nerve. The medical term for this condition is cervical radiculopathy. Understanding your ... worn for short periods of time, because long-term wear can decrease the strength of neck ... and is not intended to serve as medical advice. Anyone seeking speci? c orthopaedic advice or ...

  3. Benign breast lesions: Ultrasound

    PubMed Central

    Masciadri, N.; Ferranti, C.

    2011-01-01

    Benign breast diseases constitute a heterogeneous group of lesions arising in the mammary epithelium or in other mammary tissues, and they may also be linked to vascular, inflammatory or traumatic pathologies. Most lesions found in women consulting a physician are benign. Ultrasound (US) diagnostic criteria indicating a benign lesion are described as well as US findings in the most frequent benign breast lesions. PMID:23396888

  4. Segmental thoracic lipomatosis of nerve with nerve territory overgrowth.

    PubMed

    Mahan, Mark A; Amrami, Kimberly K; Howe, B Matthew; Spinner, Robert J

    2014-05-01

    Lipomatosis of nerve (LN), or fibrolipomatous hamartoma, is a rare condition of fibrofatty enlargement of the peripheral nerves. It is associated with bony and soft tissue overgrowth in approximately one-third to two-thirds of cases. It most commonly affects the median nerve at the carpal tunnel or digital nerves in the hands and feet. The authors describe a patient with previously diagnosed hemihypertrophy of the trunk who had a history of large thoracic lipomas resected during infancy, a thoracic hump due to adipose proliferation within the thoracic paraspinal musculature, and scoliotic deformity. She had fatty infiltration in the thoracic spinal nerves on MRI, identical to findings pathognomonic of LN at better-known sites. Enlargement of the transverse processes at those levels and thickened ribs were also found. This case appears to be directly analogous to other instances of LN with overgrowth, except that this case involved axial nerves rather than the typical appendicular nerves. PMID:24506247

  5. Oropharynx lesion biopsy

    MedlinePLUS

    Throat lesion biopsy; Biopsy - mouth or throat; Mouth lesion biopsy ... procedure. All or part of the problem area (lesion) is removed. It is sent to the laboratory to check for problems. If a growth in the mouth or throat needs to be removed, the biopsy ...

  6. Example based lesion segmentation

    NASA Astrophysics Data System (ADS)

    Roy, Snehashis; He, Qing; Carass, Aaron; Jog, Amod; Cuzzocreo, Jennifer L.; Reich, Daniel S.; Prince, Jerry; Pham, Dzung

    2014-03-01

    Automatic and accurate detection of white matter lesions is a significant step toward understanding the progression of many diseases, like Alzheimer's disease or multiple sclerosis. Multi-modal MR images are often used to segment T2 white matter lesions that can represent regions of demyelination or ischemia. Some automated lesion segmentation methods describe the lesion intensities using generative models, and then classify the lesions with some combination of heuristics and cost minimization. In contrast, we propose a patch-based method, in which lesions are found using examples from an atlas containing multi-modal MR images and corresponding manual delineations of lesions. Patches from subject MR images are matched to patches from the atlas and lesion memberships are found based on patch similarity weights. We experiment on 43 subjects with MS, whose scans show various levels of lesion-load. We demonstrate significant improvement in Dice coefficient and total lesion volume compared to a state of the art model-based lesion segmentation method, indicating more accurate delineation of lesions.

  7. Reproducible Mouse Sciatic Nerve Crush and Subsequent Assessment of Regeneration by Whole Mount Muscle Analysis

    PubMed Central

    Bauder, Andrew R.; Ferguson, Toby A.

