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Ulnar nerve tuberculoma.  


The authors report a very rare case of tuberculoma involving the ulnar nerve. The patient, a 7-year-old girl, presented with swelling over the medial aspect of her right forearm just below the elbow joint, with features of ulnar nerve palsy, including paresthesias along the little and ring fingers and claw hand deformity. There was a history of trauma and contact with a contagious case of tuberculosis. There were no other signs of tuberculosis. At surgical exploration the ulnar nerve was found to be thickened, and on opening the sheath there was evidence of caseous material enclosed in a fibrous capsule compressing and displacing the nerve fibers. The lesion, along with the capsule, was subtotally removed using curettage, and a part of the capsule that was densely adherent to the nerve fibers was left in the patient. Histopathological examination of the specimen was consistent with tuberculoma. The patient received adequate antitubercular treatment and showed significant improvement. PMID:23082843

Ramesh Chandra, V V; Prasad, Bodapati Chandramowliswara; Varaprasad, Gangumolu



Ulnar nerve damage (image)  


... arm. The nerve is commonly injured at the elbow because of elbow fracture or dislocation. The ulnar nerve is near ... surface of the body where it crosses the elbow, so prolonged pressure on the elbow or entrapment ...


Restoration of sensibility in irreparable ulnar and median nerve lesions with use of sensory nerve transfer: Long-term follow-up of 20 cases  

Microsoft Academic Search

A prospective study was conducted to evaluate patient outcomes following sensory nerve transfer. Twenty patients with irreparable ulnar or median nerve lesions underwent the procedure. Nerve involvement was bilateral in 5 cases. The mean age of the patients at the time of surgery was 29 years. The mean paralysis time and the average length of follow-up were 59 and 78

Türker Özkan; Ka?an Özer; Ayan Gülgönen



[The ulnar nerve compression syndrome].  


The ulnar nerve has to bear a large amount of compression, especially in the cubital tunnel, which can be deducted from the topographic relation of this nerve to the elbow. Apart from tightness of the tunnel, intraarticular changes can also cause compression of the nerve. A further narrow tunnel in the course of the ulnar nerve is the "loge de GUYON", situated in the hypothenar region. A careful neurological examination of sensory and motor signs as well as an accurate electromyographical examination differentiate compression syndromes from other neuropathies. Two unusual cases of a functional cubital tunnel syndrome are demonstrated: their cause was primarily a chondromatosis of the elbow joint in one case a functional vasal compression in the other case. PMID:7250791

Thümler, P; Goymann, V



Ulnar nerve dysfunction  


... surface of the body where it crosses the elbow. The damage destroys the nerve covering ( myelin sheath) ... be caused by: Long-term pressure on the elbow An elbow fracture or dislocation Temporary pain and ...


Ulnar nerve entrapment syndrome in baseball players  

Microsoft Academic Search

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,

Wilson Del Pizzo; Frank W. Jobe; Lyle Norwood



Three ulnar nerve conduction studies in patients with ulnar neuropathy at the elbow  

Microsoft Academic Search

Objective: Ulnar neuropathy at the elbow is often difficult to localize by standard electrophysiologic testing. This study compared three ulnar nerve conduction studies to determine which was more sensitive in localizing ulnar neuropathy at the elbow.Methods: Motor studies to the first dorsal interosseous and the abductor digiti quinti and a mixed ulnar nerve sensory study across the elbow.Results: Motor studies

Milind J. Kothari; Michele Heistand; Seward B. Rutkove



Collagen content in human ulnar nerve  

Microsoft Academic Search

A quantitative analysis of ulnar nerve collagen in the arm and forearm was undertaken in nine subjects. While endoneurial collagen was found to be significantly increased within the cubital tunnel, extrafascicular collagen did not increase at the elbow except in two nerves showing fusiform enlargements. Renaut bodies increased in frequency at sites of high endoneurial collagen content. Morphological determinations of

Kenneth Robert McFarlane; Martin Pollock; Donald Burton Myers



Isolated ulnar dorsal cutaneous nerve herpes zoster reactivation.  


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

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



Ulnar collateral ligament reconstruction in athletes: Muscle-splitting approach without transposition of the ulnar nerve  

Microsoft Academic Search

Eighty-three athletes with medial elbow instability underwent reconstruction of the anterior band of the ulnar collateral ligament with a muscle-splitting approach without transposition of the ulnar nerve. The purposes of this study were to describe postoperative neurologic outcomes in all 83 athletes and to describe the 2-year follow-up in 33 athletes. Postoperatively, 5% of this group had transient ulnar nerve

William H. Thompson; Frank W. Jobe; Lewis A. Yocum; Marilyn M. Pink



Median and ulnar nerve grafting in children.  


A case series of seven children and adolescents who underwent secondary nerve grafting of median or ulnar nerve is presented. The children were evaluated after a mean follow-up of 7 years, using the Disabilities of Arm Shoulder and Hand (DASH) questionnaire and the Rosen-Lundborg outcome scale. The mean DASH outcome was 14.6 and the mean Rosen-Lundborg score was 2.08. A similar study was conducted for comparison in an adult group, with a mean DASH score of 46.3 and Rosen-Lundborg score of 1.3, indicating superior treatment results in children. The treatment outcome after nerve grafting in children did not match, however, to those obtained in the primary suture group. PMID:22186705

Ceynowa, Marcin; Mazurek, Tomasz; Sikora, Tomasz



Excursion of the ulnar nerve at the elbow following epicondylectomy or transposition  

Microsoft Academic Search

We studied the excursion of the ulnar nerve at the elbow following various surgical treatments for ulnar nerve compression in a cadaver model. The ulnar nerve length was measured in various positions of flexion in four situations: the normal anatomical position, following epicondylectomy and following submuscular and subcutaneous transposition. The changes in ulnar nerve length from 0? to 120? of

A. Tsujino; Y. Itoh; K. Hayashi



Early Restoration of Pinch Grip after Ulnar Nerve Repair and Tendon Transfer  

Microsoft Academic Search

Restoration of pinch in ulnar nerve lesions may be achieved within three or four weeks by a one-stage operation combining nerve repair and tendon transfer. We have been using this approach for nerve injuries of the upper limb since 1961, to meet the socio-economic needs of patients who would otherwise need splints and long-term physiotherapy. In our experience, the procedure




Handlebar palsy – a compression syndrome of the deep terminal (motor) branch of the ulnar nerve in biking  

Microsoft Academic Search

.   We describe 3 patients who developed a severe palsy of the intrinsic ulnar supplied hand muscles after bicycle riding. Clinically\\u000a and electrophysiologically all showed an isolated lesion of the deep terminal motor branch of the ulnar nerve leaving the\\u000a hypothenar muscle and the distal sensory branch intact. This type of lesion at the canal of Guyon is quite unusual,

Daniel Capitani; Serafin Beer



Influence of age, gender, and sidedness on ulnar nerve conduction.  


Anatomic variation and susceptibility for injuries depending on gender were described for the ulnar nerve. The aim of this study was to investigate the association between gender and ulnar never motor conductance and the influence of sidedness for this association. Study was conducted as a retrospective study using nerve conduction study data of ulnar nerve of 2,526 patients. Influences of age, gender, and sidedness on ulnar never motor conduction velocity (UMV) were investigated. Regression analysis was conducted to compare the relationship between UMV and age. Regression was significantly higher in males (-0.253 vs. -0.113), suggesting higher influence of age on UMV in males than in females. When analyzing right and left sides separately, influence of age on UMV is higher in males (-0.286 vs. -0.109) only in right side. Multiple regression analysis was done comparing the influence of age, gender, and sidedness on UMV, and it found that the order of influence is gender, age, and sidedness (Beta values 0.153, -0.140, and 0.029). Ulnar nerve motor conductance depends on gender, age, and sidedness. Males are having lower UMV than females. Age-dependant change of UMV is more prominent in males than in females and is more prominent in right hand than in left hand in males. PMID:23377450

Kommalage, Mahinda; Gunawardena, Sampath



The pathology of the ulnar nerve in acromegaly  

Microsoft Academic Search

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

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



Ulnar nerve measurements in healthy individuals to obtain reference values.  


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

Yalcin, Elif; Onder, Burcu; Akyuz, Mufit



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

Microsoft Academic Search

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 volun- teers 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

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



Traumatic Nerve Lesions  

Microsoft Academic Search

Traumatic lesions of peripheral nerves are common. According to the literature a relevant lesion of a peripheral nerve exists\\u000a in roughly 2%–3% of patients admitted to Level I trauma centers. If plexus and root injuries are included the incidence rises\\u000a to about 5% (Noble et al. 1998; Robinson 2000). In general, these types of injuries are increasingly recognized in today’s

Siegfried Peer; Hannes Gruber


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

Microsoft Academic Search

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,

A. Collier; P. Burge



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


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

Ertem, Kadir



Arthroscopic Ulnar Nerve Identification During Posterior Elbow Arthroscopy  

PubMed Central

Elbow arthroscopy has increased in popularity in the past 10 years for both diagnostic and therapeutic purposes. A major limiting factor faced by the elbow arthroscopist is the close proximity of the neurovasculature to the working field, with the risk of iatrogenic injury. Many arthroscopic procedures are less extensive than their open equivalents because of an inability to consistently and safely eliminate the risk of neural and vascular injury. Many open procedures in the posterior compartment of the elbow joint are not routinely performed arthroscopically. The primary reason for this restriction in arthroscopic practice is the locality of the posteromedially positioned ulnar nerve in the posterior compartment. Experience and practice with elbow arthroscopic techniques allows surgeons to expand the indications for arthroscopic treatment of an increasing number of elbow pathologies. A philosophy that is routine in open surgery when dealing with pathology that is adjacent to neurovasculature is to identify the neurovasculature and hence reduce the risk of injury. Our aim is to translate this philosophy to arthroscopy by helping define a safe technique for identifying the ulnar nerve in the posteromedial elbow gutter and allowing for a safer performance of procedures in the posteromedial region of the elbow.

Kamineni, Srinath; Hamilton, David Anthony



[Neurotization of the deep branch of ulnar nerve and the thenar branch of median nerve with the pronator quadratus branch of anterior interosseous nerve by end-to-side transfer. An anatomic study].  


Proximal or middle lesions of median or ulnar nerves are responsible for a great loss of hand motor function. Neurotization of either deep ulnar branch of ulnar nerve (DBUN) or recurrent (thenar) branch of median nerve (RBMN) with the nerve to quadratus pronator (NPQ) from the anterior interosseous nerve (AION) could reduce length of axonal growth and therefore the reinnervation lead-time of hand intrinsic muscles. We studied the anatomy of these three nerves, to help surgeon choosing his (her) technique and approach. Twenty-three cadaver forearms were dissected. End-to-side sutures were performed to mimic these neurotizations. Distances between nerve sutures and ulnar styloid process (USP) or trapeziometacarpal joint (TM) were measured. All the sutures but one RBMN could be done. On average sutures were distant from USP by 44±17mm (neurotization of DBUN), from TM by 62±15mm (neurotization of RBMN). Knowledge of average distance to perform these neurotizations should allow choosing the best reduced approach of RBMN and DBUN. Neurotizations of DBNU and RBMN with NPQ were feasible for lesions located at 6.1cm upstream USP and 7.7cm upstream TM, respectively. End-to-side sutures remain to be clinically evaluated. PMID:24094570

Collotte, P; Freslon, M; Brèque, C; Richer, J P; Gayet, L E



Compression of the ulnar nerve in Guyon’s canal by uremic tumoral calcinosis  

Microsoft Academic Search

We describe the case of a 70-year-old woman with chronic renal failure on haemodialysis presenting with an ulnar nerve compression\\u000a in Guyon’s canal secondary to uremic tumoral calcinosis. Excision of calcium deposits and external neurolysis of the ulnar\\u000a nerve were successfully performed. Simultaneously, the hyperphosphatemia and hypercalcemia were corrected. The pathogenesis\\u000a of this condition is different from primary tumoral calcinosis.

Sebastián García; Federico Cofán; Andrés Combalia; José-María Campistol; Federico Oppenheimer; Roberto Ramón



Conduction in ulnar nerve bundles that innervate the proximal and distal muscles: a clinical trial  

PubMed Central

Background This study aims to investigate and compare the conduction parameters of nerve bundles in the ulnar nerve that innervates the forearm muscles and hand muscles; routine electromyography study merely evaluates the nerve segment of distal (hand) muscles. Methods An electrophysiological evaluation, consisting of velocities, amplitudes, and durations of ulnar nerve bundles to 2 forearm muscles and the hypothenar muscles was performed on the same humeral segment. Results The velocities and durations of the compound muscle action potential (CMAP) of the ulnar nerve bundle to the proximal muscles were greater than to distal muscles, but the amplitudes were smaller. Conclusions Bundles in the ulnar nerve of proximal muscles have larger neuronal bodies and thicker nerve fibers than those in the same nerve in distal muscles, and their conduction velocities are higher. The CMAPs of proximal muscles also have smaller amplitudes and greater durations. These findings can be attributed to the desynchronization that is caused by a wider range of distribution in nerve fiber diameters. Conduction parameters of nerve fibers with different diameters in the same peripheral nerve can be estimated.



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

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.

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



Nerve lesioning with direct current  

NASA Astrophysics Data System (ADS)

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.

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



Subcutaneous vs Submuscular Ulnar Nerve Transposition in Moderate Cubital Tunnel Syndrome  

PubMed Central

Background: The surgical treatment of Cubital tunnel syndrome (CubTS) is still a matter of debate. No consensus exists about the necessity of anterior transposition of the ulnar nerve after decompression. However, this technique is fairly common in clinical practice. Material and Methodology: In the present study we compared the operative technique (incision length, operative time), postoperative care (postoperative pain and complications) and the outcome between subcutaneous transposition and submuscular transposition of the ulnar nerve as two surgical modalities in treating moderate CubTS. Between March 2004 and March 2007, twenty six patients with moderate CubTS (according to Dellon’s grading system) were stratified according to age and gender into these two surgical techniques. The two groups were prospectively followed up 2 weeks, 6 months and 12 months postoperatively by the same observer and the operation outcome was assessed using the Bishop rating system. Results: We found that the subcutaneous transposition of the ulnar nerve was associated with shorter incision, shorter operative time, less postoperative pain, less postoperative complication and better outcome compared with the submuscular transposition. Conclusion: The authors recommend the subcutaneous technique when considering anterior transposition of the ulnar nerve in treating moderate CubTS.

Jaddue, Dhia A.K; Saloo, Salwan A; Sayed-Noor, Arkan S



Multichannel detection of magnetic compound action fields of median and ulnar nerves.  


We have recorded magnetic compound action fields, evoked by median and ulnar nerve stimulation at the wrist, with a 7-channel 1st-order SQUID gradiometer. Responses at cubita, elbow and brachial plexus were usually monophasic, with polarities and field patterns corresponding to the intracellular current flow in the leading edge of the action potential volley. PMID:2465131

Hari, R; Hällström, J; Tiihonen, J; Joutsiniemi, S L



Accidental section of the ulnar nerve in the wrist during arthroscopy.  


Arthroscopy of the wrist is a frequently performed procedure. Its role in diagnosis and treatment is significant. The complications of arthroscopy are well known and are described in the literature. We describe a case of accidental section of the ulnar nerve during repair of the triangular fibrocartilage complex during arthroscopy. The nerve section was caused by the trocar used for drainage in the 6U portal. We propose to establish the injury mechanism and describe a safe procedure for this examination. PMID:21820268

Nguyen, Minh Khanh; Bourgouin, Stéphane; Gaillard, Christophe; Butin, Christophe; Guilhem, Kevin; Levadoux, Michel; Legré, Régis



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

Microsoft Academic Search

Epineural ganglia are considered to be a usual cause of peripheral nerve compression. In this report, we present a rare case\\u000a of ulnar nerve compression by an epineural ganglion in the cubital tunnel. A 28-year-old right-handed female secretary developed\\u000a progressive pain, numbness, and weakness in her right elbow, forearm, and hand for 6 months. Atrophy of the adductor pollicis\\u000a and the

Loukas A. Boursinos; Christos G. Dimitriou



Humeral trochlear hypoplasia secondary to epiphyseal injury as a cause of ulnar nerve palsy.  


Humeral trochlear hypoplasia (HTH) is a rare condition that occasionally results in ulnar nerve palsy. A 41-year-old man developed HTH secondary to an epiphyseal injury of the trochlea incurred 33 years earlier. This may be the first report of a case of HTH caused by injury. The ulnar nerve appeared compressed by the malposition of the HTH against the medial head of the triceps brachii when the joint was flexed. The close proximity of the olecranon to the HTH also allowed the triceps brachii muscle to compress the nerve by displacing medially and overriding the bone. The condition was resolved surgically and the patient returned to his former occupation as a coal miner. PMID:2830073

Minami, A; Sugawara, M



Sensory nerve findings by tactile stimulation of median and ulnar nerves in healthy subjects of different ages.  


We studied orthodromic sensory conduction velocity along the distal and proximal segments of the median and ulnar nerves by tactile stimulation of the distal phalanx of the 3rd and 5th digits in 44 healthy subjects divided into 2 age groups: from 16 to 35 years and from 63 to 81 years. In the same nerves, we used selective electrical stimulation of the corresponding digital nerves to obtain sensory potentials. In both groups, responses to tactile stimuli had a longer latency and smaller amplitude than those to electrical stimulation, and they were distributed in a series of 6-7 main deflections, apparently regardless of whether the recording site was distal or proximal. Moreover, irrespective of the nerve and of subject age, conduction velocity along both the digit-wrist and the wrist-elbow nerve segments was significantly slower with tactile stimuli than with electrical stimuli. However, independently of the stimulus used, conduction velocity along the proximal nerve segment was significantly faster than that measured along the digit-wrist nerve segment. In both the median and ulnar nerves, maximum potential amplitude, cumulative area and conduction velocity were significantly reduced in the older age group. This finding could reflect the smaller number of Meissner's corpuscles in older subjects, and the loss of large nerve fibres in individuals over 60. PMID:7507425

Caruso, G; Nilsson, J; Crisci, C; Nolano, M; Massini, R; Lullo, F



Cortical characterization and inter-dipole distance between unilateral median versus ulnar nerve stimulation of both hands in MEG.  


Contralateral somatosensory evoked fields (SEF) by whole head MEG after unilateral median and ulnar nerve stimulation of both hands were studied in 10 healthy right-handed subjects. Major parameters describing cortical activity were examined to discriminate median and ulnar nerve evoked responses. Somatic sensitivity showed high similarity in the 4 study conditions for both hand and nerve. The brain SEFs consisted of 7-8 major peak stages with consistent responses in all subjects at M20, M30, M70 and M90. Comparable inter-hemispheric waveform profile but high inter-subject variability was found. Median nerve induced significantly shorter latencies in the early activities than those of the ulnar nerve. The 3D cortical maps in the post stimulus 450 ms timeframe showed for both nerves two polarity reversals, an early and a late one which is a new finding. Dipole characteristics showed differential sites for the M20 and M30 in the respective nerve. Higher dipole moments evoked by the median nerve were noticed when compared to the ulnar. Furthermore, the results of the dipole distances between both nerves for M20 were calculated to be at 11.17 mm +/- 4.93 (LH) and 16.73 mm +/- 5.66 (RH), respectively after right hand versus left hand stimulation. This study showed substantial differences in the cortical responses between median and ulnar nerve. Especially the dipole distance between median and ulnar nerve on the cortex was computed accurately for the first time in MEG. Little is known however of the cortical responses in chronic pain patients and the parameter(s) that may change in an individual patient or a group. These results provide precise basis for further evaluating cortical changes in functional disorders and disease sequelae related to median and ulnar nerves. PMID:16977490

Theuvenet, Peter J; van Dijk, Bob W; Peters, Maria J; van Ree, Jan M; Lopes da Silva, Fernando L; Chen, Andrew C N



T2-Signal of Ulnar Nerve Branches at the Wrist in Guyon's Canal Syndrome  

PubMed Central

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.

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



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

PubMed Central

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.

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



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

Microsoft Academic Search

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

Jaime Gasco



Compression of the ulnar nerve in Guyon's canal by pseudotumoral calcinosis in systemic scleroderma  

Microsoft Academic Search

We report one case of ulnar nerve compression in Guyon's canal due to calcium deposits in a 50-year-old woman with long standing systemic scleroderma. To our knowledge, this is the second known case. The symptoms consisted of a motor and partial sensory disturbance. Calcification of the piso-triquetral joint was prolonging into Guyon's canal, lifting its contents, and into the subcutaneous

M. Chammas; G. Meyer Zu Reckendorf; Y. Allieu



Elemental mercury exposure: correlation of urine mercury indices with ulnar nerve conduction studies  

SciTech Connect

An electrophysiological evaluation was made of the ulnar nerve in 18 men who were exposed to elemental mercury vapor in the course of their jobs at a mercury-cell chlorine plant. The men averaged 31 years of age, ranging from 19 to 56. Urinary mercury levels were available for three years prior to the evaluation of the ulnar nerve. Abnormal nerve conduction studies were obtained in five subjects, with three having prolonged sensory distal latency, one having prolonged motor distal letency and one having both prolonged motor and sensory distal latencies with a low normal SNAP amplitude. Over half of the mercury levels were significantly higher in this abnormal group. The highest correlation obstained was between sensory latency and the number of months urine mercury exceeded 0.50 milligrams/liter. The authors conclude that exposure to elemental mercury can affect both motor and sensory peripheral nerve conduction and that the degree of involvement can be related to time-integrated urine mercury levels.

Levine, S.P.; Cavender, G.D.; Langolf, G.D.; Albers, J.W.



Undersurface tear of the ulnar collateral ligament in baseball players. A newly recognized lesion.  


Seven patients were diagnosed with an undersurface tear of the deep capsular layer of the anterior bundle of the ulnar collateral ligament. Preoperatively, all of the patients had tenderness over the anterior bundle of the ulnar collateral ligament and pain with valgus stressing of the elbow. Six of the seven patients had a normal magnetic resonance imaging scan, with one magnetic resonance imaging scan showing degeneration within the ligament. All of the patients had a negative computed tomography arthrogram for extracapsular contrast extravasation. A consistent finding in five of the seven patients was a leak of contrast around the edge of the humerus or ulna, although the contrast was contained within the joint. At arthroscopic evaluation, all of the patients demonstrated medial elbow instability as valgus stress was applied across the elbow joint in 70 degrees of flexion. All of the patients underwent open medial elbow surgery, where the ulnar collateral ligament was visualized and found to be intact externally. But when the anterior bundle was incised, there was a detachment of the undersurface of the ligament at the ulna or the humerus. Cadaveric dissections were performed to define the anatomy of the insertion sites and to confirm that this lesion was not an anatomic variant. A tear of the deep layer of the ulnar collateral ligament can result in symptomatic instability that is difficult to diagnose with conventional preoperative testing. This lesion of the anterior bundle of the ulnar collateral ligament has not been previously reported, and in our series it was associated with persistent medial elbow pain in throwing athletes. PMID:8129107

Timmerman, L A; Andrews, J R


Electrophysiological assessment of focal nerve lesions  

Microsoft Academic Search

A technique is described for quantitatively characterizing focal lesions in peripheral nerves. At the lesion site, conduction fails in some fibers and is abnormally delayed in others. The technique computes the fraction of conducting fibers and the distribution of added delays (DAD). Compound action potentials (CAPs) are evoked by stimulating distally and proximally to the lesion. Then, using a model

S. J. Xiao; K. C. McGill; V. R. Hentz



Motor and sensory ulnar neuropathy following mountain-bike riding: a case report and literature review  

Microsoft Academic Search

We describe a case of ulnar nerve compression at the wrist of a woman following mountain-bike riding. Clinically, she developed complete unilateral lower ulnar nerve palsy with clawing of the ring and little fingers in her right hand. Electrophysiologic tests proved the lesion to be at the level of Guyon’s canal in the wrist. An MRI did not show any

R. Srinivas Reddy; G. Kakarala; I. J. Persad; J. Compson



Patterns of reinnervation and motor unit recruitment in human hand muscles after complete ulnar and median nerve section and resuture.  

PubMed Central

Following complete ulnar or above-elbow median nerve sections, there was no significant correlation between motor unit size (twitch amplitude) and recruitment threshold, as assessed by spike triggered averaging. This absence of orderly recruitment was attributed to misdirection of motor axons during regeneration. Following median nerve section at wrist level, where the reinnervated muscles have more synergistic actions, orderly recruitment by size appeared to be re-established. Thus, the size principle of motor unit recruitment can be re-established after nerve section in humans, if motor axons innervate their original muscles or ones with closely synergistic functions.

Thomas, C K; Stein, R B; Gordon, T; Lee, R G; Elleker, M G



Early use of artificial sensibility to improve sensory recovery after repair of the median and ulnar nerve.  


Artificial sensibility based on use of a "tactile glove" which substitutes for lack of sensory afferent inflow with acoustic feedback, was used early after repair of the median and ulnar nerves in a 21-year-old man. After six and 12 months the functional outcome exceeded what is expected in adults, and analysis with calculations for the minimal detectable change (MDC) in tactile gnosis showed a true change. This case highlights the timing of sensory re-education after nerve repair and also emphasises the importance of early restitution of afferent inflow from a denervated hand during rehabilitation. PMID:12625396

Rosén, Birgitta; Lundborg, Göran



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


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

Pawlak, Matthias; Kaczmarek, Dominik



Trochlear nerve pareses with brainstem lesions.  


Three cases of radiographic localization of fourth nerve lesions are reported: case 1--bilateral pareses due to traumatic contusion; case 2--left paresis from a collicular gunshot wound; and case 3--bilateral pareses due to a (cysticercal) cyst in the caudal cerebral aqueduct. PMID:2947930

Keane, J R



[Ulnar nerve neuropathy in the elbow region: surgical findings and conclusions about the etiologic mechanism and indications for surgery].  


The operative findings of 191 cases of so-called tardy ulnar neuritis are demonstrated. They may be divided into 2 groups, neuropathies associated with (67 cases) and without dislocation or subluxation of the nerve (124 cases). Cases of ulnar neuritis associated with dislocation of the nerve showing no other pathologic changes indicate that dislocation of the nerve alone may account for clinical signs. The next step is the formation of adhesions followed at a later date by formation of a pseudoneuroma. As this condition is mostly of congenital origin an additional factor is needed for including clinical manifestations such as direct or chronic professional trauma. Not enough importance has been attached to the strong triceps, with large muscle mass reaching far down to the olecranon, which might cause irritation of the nerve by pressing it against the wall of the sulcus or dislocating it over the epicondyle. In cases of neuropathy without dislocation/subluxation there is always a pathological finding even when there is no pseudoneuroma. The m. epitrochleoanconaeus is found in this category (14 cases, 11%). The cubital tunnel syndrom of OSBORNE in a very large sense (all possible causes of compression distal to the sulcus) has been found 28 times. Therapeutic measures aim at taking the nerve away from the causative irritation (anterior transposition) or at erradicating the cause (resection of the epicondyle, section of the arcus tendineus, excision of a tumor etc.). OSBORNE's operation has been performed only thrice. Subluxation or dislocation of the nerve may follow this procedure or the nerve is left more exposed to pressure than before. Deep submuscular transposition is preferred in patients less than 50 years old but other factors may determine the choice between deep and subcutaneous transposition such as the cause of the neuropathy, arthritis of the elbow joint, strength of the flexor muscle mass etc. PMID:186363

Nigst, H



Undersurface Tear of the Ulnar Collateral Ligament in Baseball PlayersA Newly Recognized Lesion  

Microsoft Academic Search

Seven patients were diagnosed with an undersurface tear of the deep capsular layer of the anterior bundle of the ulnar collateral ligament. Preoperatively, all of the patients had tenderness over the anterior bundle of the ulnar collateral ligament and pain with valgus stressing of the elbow. Six of the seven patients had a normal magnetic resonance imaging scan, with one

Laura A. Timmerman; James R. Andrews



Wide-range visualization of compound nerve action magnetic fields in the human median and ulnar nerves from the forearm to Erb's point.  