    2012-01-01

    Regeneration in the peripheral nervous system (PNS) is widely studied both for its relevance to human disease and to understand the robust regenerative response mounted by PNS neurons thereby possibly illuminating the failures of CNS regeneration1. Sciatic nerve crush (axonotmesis) is one of the most common models of peripheral nerve injury in rodents2. Crushing interrupts all axons but Schwann cell basal laminae are preserved so that regeneration is optimal3,4. This allows the investigator to study precisely the ability of a growing axon to interact with both the Schwann cell and basal laminae4. Rats have generally been the preferred animal models for experimental nerve crush. They are widely available and their lesioned sciatic nerve provides a reasonable approximation of human nerve lesions5,4. Though smaller in size than rat nerve, the mouse nerve has many similar qualities. Most importantly though, mouse models are increasingly valuable because of the wide availability of transgenic lines now allows for a detailed dissection of the individual molecules critical for nerve regeneration6, 7. Prior investigators have used multiple methods to produce a nerve crush or injury including simple angled forceps, chilled forceps, hemostatic forceps, vascular clamps, and investigator-designed clamps8,9,10,11,12. Investigators have also used various methods of marking the injury site including suture, carbon particles and fluorescent beads13,14,1. We describe our method to obtain a reproducibly complete sciatic nerve crush with accurate and persistent marking of the crush-site using a fine hemostatic forceps and subsequent carbon crush-site marking. As part of our description of the sciatic nerve crush procedure we have also included a relatively simple method of muscle whole mount we use to subsequently quantify regeneration. PMID:22395197

  8. Common and less common peripheral nerve disorders associated with diabetes.

    PubMed

    Knopp, Michael; Rajabally, Yusuf A

    2012-05-01

    Diabetes can be associated with a number of peripheral nerve disorders. The commonest is slowly-progressive axonal distal symmetrical sensori-motor neuropathy. Sensory loss and positive sensory symptoms are its main manifestations. Lumbosacral radiculoplexus neuropathy (LSRPN) is a distinct entity, accompanied by severe lumbar, hip, leg pain and weight loss, with subsequent weakness. Although typically unilateral, bilaterality is described, with spontaneous recovery usual over several months. The upper limb counterpart, cervical radiculoplexus neuropathy is rare. Acute painful neuropathies, including "diabetic neuropathic cachexia", are infrequent. Accompanying weight loss is usual and burning pains in the extremities are severe. Insulin-triggered acute painful neuropathy is well-described although infrequent and still poorly-understood. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) represents an immune-mediated treatable disorder, usually causing prominent diffuse motor weakness, which was described as more common in diabetics. More recent epidemiological data have however been conflicting and it is possible that CIDP is no more frequent in diabetics than in the general population. Diagnosis is made by electrophysiology and cerebrospinal fluid analysis. A painless diabetic motor neuropathy, thought to be caused by ischaemic injury and microvasculitis, has recently been postulated as separate from LSRPN and CIDP. Other focal and multifocal neuropathies that can occur in diabetics are cranial or truncal. Entrapment neuropathies are more often of median and ulnar nerves, and may in some cases benefit from decompression. Finally, autonomic neuropathies are well-described in diabetes and can be diverse in presentation with cardiovascular, gastrointestinal, urogenital and sudomotor manifestations. Their management can be difficult with debilitating symptoms despite treatment. PMID:22283678

  9. Chronic inflammatory demyelinating polyneuropathy with multiple hypertrophic nerves in intracranial, and intra- and extra-spinal segments.

    PubMed

    Niino, M; Tsuji, S; Tashiro, K

    1999-05-01

    Hypertrophic nerves have occasionally been seen in chronic inflammatory demyelinating polyneuropathy (CIDP), but most are in the cauda equina. We report a case with CIDP in whom magnetic resonance imaging (MRI) with gadolinium diethylene triamine penta-acetic acid (Gd-DTPA) enhancement demonstrated hypertrophy of various peripheral nerves including multiple cranial nerves. Interestingly, none showed neurological signs corresponding to the lesions, except for clinical signs consistent with CIDP. MRI can be useful for the detection of silent, but abnormal nerve involvement in CIDP. PMID:10397086

  10. Improved peripheral nerve regeneration in streptozotocin-induced diabetic rats by oral lumbrokinase.

    PubMed

    Lee, Han-Chung; Hsu, Yuan-Man; Tsai, Chin-Chuan; Ke, Cherng-Jyh; Yao, Chun-Hsu; Chen, Yueh-Sheng

    2015-01-01

    We assessed the therapeutic effects of lumbrokinase, a group of enzymes extracted from the earthworm, on peripheral-nerve regeneration using well-defined sciatic nerve lesion paradigms in diabetic rats induced by the injection of streptozotocin (STZ). We found that lumbrokinase therapy could improve the rats' circulatory blood flow and promote the regeneration of axons in a silicone rubber conduit after nerve transection. Lumbrokinase treatment could also improve the neuromuscular functions with better nerve conductive performances. Immunohistochemical staining showed that lumbrokinase could dramatically promote calcitonin gene-related peptide (CGRP) expression in the lamina I-II regions in the dorsal horn ipsilateral to the injury and cause a marked increase in the number of macrophages recruited within the distal nerve stumps. In addition, the lumbrokinase could stimulate the secretion of interleukin-1 (IL-1), nerve growth factor (NGF), platelet-derived growth factor (PDGF), and transforming growth factor-? (TGF-?) in dissected diabetic sciatic nerve segments. In conclusion, the administration of lumbrokinase after nerve repair surgery in diabetic rats was found to have remarkable effects on promoting peripheral nerve regeneration and functional recovery. PMID:25787300

  11. Nerve Regenerative Effects of GABA-B Ligands in a Model of Neuropathic Pain

    PubMed Central

    Cavalli, Erica; Pajardi, Giorgio

    2014-01-01

    Neuropathic pain arises as a direct consequence of a lesion or disease affecting the peripheral somatosensory system. It may be associated with allodynia and increased pain sensitivity. Few studies correlated neuropathic pain with nerve morphology and myelin proteins expression. Our aim was to test if neuropathic pain is related to nerve degeneration, speculating whether the modulation of peripheral GABA-B receptors may promote nerve regeneration and decrease neuropathic pain. We used the partial sciatic ligation- (PSL-) induced neuropathic model. The biochemical, morphological, and behavioural outcomes of sciatic nerve were analysed following GABA-B ligands treatments. Simultaneous 7-days coadministration of baclofen (10?mg/kg) and CGP56433 (3?mg/kg) alters tactile hypersensitivity. Concomitantly, specific changes of peripheral nerve morphology, nerve structure, and myelin proteins (P0 and PMP22) expression were observed. Nerve macrophage recruitment decreased and step coordination was improved. The PSL-induced changes in nociception correlate with altered nerve morphology and myelin protein expression. Peripheral synergic effects, via GABA-B receptor activation, promote nerve regeneration and likely ameliorate neuropathic pain. PMID:25165701

  12. Ultrasound of Peripheral Nerves

    PubMed Central

    Suk, Jung Im; Walker, Francis O.; Cartwright, Michael S.

    2013-01-01

    Over the last decade, neuromuscular ultrasound has emerged as a useful tool for the diagnosis of peripheral nerve disorders. This article reviews sonographic findings of normal nerves including key quantitative ultrasound measurements that are helpful in the evaluation of focal and possibly generalized peripheral neuropathies. It also discusses several recent papers outlining the evidence base for the use of this technology, as well as new findings in compressive, traumatic, and generalized neuropathies. Ultrasound is well suited for use in electrodiagnostic laboratories where physicians, experienced in both the clinical evaluation of patients and the application of hands-on technology, can integrate findings from the patient’s history, physical examination, electrophysiological studies, and imaging for diagnosis and management. PMID:23314937

  13. Medial Antebrachial Cutaneous Nerve Injury After Brachial Plexus Block: Two Case Reports

    PubMed Central

    Jung, Mi Jin; Byun, Ha Young; Lee, Chang Hee; Moon, Seung Won; Oh, Min-Kyun

    2013-01-01

    Medial antebrachial cutaneous (MABC) nerve injury associated with iatrogenic causes has been rarely reported. Local anesthesia may be implicated in the etiology of such injury, but has not been reported. Two patients with numbness and painful paresthesia over the medial aspect of the unilateral forearm were referred for electrodiagnostic study, which revealed MABC nerve lesion in each case. The highly selective nature of the MABC nerve injuries strongly suggested that they were the result of direct nerve injury by an injection needle during previous brachial plexus block procedures. Electrodiagnostic studies can be helpful in evaluating cases of sensory disturbance after local anesthesia. To our knowledge, these are the first documented cases of isolated MABC nerve injury following ultrasound-guided axillary brachial plexus block. PMID:24466530