We successfully visualized the compound nerve action magnetic fields (CAFs) in the human median and ulnar nerves from the forearm to Erb's point. To observe the CAFs, we used a superconducting quantum interference device gradiometer system that was developed for human peripheral nerves. The CAFs were visualized as a quadrupole pattern consisting of leading and trailing dipoles. The CAFs propagated along the anatomical pathway and extended longitudinally in the proximal segment. The most reasonable explanation is that the peak separation in the trailing dipole appeared when the leading dipole reached the proximal segment after stimulation of the median nerve at the wrist. A temporal dispersion of the CAFs was suggested to be visualized. PMID:14746886

Nakanishi, Kazuyoshi; Mashiko, Takunori; Fujimoto, Yoshinori; Tanaka, Nobuhiro; Iwase, Yoshiyuki; Ishida, Osamu; Ochi, Mitsuo



Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: Clinical and electrophysiological evaluation  

Microsoft Academic Search

Objective: To compare the effects of splinting alone in the treatment of ulnar nerve lesion at the elbow with the effects of applying a local steroid injection in addition to splinting.Design: Twelve nerves of 10 patients were randomly assigned into two groups: 5 nerves in Group A were treated with elbow splinting only; 7 nerves in Group B were treated

Chang-Zern Hong; Huong-Anh Long; Raghavaiah V. Kanakamedala; Ying-Ming Chang; Liva Yates



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

PubMed Central

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.



Nerve damage in leprosy: An electrophysiological evaluation of ulnar and median nerves in patients with clinical neural deficits: A pilot study  

PubMed Central

Background: Leprosy involves peripheral nerves sooner or later in the course of the disease leading to gross deformities and disabilities. Sadly, by the time it becomes clinically apparent, the nerve damage is already quite advanced. However, if the preclinical damage is detected early in the course of disease, it can be prevented to a large extent. Materials and Methods: We conducted an electrophysiological pilot study on 10 patients with clinically manifest leprosy, in the Dermatology Department of Mahatma Gandhi Institute of Medical Sciences, Sewagram. This study was done to assess the nerve conduction velocity, amplitude and latency of ulnar and median nerves. Results and Conclusion: We found reduced conduction velocities besides changes in latency and amplitude in the affected nerves. Changes in sensory nerve conduction were more pronounced. Also, sensory latencies and amplitude changes were more severe than motor latencies and amplitude in those presenting with muscle palsies. However, further studies are going on to identify parameters to detect early nerve damage in leprosy.

Kar, Sumit; Krishnan, Ajay; Singh, Neha; Singh, Ramji; Pawar, Sachin



Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model  

PubMed Central

Background and purpose Mechanisms of injury to ulnar-sided ligaments (stabilizing the distal radioulnar joint and the ulna to the carpus) associated with dorsally displaced distal radius fractures are poorly described. We investigated the injury patterns in a human cadaver fracture model. Methods Fresh frozen human cadaver arms were used. A dorsal open-wedge osteotomy was performed in the distal radius. In 8 specimens, pressure was applied to the palm with the wrist in dorsiflexion and ulnar-sided stabilizing structures subsequently severed. Dorsal angulation was measured on digitized radiographs. In 8 other specimens, the triangular fibrocartilage complex (TFCC) was forced into rupture by axially loading the forearm with the wrist in dorsiflexion. The ulnar side was dissected and injuries were recorded. Results Intact ulnar soft tissues limited the dorsal angulation of the distal radius fragment to a median of 32o (16–34). A combination of bending and shearing of the distal radius fragment was needed to create TFCC injuries. Both palmar and dorsal injuries were observed simultaneously in 6 of 8 specimens. Interpretation A TFCC injury can be expected when dorsal angulation of a distal radius fracture exceeds 32o. The extensor carpi ulnaris subsheath may be a functionally integral part of the TFCC. Both dorsal and palmar structures can tear simultaneously. These findings may have implications for reconstruction of ulnar sided soft tissue injuries.



Coupling between "hand" primary sensorimotor cortex and lower limb muscles after ulnar nerve surgical transfer in paraplegia.  


Previous neuroimaging evidence revealed an "invasion" of "hand" over "lower limb" primary sensorimotor cortex in paraplegic subjects, with the exception of a rare patient who received a surgical motor reinnervation of hip-thigh muscles by the ulnar nerve. Here, the authors show that a functional reorganization of cortico-muscular and cortico-cortical oscillatory coupling was related to the recovery of the rare patient, as a paradigmatic case of long-term plasticity in human sensorimotor cortex after motor reinnervation of paraplegic muscles. This conclusion was based on electroencephalographic and electromyographic data collected while the patient and normal control subjects performed isometric muscle contraction of the left hand or lower limb. Cortico-muscular and cortico-cortical coupling was estimated by electroencephalographic-electromyographic coherence and directed transfer function of a multivariate autoregressive model. PMID:14979799

Babiloni, C; Vecchio, F; Babiloni, F; Brunelli, G A; Carducci, F; Cincotti, F; Pizzella, V; Romani, G L; Tecchio, F T; Rossini, P M



Electron microscopic observations on nerve cell regeneration and degeneration after axon lesions  

Microsoft Academic Search

The neuronal changes were studied in the facial nucleus of mice after crush lesions and complete section of the facial nerve. These lesions were followed by complete nerve cell regeneration and extensive nerve cell disintegration, respectively.

Ansgar Torvik; Fredrik Skjörten



Inflammatory trigeminal nerve and tract lesions associated with inferior alveolar nerve anaesthesia.  


Inferior alveolar nerve blocks are commonly performed for dental anaesthesia. The procedure is generally safe with a low rate of complications. We report a patient with a reproducible, delayed-onset sensory deficit associated with contrast-enhancing lesions in the trigeminal nerve, pons and medulla following inferior alveolar nerve local anaesthesia. We propose that this previously undescribed condition is a form of Type IV hypersensitivity reaction. PMID:23591181

Blair, N F; Parratt, J D E; Garsia, R; Brazier, D H; Cremer, P D



Iatrogenic selective lesion of the median nerve at the elbow.  


A lesion of the median nerve may occur as a consequence of a compression by a haematoma or for a direct damage of the axons caused by a needle insertion. To date, no investigation reported a very selective lesion of the median nerve at the elbow, with the suffering limited only to the fibres for the first digit. A 53 year-old left-handed violinist underwent an arterial blood gas drawing. The patient complained immediately of an electrical shock impression going down the arm, followed by pin sensation into the first finger. A tingling sensation associated with numbness in the first fingertip and difficulty in the index-thumb pinch became progressively evident. The ENG-EMG findings showed an impairment mainly of the sensory fibres innervating the first digit and a drop of the motor action potential amplitude when the nerve was stimulated at the elbow. We reported a very partial lesion of the left median nerve at the elbow in a violinist who had a selective involvement of the fibres for his first digit. Even minimal lesions of the median nerve may impair severely the quality of life of patients. PMID:20514934

Di Fabio, Roberto; Casali, Carlo; Pierelli, Francesco



Ulnar impaction.  


Ulnar impaction syndrome is a common source of ulnar-sided wrist pain. It is a degenerative condition that occurs secondary to excessive load across the ulnocarpal joint, resulting in a spectrum of pathologic changes and symptoms. It may occur in any wrist but is usually associated with positive ulnar variance, whether congenital or acquired. The diagnosis of ulnar impaction syndrome is made by clinical examination and is supported by radiographic studies. Surgery is indicated if nonoperative treatment fails. Although a number of alternatives exist, the 2 primary surgical options are ulnar-shortening osteotomy or partial resection of the distal dome of the ulna (wafer procedure). This article discusses the etiology of ulnar impaction syndrome, and its diagnosis and treatment. PMID:20951904

Sammer, Douglas M; Rizzo, Marco



Posterior tibial nerve lesions in ankle arthroscopy.  


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

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



Termino-lateral nerve suture in lesions of the digital nerves: clinical experience and literature review.  


Documented experience of treatment of digital nerve lesions with the termino-lateral (end-to-side) nerve suture is limited. Our clinical experience of this technique is detailed here alongside a systematic review of the previous literature. We performed, from 2002 to 2008, seven termino-lateral sutures with epineural window opening for digital nerve lesions. Functional outcome was analysed using the two-point discrimination test and the Semmes-Weinstein monofilament test. The results showed a sensory recovery of S3+ in six cases and S3 in one case. The mean distance found in the two-point discrimination test was 12.7 mm (range 8-18 mm). After a review of the literature, we were able to obtain homogeneous data from 17 additional patients operated by termino-lateral coaptation. The overall number of cases included in our review was 24. A sensory recovery was observed in 23 out of 24 patients. The functional results were S0 in one case, S3 in one case, S3+ in twenty cases and S4 in two cases. Excluding the one unfavourable case, the mean distance in the two-point discrimination test was 9.7 mm (range 3-18 mm). It can thus be concluded that the treatment of digital nerve lesions with termino-lateral suture showed encouraging results. Based on the results obtained in this current study we believe that in case of loss of substance, end-to-side nerve coaptation may be an alternative to biological and synthetic tubulisation when a digital nerve reconstruction by means of nerve autograft is declined by the patient. PMID:19687081

Artiaco, S; Tos, P; Conforti, L G; Geuna, S; Battiston, B



A preconditioning nerve lesion inhibits mechanical pain hypersensitivity following subsequent neuropathic injury  

Microsoft Academic Search

BACKGROUND: A preconditioning stimulus can trigger a neuroprotective phenotype in the nervous system - a preconditioning nerve lesion causes a significant increase in axonal regeneration, and cerebral preconditioning protects against subsequent ischemia. We hypothesized that a preconditioning nerve lesion induces gene\\/protein modifications, neuronal changes, and immune activation that may affect pain sensation following subsequent nerve injury. We examined whether a

Gila Moalem-Taylor; Man Li; Haydn N Allbutt; Ann Wu; David J Tracey



Lifestyle risk factors for ulnar neuropathy and ulnar neuropathy-like symptoms.  


Introduction: We examined whether lifestyle factors differ between patients with ulnar neuropathy confirmed by electroneurography (ENG) and those with ulnar neuropathy-like symptoms with normal ulnar nerve ENG. Methods: Among patients examined by ENG for suspected ulnar neuropathy, we identified 546 patients with ulnar neuropathy and 633 patients with ulnar neuropathy-like symptoms. These groups were compared with 2 separate groups of matched community referents and to each other. Questionnaire information on lifestyle was obtained. The electrophysiological severity of neuropathy was also graded. We used conditional and unconditional logistic regression. Results: Responses were obtained from 59%. Ulnar neuropathy was related to smoking, adjusted odds ratio (OR) 4.31 (95% confidence interval [CI] 2.43-7.64) for >24 pack-years. Ulnar neuropathy-like symptoms were related to body mass index ?30 kg/m(2) , OR 1.99 (95% CI 1.25-3.19). Smoking was associated with increased severity of ulnar neuropathy. Conclusions: Findings suggest that smoking specifically affects the ulnar nerve. Muscle Nerve 48: 507-515, 2013. PMID:23424094

Frost, Poul; Johnsen, Birger; Fuglsang-Frederiksen, Anders; Svendsen, Susanne W



The retrograde neurocutaneous island flap of the dorsal branch of the ulnar nerve: anatomical basis and clinical application  

Microsoft Academic Search

It is well known that a cutaneous artery is constantly located near a cutaneous peripheral nerve, forming a vascular plexus around it. This vascular axis can be either a true artery or an interlacing network, ensuring the vascularization of the nerve and giving off several neurocutaneous perforators to the skin. The anatomy of the accompanying arteries of the dorsal branch

V. Casoli; P. Vérolino; P. Pélissier; E. Kostopoulos; P. Caix; V. Delmas; D. Martin; J. Baudet



Remyelination of optic nerve lesions: spatial and temporal factors.  


Optic neuritis provides an in vivo model to study demyelination. The effects of myelin loss and recovery can be measured by the latency of the multifocal visual evoked potentials. We investigated whether the extent of initial inflammatory demyelination in optic neuritis correlates with the remyelinating capacity of the optic nerve. Forty subjects with acute unilateral optic neuritis and good visual recovery underwent multifocal visual evoked potentials testing at 1, 3, 6 and 12 months. Average latency changes were analyzed. Extensive latency delay at baseline significantly improved over time with rate of recovery slowed down after 6 months. Magnitude of latency recovery was independent of initial latency delay. Latency recovery ranged from 7 to 17 ms across the whole patient cohort (average = 11.3 (3.1) ms) despite the fact that in a number of cases the baseline latency delay was more than 35-40 ms. Optic nerve lesions tend to remyelinate at a particular rate irrespective of the size of the initial demyelinated zone with smaller lesions accomplishing recovery more completely. The extent of the initial inflammatory demyelination is probably the single most important factor determining completeness of remyelination. The time period favorable to remyelination is likely to be within the first 6 months after the attack. PMID:20530125

Klistorner, Alexandr; Arvind, Hemamalini; Garrick, Raymond; Yiannikas, Con; Paine, Mark; Graham, Stuart L



Elevation of Intraocular Glutamate Levels in Rats With Partial Lesion of the Optic Nerve  

Microsoft Academic Search

Background: Acute partial lesion of the rat optic nerve, although not a model for glaucoma, mimics some of the features of the disease. Objective: To learn whether degeneration of rat optic nerve fibers and death of their retinal ganglion cells in- duced by an acute partial lesion are associated with el- evated levels of glutamate, known to occur in the

Eti Yoles; Michal Schwartz



Low-power laser efficacy in peripheral nerve lesion treatment  

NASA Astrophysics Data System (ADS)

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.

Antipa, Ciprian; Nacu, Mihaela; Bruckner, Ion I.; Bunila, Daniela; Vlaiculescu, Mihaela; Pascu, Mihai L.; Ionescu, Elena



Spinal nerve lesion induces upregulation of constitutive isoform of heme oxygenase in the spinal cord  

Microsoft Academic Search

Summary.   The influence of carbon monoxide (CO) on chronic spinal nerve lesion induced spinal cord neurodegeneration was examined using\\u000a immunohistochemical expression of the constitutive isoform of its synthesising enzyme, hemeoxygenase-2 (HO-2) in a rat model.\\u000a Spinal nerve lesion at L-5 and L-6 level was produced according to the Chung model of neuropathic pain and rats were allowed\\u000a to survive for

T. Gordh; H. S. Sharma; M. Azizi; P. Alm; J. Westman



Ulnar Collateral Ligament Reconstruction Revisited  

PubMed Central

Context: Ulnar collateral ligament (UCL) insufficiency of the elbow can be a debilitating injury that often prevents athletes from competing effectively. The overhead athlete is particularly susceptible to this injury because the anterior bundle of the UCL is the primary restraint to the valgus stress that is created during the throwing motion. Repetitive trauma from constant overhead or throwing activity can ultimately render the ligament incompetent and cause recurrent pain and instability. Results: The authors currently use a “docking” technique that provides excellent graft fixation and reduces ulnar nerve related complications. Conclusions: This article details the assessment of the throwing athlete with valgus instability secondary to UCL insufficiency and highlights the technical aspects for reconstruction. The majority of athletes who undergo UCL reconstruction of the elbow can successfully return to their preinjury function. Strength-of-Recommendation Taxonomy (SORT): A

Dodson, Christopher C.; Altchek, David W.



Individual microglia move rapidly and directly to nerve lesions in the leech central nervous system.  

PubMed Central

Small cells called microglia, which collect at nerve lesions, were tracked as they moved within the leech nerve cord to crushes made minutes or hours before. The aim of this study was to determine whether microglia respond as a group and move en masse or instead move individually, at different rates, and whether they move along axons directly to the lesion or take another route, such as along the edges of the nerve cord. Cell nuclei in living nerve cords were stained with Hoechst 33258 dye and observed under dim ultraviolet illumination using fluorescence optics, a low-light video camera, and computer-assisted signal enhancement. Muscular movements of the cord were selectively reduced by bathing in 23 mM MgCl2. Regions of nerve cord within 300 microns of the crush were observed for 2-6 hr. Only a fraction of microglia, typically less than 50%, moved at any time, traveling toward the lesion at speeds up to 7 microns/min. Cells were moving as soon as observation began, within 15 min of crushing, and traveled directly toward the lesion along axons or axon tracts. Movements and roles of leech microglia are compared with their vertebrate counterparts, which are also active and respond to nerve injury. Images

McGlade-McCulloh, E; Morrissey, A M; Norona, F; Muller, K J



Bilateral Suprascapular Nerve Entrapment by Ganglion Cyst Associated with Superior Labral Lesion  

PubMed Central

Suprascapular nerve compression is a rare cause of shoulder pain. We report the clinical features, radiological findings, arthroscopic management and outcome of three patients with suprascapular nerve compression caused by labral ganglion cyst associated with SLAP lesion. We performed simultaneous suture anchor SLAP repair and cyst decompression with a blunt probe. Upon a two-year follow-up, patients recovered full shoulder function without pain or limitations in activities of daily living.

Rizzello, Giacomo; Longo, Umile Giuseppe; Trovato, Ugo; Fumo, Caterina; Khan, Wasim Sardar; Maffulli, Nicola; Denaro, Vincenzo



Ulnar-sided wrist pain and instability.  


A variety of lesions have been associated with ulnar-sided wrist pain and/or VISI instability. A staging system for ulnar-sided perilunate instability describes progressive disruptions associated with lunotriquetral dissociation that can lead to VISI instability and emphasizes the importance of the dorsal radiocarpal ligament in preventing VISI instability. Previous studies have emphasized association between type II carpal morphology and arthrosis at the proximal pole of the hamate, which was identified as the most common location of arthrosis in the wrist. The pisotriquetral joint is another common site of degenerative changes. A better understanding of the normal anatomy and kinematics of the ulnar side of the wrist will better enable physicians to identify and treat problems in the ulnar aspect of the wrist. PMID:9571421

Viegas, S F



[Transcutaneous electrical nerve stimulation (TENS) in the treatment of a peripheral lesion of the brachial plexus].  


This case report describes the clinical history of a patient on dialysis, who suffered from a lesion of the brachial plexus, secondary to a mechanical damage after attempted suicide. Therapy with transcutaneous electrical nerve stimulation (TENS) revealed both sufficient analgesia and a striking improvement of the functional situation. Possible causes of the therapeutic success are discussed. The analgesia of TENS therapy, which has almost no side-effects, with the secondarily improved psychic situation, is regarded as the major responsible factor. This method appears to be a rewarding alternative in the treatment of pain syndromes secondary to peripheral nerve lesions. PMID:6604466

Pohl, S; Masyk-Iversen, T; Lips, U; Pichlmayr, I



Detection of optic nerve lesions in optic neuritis using frequency-selective fat-saturation sequences  

Microsoft Academic Search

MRI was performed on seven patients with acute optic neuritis, using two sequences which suppress the signal from orbital fat: frequency-selective fat-saturation and inversion recovery with a short inversion time. Lesions were seen on both sequences in all the symptomatic optic nerves studied.

D. H. Miller; D. G. Mac Manus; P. A. Bartlett; R. Kapoor; S. P. Morrissey; I. F. Moseley



Late ulnar paralysis. Study of seventeen cases.  


Seventeen cases of late ulnar paralysis treated by neurolysis-transposition are reported. The clinical characteristics of these paralysis are emphasized. A very prolonged symptom free interval, a rapid onset and a severe involvement. The ulnar transposition was most often done subcutaneously. Cubitus valgus and definite nerve compression proximal to the arcade of the flexor carpi ulnaris muscle are almost always present. The results as regards the neuropathy are notable: no patient is completely cured and only half are improved. An anatomical study of the nerve path shows the essential role, in the compression of the nerve, of the muscular arcade of the flexor carpi ulnaris muscle which acts in a way similar to the bridge of a violin. Hence, opening it longitudinally is the principal procedure of the neurolysis. This should be routine before the first signs of neuropathy occur in an elbow whose axis is out of alignment as a sequela of a childhood injury. PMID:9336632

Mansat, M; Bonnevialle, P; Fine, X; Guiraud, B; Testut, M F



Case report: Loiasis with peripheral nerve involvement and spleen lesions.  


Loiasis, which is caused by the filarial nematode Loa loa, affects millions of persons living in the rainforest areas and savannah regions of central Africa. Typical manifestations are calabar swellings and the eyeworm. We report a case of loiasis with unusual clinical complications: a peripheral neuropathy and focal hypo-echogenic lesions of the spleen, which disappeared after treatment with albendazole and ivermectin. The literature reports that L. loa infection can be associated with various manifestations, some of them being serious. More information is needed to better characterize the protean manifestations of the disease in loiasis-endemic areas to evaluate the true incidence of loiasis. PMID:21540382

Gobbi, Federico; Boussinesq, Michel; Mascarello, Marta; Angheben, Andrea; Gobbo, Maria; Rossanese, Andrea; Corachán, Manuel; Bisoffi, Zeno



Loiasis with Peripheral Nerve Involvement and Spleen Lesions  

PubMed Central

Loiasis, which is caused by the filarial nematode Loa loa, affects millions of persons living in the rainforest areas and savannah regions of central Africa. Typical manifestations are calabar swellings and the eyeworm. We report a case of loiasis with unusual clinical complications: a peripheral neuropathy and focal hypo-echogenic lesions of the spleen, which disappeared after treatment with albendazole and ivermectin. The literature reports that L. loa infection can be associated with various manifestations, some of them being serious. More information is needed to better characterize the protean manifestations of the disease in loiasis-endemic areas to evaluate the true incidence of loiasis.

Gobbi, Federico; Boussinesq, Michel; Mascarello, Marta; Angheben, Andrea; Gobbo, Maria; Rossanese, Andrea; Corachan, Manuel; Bisoffi, Zeno



Peripheral nerve injuries in athletes. Treatment and prevention.  


Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete's safe return to sports. Early, accurate anatomical diagnosis is essential. Nerve lesions may be due to acute injury (e.g. from a direct blow) or chronic injury secondary to repetitive microtrauma (entrapment). Accurate diagnosis is based upon physical examination and a knowledge of the relative anatomy. Palpation, neurological testing and provocative manoeuvres are mainstays of physical diagnosis. Diagnostic suspicion can be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. Proper equipment, technique and conditioning are the keys to prevention. Rest, anti-inflammatories, physical therapy and appropriate splinting are the mainstays of treatment. In the shoulder, spinal accessory nerve injury is caused by a blow to the neck and results in trapezius paralysis with sparing of the sternocleidomastoid muscle. Scapular winging results from paralysis of the serratus anterior because of long thoracic nerve palsy. A lesion of the suprascapular nerve may mimic a rotator cuff tear with pain a weakness of the rotator cuff. Axillary nerve injury often follows anterior shoulder dislocation. In the elbow region, musculocutaneous nerve palsy is seen in weightlifters with weakness of the elbow flexors and dysesthesias of the lateral forearm. Pronator syndrome is a median nerve lesion occurring in the proximal forearm which is diagnosed by several provocative manoeuvres. Posterior interosseous nerve entrapment is common among tennis players and occurs at the Arcade of Froshe--it results in weakness of the wrist and metacarpophalangeal extensors. Ulnar neuritis at the elbow is common amongst baseball pitchers. Carpal tunnel syndrome is a common neuropathy seen in sport and is caused by median nerve compression in the carpal tunnel. Paralysis of the ulnar nerve at the wrist is seen among bicyclists resulting in weakness of grip and numbness of the ulnar 1.5 digits. Thigh injuries include lateral femoral cutaneous nerve palsy resulting in loss of sensation over the anterior thigh without power deficit. Femoral nerve injury occurs secondary to an iliopsoas haematoma from high energy sports. A lesion of the sciatic nerve may indicate a concomitant dislocated hip. Common peroneal nerve injury may be due to a direct blow or a traction injury and results in a foot drop and numbness of the dorsum of the foot. Deep and superficial peroneal nerve palsies could be secondary to an exertional compartment syndrome. Tarsal tunnel syndrome is a compressive lesion of the posterior tibial nerve caused by repetitive dorsiflexion of the ankle--it is common among runners and mountain climbers.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8378668

Lorei, M P; Hershman, E B



Ulnar Variance Determination  

Microsoft Academic Search

Surgical procedures concerning the distal articular surfaces of the radius and ulna, demand an accurate method of measurement of ulnar variance. A new method, which is a modification of the method described by Palmer (1982), is introduced.100 randomly selected healthy persons were submitted to X-ray of the wrist and the ulnar variance was determined independently by three observers using both




Repetitive common peroneal nerve stimulation increases ankle dorsiflexor motor evoked potentials in incomplete spinal cord lesions  

Microsoft Academic Search

Plasticity of corticospinal tract (CST) activity likely plays a key role in motor function recovery after central nervous\\u000a system (CNS) lesions. In non-injured adults, 30 min of repetitive common peroneal nerve stimulation (rCPnS) increases CST\\u000a excitability by 40–50% and the effect persists for at least 30 min. The present study evaluated with transcranial magnetic\\u000a stimulation (TMS) the changes in CST excitability after

Aiko K. ThompsonBrandon; Brandon Lapallo; Michael Duffield; Briana M. Abel; Ferne Pomerantz



ATP and NO Dually Control Migration of Microglia to Nerve Lesions  

PubMed Central

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.

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



Carotid and cranial nerve reconstruction after removal of cavernous sinus lesions.  


During the last 7 years, approximately 170 neoplasms, and 35 vascular lesions involving the cavernous sinus were treated by the first two authors. During the treatment of such lesions, the direct vein graft reconstruction of the internal carotid artery from the petrous to the supraclinoid or infraclinoid ICA was performed in 23 patients. Graft occlusion occurred in 3 patients and in one of these, it was successfully salvaged by placing a long venous graft from the extracranial ICA to the M3 segment of the middle cerebral artery. The latter 3 patients were neurologically normal. One patient with significant atherosclerotic disease suffered the dissection of the distal internal carotid artery with the graft being patent. The suturing technique. This patient eventually died. Two patients with severely compromised collateral circulation suffered minor strokes due to the temporary occlusion of the ICA. This has been avoided in the more recent patients by the adoption of brain protection techniques such as moderate hypothermia, induced hypertension, and barbiturate coma. Low dose heparin therapy during grafting and high dose intravenous steroids prior to the grafting also appear to be beneficial. Direct vein graft reconstruction of the intracavernous carotid artery is a valuable tool during the management of cavernous sinus lesions. The advantages and disadvantages of this technique as well as the pros and cons of other revascularization techniques will be discussed. During microsurgical removal of cavernous sinus lesions, the cranial nerves III-VI were reconstructed by direct resuture or by nerve grafting in 16 patients. In the majority of these patients, recovery of cranial nerve function was observed, which was very encouraging.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1803071

Sekhar, L N; Sen, C N; Lanzino, G; Pomonis, S



Ulnar-sided wrist pain: diagnosis and treatment.  


Ulnar-sided wrist pain has often been equated with low back pain because of its insidious onset, vague and chronic nature, intermittent symptoms, and frustration that it induces in patients. Chronic ulnar-sided wrist pain may be accompanied by a history of workers' compensation claims and unrelenting and irresolvable pain, and it may occur in patients with dfficult personalities. Despite these issues, many patients with ulnar-sided wrist pain have pathologic lesions that may be amenable to surgical treatment. PMID:15948439

Shin, Alexander Y; Deitch, Mark A; Sachar, Kavi; Boyer, Martin I



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

PubMed Central

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.

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



The use of thoracodorsal nerve transfer in restoration of irreparable C5 and C6 spinal nerve lesions  

Microsoft Academic Search

There are only a few reports on the use of thoracodorsal nerve (TDN) transfer to the musculocutaneous or axillary nerves in cases of directly irreparable brachial plexus injuries. In this study, we analysed outcome and time-course of recovery in correlation with recipient nerves and type of nerve transfer (isolated or in combination with other collateral branches) for 27 patients with

M. M. Samardzic; D. M. Grujicic; L. G. Rasulic; B. R. Milicic



Contribution of magnetic resonance imaging for the diagnosis of median nerve lesion after endoscopic carpal tunnel release.  