  14. Dissection of intercostal nerves by means of assisted video thoracoscopy: experimental study

    PubMed Central

    2013-01-01

    In total brachial plexus preganglionic lesions (C5-C6-C7-C8 and T1) different extraplexual neurotizations are indicated for partial motor function restitution. Mostly for the flexion of the elbow. Neurotization with intercostal nerves (ICN) to musculocutaneous nerve has been known and accepted during many years with different results 2 - 5. The customary technique as described by various authors is carried out by means of a large submammary incision to harvest three or four intercostal nerves (Figure 1). Then are connected by direct suture or grafts to the musculocutaneous nerve or its motor branches 6 - 7. In this article the authors described the possibility of dissection intercostal nerves by means of assisted video thoracoscopy. (VATS-videdo assisted thoracic surgery). PMID:23406448

  15. Accessory Branch of Median Nerve Supplying the Brachialis Muscle: A Case Report and Clinical Significance

    PubMed Central

    Anastasopoulos, Nikolaos; Nitsa, Zoi; Kitsoulis, Panagiotis; Spyridakis, Ioannis

    2014-01-01

    A very rare case of an accessory branch of the median nerve taking its origin in the region of the right arm was observed to supply the infero-medial portion of the brachialis muscle in a male cadaver. Simultaneously, the ipsilateral musculocutaneous nerve was innervating the muscles of the anterior compartment of the arm. Such an aberrant muscular branch of the median nerve for the brachialis muscle is very rarely reported in the literature. Lesion of the median nerve proximal to the branch’s origin site could induce weak flexion of the elbow, whereas injury of the musculocutaneous nerve could lead to misinterpretation of symptoms. We discuss the patterns of brachialis muscle innervation as well as the clinical applications of such a variant. PMID:25653932

  16. Medial antebrachial cutaneous nerve injury after brachial plexus block: two case reports.

    PubMed

    Jung, Mi Jin; Byun, Ha Young; Lee, Chang Hee; Moon, Seung Won; Oh, Min-Kyun; Shin, Heesuk

    2013-12-01

    Medial antebrachial cutaneous (MABC) nerve injury associated with iatrogenic causes has been rarely reported. Local anesthesia may be implicated in the etiology of such injury, but has not been reported. Two patients with numbness and painful paresthesia over the medial aspect of the unilateral forearm were referred for electrodiagnostic study, which revealed MABC nerve lesion in each case. The highly selective nature of the MABC nerve injuries strongly suggested that they were the result of direct nerve injury by an injection needle during previous brachial plexus block procedures. Electrodiagnostic studies can be helpful in evaluating cases of sensory disturbance after local anesthesia. To our knowledge, these are the first documented cases of isolated MABC nerve injury following ultrasound-guided axillary brachial plexus block. PMID:24466530

  17. Intraosseous malignant peripheral nerve sheath tumor of maxilla: A case report with review of the literature

    PubMed Central

    Tamgadge, Sandhya; Modak, Neha; Tamgadge, Avinash P.; Bhalerao, Sudhir

    2014-01-01

    Malignant peripheral nerve sheath tumor (MPNST), the principle malignancy of peripheral nerve origin, though rare in the general population, occurs with excessive frequency among patients with neurofibromatosis. This tumor always arises in soft-tissues, usually found in the lower extremities and only 10-12% of all lesions occur in the head and neck region, which makes it a rare entity. The primary intraosseous MPNST is rare and has been reported most frequently in the mandible. This article discusses a case report of MPNST of the left maxilla without a history of benign nerve tissue tumor and the diagnostic difficulties associated with MPNST. PMID:25097654

  18. Nerves in a pinch: imaging of nerve compression syndromes.

    PubMed

    Hochman, Mary G; Zilberfarb, Jeffrey L

    2004-01-01

    Nerve compression is a common entity that can result in considerable disability. Early diagnosis is important to institute prompt treatment and to minimize potential injury. Although the appropriate diagnosis is often determined by clinical examination, the diagnosis may be more difficult when the presentation is atypical, or when anatomic and technical limitations intervene. In these instances, imaging can have an important role in helping to define the site and etiology of nerve compression or in establishing an alternative diagnosis. MR imaging and ultrasound provide direct visualization of the nerve and surrounding abnormalities. For both modalities, the use of high-resolution techniques is important. Bony abnormalities contributing to nerve compression are best assessed by radiographs or CT. For the radiologist, knowledge of the anatomy of the fibro-osseous tunnels, familiarity with the causes of nerve compression, and an understanding of specialized imaging techniques are important for successful diagnosis of nerve compression. PMID:15049533

  19. Optic nerve hypoplasia.

    PubMed

    Kaur, Savleen; Jain, Sparshi; Sodhi, Harsimrat B S; Rastogi, Anju; Kamlesh

    2013-05-01

    Optic nerve hypoplasia (ONH) is a congenital anomaly of the optic disc that might result in moderate to severe vision loss in children. With a vast number of cases now being reported, the rarity of ONH is obviously now refuted. The major aspects of ophthalmic evaluation of an infant with possible ONH are visual assessment, fundus examination, and visual electrophysiology. Characteristically, the disc is small, there is a peripapillary double-ring sign, vascular tortuosity, and thinning of the nerve fiber layer. A patient with ONH should be assessed for presence of neurologic, radiologic, and endocrine associations. There may be maternal associations like premature births, fetal alcohol syndrome, maternal diabetes. Systemic associations in the child include endocrine abnormalities, developmental delay, cerebral palsy, and seizures. Besides the hypoplastic optic nerve and chiasm, neuroimaging shows abnormalities in ventricles or white- or gray-matter development, septo-optic dysplasia, hydrocephalus, and corpus callosum abnormalities. There is a greater incidence of clinical neurologic abnormalities in patients with bilateral ONH (65%) than patients with unilateral ONH. We present a review on the available literature on the same to urge caution in our clinical practice when dealing with patients with ONH. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, endocrinology consultation with or without genetic testing are helpful in the diagnosis and management of ONH. (Method of search: MEDLINE, PUBMED). PMID:24082663

  20. Optic nerve hypoplasia

    PubMed Central

    Kaur, Savleen; Jain, Sparshi; Sodhi, Harsimrat B. S.; Rastogi, Anju; Kamlesh

    2013-01-01

    Optic nerve hypoplasia (ONH) is a congenital anomaly of the optic disc that might result in moderate to severe vision loss in children. With a vast number of cases now being reported, the rarity of ONH is obviously now refuted. The major aspects of ophthalmic evaluation of an infant with possible ONH are visual assessment, fundus examination, and visual electrophysiology. Characteristically, the disc is small, there is a peripapillary double-ring sign, vascular tortuosity, and thinning of the nerve fiber layer. A patient with ONH should be assessed for presence of neurologic, radiologic, and endocrine associations. There may be maternal associations like premature births, fetal alcohol syndrome, maternal diabetes. Systemic associations in the child include endocrine abnormalities, developmental delay, cerebral palsy, and seizures. Besides the hypoplastic optic nerve and chiasm, neuroimaging shows abnormalities in ventricles or white- or gray-matter development, septo-optic dysplasia, hydrocephalus, and corpus callosum abnormalities. There is a greater incidence of clinical neurologic abnormalities in patients with bilateral ONH (65%) than patients with unilateral ONH. We present a review on the available literature on the same to urge caution in our clinical practice when dealing with patients with ONH. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, endocrinology consultation with or without genetic testing are helpful in the diagnosis and management of ONH. (Method of search: MEDLINE, PUBMED). PMID:24082663