Deterioration of pre-existing signs or appearance of a nerve deficit raise difficult problems during the complicated course following endoscopic carpal tunnel release. One possible explanation is transient aggravation of nerve compression by passage of the endoscopy material, but these signs may also be due to incomplete section of the flexor retinaculum or an iatrogenic nerve lesion. Each case raises the problem of surgical revision. The authors report three cases of open revision in which MRI allowed a very precise preoperative diagnosis of the lesions and all of the MR findings were confirmed during surgical revision. In the first case, MRI showed section of the most radial branches of the median nerve (collateral nerves of the thumb, index finger and radial collateral nerve of the middle finger). The proximal origin of the nerve of the 3rd web space, above the retinaculum, an anatomical variant, was also identified. Section of 2/3 of the nerve of the 3rd web space, proximal to the superficial palmar arch, was observed in the second case. Simple thickening of the nerve of the 3rd web space, without disruption after opening of the perineurium, was observed in the third case. MRI therefore appears to be an examination allowing early and precise definition of indications for surgical revision in this new iatrogenic disease. PMID:10855297

Silbermann-Hoffman, O; Touam, C; Miroux, F; Moysan, P; Oberlin, C; Benacerraf, R



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

PubMed Central

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.

Schaakxs, Dominique; Bahm, Jorg; Sellhaus, Bernd; Weis, Joachim



Monkey Median Nerve Repaired by Nerve Graft or Collagen Nerve Guide Tube  

Microsoft Academic Search

Nerve regeneration was followed in 15 median and 1 ulnar nerve of eight Macaca fascicularis monkeys by serial elec- trophysiological assessments over a period of three and a half years. Nerve gaps of 5 mm at the wrist were bridged by collagen-based nerve guides, nerve autografts, or direct suture repairs. Thenar muscle reinnervation occurred be- tween 50 and 70 d

S. J. Archibald; J. Shefner; C. Krarup; R. D. Madison



[Lesions of the peripheral nerves after surgical treatment of fractures of the distal humerus].  


In the work we have examined 44 patients (16 women and 28 men), which the break of distal humerus is saned with operation, using adequate OSM. The average years of women patients was 29 (from 3 to 79), and of male patients 24 (from 1 to 75). After thr operative sanitary breaks distal part of humerus, using adequate OSM (fillo Kurschneri, platho metalico, clavo spiralis), it can come on lesion of perifer nerves of the arm, and mostly of n. radialis. Lesions of n. radialis we have notice on 5 patients. The rehabilitation our patients was made with prevention contraction of shoulder, elbow, hand and fingers using kinesitherapy, hydrotherapy and electrotherapy paralysis musculature with intentional exercises to the reinervation of perifer motor neuron and raising the force of musculus. PMID:12822381

Avdi?, Dijana; Gavrankapetanovi?, Ismet; Gavrankapetanovi?, Faris



The initial period of peripheral nerve regeneration and the importance of the local environment for the conditioning lesion effect.  


The aim of this study was to investigate the early period of neurite outgrowth in the regenerating rat sciatic nerve and to determine if the non-neuronal cells were important for the conditioning lesion effect. Regeneration distance was evaluated with the pinch-reflex test 6 h to 5 days after a test crush lesion. The regeneration velocity accelerated during approximately 3 days, whereupon outgrowth continued with a constant velocity. In unconditioned nerves the initial delay was 2.8 h and the constant rate of regeneration was 3.2 mm/day. In nerves with a distal conditioning lesion the initial delay was 2.4 h and the rate of regeneration increased by 52%. When the test crush was applied at the same place as the conditioning crush the initial delay was 1.9 h and the rate of regeneration increased by 61%. The conditioning lesion effect was not influenced by the distance between the cell body and the conditioning crush lesion. Furthermore, the conditioning lesion effect could not be expressed if conditioned axons grew into a freeze injured nerve section. Incorporation of [3H]thymidine increased in the regenerating nerve segment. The increase occurred earlier if this segment had been subjected to a conditioning crush lesion. The results of these experiments showed that peripheral neurites start to regenerate within a few hours after an injury, suggesting that growth cone formation is independent of the cell body reaction. A conditioning crush lesion increases the regeneration velocity and its acceleration, and the conditioning lesion effect cannot be expressed in the absence of living Schwann and other non-neuronal cells. PMID:2282506

Sjöberg, J; Kanje, M



Compression neuropathy of the radial palmar thumb nerve.  


Compression neuropathy of a single digital nerve is a rare entity. We report the case of a patient with numbness in the distribution of the radial digital nerve of the thumb caused by the use of a walking stick. The nerve was compressed between the handle of the stick, the loop and the radial sesamoid bone of the first metacarpophalangeal joint. The site of the lesion was confirmed by electrophysiologic examination. Orthodromic recording of the sensory response from the radial palmar digital nerve of the thumb documented a complete absence of nerve action potential whereas the ulnar digital thumb nerve showed a normal response. Sensory function was restored when a padded ski glove was used to protect the area of the metacarpophalangeal joint whilst using the stick. PMID:15071968

Hug, U; Burg, D; Baldi, S V; Meyer, V E



[Post-gunshot wound lesions of the peripheral nerves which may be prevented with adequate primary surgical wound care].  


The retrospective study includes 24 wounded persons with iatrogenic peripheral nerve lesion and 94 wounded whose neural damage occurred due to peripheral nerve engagement in scar tissue after main artery reconstruction, missile bone fracture or after soft tissues defects covering by Tiersch transplants. The authors analyzed frequency and localization of these lesions, intraoperative findings, applied operative procedures and clinical findings during preoperative follow-up. It is recommended to create the new bad for exposed peripheral nerve from adjacent muscles as part of primary surgical wound treatment. This procedure eliminates the risk of subsequent epineural scar formation in all situations that have been described (soft tissue defects, artery reconstruction and bone fracture) and makes the later operations on peripheral nerves unnecessary. PMID:9229929

Roganovi?, Z; Anti?, B; Petkovi?, S; Tadi?, R; Savi?, M


Effects of distal nerve injuries on dorsal-horn neurons and glia: Relationships between lesion size and mechanical hyperalgesia  

Microsoft Academic Search

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

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



Axonal growth in mesothelial chambers: effects of a proximal preconditioning lesion and/or predegeneration of the distal nerve stump.  


Preformed, autologous mesothelial chambers were utilized to study axonal growth following selective predegeneration of the distal nerve stump and/or preconditioning of the proximal nerve stump. The left and/or right sciatic nerve of rats was exposed and transected in the thigh. Two weeks after transection, the left proximal nerve stump was cross-anastomosed with the right distal nerve stump by using a mesothelial chamber leaving a 15-mm gap between the two nerve stumps. Previous studies have shown that axonal overgrowth normally does not occur over this gap distance to the distal stump. Three months after cross-anastomosing, regeneration across the 15-mm gap was evaluated by muscle action potential recordings and light microscopical examination. In experiments in which a distal nerve stump was selectively degenerated and the proximal segment was freshly cut, axons had bridged the 15-mm gap in six of seven rats. When a proximal preconditioned nerve stump was matched with a freshly cut distal stump, axonal overgrowth occurred in only 4 of 10 experiments. In experiments including a proximal preconditioned nerve stump and a distal predegenerated stump, axons bridged the gap in 6 of 8 experiments. We concluded that a priming lesion, including manipulation with proximal and/or distal stump, enhances axonal growth in mesothelial chambers. PMID:3342848

Dahlin, L B; Danielsen, N; Ochi, M; Lundborg, G



The variable clinical manifestations of ulnar neuropathies at the elbow  

Microsoft Academic Search

In twenty-five cases of ulnar neuropathy at the elbow, the involvement of the fibres from three sensory and to four motor branches were examined clinically and, where possible, electrophysiologically. Of the sensory fibres, those from the terminal digital nerves were most commonly involved. The fibres to the hand muscles were much more frequently involved than those to the forearm muscles.

J D Stewart



Ulnar neuropathy associated with subdermal contraceptive implant.  


Side effects are a common occurrence in the use of subdermal contraceptive implants (Norplant); approximately 70% to 80% of women using the device report abnormal uterine bleeding, headaches, acne, mastalgia, nervousness, appetite changes, and weight gain. Local implant site reactions range from 0.4% to 4.7%, with pain being the most common. Other insertion site complications include infection and implant expulsion. Only three cases have been described in the literature concerning implant site-related neuropathy, involving the sensory branch of the musculocutaneous nerve (lateral cutaneous nerve) in two cases and the antebrachial cutaneous nerve in the third case. We believe our report is the first case of an axonal loosing motor and sensory ulnar neuropathy associated with the removal of a subdermal contraceptive implant (Norplant). We review insertion site complications and their most likely causes. Also, we discuss alternative removal techniques for difficult-to-remove implants. PMID:9743065

Marin, R; McMillian, D



Ulnar shortening osteotomy  

Microsoft Academic Search

Objective  Ulnar shortening to unload the ulnocarpal ligamentous complex.\\u000a \\u000a \\u000a \\u000a Indications  Clinically relevant ulnar impaction syndrome, be it congenital or posttraumatic.\\u000a \\u000a \\u000a \\u000a Contraindications  Concomitant pronounced malunion of the radius.\\u000a \\u000a Osteoarthritis of the distal radioulnar joint.\\u000a \\u000a \\u000a \\u000a \\u000a Surgical Technique  Ulnopalmar approach. Oblique osteotomy of the ulna in its distal third. Removal of a bony wafer of predetermined thickness.\\u000a Internal fixation with a 7-hole LD-DC plate or special plate

Reinhard Meier; Hermann Krimmer



Use of transcutaneous electrical nerve stimulation in a young child with pain from open perineal lesions.  


Transcutaneous electrical nerve stimulation (TENS) has been shown to be an effective treatment modality in adults experiencing pain associated with a variety of conditions. Therapeutic measures that are effective with adults can often be used with children. However, the benefit of TENS for children has not been well established since few research or clinical data have been published in the literature. This case report of a 4-year-old female with open perineal skin lesions who received TENS as an adjuvant therapy for painful dressing changes illustrates that TENS can be an effective treatment in children. In addition to the pain reduction seen in our patient, TENS therapy also had an opioid-sparing effect. PMID:10584462

Merkel, S I; Gutstein, H B; Malviya, S



Giant lesions in histoid leprosy--an unusual presentation.  


A forty-year-old man presented with multiple, asymptomatic, raised lesions of one-year duration. Well-defined, non-tender papules and nodules were seen on the normal looking skin. Few giant lesions were seen over the lower legs and feet. Diffuse infiltration of the face and ears was present. Bilateral ulnar, radial cutaneous, sural and right superficial peroneal nerves were thickened. Slit-skin smear from a nodule had a BI of 6+. Biopsy showed features of histoid leprosy. The lesions had developed de novo, without previous dapsone monotherapy. PMID:16119146

Kamath H, D; Sukumar, D; Shetty, N J; NandaKishore, B


Trypanosoma cruzi infection in rats induced early lesion of the heart noradrenergic nerve terminals by a complement-independent mechanism  

Microsoft Academic Search

Summary The acute phase of the experimental Chagas' disease in rats induces extensive lesion of the heart sympathetic nerve terminals. Because of evidence indicating the involvement of immune reactions in neuron destruction provoked by Chagas' disease, we tested the effects of depleting the complement system by cobra venom factor upon the sympathetic denervation. The serum hemolytic activity against sensitized sheep

C. R. S. Machado; D. A. de Oliveira; E. M. R. D. Carvalho; F. J. Ramalho-Pinto



[Late ulnar paralysis. Study of a series of 17 cases].  


Seventeen cases of late ulnar paralysis treated by neurolysis-transposition are reported. The clinical characteristics of these paralyses are emphasized: very prolonged symptom free interval, rapid onset and severe involvement. Ulnar transposition was most often done subcutaneously. Cubitus valgus and definite nerve compression proximal to the arcade of the flexor carpi ulnaris muscle are almost always present. The results as regards the neuropathy are undependable: no patient is completely cured and only half are improved. An anatomical study of the nerve path shows the essential role, in the compression of the nerve, of the muscular arcade of the flexor carpi ulnaris muscle which acts in a way similar to the bridge of a violin. Hence, opening it longitudinally is the principal step of neurolysis. This should be routine before the first signs of neuropathy occur in an elbow whose axis is out of alignment as a sequela of a childhood injury. PMID:6322339

Mansat, M; Bonnevialle, P; Fine, X; Guiraud, B; Testut, M F



Galectin-3 is upregulated in microglial cells in response to ischemic brain lesions, but not to facial nerve axotomy.  


We have recently demonstrated that the beta-galactoside-specific lectin galectin-3 is expressed by microglial cells in vitro, but not by normal resting microglia in vivo. In the present study, we have analyzed the expression of galectin-3 by microglia under traumatic conditions in vivo using two experimental rat models which substantially differ in the severity of lesion related to a breakdown of the blood-brain barrier (BBB) and the occurrence of inflammatory processes. These two features are absent after peripheral nerve lesion and present after cerebral ischemia. Here we show that, following facial nerve axotomy under conditions allowing (nerve anastomosis) or not subsequent regeneration (nerve resection), galectin-3 is not expressed by microglia in the corresponding facial nucleus 1-112 days after lesion. Galectin-3 is also absent in microglia at sites of a defective BBB in the normal brain, such as the circumventricular organs. Following experimental ischemia (i.e., permanent occlusion of the middle cerebral artery), in contrast, galectin-3 becomes strongly expressed by activated microglia as early as 48 hours after trauma, as determined by immunohistochemistry and Western blot analysis. Our findings suggest that the expression of galectin-3 by microglia in vivo correlates with the state of microglial activation. PMID:10931529

Walther, M; Kuklinski, S; Pesheva, P; Guntinas-Lichius, O; Angelov, D N; Neiss, W F; Asou, H; Probstmeier, R



Effects of peripheral nerve lesions during pregnancy on parturition in rats  

Microsoft Academic Search

Bilateral section of either the sensory or motor branch of the pelvic nerve or pudendal nerve was performed in rats on days 8–10 of pregnancy, and the effects on delivery were observed. Bilateral resection of the sensory branch of the pelvic nerve reduced the number of live pups per litter, and increased the number of stillbirths and the number of

Hubert W. Burden; Gary T. Price; Randall H. Renegar; Charles A. Hodson



Case of fibrolipomatous hamartoma of the digital nerve without macrodactyly.  


Fibrolipomatous hamartoma of nerves without macrodactyly is a rare lesion characterized by fibrofatty proliferation causing epineural and perineural fibrosis with fatty infiltration around the nerve bundles. We report an unusual case of fibromatous hamartoma of the ulnar digital nerve of the thumb in a 43-year-old woman. Magnetic resonance imaging revealed a large fusiform mass along the nerve. The findings were unusual and pathognomonic and included a coaxial cable-like appearance on axial sections and a spaghettilike appearance on coronal sections on both T1- and T2-weighted images; these findings were useful for the diagnosis and preoperative evaluation of this lesion. Surgical exploration revealed a yellow, cordlike mass of the digital nerve enlarged by fat. Gross excision could not be done without extensive damage to the nerve. Therefore, a limited excision with biopsy of the fibrolipomatous tissue around the nerve bundles was performed. The histological appearance was consistent with fibrolipomatous hamartoma. There was no recurrence of the mass and no neurological deficit 3 years after surgery. Some authors have suggested that invasive excision can cause catastrophic sensory or motor deficits because of the extensive fatty infiltration of the nerve fascicles. In conclusion, the recommended treatment for this lesion is limited excision with only biopsy to confirm the diagnosis. PMID:22197873

Nanno, Mitsuhiko; Sawaizumi, Takuya; Takai, Shinro



Ulnar Neuropathy as a Complication of Retinal Detachment Surgery and FaceDown Positioning  

Microsoft Academic Search

Purpose: To report a case of bilateral ulnar neuropathy as an extraocular complication following retinal detachment surgery and face-down positioning. Methods: Case report. Results: Bilateral hypoesthesia and numbness of the 4th and 5th finger started 2 weeks after vitrectomy for retinal detachment and face-down positioning. Due to progressive symptoms 6 months later, unilateral ulnar nerve decompression at the elbow was

Dimitrios Brouzas; Nikolaos Gourgounis; Stavroula Davou; Eleni Loukianou; Ilias Georgalas; Chryssanthi Koursandrea



Operative Treatment of Ulnar Collateral Ligament Injuries of the Elbow in Athletes  

Microsoft Academic Search

Over a 6-year period, the senior author (JRA) performed 91 ulnar collateral ligament reconstructions (N 78) or repairs (N 13). All patients were male and between the ages of 15 and 39 years (average, 21.6). Thirty-seven patients (41%) were professional baseball players, 41 (45%) were collegiate baseball players, and 7 (7.7%) were high school or recreational players. Subcutaneous ulnar nerve

Frederick M. Azar; James R. Andrews; Kevin E. Wilk; David Groh



Hand dominance effect on median and ulnar sensory evoked amplitude and latency in asymptomatic workers  

Microsoft Academic Search

Objective: To examine the relative effect of hand dominance on the median and ulnar sensory evoked responses and grip strength in active workers.Design: A cross-sectional or survey design.Setting: Workers from 4 different sites underwent on-site testing of the median and ulnar sensory nerves in both hands (antidromic stimulation, 14cm), and testing of bilateral grip strength.Patients: 224 workers, asymptomatic of hand,

Robert A. Werner; Alfred Franzblau



Disappearance of frontal N30 component of median nerve stimulated SSEPs in two young children with abnormal striatal lesions  

Microsoft Academic Search

Median nerve stimulated short-latency somatosensory evoked potentials (MN-SSEPs) were performed in two young children with extrapyramidal symptoms. Brain MRI showed bilaterally symmetric striatal lesions in both cases. The subcortical components (N9, N11, N13, N18, P11, and P13) and the parietal component (N20) were normally detected, whereas the frontal component (N30) was not detected bilaterally in either case. In conclusion, our

Yosuke Kato; Chisako Fukuda; Yoshihiro Maegaki; Takehiko Inoue; Rika Hiraiwa; Hisayuki Hiraiwa; Kousaku Ohno; Yutaka Tomita



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


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

Watanabe, Atsuya; Souza, Felipe; Vezeridis, Peter S; Blazar, Philip; Yoshioka, Hiroshi



Increased sodium channel immunofluorescence at myelinated and demyelinated sites following an inflammatory and partial axotomy lesion of the rat infraorbital nerve  

Microsoft Academic Search

The localization of sodium channels (NaChs) change following nerve lesions and this change may contribute to the development of increased pain states. Here we examine the change in distribution of NaChs within the rat infraorbital nerve (ION) two weeks after a combined inflammatory\\/partial axotomy lesion that results in behavior showing increased sensitivity to mechanical stimuli. Sections from experimental and normal

Michael A. Henry; Angelique R. Freking; Lonnie R. Johnson; S. Rock Levinson



Experience of using the bioresorbable copolyester poly(DL-lactide-?-caprolactone) nerve conduit guide Neurolac™ for nerve repair in peripheral nerve defects: report on a series of 28 lesions.  


Synthetic nerve guides are occasionally used to repair nerve defects. The aim of the present work was to analyse the results of Neurolac™ use in a series of 23 patients. We operated on 28 nerve lesions located on various sites: arm (n = 1), elbow (n = 5), forearm (n = 4), wrist (n = 2), palm (n = 5), fingers (n = 11). Defects averaged 11.03 mm and were repaired using Neurolac™. After an average of 21.9 months' follow up (3-45 months), subjective criteria (pain, cold intolerance, Quick DASH) and objective criteria (strength, Weber and Semmes-Weinstein sensitivity tests) were compared with the contralateral side. Average pain score was 2.17/10. Cold intolerance was reported in fifteen cases. Quick DASH averaged 35.37/100. Grip strength averaged 64.62% of the contralateral side. As regards sensitivity, the difference between the two sides was 18.89 on Weber's test, and 46.92 on Semmes-Weinstein. Defect size did not affect the outcomes. We observed eight complications the most serious being two fistulizations of the Neurolac™ device close to a joint and one neuroma. Neurolac™ presents some advantages (resorption, semi-permeability, emergency use, tenseless repair) like other synthetic guides used for nerve regeneration and its transparency constitutes an added benefit. However, some difficulty in its handling and its expensiveness represent real disadvantages. Our results are not in favour of its use in repairing hand nerve defects. PMID:21987277

Chiriac, S; Facca, S; Diaconu, M; Gouzou, S; Liverneaux, P



Effects of distal nerve injuries on dorsal-horn neurons and glia: relationships between lesion size and mechanical hyperalgesia.  


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. L(5) 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

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



Clinical study of dorsal ulnar artery flap in hand reconstruction  

PubMed Central

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.

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



Digital sucking induced trophic ulcers caused by nerve deficit from amniotic constriction band.  


Two infants presented with amniotic constriction bands (ACB) in the distal third of the forearm. After teeth eruption they developed recurrent skin ulcerations mainly in the distribution of the median nerve from digital sucking. Both patients underwent reconstruction with multiple Z-plasties, followed by neurolysis of the ulnar nerve and sural nerve grafting of the median nerve. This neurological complication presented late in ACB as ulcerative lesions and secondary infection from digital sucking on the insensate digits. Thorough physical examination of the extremities at an early stage in children with ACB is essential to exclude an occult neurological dysfunction. Exploration of peripheral nerves is warranted in cases of deep forearm ACB during their soft tissue reconstruction. PMID:20347623

Beidas, Omar; Rayan, Ghazi M; Al-Harthy, A



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

Microsoft Academic Search

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

Alexandra Borges; Jan Casselman



Gradual and reversible central vestibular reorganization in frog after selective labyrinthine nerve branch lesions  

Microsoft Academic Search

.   Postlesional reorganization of vestibular afferent and commissural inputs onto second-order vestibular neurons was studied\\u000a in the isolated brain after unilateral section of the N.VIII, of the ramus anterior (RA) of N.VIII, of the utricular (UT)\\u000a or of the anterior vertical and horizontal canal nerves in combination. RA nerve section eliminated the inputs from utricular,\\u000a anterior vertical and horizontal canal

Fumiyuki Goto; Hans Straka; Norbert Dieringer



[Microsurgical reconstructive-rehabilitative operations in traumatic lesions of the peripheral nerves].  


Microsurgical reconstructive-restorative operations were conducted on the peripheral nerves of the limbs in 381 patients at the Kazakh centre of microsurgery from 1983. The patients were divided into 3 groups: group 1-60 patients who underwent emergency neurography during replantation of limbs and their segments; group 2-186 patients in whom neurovascular bundles of the limbs were restored (320 nerves were restored) in the late period after the trauma; group 3-135 patients who were subjected to operative interventions on the brachial plexus and the adjacent vessels. In sequelae of injury to the neurovascular bundles of the limbs and the trunks of the brachial plexus one-stage operations must be carried out on the peripheral nerves and the accompanying vessels. The result of the operation is determined by the lapse of time from the moment of the injury, the type of reconstruction, and the length of the graft used. PMID:2629431

Aliev, M A; Akhmetov, K K; Chentsov, V I; Gorgots, O V


Pulsed Radiofrequency Lesioning of the Axillary and Suprascapular Nerve in Calcific Tendinitis  

PubMed Central

The patient was a 45-year-female who presented with pain at right shoulder and right upper arm. The patient suffered from right shoulder and arm pain for 3 years and had pain management which was performed using medication and conservative management after she had been diagnosed with calcific tendinitis. However, substantial pain relief was not consistently achieved, and recurrence of pain was reported. Therefore, we performed right axillary nerve and suprascapular nerve block through pulsed radiofrequency. Two months after the procedure, the shoulder pain gradually subsided with the size reduction of the calcified nodule and she needed no more pain management.

Kim, Jun Sik; Choi, Eun Joo; Lee, Pyung Bok; Lee, Guen Young



Asymptomatic spinal cord lesions in clinically isolated optic nerve, brain stem, and spinal cord syndromes suggestive of demyelination  

PubMed Central

OBJECTIVES—Conventional T2 weighted MRI studies have highlighted the fact that the presence of clinically silent brain lesions increases the risk of developing clinically definite multiple sclerosis after an isolated syndrome of the optic nerve, brain stem, or spinal cord. The objectives of the present study are: (1) to show whether or not these patients also have asymptomatic abnormalities of the spinal cord, and (2) to recruit a new cohort of such patients using high resolution MRI of both brain and spinal cord.?METHODS—The brain was imaged in the axial plane with 3 mm thick contiguous slices using a proton density and T2 weighted fast spin echo (FSE) sequence; a T1 weighted sequence after the injection of gadolinium-DTPA; and a fast fluid attenuated inversion recovery (fFLAIR) sequence. The spinal cord was imaged in the sagittal plane with 3 mm thick slices using a T2 weighted FSE and a T1 weighted gadolinium enhanced sequence.?RESULTS—Thirty three patients, mean age 31 (16-46) were recruited. There were 14 men and 19 women. Brain MRI was abnormal in 22 (67%); no patient was seen with abnormalities on only one or other sequence. Six patients (18%) displayed one or more gadolinium enhancing lesions on brain MRI. In the spinal cord, nine (27%) patients displayed one or more clinically silent lesions on FSE. Two patients showed one and two gadolinium enhancing lesions in the spinal cord respectively.?CONCLUSION—This high incidence of spinal cord lesions emphasises that asymptomatic demyelinating lesions may also involve clinically eloquent pathways. Follow up studies are required to determine their prognostic importance.??

O'Riordan, J; Losseff, N; Phatouros, C; Thompson, A; Moseley, I; MacManus, D; McDonald, W; Miller, D



[Distal radio-ulnar prosthesis].  


Many procedures have been proposed for the treatment of traumatic painful instabilities of the Distal Radio-Ulnar Joint (DRUJ). Moore-Darrach, Milch, Baldwin, Bowers, Kapandji-Sauvé. Except for the Milch procedure, the risk of painful instability of the ulnar stump is real, but not very frequent if the technique is correctly applied. When this complication occurs, the best way to ensure the ulnar stump stabilization is mechanical, by mean of a DRUJ Prosthesis which we were the first to imagine and build. Used in two cases, with or without remnant ulnar head, these two types of prosthesis seem to have been favourable. Obviously, it is too early to know the final value of this prosthesis, based only on two cases, but it seemed important to make it known as an additional possibility in the treatment of the DRUJ problems. These two types of prosthesis are conceived on original principles: cementless fixation but with screws and nuts giving immediate and definitive stability and allowing a fast rehabilitation. The articular pieces are composite, metal on H.D. Polythylene. The articular surface is spherical permitting all the mobilities of this complex joint. The two articular surfaces are supported by two pieces: the proximal part, holding a hollow hemisphere, inserted in the ulna and the same for the two types of prosthesis, and a distal part, holding the sphere; this part is different according to the type of the prosthesis. We are well aware that in time and with clinical experience, some of its secondary characteristics will evolve, mainly its fixation system. At the present time this prosthesis is indicated in two "second look" situations: painful ulnar stump instability after a Kapandji-Sauvé procedure, and after a Moore-Darrach procedure. Perhaps it will be used in unstable stumps after a Bowers procedure? It is possible that this prosthesis will be used primarlly in the future when its reliability has been definitively established. We are working towards this objective. PMID:1280973

Kapandji, A I



Outcome analysis of ulnar shortening osteotomy for ulnar impaction syndrome  

PubMed Central

BACKGROUND: Ulnar-sided wrist pain is a common problem in the upper extremity. It affects a broad patient population and can be difficult to treat. Ulnar impaction syndrome (UIS) is major cause of ulnar-sided wrist pain and a number of different operations have been used to correct it, including ulnar shortening osteotomy (USO). OBJECTIVE: To retrospectively review functional outcomes and complication rates of USO for UIS at the Hand and Upper Limb Centre (London, Ontario) over a two-year period. METHODS: Twenty-eight patients who underwent USO between 2007 and 2009 participated in the present study. Ulnar variance pre- and post-surgery was assessed using standard radiographic examination. Patient-rated outcomes were measured using a visual analogue scale (VAS) for pain and the Disabilities of the Arm, Shoulder and Hand (DASH) survey for functional outcomes. Objective grip strength and range of motion were compared with the contralateral extremity. RESULTS: On average, USO achieved a 3.11 mm reduction in ulnar variance. Nonunion occurred in five patients and required a secondary bone grafting procedure. All USO eventually healed. Overall, pain improved by 47.2% and the mean DASH score after surgery was 37.21. Flexion, extension and supination range of motion decreased by 10° compared with the unaffected side. Eleven patients (39%) elected to undergo a second surgery for hardware removal. Patients receiving compensation from the Workplace Safety and Insurance Board experienced significantly higher residual pain (VSA 5.24 versus 1.97) and disability levels (DASH 60.23 versus 25.70). Smokers also experienced worse outcomes in terms of pain (VSA 4.43 versus 2.36) and disability (DASH 51.06 versus 29.67). In this cohort, smoking was not associated with a higher rate of nonunion. CONCLUSION: USO is effective in reducing pain in UIS and improves disability, at the price of a small decrease in range of motion. Smokers and people receiving compensation from the Workplace Safety and Insurance Board, however, have significantly worse subjective outcomes (VAS and DASH), but similar objective outcomes (range of motion).

Fulton, Courtney; Grewal, Ruby; Faber, Kenneth J; Roth, James; Gan, Bing Siang



The Lefevre ulnar nail.  


The Lefevre nail applies the principles of locked intramedullary nailing in the treatment of fractures of the ulna. It is made up of two segments which slide telescopically, so that assembly may be in compression, distraction or neutral. Fixation at the two ends of the ulna is guaranteed by two transverse screws. It may be used in pseudarthrosis and osteotomies for lengthening and shortening, as well as in simple or complex fractures. The cases presented provide an overview of the use of the nail at the Brest Center, where the nail was invented and developed, and at the Rizzoli Institute. The study includes 22 fractures, 1 pseudarthrosis and 1 osteotomy. Consolidation was obtained in all of the cases after an average of 2.5 months. Immobilization in plaster was required only in cases with associated lesion of radius. The functional results obtained were satisfactory. PMID:1756675

Boriani, S; Lefevre, C; Malingue, E; Bettelli, G


Ulnar-sided wrist pain in athletes.  


A previously unpublished report of seven professional athletes who were treated for ulnar-sided wrist pain is presented in this article. This report is followed by an introduction to the anatomy, examination, and imaging of the ulnar side of the wrist. Specific sources of ulnar-sided wrist pain, including triangulofibrocartilage complex tears, lunotriquetral instability, distal radioulnar joint pathology, extensor carpi ulnaris subluxation, calcific flexor carpi ulnaris tendinitis, and pisotriquetral arthritis are presented. PMID:9700420

Buterbaugh, G A; Brown, T R; Horn, P C



The pharmacological effects of acute and chronic clenbuterol treatments after lesions of central noradrenergic nerve terminals.  


Acute administration of clenbuterol, a lipophilic beta-adrenergic agonist, decreases motor activity and antagonizes the reserpine-induced hypothermia in mice. After chronic administration of clenbuterol, the acute effect on motor activity disappears (tachyphylaxis) and the acute effect on reserpine hypothermia is potentiated (facilitation). These effects of clenbuterol (either acute or chronic + acute treatments) are not abolished after specific lesions of the noradrenergic system by the neurotoxin DSP-4 which reduces the cerebral levels of norepinephrine to 30% of controls. Although it cannot be excluded that a 70% lesion may be insufficient, another explanation is that beta-adrenergic receptors involved in hypomotility and in reserpine-induced hypothermia may not be located on noradrenergic neurons or may be different from the post-synaptic beta-adrenergic receptors which become hypersensitive after DSP-4 denervation. PMID:3560967

Francès, H; Struck, I; Simon, P; Raisman, R


[Arthroscopic treatment of the ulnar impaction syndrome].  


The ulnar impaction syndrome is due to hyperpressure in the ulnocarpal joint. It occurs most frequently following distal radial fractures with shortening, but can also be secondary to a primitive length discrepancy between a short radius and a long ulna (positive ulnar variance). Symptoms and clinical findings, even though characteristic, are not specific. Standard X rays show a positive ulnar variance, and sometimes a hyperpressure cyst in the lunate. CT arthroscan and MRI studies demonstrate indirect signs of hyperpressure. If medical treatment fails to improve the condition, the choice surgical technique is arthroscopic, allowing debridement of the TFCC central tear, and shortening of the horizontal aspect of the ulnar head. PMID:17361891

Leclercq, C



[Arthroscopic treatment of the ulnar impaction syndrome.  


The ulnar impaction syndrome is due to hyperpressure in the ulnocarpal joint. It occurs most frequently following distal radial fractures with shortening, but can also be secondary to a primitive length discrepancy between a short radius and a long ulna (positive ulnar variance). Symptoms and clinical findings, even though characteristic, are not specific. Standard X rays show a positive ulnar variance, and sometimes a hyperpressure cyst in the lunate. CT arthroscan and MRI studies demonstrate indirect signs of hyperpressure. If medical treatment fails to improve the condition, the choice surgical technique is arthroscopic, allowing debridement of the TFCC central tear, and shortening of the horizontal aspect of the ulnar head. PMID:17349396

Leclercq, C



[TFCC (Triangular Fibrocartilage Complex) lesions. Diagnosis and therapy].  


Lesions of the TFCC may have degenerative or post-traumatic causes. Distal radioulnar joint as well as the ulnocarpal joint can be affected. Patients present with ulnar-sided wrist pain especially in forearm rotation. Therapy depends on the degree of lesions and additional pathology. Wrist arthroscopy offers a certain diagnostic tool. In addition, adequate therapy can be realized. After failed arthroscopic therapy, ulnar shortening osteotomy reduces ulnar load significantly. PMID:10550439

Beyermann, K; Krimmer, H; Lanz, U



Methylmercury poisoning in common marmosets--MRI findings and peripheral nerve lesions.  


Common marmosets were used as model animals for methylmercury (MeHg) poisoning. Six marmosets were given MeHg of 5 ppm Hg in drinking water. The animals were divided into 3 groups of 2 each. The first group was examined for acute symptomatic MeHg poisoning. They were given MeHg for 70 and 90 days, respectively, to manifest severe symptoms. The second group was sacrificed after 38 days of MeHg exposure, when they had acute-subclinical MeHg poisoning. The third group of animals was exposed for 21 days, and then observed for 2.5 years without MeHg exposure. One of them showed typical symptoms of MeHg poisoning after MeHg exposure had ended, but the other one showed only slight symptoms without ataxia. This experiment demonstrated that MeHg causes pathological changes in neural tissues including the peripheral nerves in common marmosets. Furthermore, common marmosets were found to show MeHg-induced pathological changes similar to those in humans in the cerebrum and cerebellum. PMID:12512874

Eto, Komyo; Yasutake, Akira; Korogi, Yukunori; Akima, Michio; Shimozeki, Toshie; Tokunaga, Hidehiro; Kuwana, Takashi; Kaneko, Yosuke


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

SciTech Connect

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.

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))



Imaging of ulnar-sided wrist pain.  


Pain on the ulnar side of the wrist is a complex diagnostic dilemma. This is mainly due to the small size and complexity of the anatomical structures. The issue is compounded by the occurrence of positive imaging findings that are clinically asymptomatic. This pictorial essay deals with the imaging manifestations of different causes of ulnar-sided wrist pain. PMID:20864307

Porteous, Rory; Harish, Srinivasan; Parasu, Naveen



Know your anatomy. Local anesthesia for cutaneous lesions of the head and neck--practical applications of peripheral nerve blocks.  


Peripheral nerve blocks can be used routinely in an outpatient setting. The innervation of the face and the technique we use to perform nerve blocks are reviewed. We present four cases of skin cancer and one of rhinophyma in which nerve blocks were used to minimize the discomfort associated with local anesthesia. PMID:1541758

Randle, H W; Salassa, J R; Roenigk, R K



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

NASA Astrophysics Data System (ADS)

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.

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



Percutaneous radiofrequency lesioning of the suprascapular nerve for the management of chronic shoulder pain: a case series  

PubMed Central

Purpose The objective of this study was to retrospectively evaluate the analgesic effects of continuous radiofrequency lesioning of the suprascapular nerve (SSN) for chronic shoulder pain. The authors sought to obtain insight into the time-sensitive analgesic success and complications of this therapy. Patients and methods This study was a retrospective case series involving patients with unremitting shoulder pain that had lasted for at least 12 months. Patients were selected if they showed a reduction of at least 50% in pain intensity during the anesthetic phase after SSN block, no additional motor weakness of the shoulder, and pain relief lasting for less than 2 months after separate treatments of the SSN with depot corticosteroids and pulsed radiofrequency. Nine patients were referred to the Arnold Pain Management Center. Of these nine patients, six patients who had significant chronic shoulder pain unresponsive to oral medications and intra-articular injections and who were not considered surgical candidates were selected. These patients were treated with a single radiofrequency lesion of the SSN at 80°C for 60 seconds. The primary outcome was a reduction in pain intensity by 50%, as determined by the numeric rating scale, and duration of this effect. The secondary outcome was improvement in either the passive or the active range of motion (ROM). Patients were also monitored for adverse effects such as weakness or increased pain. Results The pooled mean numeric rating scale score before the procedure was 7.2 ± 1.2; this fell to 3.0 ± 0.9 at 5–7 weeks post procedure. The duration of pain relief ranged from 3 to 18 months, and all patients underwent at least one additional treatment. The change in baseline ROM improved from an average of 60° ± 28° (flexion) and 58° ± 28° (abduction) to 99° ± 46° (flexion) and 107° ± 39° (abduction). No adverse side effects were observed. Conclusion Continuous radiofrequency lesioning of the SSN seems to be an effective treatment for chronic shoulder pain. There can be improved ROM of the shoulder following this treatment. More formal, controlled studies are required to confirm these observations.

Simopoulos, Thomas T; Nagda, Jyotsna; Aner, Musa M



The pathogenesis of ulnar polydactyly in humans.  


The pathogenesis of ulnar polydactyly in humans is not known. There are numerous syndromes that are associated with ulnar polydactyly. We have noted that the genetic defects in these syndromes lead to a disturbance of the normal balance between the two forms of the Gli3 protein (the active and repressor forms of Gli3, which are known as Gli3-A and Gli3-R, respectively), leading to a relative increase in the Gli3-R protein. We offer the hypothesis of a unified pathogenesis of ulnar polydactyly through the relative predominance of Gli3-R. PMID:23435486

Al-Qattan, M M; Al-Motairi, M I



Poland anomaly with contralateral ulnar ray defect  

Microsoft Academic Search

We report an atypical case of the Poland anomaly. Unreported features are that the hand abnormality is on the contralateral side to the chest wall defect, there is an ulnar ray predominance, and lack of syndactyly.

C V Powell; R C Coombs; T J David



Heat-sensitive conduction block in ulnar neuropathy at the elbow  

Microsoft Academic Search

Objectives: To study the effects of elbow heating on conduction block (CB) and across-elbow conduction velocity (CV) in patients with ulnar neuropathy at the elbow (UNE).Methods: We studied 15 patients with UNE, performing motor nerve conduction studies at 32°C and after heating the elbow to 42°C.Results: At 32°C, mean response amplitude and area with above-elbow (AE) stimulation were 20.4 and

Seward B Rutkove; Margot A Geffroy; Seth H Lichtenstein



The athlete's wrist: ulnar-sided pain.  


Ulnar-sided wrist pain is one of the most common symptoms in athletes of baseball, racket sports, golf, and wrestling where there is frequent use of the hands as well as in soccer and running, where hand use is minimal. Compared with all wrist injuries, ulnar-sided wrist injury is a relatively serious condition for athletes because it plays an important role in performing a strong grip and in the rotation of the forearm. Ulnar-sided wrist pain in athletes can be related to acute trauma or chronic overuse. Acute trauma can lead to bone fractures and sprains/tears of ligaments. Repetitive mechanical stresses to tendons, ligaments, and the joint structures can lead to tendinitis or osteoarthrosis. Diagnosis of the ulnar-sided wrist pain is challenging both for hand surgeons and radiologists because of the small and complex anatomy. In the present article, we discuss mechanisms of wrist injury, sports-specific ulnar-sided wrist injuries, and the differential diagnosis of ulnar-sided wrist pain. PMID:23047280

Yamabe, Eiko; Nakamura, Toshiyasu; Pham, Peter; Yoshioka, Hiroshi



Effect of recombinant human nerve growth factor on presynaptic cholinergic function in rat hippocampal slices following partial septohippocampal lesions: measures of [3H]acetylcholine synthesis, [3H]acetylcholine release and choline acetyltransferase activity.  


To determine whether intraventricular administration of nerve growth factor alters presynaptic cholinergic function in the intact hippocampus or following partial lesions of the fimbria, we investigated the effects of recombinant human nerve growth factor treatment on [3H]acetylcholine synthesis and release by hippocampal slices following various treatment regimens. For chronic nerve growth factor treatment, 1 microgram of recombinant human nerve growth factor was injected intraventricularly every second day. Lesions reduced [3H]acetylcholine synthesis (by 48%) and spontaneous and evoked [3H]acetylcholine release by 35 and 61%, respectively. Chronic nerve growth factor treatment over three weeks elevated [3H]acetylcholine synthesis (by 39%) and spontaneous and evoked [3H]acetylcholine release by 27 and 64%, respectively, over values in lesioned hippocampi of animals treated with a control protein (cytochrome c). The nerve growth factor-induced enhancement of presynaptic cholinergic function persisted for three weeks following the termination of nerve growth factor administration. Furthermore, chronic (nine-week) treatment with nerve growth factor increased [3H]acetylcholine by 118% over values in lesioned hippocampi of animals treated with cytochrome c. These findings indicate that chronic treatment with recombinant human nerve growth factor increases the capacity of hippocampal cholinergic neurons surviving a partial fimbrial transection to synthesize, store and release acetylcholine. Application of recombinant human nerve growth factor during the initial weeks after lesioning was necessary to product significant elevations in acetylcholine synthesis, since chronic recombinant human nerve growth factor treatment after delays of three or more weeks were ineffective. Furthermore, chronic nerve growth factor treatment failed to stimulate acetylcholine synthesis and release in intact hippocampal cholinergic systems. Single intraventricular injections of recombinant human nerve growth factor at the time of lesioning resulted in a small decrease in acetylcholine synthesis which, however, was not accompanied by a change in the rate of evoked acetylcholine release from cholinergic neurons surviving the lesion. The study indicates that chronic or repeated administration of nerve growth factor during the onset of degenerative events is necessary for the stimulation of presynaptic cholinergic function in the hippocampus of adult rats with partial fimbrial transections. PMID:1956513

Lapchak, P A; Hefti, F



Sensory electroneurographic parameters and clinical recovery of sensibility in sutured human nerves  

Microsoft Academic Search

A total of 37 patients with traumatic transection of median or ulnar nerves at the wrist (total 41 nerves) were examined clinically and electrophysiologically 4–59 months after primary or secondary suture or grafting. There was a significant increase of cumulative amplitude with the time after suture, whereas maximum sensory nerve conduction velocity and maximum amplitude of nerve action potentials did

W. Tackmann; J. Brennwald; H. Nigst



Non-invasive stimulation of the vibrissal pad improves recovery of whisking function after simultaneous lesion of the facial and infraorbital nerves in rats.  


We have recently shown that manual stimulation of target muscles promotes functional recovery after transection and surgical repair to pure motor nerves (facial: whisking and blink reflex; hypoglossal: tongue position). However, following facial nerve repair, manual stimulation is detrimental if sensory afferent input is eliminated by, e.g., infraorbital nerve extirpation. To further understand the interplay between sensory input and motor recovery, we performed simultaneous cut-and-suture lesions on both the facial and the infraorbital nerves and examined whether stimulation of the sensory afferents from the vibrissae by a forced use would improve motor recovery. The efficacy of 3 treatment paradigms was assessed: removal of the contralateral vibrissae to ensure a maximal use of the ipsilateral ones (vibrissal stimulation; Group 2), manual stimulation of the ipsilateral vibrissal muscles (Group 3), and vibrissal stimulation followed by manual stimulation (Group 4). Data were compared to controls which underwent surgery but did not receive any treatment (Group 1). Four months after surgery, all three treatments significantly improved the amplitude of vibrissal whisking to 30° versus 11° in the controls of Group 1. The three treatments also reduced the degree of polyneuronal innervation of target muscle fibers to 37% versus 58% in Group 1. These findings indicate that forced vibrissal use and manual stimulation, either alone or sequentially, reduce target muscle polyinnervation and improve recovery of whisking function when both the sensory and the motor components of the trigemino-facial system regenerate. PMID:21526334

Bendella, H; Pavlov, S P; Grosheva, M; Irintchev, A; Angelova, S K; Merkel, D; Sinis, N; Kaidoglou, K; Skouras, E; Dunlop, S A; Angelov, Doychin N



Color Doppler Imaging of an Ulnar Artery Perforator Forearm Flap for Resurfacing Finger Defects.  


BACKGROUND: Fingertip defect reconstruction with various free perforator flaps has been widely reported. We recommend a technique of using color Doppler imaging to locate ulnar artery perforator. And we used a free mesioforearm flap based on ulnar artery perforator for the reconstruction of fingertip defect. PATIENTS AND METHODS: Since 2010, 7 fingertip defect cases have been repaired at our hospital using free mesioforearm flaps, based on the ulnar artery perforator. The free flap was designed according to Doppler detection. The flap contained perforator vessels and cutaneous nerves. The donor site was directly sutured or skin grafted. RESULTS: All 7 flaps survived with good quality and esthetic contours and grasp function of the hand was satisfactory. They were evaluated by 2-point discrimination, with 5 cases with neurorrhaphy of 6 to 8 mm and 2 cases without neurorrhaphy of 10 to 12 mm. CONCLUSIONS: Ultrasound is a suitable method for preoperatively locating the vascular pedicle. The free mesioforearm flap based on ulnar artery perforator is a good option to repair fingertip defect. PMID:23657043

Shen, Xiang-Qian; Shen, Hui; Xu, Ji-Hua; Wu, Shou-Cheng; Chen, Qiang; Chen, Bo



Imaging of ulnar-sided wrist pain.  


Ulnar-sided wrist pain has long been a diagnostic problem, partly because of the complex anatomy and many possible causes of pain in this region. This article discusses anatomy, pathophysiology, and imaging appearance of the more common causes, including tears of the triangular fibrocartilage complex, disorders of the distal radioulnar joint, tears of the lunotriquetral ligament, disorders of the extensor carpi ulnaris tendon, disorders of the pisotriquetral joint, the impingement and impaction syndromes, and ulnar wrist masses. Along with clinical history and physical examination, imaging is important in evaluation of ulnar-sided wrist pain. Conventional radiographs, conventional arthrography, CT, MRI, and MR arthrography are useful modalities that are often used in concert to help guide diagnosis and treatment. PMID:16798140

Coggins, Claire A



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


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

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



Arthroscopic excision of ulnar styloid in stylocarpal impaction.  


Stylocarpal impaction is an uncommon cause of ulnar-sided wrist pain in which the long ulnar styloid affects the triquetrum. Previous authors have described an open excision of the ulnar styloid. We present a new technique for arthroscopic identification and subsequent excision of the ulnar styloid. The diagnosis was suspected on plain radiographs and was confirmed by dynamic fluoroscopy. Four patients with ulnar styloid impaction were successfully managed. A diagnostic arthroscopy was performed. With the arthroscope in the 4-5 portal, a 3.5-mm burr was introduced into the 6 U portal. By palpation, the burr was placed onto the tip of the ulnar styloid and confirmed with fluoroscopy. Sufficient ulnar styloid was removed to prevent impingement; this was confirmed on fluoroscopy. We undertook resection of the ulnar styloid to 3 mm (normal, 3 to 6 mm). Adjacent soft tissue structures were not violated. Arthroscopic ulnar styloid identification and excision is a relatively simple procedure. Disruption of the triangular fibrocartilage, dorsal ulnar capsular ligament, and volar ulnar carpal ligament is avoided. Fluoroscopy is valuable in providing preoperative and intraoperative identification of the ulnar styloid and impingement. Postoperatively, patients can recommence activities of daily living as comfort allows. PMID:16762709

Bain, Gregory I; Bidwell, Terri A



A Review of Distal Ulnar Hemi-Resection Arthroplasty  

Microsoft Academic Search

15 patients with pain and disability on the ulnar side of the wrist were treated by distal ulnar hemiresection arthroplasty. The patients’ diagnoses fell into three groups, namely ulnocarpal impingement, primary osteoarthritis of the distal radio-ulnar joint and traumatic disruption of the distal radioulnar joint. Patients were assessed pre- and post-operatively on the basis of pain and forearm rotation. Grip




Bilateral ptosis with pupil sparing because of a discrete midbrain lesion: magnetic resonance imaging evidence of topographic arrangement within the oculomotor nerve.  


The topographic arrangement within the midbrain oculomotor nerve is not adequately elucidated in humans. Two patients with a partial oculomotor palsy because of a localized infarction or hematoma were treated. Both patients had bilateral ptosis, impaired adduction, and supraduction. One patient had impaired infraduction and pupillary involvement on one side. Results of computed tomography and magnetic resonance imaging revealed discrete lesions at the dorsal midbrain tegmentum that spared the rostral midbrain. The authors' cases elucidate that pupillary components take the most rostral course. This report provides indirect magnetic resonance imaging evidence to prove the course of pupillary fibers. Based on the different neuro-ophthalmologic findings in the authors' cases (sparing or affecting pupillary component and infraduction), the nerves of the inferior rectus and inferior oblique for infraduction pass more rostrally than those of medial rectus, superior rectus, and levator palpebrae. The nuclear and fascicular arrangement within the midbrain oculomotor nerve is speculated to be pupillary, extraocular, and eyelid elevation in the rostro-caudal order, based on the neuro-ophthalmologic impairment and magnetic resonance imaging findings in the authors' patients and in previous animal experiments. Knowing the fascicular and nuclear arrangement within the midbrain in detail will offer diagnostic clues for differentiation of causes for partial oculomotor palsy. PMID:10870930

Saeki, N; Yamaura, A; Sunami, K



Gait phase information provided by sensory nerve activity during walking: applicability as state controller feedback for FES  

Microsoft Academic Search

In this study, we extracted gait-phase information from natural sensory nerve signals of primarily cutaneous origin recorded in the forelimbs of cats during walking on a motorized treadmill. Nerve signals were recorded in seven cats using nerve cuff or patch electrodes chronically implanted on the median, ulnar, and\\/or radial nerves. Features in the electroneurograms that were related to paw contact

K. D. Strange; J. A. Hoffer; J. B. Wagenaar



Spinal nerve lesion-induced mechanoallodynia and adrenergic sprouting in sensory ganglia are attenuated in interleukin-6 knockout mice  

Microsoft Academic Search

Tight ligation and transection of the L5 spinal nerve (SNL) gives rise to pain which is dependent upon activity in the sympathetic nervous system. It also results in novel adrenergic sympathetic innervation of the dorsal root ganglion (DRG) with the formation of pericellular axonal basket structures around some DRG neurons. Since the sympathetic sprouting and basket formation may represent an

Matt S. Ramer; Patricia G. Murphy; Peter M. Richardson; Mark A. Bisby



Effects of lesions of the optic nerve, optic tectum and nervus terminalis on rod precursor proliferation in the goldfish retina.  


Teleost retinas grow throughout life by proliferation of neuroblasts at the retinal margin and dedicated rod precursors in the outer nuclear layer. Mechanisms regulating this proliferation are largely unknown. Previous investigators observed that rod precursor replication, as detected by incorporation of radioactive thymidine into cells of the outer nuclear layer, is enhanced after optic nerve crush. We attempted to determine whether this was due to severing of the retinopetal (nervus terminalis, n.t.) or retinofugal (retinal ganglion cell) axons in the optic nerve of the goldfish, Carassius auratus. In the first series of experiments, we ablated unilaterally the optic nerve, olfactory bulb (containing n.t. ganglia), or optic tectum (containing retinal ganglion cell axons and n.t. collaterals). Rod precursor proliferation increased dramatically in both retinas as soon as 5 days after surgery; in addition, the numbers of dividing cells were greater in the ipsilateral retina 10-15 days after optic nerve crush or tectal ablation and in the contralateral retina 20-25 days after olfactory bulb ablation. These observations are not accounted for by the known projections of retinal ganglion cells, but are consistent with the projections of the n.t. In the second series of experiments, n.t. projections to the brain and retina were severed bilaterally 7-8 weeks before the unilateral optic nerve crush or hemitectal ablation. Rod precursor proliferation increased as before, but the quantities of dividing cells were always equal in both retinas. We conclude that the n.t. may modulate rod proliferation locally and that injury to (some) brain regions may cause release of mitogens that affect rod precursors in both retinas. PMID:1515918

Owusu-Yaw, V; Kyle, A L; Stell, W K



The Ulnar Collateral Ligament Procedure Revisited  

PubMed Central

Context: The ulnar collateral ligament of the elbow (UCL) is frequently injured in throwing athletes, most commonly baseball pitchers. The ligament is reconstructed through bone tunnels using palmaris longus or gracilis autograft. Results: This study highlights the following technique for UCL reconstruction in over 2000 athletes.2 Conclusion: When conservative management fails, ligament reconstruction can allow the athlete to return to their sport.1

Andrews, James R.; Jost, Patrick W.; Cain, E. Lyle



DRUJ brace with ulnar styloid accommodation  

US Patent & Trademark Office Database

The DRUJ brace is donned circumferentially around the distal radioulnar joint and provides adjustable compression of the proximal portion of the distal radioulnar joint that is independent of adjustable compression of the distal portion of the distal radioulnar joint, without compression of the ulnar styloid. Compression is maintained by hook and loop fasteners.

Howard; Wendy Marie Medeiros (Haiku, HI)



Ulnar shortening osteotomy after Colles fracture.  


Ulnar shortening is well accepted in the treatment of ulnar abutment but less so in patients with a shortened radius and ulnar-sided wrist pain as a result of a Colles fracture. Sixteen patients with pain and reduced range of movement (ROM) and a median preoperative ulnar positive variance of 5 mm (range 0.5-11) had 17 osteotomies. Nine were male and seven female with a median age of 35 (range 15-55) years were operated on. Fifteen patients with 16 osteotomies could be reached for follow-up. The ulna was shortened by a median of 4.5 mm (range 3-12). The median pain score was reduced by 3 points (range 0-5). Postoperative ROM was improved in nine, unchanged in six, and reduced in one wrists. There were four complications: one re-fracture, two transient paraesthesiae, and one superficial infection. Seven of the patients regarded the result as excellent, six as good, three as fair, and none regarded it as poor. Thirteen of the 16 would have chosen the operation again, three would not. PMID:16019750

Petersen, Kirstin; Breddam, Marianne; Jørgsholm, Peter; Schrøder, Henrik



Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome)  


... away from you, and then bend your elbow. Surgical Treatment Your doctor may recommend surgery to take ... ridge and stretching when your elbow is bent. Surgical Recovery Depending on the type of surgery you ...


Cholecystokinin-8 protects central cholinergic neurons against fimbria-fornix lesion through the up-regulation of nerve growth factor synthesis  

PubMed Central

In this study, we demonstrate that cholecystokinin-8 (CCK-8) induces an increase in both nerve growth factor (NGF) protein and NGF mRNA in mouse cortex and hippocampus when i.p. injected at physiological doses. By using fimbria–fornix-lesioned mice, we have also demonstrated that repeated CCK-8 i.p. injections result in recovery of lesion-induced NGF deficit in septum and restore the baseline NGF levels in hippocampus and cortex. Parallel to the effects on NGF, CCK-8 increases choline acetyltransferase (Chat) activity in forebrain when injected in unlesioned mice and counteract the septo-hippocampal Chat alterations in fimbria–fornix-lesioned mice. To assess the NGF involvement in the mechanism by which CCK-8 induces brain Chat, NGF antibody was administrated intracerebrally to saline- and CCK-8-injected mice. We observe that pretreatment with NGF antibody causes a marked reduction of NGF and Chat activity in septum and hippocampus of both saline- and CCK-8-injected mice. This evidence indicates that the CCK-8 effects on cholinergic cells are mediated through the synthesis and release of NGF. Taken together, our results suggest that peripheral administration of CCK-8 may represent a potential experimental model for investigating the effects of endogenous NGF up-regulation on diseases associated with altered brain cholinergic functions.

Tirassa, Paola; Aloe, Luigi; Stenfors, Carina; Turrini, Paolo; Lundeberg, Thomas



Revision Ulnar Collateral Ligament Reconstruction Using a Suspension Button Fixation Technique  

Microsoft Academic Search

Background: Revision ulnar collateral ligament reconstruction remains a challenging problem. The objective of this study was to biomechanically evaluate an ulnar collateral ligament reconstruction technique using a suspension button fixation technique that can be used even in the case of ulnar cortical bone loss.Hypothesis: An ulnar suspension fixation technique for ulnar collateral ligament reconstruction can restore elbow kinematics and demonstrate

Gregory H. Lee; Orr Limpisvasti; Maxwell C. Park; Michelle H. McGarry; Lewis A. Yocum; Thay Q. Lee



Nerve conduction in Frogs and Humans  

NSDL National Science Digital Library

These exercises are taken from a vertebrate physiology course, and use either a human subject or a dissected frog, thus providing relatively simply alternatives that may suit your needs. Nerve conduction velocity can be measured in the frog sciatic nerve with recordings of the biphasic action potential on the outside of the nerve trunk. Absolute and relative refractory periods can also be determined. Conduction velocity in the human can be obtained from electromyograms taken from the fourth and fifth fingers following stimulation of the ulnar nerve.

Elizabeth Vizsolyi (Univ. of British Columbia;)



[A case of acute polyradiculoneuritis with multiple cranial nerve palsy and cerebral lesion--possible evidence of encephalo-myelo-radiculo-neuropathy].  


We report a case of acute polyradiculoneuritis with multiple cranial nerve palsy and cerebral lesions. A boy, born on July 26, 1987, developed unusual sensation on the extremities, backache and sleep disturbance on June 23, 1996. On July 2, following a complaint of blindness he developed a convulsion and was admitted to our hospital. Neurological examination revealed intact consciousness, severe external ophthalmoplegia, bifacial palsy and generalized areflexia. On the next day, flaccid tetraplegia and respiratory dysfunction developed and progressed without disturbance of consciousness. After tracheal intubation he was under mechanical ventilation. A lumbar puncture examination showed clear CSF with increased protein 166 mg/dl. no cells and normal myelin basic protein. Serum antibodies against gangliosides (GM1, asialo-GM1, GD1b and GQ1b) were not detected. A posterior tibial nerve conduction velocity was mildly delayed with disappearance of F- wave. On the other hand, very slow background activity was shown by EEG, extensive focal hypoperfusion of cerebral blood flow by SPECT and supratentorial multiple high intensity lesions by T2 weighted MRI of the brain. There were no abnormal signals in the brainstem and cerebellum on MRI. His condition dramatically improved after plasmapheresis. The abnormal findings of SPECT and MRI promptly disappeared within 3 weeks, although abnormal signs on EEG persisted. He was successfully weaned off the respirator and recovered strength of the limbs. He was discharged on August 28, 1996, with supported walk and bifacial palsy, then he completely recovered by 7 months. The condition of case was compatible with 'encephalo-myelo-radiculo-neuropathy', a disease entity that had previously been reported in a few patients in whom with Guillain-Barré or Fisher syndrome and cerebral symptoms co-existed. PMID:9780746

Itokazu, N; Kodama, Y; Kontani, S; Inoue, S; Sugimoto, T; Ohi, T



Persistent modification of synaptic interactions between sensory and motor nerve cells following discrete lesions in the central nervous system of the leech  

PubMed Central

We have examined changes that develop in the synaptic interactions of sensory and motor nerve cells following surgical lesions to the central nervous system of the leech. In one type of operation an individual ganglion was isolated from the rest of the nervous system by severing all the incoming and outgoing fibres. During the next few weeks, marked changes appeared in synaptic interactions. 1. In chronically isolated ganglia inhibitory potentials were recorded in the motoneurone which raises the skin into ridges (the AE cell) following impulses in sensory neurones that respond to pressure (P) or noxious (N) stimuli. In contrast the same AE cell in ganglia taken from normal animals shows excitatory synaptic potentials when the P or N sensory cells are stimulated. 2. Another altered synaptic interaction in ganglia isolated by lesions was that between sensory cells responding to touch and a motoneurone that supplies longitudinal muscles (L cell). Instead of the pure, electrical coupling potential seen normally, a large, additional chemically mediated excitatory potential was also apparent. 3. Some of the changes in synaptic interactions were not restricted to synapses within the isolated ganglion, but appeared gradually over the following year in successive ganglia along the length of the ventral nerve cord. 4. Indirect evidence suggests that the altered synaptic potentials that became conspicuous after operations are also present but smaller and obscured in normal animals. 5. It is concluded that some synapses in the leech nervous system are more readily changed than others by cutting the connectives. Furthermore, these changes influence in a predictable manner the way in which the animal behaves in response to mechanical stimuli.

Jansen, J. K. S.; Muller, K. J.; Nicholls, J. G.



[Chronic ulnar wrist pain in adults: diagnosis and treatment principles].  


Adult patients with chronic ulnar wrist pain often seek medical advice. There are a number of diagnoses for chronic ulnar-sided wrist pain. A sound diagnostic strategy is therefore of paramount importance. Patient's history, clinical examination and high quality standard radiographs are the most important part of this strategy. Sophisticated investigations should only be performed to focus on solid clinical hypotheses. The palmar and dorsal aetiologies of ulnar wrist pain are considered as well as their treatment principles. PMID:22030264

Herzberg, G



Ulnar Variance in Kienb?ck’s Disease  

Microsoft Academic Search

Forty four patients with forty seven wrists suffering from Kienb?ck’s disease were re-examined. The mean observation time was 20.5 years. In all forty seven wrists the treatment had been immobilization. Using a standard X-ray projection, and a reliable method of ulnar variance measuring, the ulnar variance was determined by three observers independently. Comparing the result with the ulnar variance in




Long-term Outcomes of Ulnar Shortening Osteotomy for Idiopathic Ulnar Impaction Syndrome: At Least 5-Years Follow-up  

PubMed Central

Background There have been few outcomes studies with follow-up after performing ulnar shortening osteotomy for ulnar impaction syndrome. We investigated the long-term clinical and radiological outcomes of ulnar shortening osteotomy for the treatment of idiopathic ulnar impaction syndrome. Methods We retrospectively reviewed 36 patients who had undergone ulnar shortening osteotomy for idiopathic ulnar impaction syndrome for a mean follow-up of 79.1 months (range, 62 to 132 months). The modified Gartland and Werley scores were measured pre- and postoperatively. The radiographic parameters for the assessment of the distal radioulnar joint (DRUJ) as well as the relationship between these radiographic parameters and the clinical and radiological outcomes were determined. Results The average modified Gartland and Werley wrist score improved from 65.5 ± 8.1 preoperatively to 93.4 ± 5.8 at the last follow-up visit. The average preoperative ulnar variance of 4.7 ± 2.0 mm was reduced to an average of -0.6 ± 1.4 mm postoperatively. Osteoarthritic changes of the DRUJ were first seen at 34.8 ± 11.1 months follow-up in 6 of 36 wrists (16.7%). Those who had osteoarthritic changes in the DRUJ had significantly wider preoperative ulnar variance, a longer distal radioulnar distance and a greater length of ulnar shortening, but the wrist scores of the patients who had osteoarthritic changes in the DRUJ were comparable to those who did not have osteoarthritic changes in the DRUJ. Conclusions The clinical outcomes are satisfactory for even more than 5 years after ulnar shortening osteotomy for treating idiopathic ulnar impaction syndrome despite the osteoarthritic changes of the DRUJ. The patients who need a larger degree of ulnar shortening may develop DRUJ arthritis.

Lee, Hyuk Jin; Gong, Hyun Sik; Rhee, Seung Hwan; Kim, Jihyeung; Kim, Kang Wook; Kong, Bong Young; Oh, Won Seok



Symmetric Lipofibromatous Hamartoma Affecting Digital Nerves  

PubMed Central

Lipofibromatous hamartoma of the nerve is a benign tumor, which affects the major nerves and their branches in the human body. It is often found in the median nerve of the hand and is commonly associated with macrodactyly, but it is rarely found in the digital nerves at the peripheral level. This tumor is often found in young adults and may go through a self-limiting course. However, operation is indicated when the tumor size is large or when the associated nerve compressive symptoms are present. We have experienced a rare case of lipofibromatous hamartoma that symmetrically involved the volar digital nerves of both index fingers on the ulnar side. With the aid of a microscope, we dissected and removed the tumor as much as possible without sacrificing the nerve. No sensory change occurred in both fingers and no sign of recurrence was observed upon follow-up.

Jung, Sung-No; Yim, Youngmin



Gamekeeper's thumb: ulnar collateral ligament injury.  


Injury to the ulnar collateral ligament of the thumb, once a common chronic occupational injury occurring in British gamekeepers, is now most frequently an acute sports-related injury in skiers, football players and other athletes. Differentiation of complete versus partial tears of the ligament is crucial because the treatment for complete tears is surgical. Radiographic evaluation, while important, has a limited role. Partial ligamentous tears, or those associated with uncomplicated avulsion fractures of the proximal phalanx, can be adequately treated by the family physician using simple shortarm thumb spica casting. PMID:8623701

Richard, J R



Ruptured aneurysm of the ulnar artery in a woman with neurofibromatosis.  


A 61-year-old woman with neurofibromatosis type 1 (Recklinghausen's disease) was referred for massive swelling of the right forearm, pain, increasing numbness, and impaired movement of the fingers. Angiography demonstrated a 13- x 11-mm aneurysm and a capped rupture of the ulnar artery. Because of the complicated soft-tissue condition, interventional treatment was indicated. Two 360 degrees coils were placed for embolization of the ruptured aneurysm. Arterial involvement in neurofibromatosis is a well known but infrequent occurrence. Stenotic lesions predominate. Aneurysmal defects are less common, and rupture of peripheral arteries is exceptional. PMID:19216968

Scheuerlein, Hubert; Ispikoudis, Nikolaos; Neumann, Rotraud; Settmacher, Utz



Enchondroma Protuberans of Ulnar Bone: A Case Report and Review of Literature  

PubMed Central

Introduction. Enchondroma protuberans is an extremely rare benign cartilaginous bone tumor. We report the first case report of enchondroma protuberans in the forearm. Presentation of Case. We report a case of enchondroma protuberans originating in the left ulnar bone of a young woman. A 20-year-old female referred to our hospital complaining of progressive sustained left forearm pain with a radiation to fourth and fifth finger. Conventional radiography revealed a well-defined eccentric osteolytic lesion in the distal diaphysis of ulna with expansion of overlying cortex (without calcification). Magnetic resonance imaging showed a well-defined ovoid intramedullary lesion, which was exophytically protruding from medial surface of left ulnar bone. Histopathology confirmed the diagnosis. Discussion. Enchondroma protuberans typically present as a well-defined intramedullary osteolytic lesion that may be accompanied by a fine matricidal calcification. The connection between the intramedullary portion and the exophytic protrusion can be seen well by magnetic resonance imaging. Conclusion. Enchondroma protuberans should be considered in the differential diagnosis of osteochondroma, enchondroma, and periosteal chondroid tumors.

Mohammadi, Afshin; Hedayati Asl, Abbas; Ghasemi-Rad, Mohammad; Noroozinia, Farahnaz



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

Microsoft Academic Search

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

Fritz Buchthal; Annelise Rosenfalck; Werner Trojaborg



Sympathetic skin response and regeneration of sudomotor fibers after complete division of peripheral nerves  

Microsoft Academic Search

Sympathetic skin responses (SSRs) were studied in hands of patients during regeneration of their median or ulnar nerves following complete severance and suture. The SSRs were elicited with electrical stimuli presented to the forearm of the normal side and recorded between the dorsum of the hand and three sites in the innervation area of the two nerves. The amplitude and

Uroš Ah?an; Jerneja Kolbl; Martin Janko



Ulnar lengthening using a half-ring sulcated external fixator for ulnar longitudinal deficiency: a case report.  


Ulnar longitudinal deficiency (ULD) is a rare condition of the upper limbs. Although radius lengthening for radial longitudinal deficiencies (RLD) was found to be successful, no ulnar lengthening for ULD without RLD and hand deformities has been reported. Herein, we present a Bayne type II ULD case report of the ulnar lengthening and gradual reduction of the dislocated radial head in an 11-year-old boy using a half-ring sulcated external fixator. For ulnar lengthening/radial longitudinal traction for radial head reduction, transverse osteotomy in mid ulna was performed and half-ring sulcated external fixator was used for ulnar distraction lengthening. Radial longitudinal traction and stabilization of external fixator were achieved by transverse pins through ulna and radius. Distraction (1 mm/day) began at 5th day and was completed at 95th postoperative day. External fixator was applied for 7 months. Successful ulnar lengthening (81 mm; 62 % gain) was achieved 1-year after the surgery and the range of elbow motion at 2 years was >40°. Forearm rotation and wrist extension/flexion were also preserved with no complaints of pain. We concluded that ulnar distraction lengthening and gradual reduction of radial head could improve appearance of the arm and were of significant benefit to the patient. PMID:23504634

Chen, Guang-Xing; Zhou, Zhong-An; Yang, Liu



Fractures of the ulnar coronoid process.  


The ulnar coronoid process plays a central role in elbow stability due to its unique anatomic characteristics. A fracture of the coronoid, although uncommon, represents a serious injury that can adversely affect functional outcome if not treated appropriately. Several surgical interventions addressing different fracture patterns are being increasingly recognised as effective treatment options even for smaller fragments. A review of the literature was performed in order to evaluate different treatment strategies applied to clearly defined fracture configurations. 14 articles reporting data for the management of 236 coronoid fractures met our inclusion criteria and were subjected to critical analysis. The data suggest that recognition of specific coronoid fracture patterns, use of appropriate classification systems and application of staged surgical protocols can stabilise the elbow effectively and lead to favourable outcomes. PMID:21963158

Manidakis, Nikolaos; Sperelakis, Ioannis; Hackney, Roger; Kontakis, George



Non-invasive stimulation of the vibrissal pad improves recovery of whisking function after simultaneous lesion of the facial and infraorbital nerves in rats  

Microsoft Academic Search

We have recently shown that manual stimulation of target muscles promotes functional recovery after transection and surgical\\u000a repair to pure motor nerves (facial: whisking and blink reflex; hypoglossal: tongue position). However, following facial nerve\\u000a repair, manual stimulation is detrimental if sensory afferent input is eliminated by, e.g., infraorbital nerve extirpation.\\u000a To further understand the interplay between sensory input and motor

H. Bendella; S. P. Pavlov; M. Grosheva; A. Irintchev; S. K. Angelova; D. Merkel; N. Sinis; K. Kaidoglou; E. Skouras; S. A. Dunlop; Doychin N. Angelov



[Nerve injuries in children].  


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

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



Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers  

Microsoft Academic Search

Background: Ulnar collateral ligament reconstruction is commonly performed in major league pitchers, but little is known about pitching performance after a return to major league play.Hypothesis: Pitching performance after ulnar collateral ligament reconstruction returns to baseline by the second season after surgery.Study Design: Cohort study (prognosis); Level of evidence, 2.Methods: Data were reviewed for 68 major league pitchers who pitched

Brett W. Gibson; David Webner; G. Russell Huffman; Brian J. Sennett



Ageing does not affect ulnar variance: an investigation in Taiwan.  


This paper presents a longitudinal study of the effect of ageing on ulnar variance. Between 1976 and 1985, ulnar variance in 1000 normal adult subjects was measured using the Palmer method. In 1995 to 2002, 17 to 22 years later, the ulnar variance was measured again in 864 of them. They were stratified into three age groups: Group I consisted of 351 subjects of young age (20-39 year-old), Group II of 318 subjects of middle age (40-59 year-old) and group III of 195 subjects of old age (60 year-old or older). The means of the initial and the final ulnar variance of the whole series and the three groups were compared by the paired Student's t-test. There were no significant differences between the initial and final ulnar variances in all three age groups and in the whole series. In normal subjects without diseases or injuries affecting the wrist, ageing does not affect the ulnar variance. PMID:18936124

Chen, W-S; Wang, J-W



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

PubMed Central

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.

Langer, P; Fadale, P; Hulstyn, M



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


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

Langer, P; Fadale, P; Hulstyn, M



The face of Ulnar Mammary syndrome?  


Ulnar Mammary syndrome (UMS) is an autosomal disorder caused by haploinsufficiency of the TBX3 gene. There is marked intrafamilial variation in expression of the syndrome. We present one three generation family in which the proband has absence of the right ulna and third, fourth and fifth rays in her right hand. Her mother and maternal grandmother have more subtle anomalies while all have a similar facial appearance with a broad nasal tip, a broad jaw, a prominent chin and a tongue frenulum. They have a single base pair insertion (c. 992dup) in TBX3. We compare faces from the handful of published UMS patients which include photographs, this family and four other cases with TBX3 mutations. All have similarities in appearance which we suggest could alert clinicians to the possibility of a TBX3 mutation if individuals present with more subtle features of UMS such as postaxial polydactyly, isolated 5th finger anomalies, delayed puberty in males, breast hypoplasia or short stature with or without growth hormone deficiency. PMID:21199695

Joss, Shelagh; Kini, Usha; Fisher, Richard; Mundlos, Stefan; Prescott, Katrina; Newbury-Ecob, Ruth; Tolmie, John



Osteochondritis dissecans of the capitellum: a review of the literature and a distal ulnar portal.  


Osteochondritis dissecans (OCD) of the humeral capitellum most commonly affects young athletes engaged in sports that repetitively stress the elbow. It is characterized by localized injury of subchondral bone of the humeral capitellum. To determine the best treatment option for OCD in young athletes, it is important to differentiate between stable and unstable OCD lesions. Stable lesions can be treated with rest, whereas unstable lesions, as well stable lesions that do not respond to conservative therapy, may require a surgical approach. Magnetic resonance imaging is the diagnostic study of choice to evaluate capitellar OCD lesions and loose bodies and to accurately determine the stability and viability of the OCD fragment. A variety of surgical approaches have been reported, from internal fixation of large fragments to autologous chondrocyte grafts. Arthroscopic surgery is becoming the standard treatment of capitellar OCD. This minimally invasive approach shows good results, a low risk of operative morbidity, and early recuperation postoperatively. The distal ulnar portal we describe here allows for ergonomic exposure to the posterolateral capitellum, providing easier access for drilling, burring, and local debridement of lesions amenable to arthroscopy. PMID:21035989

van den Ende, Kimberly I M; McIntosh, Amy L; Adams, Julie E; Steinmann, Scott P



[Nerve entrapment syndromes in athletes].  


Sports-related injuries most commonly involve the musculoskeletal system. However, physicians are less familiar with damage to the peripheral nerves attributable to particular sports activities. Nerve entrapment syndromes associated with physical activity may affect all nerves for which entrapment syndromes are known. Peripheral nerve lesions are serious and may delay or preclude the athletes' return to sports, especially in cases with a delayed diagnosis. The aim of the paper is to give an overview of chronic sports-related nerve lesions. Acute nerve injuries are not the focus of this review. A literature search regarding sports-related nerve lesions was conducted. Due to the lack of prospective epidemiological studies, case reports were included (evidence level 4). Nerve entrapment syndromes specific for particular sports activities are described including clinical presentation, diagnostic work-up and treatment. Repetitive and vigorous use or overuse makes the athlete vulnerable to disorders of the peripheral nerves, additionally sports equipment may cause compression of the nerves. The treatment is primarily conservative and includes modification of movements and sports equipment, shoe inserts, splinting, antiphlogistic drugs and local administration of glucocorticoids. Most often cessation of the offending physical activity is necessary. When symptoms are refractory to conservative therapy a referral to surgery is indicated. The outcome of surgical treatment regarding the return of the athlete to competitive sports is not sufficiently investigated in many nerve entrapment -syndromes.This article was primarily published in "Akt Neurol 2012; 6: 292-308". PMID:24030432

Reuter, I; Mehnert, S



Effects of Acute Organophosphorus Poisoning on Function of Peripheral Nerves: A Cohort Study  

PubMed Central

Background Following acute organophosphorus (OP) poisoning patients complain of numbness without objective sensory abnormalities or other features of OP induced delayed polyneuropathy. The aim of this study was to measure peripheral nerve function after acute exposure to OP. Methods A cohort study was conducted with age, gender and occupation matched controls. Motor nerve conduction velocity (MNCV), amplitude and area of compound muscle action potential (CMAP), sensory nerve conduction velocity (SNCV), F- waves and electromyography (EMG) on the deltoid and the first dorsal interosseous muscles on the dominant side were performed, following acute OP poisoning. All neurophysiological assessments except EMG were performed on the controls. Assessments were performed on the day of discharge from the hospital (the first assessment) and six weeks (the second assessment) after the exposure. The controls were assessed only once. Results There were 70 patients (50 males) and 70 controls. Fifty-three patients attended for the second assessment. In the first assessment MNCV of all the motor nerves examined, CMAP amplitude and SNCV of ulnar nerve, median and ulnar F-wave occurrence in the patients were significantly reduced compared to the controls. In the second assessment significant reduction was found in SNCV of both sensory nerves examined, MNCV of ulnar nerve, CMAP amplitude of common peroneal nerve, F-wave occurrence of median and ulnar nerves. No abnormalities were detected in the patients when compared to the standard cut-off values of nerve conduction studies except F-wave occurrence. EMG studies did not show any abnormality. Conclusion There was no strong evidence of irreversible peripheral nerve damage following acute OP poisoning, however further studies are required.

Jayasinghe, Sudheera S.; Pathirana, Kithsiri D.; Buckley, Nick A.



Axo-glial dysjunction. A novel structural lesion that accounts for poorly reversible slowing of nerve conduction in the spontaneously diabetic bio-breeding rat.  

PubMed Central

Biochemical abnormalities in peripheral nerve are thought to precede and condition the development of diabetic neuropathy, but metabolic intervention in chronic diabetic neuropathy produces only limited acute clinical response. The residual, metabolically unresponsive neurological deficits have never been rigorously defined in terms of either persistent metabolic derangements or irreversible structural defects because human nerve tissue is rarely accessible for anatomical and biochemical study and experimentally diabetic animals do not develop the structural hallmarks of human diabetic neuropathy. Detailed neuroanatomical-functional-biochemical correlation was therefore undertaken in long-term spontaneously diabetic BB-Wistar rats that functionally and structurally model human diabetic neuropathy. Vigorous insulin replacement in chronically diabetic BB rats essentially normalized both the sural nerve fiber caliber spectrum and the decreased sciatic nerve myo-inositol and (Na,K)-ATPase levels generally associated with conduction slowing in diabetic animals; yet, nerve conduction was only partially restored toward normal. Morphometric analysis revealed a striking disappearance of paranodal axo-glial junctional complexes that was not corrected by insulin replacement. Loss of these strategic junctional complexes, which are thought to limit lateral migration of axolemmal Na channels away from nodes of Ranvier, correlates with and can account for the diminished nodal Na permeability and resultant nodal conduction delay characteristic of chronic diabetic neuropathy in this animal model. Images

Sima, A A; Lattimer, S A; Yagihashi, S; Greene, D A



Biomechanics of a Less Invasive Procedure for Reconstruction of the Ulnar Collateral Ligament of the Elbow  

Microsoft Academic Search

A reconstruction of the anterior bundle of the ulnar collateral ligament of the elbow using bone anchors was compared regarding strain and valgus load strength with the intact ulnar collateral ligament and the reconstructed ulnar collateral ligament using bone tunnels. In both normal and reconstructed elbows, the anterior band and posterior band were tight during only a portion of the

Keith S. Hechtman; Evert W. Tjin-A-Tsoi; John E. Zvijac; John W. Uribe; Loren L. Latta



Distal radioulnar joint arthroscopy and the volar ulnar portal.  


Pain on the ulnar side of the wrist remains poorly understood. As attention has shifted toward the myriad causes of ulnar-sided wrist pain, the utility of viewing the wrist from a volar ulnar (VU) perspective has emerged. Lunotriquetral ligament tears have been implicated in the pathogenesis of volar intercalated segmental instabilities. They often originate in the palmar subregion, which is most important for maintaining stability. These tears are difficult to visualize through the 4, 5, or 6R portals. They are well seen through a VU portal, and the direct line of sight facilitates debridement. The VU portal has potential use in the arthroscopic diagnosis and treatment of patients with injuries to the ulnar sling mechanism. It aids in triangular fibrocartilage repairs especially those involving the dorsal aspect between the ulnar styloid and the radial insertion, because the proximity of the 4, 5, and 6R portals makes triangulation of the instruments difficult. Although arthroscopy of the dorsal aspect of the distal radioulnar joint has been well described, it has largely remained a curiosity, with few clinical indications. Recent biomechanical studies have highlighted the importance of the deep attachment of the triangular fibrocartilage complex in maintaining distal radioulnar joint stability. The volar distal radioulnar portal is useful for assessing the foveal attachment. It may be used where there is the suspicion of a peripheral triangular fibrocartilage detachment due to a loss of its normal tension despite the lack of a visible tear during radiocarpal arthroscopy. The judicious use of these portals deserves consideration for inclusion as part of a thorough arthroscopic examination of selected patients with ulnar-sided wrist pain. PMID:17536523

Slutsky, David J



Simultaneous Paresthesia of the Lingual Nerve and Inferior Alveolar Nerve Caused by a Radicular Cyst  

Microsoft Academic Search

The inferior alveolar nerve is sometimes affected by periapical pathoses and mandibular cysts. However, mandibular intraosseous lesions have not been reported to disturb the lingual nerve. A case of simultaneous paresthesia of the right lingual nerve and the right inferior alveolar nerve is presented. The possible mechanisms of this extremely uncommon condition are discussed.

Yoshiki Hamada; Hiroyuki Yamada; Akiko Hamada; Toshirou Kondoh; Mami Suzuki; Kazuhide Noguchi; Ko Ito; Kanichi Seto



Cranial Nerves IX, X, XI, and XII  

PubMed Central

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.

Sanders, Richard D.



Effectiveness of interference screw fixation in ulnar collateral ligament reconstruction.  


Ulnar collateral ligament disruptions of the elbow are increasingly common for athletes involved in overhead sports. One newer reconstructive technique combines the use of a biotenodesis screw for ulnar fixation with the docking procedure for humeral fixation referred to as the DANE procedure. Biomechanical evaluations have determined that the combined procedure has properties similar to previous methods, but few comparative clinical studies have been performed. The current study compares the DANE procedure to a traditional method of ulnar collateral ligament reconstruction with a medium range follow-up. Twelve ulnar collateral ligament reconstructions were observed for a minimum of 21 months. Six reconstructions were performed using bone tunnels on the ulna. The other 6 used a biotenodesis interference screw on the ulna. Both groups used the docking procedure on the humerus. Identical rehabilitation phases were followed by both groups. Attention was paid not only to the time to return to play and the level able to be returned to but also to interoperative differences, including tourniquet time. We concluded that the DANE reconstruction is an appropriate and effective method. Results are similar to those achieved with a traditional reconstructive method. The study also demonstrates that tourniquet time and, therefore, operative time is less for the DANE procedure. PMID:19292392

Nissen, Carl W



Ulnar artery thrombosis: A sports-related injury  

Microsoft Academic Search

A case of ulnar artery thrombosis following a sports- related injury is reported. Treatment by resection of the thrombosed segment and replacement with a reversed vein graft resulted in complete relief of symptoms. An extensive review of the literature is presented.

Gary L. Porubsky; Samuel I. Brown; James R. Urbaniak



Radial ray deficiency and ulnar ray deficiency in two sibs.  


A kindred with a diabetic mother is described with one sibling with a radial deficiency (type 1 radial dysplasia (Bayne) with a hypoplastic thumb type 3 of Blauth) and one with an ulnar ray deficiency (type 2 of Ogden or type 1 of Swanson). A metabolic cause is probable, although the diabetes was well controlled during pregnancy. PMID:1642817

De Smet, L; Fabry, G; Fryns, J P



A Prospective Clinical Evaluation of Biodegradable Neurolac Nerve Guides for Sensory Nerve Repair in the Hand  

Microsoft Academic Search

Purpose: Our purpose was to study the recovery of sensory nerve function after treatment of traumatic peripheral nerve lesions with a biodegradable poly(DL-lactide--caprolactone) Neurolac nerve guide (Polyganics B.V., Groningen, the Netherlands) versus the current standard reconstruc- tion techniques. Methods: Thirty patients with 34 nerve lesions were included in this randomized, multicenter trial. Results: Both groups were comparable considering their demographics.

Mariëtta J. O. E. Bertleff; Marcel F. Meek; Jean-Phillipe A. Nicolai



Conduction velocity in the proximal segments of a motor nerve in the Guillain-Barré syndrome  

Microsoft Academic Search

Conduction velocity from spinal cord to axilla (estimated using the F wave) has been compared with conduction velocity from axilla to wrist (measured in the conventional manner) in the motor fibres of the ulnar nerve in 17 controls subjects and in 11 patients with the Guillain-Barré syndrome (GBS). In the patients with GBS the conduction velocity was, in general reduced

D King; P Ashby



Increased cortical excitability induced by transcranial DC and peripheral nerve stimulation  

Microsoft Academic Search

This study investigated the effect of short periods of simultaneous weak anodal direct current (DC) stimulation and peripheral ulnar nerve (ES) stimulation on corticospinal excitability. The experiments involved repeated testing of ten normal subjects with four different protocols: (1) No Stimulation; (2) DC only; (3) ES only; (4) DC plus ES. Motor evoked potentials (MEP) were recorded from the First

J. Uy; M. C. Ridding



Location of nerve entry points of flexor digitorum profundus  

Microsoft Academic Search

The aim of this study was to elucidate the anatomical location of nerve entry points of Flexor digitorum profundus (FDP) and\\u000a its implications for non-surgical neurolysis. A total of 21 amputated forearms of 11 Korean fresh cadavers were dissected.\\u000a Two transverse x-axes joined the medial and lateral epicondyles and the radial and ulnar styloid processes. The longitudinal y-axis joined the

K. Hwang; S. Jin; S.-H. Hwang; K.-M. Lee; S.-H. Han



A Comparison of Ulnar Shortening Osteotomy Alone Versus Combined Arthroscopic Triangular Fibrocartilage Complex Debridement and Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome  

PubMed Central

Background This study compared the results of patients treated for ulnar impaction syndrome using an ulnar shortening osteotomy (USO) alone with those treated with combined arthroscopic debridement and USO. Methods The results of 27 wrists were reviewed retrospectively. They were divided into three groups: group A (USO alone, 10 cases), group B (combined arthroscopic debridement and USO, 9 cases), and group C (arthroscopic triangular fibrocartilage complex [TFCC] debridement alone, 8 cases). The wrist function was evaluated using the modified Mayo wrist score, disabilities of the arm, shoulder and hand (DASH) score and Chun and Palmer grading system. Results The modified Mayo wrist score in groups A, B, and C was 74.5 ± 8.9, 73.9 ± 11.6, and 61.3 ± 10.2, respectively (p < 0.05). The DASH score in groups A, B, and C was 15.6 ± 11.8, 19.3 ± 11.9, and 33.2 ± 8.5, respectively (p < 0.05). The average Chun and Palmer grading score in groups A and B was 85.7 ± 8.9 and 84.7 ± 6.7, respectively. The difference in the Mayo wrist score, DASH score and Chun and Palmer grading score between group A and B was not significant (p > 0.05). Conclusions Both USO alone and combined arthroscopic TFCC debridement with USO improved the wrist function and reduced the level of pain in the patients treated for ulnar impaction syndrome. USO alone may be the preferred method of treatment in patients if the torn flap of TFCC is not unstable.

Song, Hyun Seok



Tuberculous Tenosynovitis and Ulnar Bursitis of the Wrist  

PubMed Central

Tuberculous infection of the hand is a rare form of extrapulmonary tuberculosis that, left untreated, can cause serious joint and tendon damage. We report the case of a 65-year-old male patient who presented with an insidious flexor weakness of the fifth finger but without any history of trauma. Magnetic resonance imaging revealed a partial tear of the fifth finger flexor tendon with a fluid collection in the tendon sheath and in the flexor compartment along the ulnar side. Under ultrasound guidance, this fluid collection was aspirated and analyzed for Mycobacterium tuberculosis using polymerase chain reaction. The assay was positive for the microorganism, confirming the diagnosis of tuberculous tenosynovitis and ulnar bursitis of the wrist. The early suspicion and diagnosis of this extrapulmonary disease facilitated anti-tuberculous chemotherapy and helped avoid a hasty injection of corticosteroid.

Lee, Sang-Min; Song, Ah-Rom



Effect of limb dominance on motor nerve conduction.  


The economic, social and personal burden of common neurological disorders has been the subject of intense study all over the world. Nerve conduction velocity being affected by factors like age, gender and temperature is a well known fact. The effect of handedness on nerve conduction is not known much and needs further evaluation. In the present study 50 medical students divided into 2 groups of 25 each, depending on the handedness were incorporated. Motor nerve conduction of the median and ulnar nerve was studied. It was found there was no significant difference in velocity between the dominant and non dominant limbs of the same individuals, but nerve conduction in right handed subjects was more as compared to their counterparts for both dominant and non dominant limbs. This finding suggests that there should exist a separate set of normative data for both right and left handed individuals to be used in practice. PMID:20329377

Bhorania, Seema; Ichaporia, Rati B


Neuropathic pain after C7 spinal nerve transection in man  

Microsoft Academic Search

Various animal models of neuropathic pain have been developed which involve creating a lesion in a spinal root. We describe a human correlate in which patients developed a neuropathic pain syndrome after having one spinal nerve surgically divided. In some patients with brachial plexus lesions, the C7 spinal nerve from the opposite side is divided and used as a nerve

Zahid Ali; Richard A Meyer; Allan J Belzberg



Diagnosis and management of ulnar collateral ligament injuries in throwers.  


Although ulnar collateral ligament (UCL) injuries are reported most commonly in baseball players (especially in pitchers), these also have been observed in other throwing sports including water polo, javelin throw, tennis, and volleyball. This article reviews the functional anatomy and biomechanics of the UCL with associated pathophysiology of UCL injuries of the elbow of the athlete participating in overhead throwing. Evaluation, including pertinent principles in history, physical examination, and imaging modalities, is discussed, along with the management options. PMID:23531973

Freehill, Michael T; Safran, Marc R


Excision of the ulnar head in patients with rheumatoid arthritis.  

PubMed Central

In 40 patients with rheumatoid arthritis 43 operations for excision of the ulnar head were performed. A follow-up study was performed after 35 months. In 38 patients wrist pain had disappeared completely or almost completely. The function in use, supination and pronation of the wrists, and wrist strength had all much improved. The stability of the radiocarpal joint was good after operation. Only minor complications were seen.

Rasker, J J; Veldhuis, E F; Huffstadt, A J; Nienhuis, R L



Coupling between wrist flexion–extension and radial–ulnar deviation  

Microsoft Academic Search

Background. Conventional wrist joint goniometry evaluates range of motion in isolated directions. The coupling between wrist flexion–extension and radial–ulnar deviation was investigated.Methods. Ten healthy young male subjects performed wrist flexion–extension, radial–ulnar deviation, and circumduction motions. Flexion–extension and radial–ulnar deviation angles were computed from the coordinates of surface markers attached to the forearm and hand. A motion analysis system recorded marker

Zong-Ming Li; Laurel Kuxhaus; Jesse A. Fisk; Thomas H. Christophel



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


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

Vezeridis, Peter S; Yoshioka, Hiroshi; Han, Roger; Blazar, Philip



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

PubMed Central

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.

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



Occupational True Aneurysm of the Ulnar Artery: A Case Report of Hypothenar Hammer Syndrome  

PubMed Central

A 32-year-old male patient was admitted to the hospital with a pulsing mass of the right palm. He was an electrical construction engineer who frequently used a screwdriver. Computed tomography (CT) examination revealed a 22- × 30-mm saccular aneurysm of the right ulnar artery. The ulnar artery aneurysm was resected, and we could perform direct anastomosis of the ulnar artery. The dilated true aneurysm was compatible with a traumatic origin. A postoperative enhanced CT examination showed smooth reconstruction of the palmar arch. An occupational true aneurysm of the ulnar artery could be treated by resection and direct anastomosis.



Contribution of the ulnar digits to grip strength  

PubMed Central

PURPOSE: To determine the contribution of ulnar digits to overall grip strength. SUBJECTS: Fifty individuals (25 men and 25 women; 100 hands) with a mean age of 35.6 years (range 19 to 62 years) were tested. Exclusion criteria included previous history of hand injuries, entrapment neuropathies and systemic diseases. METHODS: Ethics approval was granted before testing. A calibrated Jamar dynamometer (Lafayette Instrument Company, USA) was used to test subjects in three configurations: entire hand – index, middle, ring and little fingers; index, middle and ring fingers; and index and middle fingers. Little and ring fingers were excluded using generic hand-based finger splints. The order of testing was kept constant, and subjects were tested three times on each hand for each configuration. The average of the three trials at each configuration was recorded. Subjects received 1 min of rest between each testing configuration. The data were analyzed using a 3×2 repeated measures ANOVA with hand dominance and configuration as the within-subject factors, followed by two independent sample t tests to compare flexor digitorum superficialis (FDS) independence and FDS nonindependence on right and left hand grip strength measurements in the index, middle, ring and little condition. RESULTS: Univariate results demonstrated that grip strength was significantly predicted by the interaction between hand dominance and configuration, while the parsing of the interaction term demonstrated greater grip strength across all levels of configuration for the dominant and nondominant hand. There were no significant differences between FDS independence and FDS nonindependence for either hand on grip strength. DISCUSSION: The results indicate a significant decrease in grip strength as ulnar fingers were excluded. Furthermore, exclusion of the little finger has differing effects on the grip strength of the dominant and nondominant hands – the dominant hand had a greater loss of strength with the little finger excluded than the nondominant hand. CONCLUSIONS: The ulnar two digits play a significant role in overall grip strength of the entire hand. In the present study, exclusion of the ulnar two digits resulted in a 34% to 67% decrease in grip strength, with a mean decrease of 55%. Exclusion of the little finger from a functional grip pattern decreased the overall grip strength by 33%. Exclusion of the ring finger from a functional grip pattern decreased the overall grip strength by 21%. It is clear that limitation of one or both of the ulnar digits adversely affects the strength of the hand. In addition, there was no significant difference between grip strength of FDS-independent and FDS-nonindependent subjects for either hand.

Methot, Jennifer; Chinchalkar, Shrikant J; Richards, Robert S



Peripheral nerve injuries in sports-related surgery: presentation, evaluation, and management: AAOS exhibit selection.  


Peripheral nerve injuries during sports-related operative interventions are rare complications, but the associated morbidity can be substantial. Early diagnosis, efficient and effective evaluation, and appropriate management are crucial to maximizing the prognosis, and a clear and structured algorithm is therefore required. We describe the surgical conditions and interventions that are commonly associated with intraoperative peripheral nerve injuries. In addition, we review the common postoperative presentations of patients with these injuries as well as the anatomic structures that are directly injured or associated with these injuries during the operation. Some examples of peripheral nerve injuries incurred during sports-related surgery include ulnar nerve injury during ulnar collateral ligament reconstruction of the elbow and elbow arthroscopy, median nerve injury during ulnar collateral ligament reconstruction of the elbow, axillary nerve injury during Bankart repair and the Bristow transfer, and peroneal nerve injury during posterolateral corner reconstruction of the knee and arthroscopic lateral meniscal repair. We also detail the clinical and radiographic evaluation of these patients, including the utility and timing of radiographs, magnetic resonance imaging (MRI), ultrasonography, electromyography (EMG), and nonoperative or operative management. The diagnosis, evaluation, and management of peripheral nerve injuries incurred during sports-related surgical interventions are critical to minimizing patient morbidity and maximizing postoperative function. Although these injuries occur during a variety of procedures, common themes exist regarding evaluation techniques and treatment algorithms. Nonoperative treatment includes physical therapy and medical management. Operative treatments include neurolysis, transposition, neurorrhaphy, nerve transfer, and tendon transfer. This article provides orthopaedic surgeons with a simplified, literature-based algorithm for evaluation and management of peripheral nerve injuries associated with sports-related operative procedures. PMID:22992827

Maak, Travis G; Osei, Daniel; Delos, Demetris; Taylor, Samuel; Warren, Russell F; Weiland, Andrew J



Ulnar-sided wrist pain after four-corner fusion in a previously-asymptomatic ulnar positive wrist: a case report.  


Scaphoid excision and four-corner fusion is one of the treatment choices for patients who have stage II or III SLAC (scapholunate advanced collapse)/SNAC (scaphoid non-union advanced collapse) wrist arthritis. We report a case of ulnar-sided wrist pain which occurred after four-corner fusion for stage II SNAC wrist with a previously-asymptomatic ulnar positive variance, and was successfully treated by ulnar shortening osteotomy. This case highlights a possible coincidental pathology of the ulnocarpal joint in the setting of post-traumatic radiocarpal arthrosis. PMID:19598323

Gong, Hyun Sik; Jeon, Su Ha; Baek, Goo Hyun



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


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

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



Nerve and Nerve Root Biomechanics  

Microsoft Academic Search

\\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

Kristen J. Nicholson; Beth A. Winkelstein


Sensory handedness is not reflected in cortical responses after basic nerve stimulation: a MEG study.  


Motor dominance is well established, but sensory dominance is much less clear. We therefore studied the cortical evoked magnetic fields using magnetoencephalography (MEG) in a group of 20 healthy right handed subjects in order to examine whether standard electrical stimulation of the median and ulnar nerve demonstrated sensory lateralization. The global field power (GFP) curves, as an indication of cortical activation, did not depict sensory lateralization to the dominant left hemisphere. Comparison of the M20, M30, and M70 peak latencies and GFP values exhibited no statistical differences between the hemispheres, indicating no sensory hemispherical dominance at these latencies for each nerve. Field maps at these latencies presented a first and second polarity reversal for both median and ulnar stimulation. Spatial dipole position parameters did not reveal statistical left-right differences at the M20, M30 and M70 peaks for both nerves. Neither did the dipolar strengths at M20, M30 and M70 show a statistical left-right difference for both nerves. Finally, the Laterality Indices of the M20, M30 and M70 strengths did not indicate complete lateralization to one of the hemispheres. After electrical median and ulnar nerve stimulation no evidence was found for sensory hand dominance in brain responses of either hand, as measured by MEG. The results can provide a new assessment of patients with sensory dysfunctions or perceptual distortion when sensory dominance occurs way beyond the estimated norm. PMID:22080222

Chen, Andrew C N; Theuvenet, Peter J; de Munck, Jan C; Peters, Maria J; van Ree, Jan M; Lopes da Silva, Fernando L



Piriformis syndrome surgery causing severe sciatic nerve injury.  


Piriformis syndrome is a controversial entrapment neuropathy in which the sciatic nerve is thought to be compressed by the piriformis muscle. Two patients developed severe left sciatic neuropathy after piriformis muscle release. One had a total sciatic nerve lesion, whereas the second had a predominantly high common peroneal nerve lesion. Follow-up studies showed reinnervation of the hamstrings only. We conclude that piriformis muscle surgery may be hazardous and result in devastating sciatic nerve injury. PMID:22922582

Justice, Phillip E; Katirji, Bashar; Preston, David C; Grossman, Gerald E



Nerve conduits for nerve reconstruction  

Microsoft Academic Search

Although autogenous nerve grafting remains the gold standard for repair of peripheral nerve defects, the use of various conduits can be a substitute provided these conduits meet the above-mentioned prerequisites. For the moment, autogenous vein grafts or denatured muscle grafts can be used to bridge short defects, especially in distal sensory nerves. Incorporation of muscle into a vein graft expands

Huan Wang; William C. Lineaweaver



Histology and Arthroscopic Anatomy of the Ulnar Collateral Ligament of the Elbow  

Microsoft Academic Search

The histology and arthroscopic anatomy of the ulnar collateral ligament of the elbow were studied in cadav eric specimens. The capsule consists of two layers of collagen fibers, with two distinct ligamentous bundles corresponding to anterior and posterior portions of the ulnar collateral ligament. The posterior bundle consists of distinct collagen bundles within the layers of the cap sule ;

Laura A. Timmerman; James R. Andrews



Sonography of injury of the ulnar collateral ligament of the elbow—initial experience  

Microsoft Academic Search

Objective The purpose of this study is to describe the sonographic appearance of injuries of the ulnar collateral ligament (UCL) of the elbow. Design and patients Eight non-professional male baseball pitchers, ages 13–35 years, with medial elbow pain and clinical suspicion of ulnar collateral ligament injury, were referred for imaging. All eight underwent sonography of the affected and contralateral asymptomatic

Theodore T. Miller; Ronald S. Adler; Lawrence Friedman



The treatment of ulnar impaction syndrome: a systematic review of the literature.  


Ulnar impaction syndrome is a common cause of ulnar-sided wrist pain that is thought to be a result of abutment between the ulna and the ulnar carpus. A systematic review of the literature was conducted to determine the effectiveness of different treatment options in managing ulnar impaction syndrome. PubMed, the Cochrane database, and secondary references were reviewed to identify all English-language articles with reported results on the treatment of ulnar impaction syndrome. A total of 16 articles met the criteria for review. Three procedures were identified as the most commonly used in treating this syndrome: ulnar shortening osteotomy, the wafer procedure, and the arthroscopic wafer procedure. Mean time to union and percentage nonunion for the osteotomy group was 10.3 weeks and 1.7%, respectively. The overall complication rate for patients in the ulnar shortening osteotomy group, the wafer procedure group, and the arthroscopic wafer group was 30%, 8.8%, and 21%, respectively. The authors were unable to determine a single best treatment option based on the available studies, mainly due to the variability in the reporting of subjective outcome measures. Ulnar shortening osteotomy was associated with a higher complication rate than other procedures. PMID:21244809

Katz, David I; Seiler, John G; Bond, T Christopher



Ulnar Shaft Stress Fracture in a High School Softball Pitcher  

PubMed Central

This article presents a case of a 17-year-old softball pitcher with insidious onset of right forearm pain. On presentation, the patient had tenderness on palpation of the midshaft of the ulna, pain with resisted pronation, and pain with fulcrum-type stressing of the forearm. A bone scan revealed increased uptake in the right ulna, and a subsequent magnetic resonance imaging revealed bone marrow edema and numerous small ulnar stress fractures. She was treated with bone stimulation and complete rest and is in the process of returning to pitching.

Bigosinski, Krystian; Palmer, Trish; Weber, Kathleen; Evola, Jennifer



[Therapy of triangular fibrocartilage complex lesions].  


The triangular fibrocartilage complex (TFCC) represents an important anatomical structure interposed between the ulnar carpus and the distal ulnar. Injuries and degenerative changes of the TFCC are of high clinical relevance and there are numerous treatment options available based on different concepts and which are being used to varying extents. The aim of this systematic review was to evaluate the effectiveness of different therapies for lesions of the TFCC. Studies on TFCC lesions were systematically reviewed, classified into evidence levels and selected according to predefined criteria. A total of 259 publications were identified as being potentially relevant and finally 35 studies could be included in the review. In addition, a survey was performed among German hand surgeons in order to identify commonly used procedures for TFCC lesions in Germany. The classification of Palmer is mostly used both in the literature and in Germany and therapeutic decisions are predominantly based on this classification. The systematic review revealed some common treatment strategies for traumatic and degenerative lesions. Generally, the level of evidence was poor for all identified publications. For this reason, evidence-based recommendations for the treatment of TFCC lesions could not be derived from the literature. There was broad consent between the results of the literature review and the survey. PMID:22706650

Schädel-Höpfner, M; Müller, K; Gehrmann, S; Lögters, T T; Windolf, J



The Modified Docking Procedure for Elbow Ulnar Collateral Ligament Reconstruction2Year Follow-up in Elite Throwers  

Microsoft Academic Search

Background: Ulnar collateral ligament injury is most common in the overhead-throwing athlete. Jobe et al published the first report of ulnar collateral ligament reconstruction in throwing athletes with a 62.5% success rate. Recently, Altchek developed a new docking technique for reconstruction of the ulnar collateral ligament. The authors report the first series using a further modification of the docking technique

George A. Paletta; Rick W. Wright



The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius.  


A total of 118 consecutive patients with a fracture of the distal radius were treated with a volar locking plate; 50 patients had no ulnar styloid fracture, 41 had a basal ulnar styloid fracture, and 27 had a fracture of the tip of the ulnar styloid. There were no significant differences in radiological and clinical results among the three groups. The outcome was good and was independent of the presence of a fracture of the ulnar styloid. A total of five patients (4.2%) had persistent ulnar-sided wrist pain at final follow-up. Nonunion of the ulnar styloid fracture did not necessarily lead to ulnar wrist pain. Patients with persistent ulnar pain had a higher mean initial ulnar variance and increased post-operative loss of ulnar variance. The presence of an associated ulnar styloid fracture of the ulnar styloid does not adversely affect the outcome in patients with a fracture of the distal radius treated by volar plating. PMID:19092013

Zenke, Y; Sakai, A; Oshige, T; Moritani, S; Nakamura, T



Ulnar buttress arthroplasty after enbloc resection of a giant cell tumor of the distal ulna  

PubMed Central

Enbloc resection with or without ulnar stump stabilization is the recommended treatment for giant cell tumors (GCT) of the distal ulna. A few sporadic reports are available where authors have described various procedures to prevent ulnar stump instability and ulnar translation of carpal bones. We report a GCT of the distal ulna in a 43-year-old male which was resected enbloc. The distal radioulnar joint was reconstructed by fixing an iliac crest graft to the distal end of the radius (ulnar buttress arthroplasty) and the ulnar stump was stabilized with extensor carpi ulnaris tenodesis. After a followup at three years, there was no evidence of tumor recurrence or graft resorption; the patient had a normal range of movement of the wrist joint and the functional outcome was excellent as per the score of Ferracini et al.

Naik, Monappa A; Sujir, Premjit; Rao, Sharath K; Tripathy, Sujit K



Cranial Nerve II  

PubMed Central

This article contains a brief review of the anatomy of the visual system, a survey of diseases of the retina, optic nerve and lesions of the optic chiasm, and other visual field defects of special interest to the psychiatrist. It also includes a presentation of the corticothalamic mechanisms, differential diagnosis, and various manifestations of visual illusions, and simple and complex visual hallucinations, as well as the differential diagnoses of these various visual phenomena.

Gillig, Paulette Marie; Sanders, Richard D.



Peripheral Nerve Tumors  

Microsoft Academic Search

\\u000a Peripheral nerve tumors (PNTs) are rare soft tissue lesions that can arise anywhere on the body and as a result have a wide\\u000a differential diagnosis, which is often confirmed to be a PNT only at surgery. PNTs occur both sporadically and within the\\u000a context of genetically predisposing syndromes; hence, a thorough history of the mass and associated symptoms, with a

Joseph Wiley; Asis Kumar Bhattacharyya; Gelareh Zadeh; Patrick Shannon; Abhijit Guha


[Femoral nerve palsy as delayed complication after total hip replacement: delayed hematoma formation in unexpected screw malpositioning].  


Nerve injury after total hip replacement is a rare but severe complication. If the nerve lesion becomes evident in the early postoperative phase the lesion is often due to an incorrect implant position, direct nerve injury or vascular injury with manifestation of a hematoma which results in nerve compression. Secondary nerve lesions are more often due to a chronic hematoma with nerve compression. Secondary nerve lesions in particular are often a diagnostic challenge and should lead to an early revision after comprehensive imaging diagnostics. PMID:23695194

Fritzsche, H; Kirschner, S; Hartmann, A; Hamann, C



In vivo nerve-macrophage interactions following peripheral nerve injury  

PubMed Central

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.

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



In vivo nerve-macrophage interactions following peripheral nerve injury.  


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 Wld(s) 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

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



Ulnar nerve compression possibly due to aberrant veins: sonography is elucidatory for idiopathic cubital tunnel syndrome  

Microsoft Academic Search

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

Erkan K?l?ç; Levent Özçakar



Physique as a risk factor for ulnar variance in elite female gymnasts.  


The aims of this study were: 1) to determine ulnar variance variability of elite, female gymnasts; 2) to evaluate the relationship between ulnar variance and physique, maturity status, and training characteristics of these gymnasts. All 156 skeletally immature female gymnasts were participants at the World Championships Artistic Gymnastics, Rotterdam, The Netherlands, in 1987. Chronological ages varied between 13.1 and 20.6 yr (mean = 15.9 +/- 1.3 yr). A large set of anthropometric dimensions was taken and somatotype was determined by the Heath-Carter technique. Skeletal age was assessed by the Tanner-Whitehouse II method. Menarcheal status and training data were collected by questionnaire. Ulnar variance was determined according to Hafner et al. Gymnasts differ significantly from reference girls with respect to physique and maturational status: gymnasts were smaller and delayed in skeletal maturity with about 1.5 yr. For those who had attained menarche, mean age at menarche was 15.1 +/- 1.3 yr. Ulnar variance shows a normal distribution in the gymnasts, ranging from -10.5 mm to +5.9 mm, which is somewhat more positive, i.e., an ulnar overgrowth, than reference wrists. The relationship between ulnar variance and somatic and maturational features suggests that female gymnasts who are more mature and have a physique characterized as relatively tall with a high lean body mass are at greater risk for developing a positive ulnar variance. No relationship between ulnar variance and training characteristics was evident. It is concluded that the observed positive ulnar variance in this sample of elite female gymnasts is less pronounced than originally stated in most "case reports." PMID:9148084

Claessens A, L; Lefevre, J; Beunen, G; De Smet, L; Veer, A M



Laparoscopic obturator nerve neurolysis after pelvic lymphadenectomy  

Microsoft Academic Search

Postoperative neuropathy is a known complication of major pelvic oncologic surgery. Obturator nerve injury complicating pelvic lymph node dissection has been reported in the literature. Severity and duration of symptoms are determined by the severity of the initial nerve lesion. Different management options have been described in the literature. We report here on a patient who developed right obturator neuropathy

Arash Rafii; Denis Querleu



Acute Ulnar Shortening for Delayed Presentation of Distal Radius Growth Arrest in an Adolescent  

PubMed Central

Distal radius physeal fractures are common in children and adolescents. However, posttraumatic growth arrest is uncommon. The management of posttraumatic growth arrest is dependent on the severity of the deformity and the remaining growth potential of the patient. Various treatment options exist. We present a 17-year-old male with distal radius growth arrest who presented four years after the initial injury. He had a symptomatic 15?mm positive ulnar variance managed with an ulnar shortening osteotomy with the use of the AO mini distractor intraoperatively. To the best of our knowledge, an acute ulnar shortening of 15?mm is the largest reported.

Ellanti, Prasad; Harrington, Paul



Madelung Deformity: Surgical Prophylaxis (Physiolysis) During the Late Growth Period by Resection of the Dyschondrosteosis Lesion  

Microsoft Academic Search

The majority of cases of Madelung deformity are caused by hereditary dyschondrosteosis at the wrist. The principal lesion in the ulnar zone of the distal radial physis retards growth asymmetrically, especially in late childhood. Resection of this zone and its replacement with autologous fat (Langenski?ld procedure, or physiolysis) restores growth and minimizes deformity. The resection of an abnormal ligament tethering




Current Concepts in Rehabilitation Following Ulnar Collateral Ligament Reconstruction  

PubMed Central

Injuries to the ulnar collateral ligament (UCL) in throwing athletes frequently occurs from the repetitive valgus loading of the elbow during the throwing motion, which often results in surgical reconstruction of the UCL requiring a structured postoperative rehabilitation program. Several methods are currently used and recommended for UCL reconstruction using autogenous grafts in an attempt to reproduce the stabilizing function of the native UCL. Rehabilitation following surgical reconstruction of the UCL begins with range of motion and initial protection of the surgical reconstruction, along with resistive exercise for the entire upper extremity kinetic chain. Progressions for resistive exercise are followed that attempt to fully restore strength and local muscular endurance in the rotator cuff and scapular stabilizers, in addition to the distal upper extremity musculature, to allow for a return to throwing and overhead functional activities. Rehabilitation following UCL reconstruction has produced favorable outcomes, allowing for a return to throwing in competitive environments.

Ellenbecker, Todd S.; Wilk, Kevin E.; Altchek, David W.; Andrews, James R.



Fixation strength of the ulnar component of total elbow replacement.  


After clinical failure of ulnar component fixation by olecranon fracture occurred, this study examined different component designs to find the strongest type. Components requiring square cuts or rounded cuts to prepare the proximal ulna with short or long stems of polyethylene or metal were implanted in paired cadaver bones and tested to failure. Loads were applied through the articular surface in an anterior-posterior direction, causing bending fracture of the olecranon. The main findings were a higher strength if the bone was prepared to take a rounded rather than a square-shaped prosthesis body, a slightly higher strength with a metal component compared with a similarly shaped polyethylene component, and slightly less strength if a longer stem was used. We recommend the use of a polyethylene component with a rounded shape and short stem, because it will be thinner, entailing less bone excavation. Additionally, it is less costly than a metal-backed design. PMID:8742872

Zafiropoulos, G; Amis, A A


Unilateral Abducens Nerve Palsy as an Early Feature of Multiple Mononeuropathy Associated with Anti-GQ1b Antibody  

PubMed Central

Patients with anti-GQ1b antibody syndrome show various combinations of ophthalmoplegia, ataxia, areflexia, or altered sensorium as clinical features. We describe herein a unique case with unilateral abducens nerve palsy as an early feature of multiple mononeuropathy involving dysfunctions of the inferior dental plexus and the ulnar nerve, which was thought to be associated with anti-GQ1b antibody. A 27-year-old man presented with acute-onset diplopia. He subsequently experienced numbness not only in the right lower teeth and gums but also on the ulnar side of the left hand. Neurological examinations revealed dysfunctions of the right abducens nerve, the right inferior dental plexus, and the left ulnar nerve, suggesting multiple mononeuropathy. Serum anti-GQ1b antibody was positive. This is a rare case report of a patient with unilateral abducens nerve palsy as an early feature of multiple mononeuropathy associated with anti-GQ1b antibody. We suggest that anti-GQ1b antibody syndrome should be taken into consideration as a differential diagnosis of acute multiple mononeuropathy if ophthalmoplegia is present unilaterally.

Kinno, Ryuta; Ichikawa, Hiroo; Tanigawa, Hiroto; Itaya, Kazuhiro; Kawamura, Mitsuru



[Results of regeneration after peripheral nerve injuries].  


Based on a group of distal injuries of the median and ulnar nerve the authors evaluate the results of peripheral nerve regeneration. For evaluation of the results and comparison with other work they emphasize the necessity of adherence to objective criteria of a useful degree of reinnervation. In their opinion the most suitable criterium is evaluation of sensitive reinnervation respecting the discrimination test up to 12 mm in the entire autozone of the nerve. The results of suture depend on the technique, interval (injury-operation) and the patient's age. In acute operations 45% of the patients of all age groups achieved the useful grade of sensitive regeneration. In late operations, where the degree of useful regeneration was achieved only in 19% of patients, the authors draw attention to the fact that a successful outcome was achieved only in patients under 30 years. The main prerequisite of successful regeneration of peripheral nerves in according to the authors early diagnosis and treatment in the acute period. With regard to the declining regeneration potential with advancing age early treatment is much more important in patients older than 30 years. Microsurgical technique is a condition sine qua non. PMID:8310332

Sames, M; Benes, V



The recurrent laryngeal nerve (RLN): application to transhiatal oesophagectomy  

Microsoft Academic Search

To emphasize the risks of recurrent laryngeal nerve lesions during transhiatal oesophagectomy an anatomical study of the course of the recurrent laryngeal nerve (RLN) was performed. Twenty RLN were dissected in their thoracic portion. This work showed the constancy of the low origin of the nerve in the adult under the aortic arch, and its course in the tracheal angle.

A. Dia; D. Valleix; B. Dixneuf; D. Philippi; B. Descottes; M. Caix; A. Ndiaye; M. L. Sow



Investigation of Conduction Velocity of Peripheral Nerves in Diabetes Mellitus.  

National Technical Information Service (NTIS)

In patients with diabetes mellitus with peripheral nerve lesions the velocity of spread of excitation along the motor fibers of these nerves is reduced. This decrease is seen in some patients in clinically intact nerves, and it is intensified with an incr...

V. M. Prikhozhan L. V. Soloveva



Ulnar shortening after failed arthroscopic treatment of triangular fibrocartilage complex tears.  


Ulnar shortening osteotomy was performed in 11 wrists with ulnar abutment syndrome, after failed arthroscopic surgery on the TFCC (ten debridements, one repair). A delayed union was present in three, a non-union occurred in two, of whom one needed a revision and grafting procedure. According to the Mayo wrist score, only four had an acceptable outcome. Patient's satisfaction was higher: seven were satisfied, four were not. The postoperative wrist pain score was good in ten patients. Overall outcome was not very successful. Problems related to the procedure could be avoided by adapting the technique (oblique osteotomy, palmar placement of the plate, and compression devices). The key statement remains however to us; ulnar sided wrist pain thought to be caused by an ulnar abutment is not necessarily resolved by decompressing the ulnocarpal joint. PMID:11723772

Van Sanden, S; De Smet, L



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

Code of Federal Regulations, 2013 CFR

...hemi-wrist) polymer prosthesis. (a) Identification. A wrist joint ulnar (hemi-wrist) polymer prosthesis is a mushroom-shaped device made of a medical grade silicone elastomer or ultra-high molecular weight polyethylene intended to...



Isolated lateral pectoral nerve injury: trauma from a seat belt.  


A 35-year-old man sustained an isolated injury to the lateral pectoral (anterior thoracic) nerve as the result of a seat belt injury. This resulted in atrophy of the clavicular head of the pectoralis major. Electromyography confirmed localized abnormal findings in this muscle and an isolated lesion of the lateral pectoral nerve, the first reported case of such a lesion. PMID:2923545

Marrero, J L; Goldfine, L J



Pinched Nerve  


... take about one hour: Nerve conduction study. Patch-style electrodes are placed on your skin to stimulate ... not-for-profit organization and proceeds from Web advertising help support our mission. Mayo Clinic does not ...


Nerve Injuries  


... educated." After the nerve has recovered, sensory re-education may be needed to improve feeling to the hand or finger. This involves physician therapy and the appropriate therapy based on the nature of the injury will be recommended ...


Nerve conduction  

MedlinePLUS Videos and Cool Tools

... fascicles) that contain hundreds of individual nerve fibers (neurons). Neurons consist of dendrites, axon, and cell body. The ... tree-like structures that receive signals from other neurons and from special sensory cells that sense the ...


Lesions in Nerves and Plexus after Radiotherapy.  

National Technical Information Service (NTIS)

Apart from the typical, radiation-induced changes in the skin, common secondary findings were oedemas, radiation-induced ulceration, fibroses of the mediastinum and lungs, pleura adhesions, and osteoradionecroses. In one patient with radiogenic paresis of...

W. Vees



Periprosthetic bone resorption and sigmoid notch erosion around ulnar head implants: a concern?  


Metallic ulnar head implants have been proposed not only to solve symptomatic radioulnar impingement after Darrach or Sauvé-Kapandji procedures, but also to prevent such an impingement when treating arthritic distal radioulnar joint. This article prospectively analyzes a series of ulnar head implants with special reference to bone resorption at the prosthesis collar and erosion of the sigmoid notch of the distal radius at an average follow-up of 32 months (minimum 24 months). PMID:20951906

Herzberg, Guillaume



Anatomic basis of ulnar index metacarpal reverse flow vascularized bone graft for index distal bone loss  

Microsoft Academic Search

Well-known advantages of vascularized bone grafts led us to determine the anatomical basis of a metacarpal vascularized bone\\u000a graft to find a solution for distal index bone loss. Seventeen adult human hands from fresh cadavers were dissected and analyzed.\\u000a For each hand, we studied the second dorsal metacarpal artery, the ulnar dorsal proper digital artery of index, and the ulnar

L. Ardouin; D. Le Nen; B. Geffard; N. Hanouz; C. Vielpeau; E. Salame



Ulnar Collateral Ligament Reconstruction in High School Baseball PlayersClinical Results and Injury Risk Factors  

Microsoft Academic Search

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

Damon H. Petty; James R. Andrews; Glenn S. Fleisig; E. Lyle Cain



Time course of induction of increased human motor cortex excitability by nerve stimulation.  


Manipulation of afferent input induces changes in the excitability and organisation of human corticomotor representations. These changes are generally short lived, although can be prolonged by repetition. Here, we charted the time-course of the change of motor cortex excitability induced by electrical stimulation of radial and ulnar nerves. Corticomotor excitability was evaluated by measuring the amplitude of the motor evoked potentials in the first dorsal interosseous muscle by transcranial magnetic stimulation of the optimal cortical area. Measurements were carried out before the start of peripheral nerve stimulation, and then during the peripheral nerve stimulation at 15 min intervals over a period of 2 h. The amplitudes of the motor evoked potentials significantly increased during the 2 h period of peripheral nerve stimulation. Cortical excitability peaked after about 45-60 min stimulation. These clear-cut changes in cortical excitability following peripheral nerve stimulation may reveal some of the mechanisms underlying motor learning and cortical plasticity. PMID:12151785

McKay, Darrin; Brooker, Raylene; Giacomin, Paul; Ridding, Michael; Miles, Timothy



Chronic constriction model of rat sciatic nerve: nerve blood flow, morphologic and biochemical alterations  

Microsoft Academic Search

We evaluated the nerve blood flow (NBF), light and electron microscopy, and adrenergic innervation of rat sciatic nerve at\\u000a 2–45 days after the application of four loose ligatures. Ischemia developed at the lesion edge, creating an endoneurial dam.\\u000a Calcitonin gene-related peptide, norepinephrine and NBF were increased within the lesion. Morphologic alterations consisted\\u000a of early endoneurial edema, followed by myelinated fiber

Hideyuki Sasaki; Mikihiro Kihara; Paula J. Zollman; Kim K. Nickander; Inge L. Smithson; James D. Schmelzer; Catherine L. Willner; Eduardo E. Benarroch; Phillip A. Low



Pharmacological characterisation of the spared nerve injury model of neuropathic pain  

Microsoft Academic Search

The spared nerve injury (SNI) model involves a lesion of two of the three terminal branches of the sciatic nerve (tibial and common peroneal nerves) leaving the sural nerve intact. The changes in pain-like sensation of the injured animals appear to correlate with a number of symptoms presented in human patients with neuropathic pain syndromes. In order to characterise the

Helle Kirstein Erichsen; Gordon Blackburn-Munro



Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears.  


Ulnar-sided wrist pain is a common cause of upper extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Because of its overlapping anatomy, complex differential diagnosis, and varied treatment outcomes, the ulnar side of the wrist has been referred to as the "black box" of the wrist, and its pathology has been compared with low back pain. Common causes of ulnar-sided wrist pain include triangular fibrocartilaginous complex injuries, lunotriquetrial ligament injuries, and ulnar impaction syndrome. PMID:22721461

Sachar, Kavi



Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears.  


Ulnar-sided wrist pain is a common cause of upper-extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Because of its overlapping anatomy, complex differential diagnosis, and varied treatment outcomes, the ulnar side of the wrist has been referred to as the "black box" of the wrist, and its pathology has been compared with that of low back pain. Common causes of ulnar-sided wrist pain include triangular fibrocartilage complex injuries, lunotriquetral ligament injuries, and ulnar impaction syndrome. PMID:18984356

Sachar, Kavi



Darrach's ulnar resection and ulna intercalary bone graft for non-union of the distal radius: two birds one shot  

Microsoft Academic Search

The authors report a painful non-union of the distal radius in a 28-year-old man who sustained a gunshot wound to his distal\\u000a forearm at the age of 13. The non-union was complicated with dislocation of the distal radio-ulnar joint (DRUJ) and ulnar\\u000a impaction. The non-union was reconstructed 15 years after the initial injury with Darrach ulnar shortening and ulnar intercalary\\u000a bone

Iulian NusemAli; Ali Kalhor Moghaddam



Ulnar collateral ligament injury of the thumb metacarpophalangeal joint.  


Injury to the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint is a common entity encountered by the sports physician and orthopedic surgeon. The term "gamekeeper's thumb," which is sometimes used incorrectly to mean any injury to this ligament, refers to a chronic injury to the UCL in which it becomes attenuated through repetitive stress. In contrast, the term "skier's thumb" refers to an acute ligament injury as seen in skiers who fall on an abducted thumb or athletes who sustain a valgus force on an abducted thumb. If the patient allows a clinical examination, valgus stress testing can diagnose a complete UCL rupture when there is no solid endpoint with the thumb held in 30 degrees of MCP flexion and with the thumb held in extension. In cases with complete UCL tears, operative treatment has been shown to produce excellent results and is recommended. If there is a firm endpoint to valgus stress testing, a partial UCL tear is diagnosed and nonoperative treatment usually favored. PMID:20215892

Ritting, Andrew W; Baldwin, Paul C; Rodner, Craig M



Spinal Cord and Nerve Root Decompression  

Microsoft Academic Search

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

Keith R. Lodhia; Paul Park; Gregory P. Graziano


Contribution of collateral sprouting to the sensory and sudomotor recovery in the human palm after peripheral nerve injury.  


The contribution of collateral sprouting to the sensory and sudomotor recovery was studied in 52 patients aged 3-66 years (mean 35.5 years) from 2 to 9 years following nerve injury and repair. The study included three groups of patients: (1) patients with complete division of median and ulnar nerves (skin reinnervation exclusively due to axon regeneration), (2) patients with isolated division of ulnar or median nerve (skin reinnervation due to axon regeneration and possible collateral sprouting), and (3) patients in whom injured axons failed to regenerate (skin reinnervation exclusively due to collateral sprouting). The end stage of sensory and sudomotor recovery was studied by: clinical methods, sensory nerve action potential (SNAP) measurements, sympathetic skin response (SSR) and the ninhydrin test. We found that recovery of sensory and sudomotor function in groups 1 and 2 was similar. End-stage sudomotor and sensory recovery within the autonomous area of the nerve did not depend on possible collateral reinnervation. Collateral reinnervation from the uninjured nerve was limited to the border innervation area of the palm and ring finger. Adjacent uninjured nerve may contribute to sprouting of nociceptive axons providing a protective function. PMID:9849363

Ahcan, U; Arn?z, Z M; Bajrovi?, F; Janko, M



Nerve Racking  

NSDL National Science Digital Library

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.

Integrated Teaching And Learning Program


Effects of melatonin on peripheral nerve regeneration.  


In the available literature, there are thousands of studies on peripheral nerve regeneration using many nerves of several animals at different ages with various types of lesions and different methods of evaluation at certain time of follow-up. Despite many experimental data and clinical observations, there is still no ideal treatment method enhancing peripheral nerve regeneration. In clinical practice, various types of surgical nerve repair techniques do not frequently result in complete recovery due to neuroma formation, lipid peroxidative damage, ischemia and other factors. Recently, a number of neuroscientists demonstrated that pineal neurohormone melatonin (MLT) has an effect on the morphologic features of the nerve tissue, suggesting its neuroprotective, free radical scavenging, antioxidative, and analgesic effects in degenerative diseases of peripheral nerves. At present, it is widely accepted that MLT has a useful effect on axon length and sprouting after traumatic events to peripheral nerves. Our studies using various experimental injury models clearly suggest positive effects of MLT on the number of axons, thickness of myelin sheath by inhibition of collagen accumulation and neuroma formation following traumatic events to peripheral nerves, myelination of developing peripheral nerve after intrauterine ethanol exposure. Nevertheless, further experimental and randomized controlled clinical studies are vital to identify the clinical use of MLT hormone. This is an overview of recent patents and current literature in terms of the effects of MLT on peripheral nerve regeneration based on a critical analysis of electrophysiological, biochemical and light and electron microscopic findings, in addition to functional observations. PMID:22074585

Turgut, Mehmet; Kaplan, Süleyman



Trigeminal neuralgia and facial nerve paralysis.  


The trigeminal nerve is the largest of the cranial nerves. It provides sensory input from the face and motor innervation to the muscles of mastication. The facial nerve is the cranial nerve with the longest extracranial course, and its main functions include motor innervation to the muscles of facial expression, sensory control of lacrimation and salivation, control of the stapedial reflex and to carry taste sensation from the anterior two-thirds of the tongue. In order to be able adequately to image and follow the course of these cranial nerves and their main branches, a detailed knowledge of neuroanatomy is required. As we are dealing with very small anatomic structures, high resolution dedicated imaging studies are required to pick up normal and pathologic nerves. Whereas CT is best suited to demonstrate bony neurovascular foramina and canals, MRI is preferred to directly visualize the nerve. It is also the single technique able to detect pathologic processes afflicting the nerve without causing considerable expansion such as is usually the case in certain inflammatory/infectious conditions, perineural spread of malignancies and in very small intrinsic tumours. Because a long course from the brainstem nuclei to the peripheral branches is seen, it is useful to subdivide the nerve in several segments and then tailor the imaging modality and the imaging study to that specific segment. This is particularly true in cases where topographic diagnosis can be used to locate a lesion in the course of these nerves. PMID:15690205

Borges, Alexandra



Osteoid osteoma of the hamate: an unusual cause of ulnar-sided wrist pain.  


Ulnar-sided wrist pain is a common complaint that presents a diagnostic challenge. Determining the cause of ulnar-sided wrist pain is difficult, largely due to the complexity of the anatomic and biomechanical properties of the ulnar side of the wrist. Osteoid osteoma is a benign skeletal neoplasm of unknown etiology that is composed of osteoid and woven bone. Its incidence is 11% of benign tumors and 3% of all primary bone tumors, with 6% to 13% of all cases occurring in the hand. Osteoid osteoma of the hamate can produce ulnar-sided wrist pain in the dorsal or volar aspect of the wrist, depending on the location of the tumor in the bone. In its classical and most frequent form, the osteoma may settle in the cortex or the spongiosa. A third rare form appears subperiosteally. Occasionally it destroys the articular cartilage by erosion or penetration. Most of the tumors will produce dorsal pain. A tumor located in the hook will produce volar pain. This article describes a case of ulnar-sided wrist pain due to a rare case of osteoid osteoma of the hamate. We recommend marking the nidus with a needle intraoperatively with the aid of radiography. PMID:20608627

Rubin, Guy; Wolovelsky, Alejandro; Rinott, Micha; Rozen, Nimrod



[The electroneuromyographic study of the radial nerve: compressive ischemic neuropathy of the posterior interosseous nerve].  


The electroneuromyographic study of the posterior interosseous nerve (PIN) with determination of conduction block (CB) at the level of the upper third of the forearm using the surface electrodes has been carried out. Seven healthy volunteers, 22 patients with compressive-ischemic neuropathy (CIN) at the level of the supinator, 14 patients with the total affection of the radical nerve, aged from 21 to 64 years, have been studied. The M-response has been recorded from the extensor digitorum communis. Stimulation has been performed at: (1) the middle of the forearm; (2) the lateral brachium; (3) the axillary crease; (4) the Erb's point; (5) the sulcus of ulnar nerve; (6) the cubital flexion; (7) the inner part of the shoulder. A method of stepwise stimulation has been used in the segment "a middle third of the forearm--a middle third of the shoulder". The M-responses of similar shape and amplitude have been recorded by stimulation of the first and second points in the controls. The M-responses recorded by stimulation of the brachial plexus were higher by average of 44,2% compared to the radical nerve in the shoulder area. The focal CB was found between two stimulation points in 86,4% of patients with PIN CIN that was confirmed by the method of stepwise nerve stimulation as well. The correlation between CB and the data of the global electromyogram was revealed. In patients with the total affection of the radical nerve, the M-responses during stimulation of distal and proximal PIN points were absent and the similar M-responses were recorded by stimulation of the brachial plexus (the Erb's point and the axillary crease) as well as the inner part of the shoulder. PMID:18833118

Khodulev, V I; Nechipurenko, N I; Antonov, I P; Arkind, G D



Peripheral nerve regeneration through optic nerve grafts  

Microsoft Academic Search

Grafts of optic nerve were placed end-toend with the proximal stumps of severed common peroneal nerves in inbred mice. It was found that fraying the proximal end of adult optic nerve grafts to disrupt the glia limitans increased their chances of being penetrated by regenerating peripheral nerve fibres. Suturing grafts to the proximal stump also enhanced their penetration by axons.

P. N. Anderson; P. Woodham; M. Turmaine



The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain.  


Forty-five patients with persistent ulnar-sided wrist pain and a positive ulnocarpal stress test were investigated by X-ray, arthrography, 99mTechnetium bone scanning, magnetic resonance imaging and wrist arthroscopy. Ulnar wrist pathology was positively identified in nine of 45 patients by X-ray, 18 of 37 by arthrography, 19 of 27 by bone scan, four of 33 by MRI, and in all 45 patients by arthroscopy. The final diagnosis was ulnocarpal abutment syndrome in 28 patients, traumatic triangular fibrocartilage (TFC) tear in six, lunotriquetral (LT) ligament tear in five, TFC and LT ligament tear in one, wrist arthritis in four and cartilaginous free body in one. The ulnocarpal stress test is a useful provocative test, and a positive test suggests the presence of ulnar-sided wrist pathology. The test is sufficiently sensitive to warrant further investigation by arthroscopy. PMID:9457572

Nakamura, R; Horii, E; Imaeda, T; Nakao, E; Kato, H; Watanabe, K



Preoperative Evaluation of the Ulnar Collateral Ligament by Magnetic Resonance Imaging and Computed Tomography ArthrographyEvaluation in 25 Baseball Players with Surgical Confirmation  

Microsoft Academic Search

A prospective study was completed on 25 baseball play ers with medial side elbow pain. They were evaluated preoperatively with both computed tomography arthro gram and magnetic resonance imaging examinations of the elbow to assess the ulnar collateral ligament. At surgery, 16 of 25 patients had an abnormal ulnar col lateral ligament and 9 patients had a normal ulnar col

Laura A. Timmerman; Martin L. Schwartz; James R. Andrews



Blue lesions.  


Blue color is found in a wide range of malignant and benign melanocytic and nonmelanocytic lesions and in lesions that result from penetration of exogenous materials, such as radiation or amalgam tattoo or traumatic penetration of particles. Discriminating between different diagnostic entities that display blue color relies on careful patient examination and lesion assessment. Dermoscopically, the extent, distribution, and patterns created by blue color can help diagnose lesions with specificity and differentiate between benign and malignant entities. This article provides an overview of the main diagnoses whereby blue color can be found, providing simple management rules for these lesions. PMID:24075551

Longo, Caterina; Scope, Alon; Lallas, Aimilios; Zalaudek, Iris; Moscarella, Elvira; Gardini, Stefano; Argenziano, Giuseppe; Pellacani, Giovanni



MRI follow-up after free tendon graft reconstruction of the thumb ulnar collateral ligament  

Microsoft Academic Search

Objective  Our aim was to analyse whether MRI is useful in the follow-up of reconstruction of the ulnar collateral ligament (UCL) of\\u000a the metacarpophalangeal joint of the thumb, to describe normal postoperative findings, and to evaluate different MR sequences.\\u000a \\u000a \\u000a \\u000a \\u000a Material and Methods  Our study material consists of 10 patients who, because of a chronic rupture of the ulnar collateral ligament of the

M. Lohman; J. Vasenius; O. Nieminen; L. Kivisaari



Deep peroneal nerve transfer for established plantar sensory loss.  


Patients with established or irreversible plantar sensory loss often have normal sensation on the dorsal aspect of the foot, due to an intact deep peroneal nerve. A new method of deep peroneal nerve transfer is proposed for repair of plantar sensory loss caused by extensive nerve gaps or high-level lesions of the posterior tibial nerve. Two cases in which this technique was used are described. The surgical technique is relatively easy, with a short operating time, rapid nerve regeneration after surgery, accurate sensory recovery, and minimal donor-site morbidity with sensory loss only on the first web space of the foot. PMID:14634907

Koshima, Isao; Nanba, Yuzaburo; Tsutsui, Tetsuya; Takahashi, Yoshio



Nerve regeneration using tubular scaffolds from biodegradable Polyurethane  

Microsoft Academic Search

\\u000a \\u000a Introduction  In severe nerve lesion, nerve defects and in brachial plexus reconstruction, autologous nerve grafting is the golden standard.\\u000a Although, nerve grafting technique is the best available approach a major disadvantages exists: there is a limited source\\u000a of autologous nerve grafts.\\u000a \\u000a This study presents data on the use of tubular scaffolds with uniaxial pore orientation from experimental biodegradable polyurethanes\\u000a coated with

T. Hausner; R. Schmidhammer; S. Zandieh; R. Hopf; A. Schultz; S. Gogolewski; H. Hertz; H. Redl


Considerations in nerve repair  

Microsoft Academic Search

ome nerve injuries require repair in order to regain sen- sory or motor function. Although this article focuses pri- marily on trigeminal nerve (TN) injuries and repairs, the facts presented may apply to any peripheral nerve repair. The primary indications for nerve repair or grafting are 1) an injury or continuity defect in a nerve, as a result of trauma,



Nerve conduction velocity  


Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve. ... travel between electrodes are used to determine the speed of the nerve signals. Electromyography (recording from needles ...


Extensor Loop Operation for Traumatic and Spontaneous Ulnar Dislocation of the Extensor Tendons  

Microsoft Academic Search

Dislocation of the extensor digitorum communis tendon over the metacarpophalangeal joint is a rare problem with patients without rheumatoid disorders. We report 3 patients with ulnar dislocation of the extensor tendons due to different causes. One of these cases was classified as a spontaneous dislocation and the other two as post-traumatic episodes. All patients were successfully treated by extensor loop

Chia-Jueng Chuang; Tim-Mo Chen; Hsian-Jenn Wang; Tian-Yeu Cheng


Glenohumeral Internal Rotation Deficits in Baseball Players With Ulnar Collateral Ligament Insufficiency  

Microsoft Academic Search

Background: The kinetic chain of the throwing motion functions to optimize efficiency of proximal segments to decrease force loads seen at smaller, distal segments such as the ulnar collateral ligament. Several studies have shown that shoulder internal rotation forms the physiologic counter to the valgus torque generated during the late cocking phase of throwing. Previous studies have implicated decreased glenohumeral

Joshua S. Dines; Joshua B. Frank; Meredith Akerman; Lewis A. Yocum



Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers  

Microsoft Academic Search

Sonography is a valuable method for imaging superficial tendons and ligaments. The ability to obtain comparison images easily with dynamic stress allows assessment of ligament and tendon integrity. We studied the medial elbow joints of two baseball pitchers using MR imaging and dynamic sonography. Both sonography and MR imaging identified the ulnar collateral ligament tears. Dynamic sonography uniquely demonstrated the

Arthur A. De Smet; Thomas C. Winter; Thomas M. Best; David T. Bernhardt



Valgus Laxity of the Ulnar Collateral Ligament of the Elbow in Collegiate Athletes  

Microsoft Academic Search

In this investigation, we determined the patterns of valgus laxity and acquired valgus laxity of the ulnar collateral ligament in the elbows of collegiate athletes involved in overhead and nonoverhead sports. Acquired valgus laxity of the elbow is defined as the differential amount of stress valgus opening between the dominant and nondominant elbows. Forty-eight asymptomatic male athletes involved in sports

Hardayal Singh; Daryl C. Osbahr; M. Quinn Wickham; Donald T. Kirkendall; Kevin P. Speer



Elbow Ulnar Collateral Ligament Reconstruction in Javelin Throwers at a Minimum 2Year Follow-up  

Microsoft Academic Search

Background: There are several large series of outcomes after ulnar collateral ligament (UCL) reconstruction that have 1 or 2 javelin throwers included. To our knowledge, however, there are no reports that focus solely on the results of UCL reconstruction in this group of athletes.Hypothesis\\/Purpose: We hypothesize that by using modern UCL reconstruction techniques, javelin throwers can reliably expect to return

Joshua S. Dines; Kristofer J. Jones; Cynthia Kahlenberg; Andrew Rosenbaum; Daryl C. Osbahr; David W. Altchek




Microsoft Academic Search

Five cases of symptomatic acquired positive ulnar variance are described. All cases occurred due to premature physeal closure of the growth plate in teenage girl gymnasts. All cases demonstrated ulnocarpal impingement, for which we describe a clinical test.Arthroscopic assessment of the wrist allowed us to assess the integrity of the TFCC (triangular fibrocartilaginous complex) and decide on the most appropriate




Comminuted fracture of the ulnar carpal bone in a Labrador retriever dog.  


A 4-year-old male Labrador retriever dog was evaluated for acute lameness without weight-bearing in the right forelimb after an 8-meter fall. Radiographs revealed a comminuted fracture of the ulnar carpal bone that required removal of bone fragments. This appears to be the first report of such a condition. PMID:24179242

Vedrine, Bertrand



Neuroprotection of nerve growth factor-loaded microspheres on the D2 dopaminergic receptor positive-striatal neurones in quinolinic acid-lesioned rats: a quantitative autoradiographic assessment with iodobenzamide  

Microsoft Academic Search

Huntington's disease (HD) results from the degeneration of striatal neurones, mainly ?-aminobutyric acid (GABA)ergic projection neurones and lately cholinergic interneurones. The use of trophic factors as agents able to prevent such neural degeneration is a promising strategy. The aim of this study was to validate nerve growth factor-loaded (NGF-loaded) poly-d,l-lactide-co-glycolide (PLGA) microspheres for treatment of HD in a rat model

Christelle Gouhier; Sylvie Chalon; Marie-Claire Venier-Julienne; Sylvie Bodard; Jean-Pierre Benoit; Jean-Claude Besnard; Denis Guilloteau



Isolated third cranial nerve palsy: a rare presentation of neurocysticercosis.  


Isolated third cranial nerve palsy is usually due to vascular causes like posterior communicating artery aneurysm and it is rare in neurocysticercosis. Third cranial nerve palsy in neurocysticercosis is usually caused by supratentorial or sub-arachnoid lesions with accompanying hydrocephalus or meningitis. We report a patient who presented with isolated third cranial nerve palsy without any other brainstem signs caused by neurocysticercosis involving the midbrain. PMID:19340520

Ranjith, M P; Divya, R; Sahni, A



Nerve Impulses in Plants  

ERIC Educational Resources Information Center

|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)|

Blatt, F. J.



Nerve Impulses in Plants  

ERIC Educational Resources Information Center

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)

Blatt, F. J.



Peripheral Third Cranial Nerve Enhancement in Multiple Sclerosis  

Microsoft Academic Search

Summary: Cranial nerve III dysfunction in multiple scle- rosis (MS) is uncommon. Seven cases of isolated cranial nerve III paresis associated with MS have been reported in the English-language literature. MR imaging was obtained in five cases demonstrating lesions within the midbrain. We present the detailed clinical and MR imaging findings of a young woman with MS and an isolated,

M. Tariq Bhatti; Ilona M. Schmalfuss; Lorna S. Williams; Ronald G. Quisling


[Facial nerve injuries caused by firearms].  


In the period from 1990 to 1994, 52 facial nerve injuries caused by fragments firearm projectiles were managed. Their features (localization, severity and extensiveness) were correlated with 37 nerve injuries in blunt head injuries with fracture of temporal bone. In blunt head injuries, 81.1% patients were with the nerve lesion in the area of geniculate ganglion (labyrinthine and tympanic segment). Compression of nerve with bone fragments of fallopian tube was found in 56.8% cases, the cleft of neural sheath and intraneural hematoma were rarer, while the nerve tear was not found in any injured. The distal part of mastoid and beginning part of parotid nerve segment were injured in over 70% cases of gunshot injuries, and in 38.5% cases the injury was multiple. Direct suture was performed in 8 nerve injuries, neuroplasty in 6, and the other injuries were managed by skeletization of fallopian tube, nerve decompression or some other microsurgical procedure. Micro-surgery was performed 7-14 days after the injury. PMID:9612121

Haralampiev, K; Risti?, B; Kitanoski, B; Jakovljevi?, B; Lili?, V


Sciatic nerve: sonographic evaluation and anatomic-pathologic considerations.  


Sonographic analysis of the sciatic nerve was performed in vitro (anatomic specimen), in vivo (healthy volunteers), and in 16 patients with suspected peripheral sciatic nerve lesions. The ultrasound (US) examinations were performed with standard and high-resolution US equipment with linear-array configuration. The normal nerve displayed an echogenic fibrillar texture with round cross-sectional structure on both in vitro and in vivo sonograms. Satisfactory delineation of the nerve was obtainable in all cases. Nerve displacement was the main sonographic finding in cases of extrinsic compression. The lesion displayed variable echotexture, ranging from hypoechogenicity or mixed echogenicity in hematomata to hyperechogenicity in cases of fibrosis. Primary nerve tumors (neurofibroma) or infiltrating tumors (desmoid) caused clear disruption of the nerve structure. Use of sonography enabled assessment of the continuity of the nerve margins with the interposed graft in a case of reconstructive surgery. The potential to image sciatic nerve lesions noninvasively may have an important impact on diagnosis, treatment, and prognosis in symptomatic patients. PMID:1924780

Graif, M; Seton, A; Nerubai, J; Horoszowski, H; Itzchak, Y



Nerve conduction studies in upper extremities: skin temperature corrections.  


The relationship of skin to near nerve (NN) temperature and to nerve conduction velocity (NCV) and distal latency (DL) was studied in 34 normal adult subjects before and after cooling both upper extremities. Median and ulnar motor and sensory NCV, DL, and NN temperature were determined at ambient temperature (mean X skin temp = 33 C) and after cooling, at approximately 26, 28, and 30 C of forearm skin temperature. Skin temperatures on the volar side of the forearm, wrist, palm, and fingers and NN temperature at the forearm, midpalm, and thenar or hypothenar eminence were compared with respective NCV and DL. Results showed a significant linear correlation between skin temperature and NN temperature at corresponding sites (r2 range, 0.4-0.84; p less than 0.005). Furthermore, both skin and NN temperatures correlated significantly with respective NCV and DL. Midline wrist skin temperature showed the best correlation to NCV and DL. Median motor and sensory NCV were altered 1.5 and 1.4m/sec/C degree and their DL 0.2 msec/C degree of wrist skin temperature change, respectively. Ulnar motor and sensory NCV were changed 2.1 and 1.6m/sec/C degree respectively, and 0.2 msec/C degree wrist temperature for motor and sensory DL. Average ambient skin temperature at the wrist (33 C) was used as a standard skin temperature in the temperature correction formula: NCV or DL(temp corrected) = CF(Tst degree - Tm degree) + obtained NCV or DL, where Tst = 33 C for wrist, Tm = the measured skin temperature, and CF = correction factor of tested nerve. Use of temperature correction formula for NCV and DL is suggested in patients with changed wrist skin temperature outside 29.6-36.4C temperature range. PMID:6615178

Halar, E M; DeLisa, J A; Soine, T L



Vascular lesions.  


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

Ting, Patricia T; Rao, Jaggi



Inferior alveolar nerve paresthesia caused by endodontic pathosis: A case report and review of the literature  

Microsoft Academic Search

Sensory disturbances such as anesthesia, hypoesthesia, hyperesthesia, and paresthesia may be present in the oral cavity, stemming from many local and systemic factors. Paresthesia of the inferior alveolar nerve is quite rare because of the unique anatomy of this nerve. Among other effects, periapical lesions can damage the nerve, resulting in paresthesia of its innervated area. Only a few cases

Michele Giuliani; Carlo Lajolo; Giorgio Deli; Caterina Silveri



Large-Scale Functional Reorganization in Adult Monkey Cortex after Peripheral Nerve Injury  

NASA Astrophysics Data System (ADS)

In adult monkeys, peripheral nerve injuries induce dramatic examples of neural plasticity in somatosensory cortex. It has been suggested that a cortical distance limit exists and that the amount of plasticity that is possible after injury is constrained by this limit. We have investigated this possibility by depriving a relatively large expanse of cortex by transecting and ligating both the median and the ulnar nerves to the hand. Electrophysiological recording in cortical areas 3b and 1 in three adult squirrel monkeys no less than 2 months after nerve transection has revealed that cutaneous responsiveness is regained throughout the deprived cortex and that a roughly normal topographic order is reestablished for the reorganized cortex.

Garraghty, Preston E.; Kaas, Jon H.



Correlation between electromyographic reflex and MR Imaging examinations of the trigeminal nerve  

Microsoft Academic Search

BACKGROUND AND PURPOSE: Previous studies have shown that clinical localization of trigeminal nerve lesions is inaccurate as compared with MR imaging findings. The purpose of our study was to ascertain the added value of electromyographic (EMG) investigation of the trigeminal nerve reflexes for the improvement of lesion localization and for the preselection of patients for MR imaging. METHODS: We reviewed

Charles B. L. M. Majoie; Majid Aramideh; Frans-Jan H. Hulsmans; Jonas A. Castelijns; Beek van E. J. R; Bram W. Ongerboer de Visser



The effect of conservative management in extensor plus finger after partial amputation to the ulnar digits--a case report.  


The extensor plus finger after partial amputation of ulnar digits can affect the functions of the hand. The therapist intricate knowledge of intrinsic and extrinsic mechanism of fingers and creative approach in therapy would solve the puzzle when managing complex problem (extensor plus finger). Here we study a case of extensor plus finger after partial amputation of ulnar digits, its mechanism, and our experience with conservative management in managing extensor plus finger. PMID:22411113

Sudhakar, Gangatharam; Le blanc, Monique



Combined Flexor-Pronator Mass and Ulnar Collateral Ligament Injuries in the Elbows of Older Baseball Players  

Microsoft Academic Search

Background: Ulnar collateral ligament reconstruction techniques have afforded baseball players up to a reported 90% return to prior or higher level of play. A subpopulation exists with less impressive clinical outcomes potentially related to the presence of a concomitant flexor-pronator mass injury.Hypothesis\\/Purpose: Combined flexor-pronator and ulnar collateral ligament injuries occur in older players, and results in this group are inferior

Daryl C. Osbahr; Swarup S. Swaminathan; Answorth A. Allen; Joshua S. Dines; Struan H. Coleman; David W. Altchek



Thyroid Hormones and Peripheral Nerve Regeneration  

PubMed Central

Peripheral nerve regeneration is a unique process in which cellular rather than tissue response is involved. Depending on the extent and proximity of the lesion and the age and type of the neuronal soma, the cell body may either initiate a reparative response or may die. Microsurgical intervention may alter the prognosis after a peripheral nerve injury but to a certain extent. By altering the biochemical microenvironment of the neuron, we can increase the proportion of neurons that survive the injury and initiate the reparative response. Thyroid hormone critically regulates tissue growth and differentiation and plays a crucial role during organ development. Furthermore, recent research has provided new insight into thyroid hormone cellular action. Thyroid hormone regulates stress response intracellular signaling and targets molecules important for cytoskeletal stability and cell integrity. Changes in thyroid hormone signaling occur in nerve and other tissues, with important physiological consequences. The interest in thyroid hormone in the context of nerve regeneration has recently been revived.

Papakostas, Ioannis D.; Macheras, George A.



Sensory nerve action potentials and sensory perception in women with arthritis of the hand  

PubMed Central

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.



Effects of 940 nm light-emitting diode (led) on sciatic nerve regeneration in rats  

Microsoft Academic Search

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

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


Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system  

PubMed Central

Background Clinical tests to assess peripheral nerve disorders can be classified into two categories: tests for afferent/efferent nerve function such as nerve conduction (bedside neurological examination) and tests for increased mechanosensitivity (e.g. upper limb neurodynamic tests (ULNTs) and nerve palpation). Reliability reports of nerve palpation and the interpretation of neurodynamic tests are scarce. This study therefore investigated the intertester reliability of nerve palpation and ULNTs. ULNTs were interpreted based on symptom reproduction and structural differentiation. To put the reliability of these tests in perspective, a comparison with the reliability of clinical tests for nerve function was made. Methods Two experienced clinicians examined 31 patients with unilateral arm and/or neck pain. The examination included clinical tests for nerve function (sensory testing, reflexes and manual muscle testing (MMT)) and mechanosensitivity (ULNTs and palpation of the median, radial and ulnar nerve). Kappa statistics were calculated to evaluate intertester reliability. A meta-analysis determined an overall kappa for the domains with multiple kappa values (MMT, ULNT, palpation). We then compared the difference in reliability between the tests of mechanosensitivity and nerve function using a one-sample t-test. Results We observed moderate to substantial reliability for the tests for afferent/efferent nerve function (sensory testing: kappa = 0.53; MMT: kappa = 0.68; no kappa was calculated for reflexes due to a lack of variation). Tests to investigate mechanosensitivity demonstrated moderate reliability (ULNT: kappa = 0.45; palpation: kappa = 0.59). When compared statistically, there was no difference in reliability for tests for nerve function and mechanosensitivity (p = 0.06). Conclusion This study demonstrates that clinical tests which evaluate increased nerve mechanosensitivity and afferent/efferent nerve function have comparable moderate to substantial reliability. To further investigate the clinometric properties of these tests, more studies are needed to evaluate their validity.

Schmid, Annina B; Brunner, Florian; Luomajoki, Hannu; Held, Ulrike; Bachmann, Lucas M; Kunzer, Sabine; Coppieters, Michel W



Peripheral third cranial nerve enhancement in multiple sclerosis.  


Cranial nerve III dysfunction in multiple sclerosis (MS) is uncommon. Seven cases of isolated cranial nerve III paresis associated with MS have been reported in the English-language literature. MR imaging was obtained in five cases demonstrating lesions within the midbrain. We present the detailed clinical and MR imaging findings of a young woman with MS and an isolated, painful pupil involving complete left cranial nerve III palsy. Initial MR imaging showed isolated enhancement of the cisternal portion of the cranial nerve III, suggesting that peripheral nervous system involvement may develop as part of the disease process in some patients with MS. PMID:12917135

Bhatti, M Tariq; Schmalfuss, Ilona M; Williams, Lorna S; Quisling, Ronald G



Vascularized sural nerve graft and extracorporeally irradiated osteochondral autograft for oncological reconstruction of wrist sarcoma: case report and review of literature.  


For tumors that are located beside the main peripheral nerve, combined wide resection of both the tumor and peripheral nerve is mandatory. We here present an interesting case with synovial sarcoma of the wrist. An 8 cm of ulnar nerve defect was reconstructed by vascularized, folded sural nerve graft with the peroneal flap, whereas an 8 cm of distal ulna was reconstructed using extracorporeally irradiated osteochondral autograft. Our case showed excellent nerve regeneration. Extracorporeal irradiated osteochondral graft was a good option for reconstruction of the distal ulna. This procedure should be indicated for the reconstruction of non-weight-bearing joints. These kinds of reconstruction have been addressed in only a few cases of oncological reconstruction. PMID:24051468

Muramatsu, Keiichi; Moriya, Atsushi; Miyoshi, Tomoyuki; Tominaga, Yasuhiro; Seto, Shinichiro; Taguchi, Toshihiko



A self-administered questionnaire of ulnar neuropathy at the elbow  

Microsoft Academic Search

We report a new self-administered questionnaire for assessment of symptom severity of ulnar neuropathy at the elbow (UNE).\\u000a The new UNE and Levine's questionnaires were administered to a sample of UNE subjects and for comparison also to a sample\\u000a of subjects with carpal tunnel syndrome (CTS). We enrolled 89 consecutive patients (32 women, 57 men, mean age 52.3 years)\\u000a with

M. Mondelli; L. Padua; F. Giannini; G. Bibbò; I. Aprile; S. Rossi



Maximumisometric moments generated by the wrist muscles in flexion-extension and radial-ulnar deviation  

Microsoft Academic Search

Maximum isometric and passive moments about the wrist were measured for a range of flexion-extension and radial-ulnar deviation angles in 10 healthy adult males. Each subject was seated in a test apparatus with his shoulder abducted 90°, elbow flexed 90°, and body and forearm constrained. Peak flexion moments ranged from 5.2 to 18.7 N m (mean = 12.2, SD =

Scott L. Delp; Anita E. Grierson; Thomas S. Buchanan



Sympathetic alterations after midline medullary raphe lesions.  


The present study was designed to determine the functional importance of the midline medullary raphe nuclei in the autonomic regulation of the cardiovascular system in the anesthetized cat. Baroreceptor and somatosympathetic reflexes as well as the effects of electrical stimulation of vagal afferents and pressor and depressor sites in the hypothalamus and spinal trigeminal tract were determined before and after midline medullary lesions that extended from 2 to 7 mm rostral to the obex. Midline medullary lesions failed to affect baroreceptor reflexes as judged by the lack of effect on the sympathoinhibition associated with the pressor response to phenylephrine and the degree of slow-wave locking of sympathetic activity to the cardiac cycle. However, the lesion did significantly increase spontaneous sympathetic activity recorded from the inferior cardiac nerve. Blood pressure and heart rate were not altered by midline lesions. In addition, the computer-summed sympathoexcitatory response to electrical stimulation of somatic afferents in the sciatic nerve and the sympathoinhibitory response to stimulation of vagal afferent fibers were not affected by midline lesions. In contrast, the decrease in blood pressure and inhibition of sympathetic nerve activity elicited by electrical stimulation of the spinal trigeminal tract were completely abolished by the lesion. Depressor responses evoked from the anteroventral third ventricle region of the hypothalamus but not pressor responses elicited from the posterior hypothalamus were eliminated following midline medullary lesions. Finally, the sympathoinhibitory actions of the serotonin antagonist methysergide were blocked by medullary raphe lesions. These data indicate that neural elements in the medial medullary area function to provide a tonic inhibition of sympathetic nerve activity that is of nonbaroreceptor origin. Depressor responses evoked from the anterior hypothalamus and the spinal trigeminal tract also are mediated through this area of the medulla. Finally, the data support our contention that medullary serotonergic neurons have a sympathoexcitatory function. PMID:3605394

McCall, R B; Harris, L T



Regeneration of Dorsal Column Fibers into and beyond the Lesion Site following Adult Spinal Cord Injury  

Microsoft Academic Search

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

Simona Neumann; Clifford J Woolf



Pink lesions.  


Dermoscopy (dermatoscopy or surface microscopy) is an ancillary dermatologic tool that in experienced hands can improve the accuracy of diagnosis of a variety of benign and malignant pigmented skin tumors. The early and more accurate diagnosis of nonpigmented, or pink, tumors can also be assisted by dermoscopy. This review focuses on the dermoscopic diagnosis of pink lesions, with emphasis on blood vessel morphology and pattern. A 3-step algorithm is presented, which facilitates the timely and more accurate diagnosis of pink tumors and subsequently guides the management for such lesions. PMID:24075552

Giacomel, Jason; Zalaudek, Iris



Ciliary neurotrophic factor promotes motor reinnervation of the musculocutaneous nerve in an experimental model of end-to-side neurorrhaphy  

PubMed Central

Background It is difficult to repair nerve if proximal stump is unavailable or autogenous nerve grafts are insufficient for reconstructing extensive nerve damage. Therefore, alternative methods have been developed, including lateral anastomosis based on axons' ability to send out collateral sprouts into denervated nerve. The different capacity of a sensory or motor axon to send a sprout is controversial and may be controlled by cytokines and/or neurotrophic factors like ciliary neurotrophic factor (CNTF). The aim of the present study was to quantitatively assess collateral sprouts sent out by intact motor and sensory axons in the end-to-side neurorrhaphy model following intrathecal administration of CNTF in comparison with phosphate buffered saline (vehiculum) and Cerebrolysin. The distal stump of rat transected musculocutaneous nerve (MCN) was attached in an end-to-side fashion with ulnar nerve. CNTF, Cerebrolysin and vehiculum were administered intrathecally for 2 weeks, and all animals were allowed to survive for 2 months from operation. Numbers of spinal motor and dorsal root ganglia neurons were estimated following their retrograde labeling by Fluoro-Ruby and Fluoro-Emerald applied to ulnar and musculocutaneous nerve, respectively. Reinnervation of biceps brachii muscles was assessed by electromyography, behavioral test, and diameter and myelin sheath thickness of regenerated axons. Results Vehiculum or Cerebrolysin administration resulted in significantly higher numbers of myelinated axons regenerated into the MCN stumps compared with CNTF treatment. By contrast, the mean diameter of the myelinated axons and their myelin sheath thickness in the cases of Cerebrolysin- or CNTF-treated animals were larger than were those for rats treated with vehiculum. CNTF treatment significantly increased the percentage of motoneurons contributing to reinnervation of the MCN stumps (to 17.1%) when compared with vehiculum or Cerebrolysin treatments (at 9.9 or 9.6%, respectively). Reduced numbers of myelinated axons and simultaneously increased numbers of motoneurons contributing to reinnervation of the MCN improved functional reinnervation of the biceps brachii muscle after CNTF treatment. Conclusion The present experimental study confirms end-to-side neurorrhaphy as an alternative method for reconstructing severed peripheral nerves. CNTF promotes motor reinnervation of the MCN stump after its end-to-side neurorrhaphy with ulnar nerve and improves functional recovery of the biceps brachii muscle.



Nerves and Tissue Repair.  

National Technical Information Service (NTIS)

Studies have been conducted with regenerating amphibian sciatic nerves in organ culture to characterize further transport and release of transferrin in growing axons of peripheral nerves. The hypothesis under investigation is that transferrin, the iron-tr...

A. L. Mescher



Tibial nerve dysfunction  


... nerve dysfunction is a loss of movement or sensation in the foot from damage to the tibial ... the leg. The tibial nerve supplies movement and sensation to the calf and foot muscles. A problem ...


Optic Nerve Disorders  


... each eye carries impulses to the brain, where visual information is interpreted. Damage to an optic nerve ... determine where the problem is in the pathway. Visual Pathways and the Consequences of Damage Nerve signals ...


Common peroneal nerve dysfunction  


... type of peripheral neuropathy (damage to nerves outside the brain or spinal cord). This condition can affect people ... people: Who are very thin (for example, from anorexia nervosa ) ... damage the common peroneal nerve Charcot-Marie-Tooth disease is ...


Nerve Injuries in Athletes.  

ERIC Educational Resources Information Center

|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)|

Collins, Kathryn; And Others



Skin and Nerve Biopsies  

Center for Drug Evaluation (CDER)

Text VersionPage 1. Skin and Nerve Biopsies RA Malik Page 2. ... Nerve Biopsy • Evidence from Clinical Trials • Skin Biopsy • Evidence from Clinical Trials ... More results from


Surgical treatment of missed Monteggia lesions in children  

PubMed Central

Purpose The treatment of an unrecognized Monteggia lesion continues to pose a therapeutic challenge, as evidenced by the variety of surgical techniques described. Moreover, there are high complication and redislocation rates following surgery. This report concerns a surgical technique to reduce a chronic dislocation of the radial head utilizing an ulnar osteotomy and internal fixation. Methods Six consecutive cases of missed Monteggia lesions were treated in our institution between August 2001 and September 2003. Patient mean age was 6.5 (range 4–8) years, and the mean interval between injury and surgical procedure was 17 (range 1–49) months. Surgery consisted of an ulnar osteotomy with angulation and lengthening, bone grafting at the osteotomy site, and internal fixation. Open reduction of the radial head, repair or reconstruction of the annular ligament or temporary fixation of the radial head with a transarticular wire was not undertaken. Cast immobilization with the forearm in neutral rotation was maintained for 2 weeks. Results There was one case of nonunion. At an average follow-up of 3 (range 1.5–4.4) years, all patients had regained painless function of the forearm, good range of elbow and forearm motion, and maintenance of the radial head reduction. Conclusions Both angulation and elongation of the ulna are required to allow for reduction of the radial head. We do not see any indication for procedures directed at the radio-capitellar joint.

Ceroni, Dimitri; Lefevre, Yan; De Rosa, Vincenzo; De Coulon, Geraldo; Kaelin, Andre



Facial nerve: From anatomy to pathology.  


The facial nerve (CN VII) emerges from the facial nerve nucleus in the pons. It is accompanied by CN VIII along its cisternal pathway, as well as at the internal auditory meatus. Its petrous pathway includes a labyrinthine segment, a horizontal tympanic segment and a vertical mastoid segment until the stylomastoid foramen. It then continues to the parotid gland. Pontine impairment is usually associated with other neurological symptoms. Lesions of the cerebellopontine angle (most often meningioma and schwannoma) initially result in impairment of CN VIII. The impairment of CN VII takes second place. Peripheral impairment (outside of a traumatic context) is most often due to Bell's palsy. PMID:23891166

Toulgoat, F; Sarrazin, J L; Benoudiba, F; Pereon, Y; Auffray-Calvier, E; Daumas-Duport, B; Lintia-Gaultier, A; Desal, H A



Engineering peripheral nerve repair.  


Current approaches for treating peripheral nerve injury have resulted in promising, yet insufficient functional recovery compared to the clinical standard of care, autologous nerve grafts. In order to design a construct that can match the regenerative potential of the autograft, all facets of nerve tissue must be incorporated in a combinatorial therapy. Engineered biomaterial scaffolds in the future will have to promote enhanced regeneration and appropriate reinnervation by targeting the highly sensitive response of regenerating nerves to their surrounding microenvironment. PMID:23790730

Marquardt, Laura M; Sakiyama-Elbert, Shelly E



The Lesion Game: a special communication.  


The Lesion Game is a personal computer program that allows the user to view and study muscle innervations and nerve lesions of the brachial plexus. The core of the program is a table that consists of 44 brachial plexus lesions, 50 muscles, and 2 sensations (for brachium and forearm) of the upper extremity, which are innervated by the brachial plexus. After the program randomly selects a lesion, the user attempts to find the lesion in as few guesses (manual muscle tests) as possible. As muscles are selected (muscle tested), the computer searches the table to find the appropriate "strength" of weak or normal, based on the location of the randomly selected lesion. After displaying the strength of the muscle selected, a graphic representation of the strength is shown on a diagram of the brachial plexus. The graphic aspect of the program helps the user to visualize areas of the brachial plexus that may still contain the lesion. While playing the Lesion Game, the user can view a detailed picture of the brachial plexus, view all the possible lesions of the Lesion Game, or view charts of upper extremity innervations. An additional program mode allows beginning users to view and study muscle innervations without having to solve lesions. The program is extremely simple to use because it is entirely mouse-driven. PMID:2550973

Guiteras, D J



Cranial Nerves Model  

NSDL National Science Digital Library

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.

Juliann Garza (University of Texas-Pan American Physician Assistant Studies)



Characteristics of Nerve Agents.  

National Technical Information Service (NTIS)

There are three types of nerve agents currently stored in chemical stockpiles in the United States: VX, GB and GA. All three nerve agents are members of the organophosphate family. Nerve agent VX, a clear, odorless and tasteless liquid, has an appearance ...



Adipose-derived stem cells promote peripheral nerve repair  

PubMed Central

Introduction Recent evidence suggests that the implantation of bone marrow-derived mesenchymal stem cells improves peripheral nerve regeneration. In this study we aimed to investigate whether adipose-derived stem cells (ADSCs) can be used for peripheral nerve repair. Material and methods In a rat model, nerve regeneration was evaluated across a 15 mm lesion in the sciatic nerve by using an acellular nerve injected with allogenic ADSCs. The walking behaviour of rats was measured by footprint analysis, and electrophysiological analysis and histological examination were performed to evaluate the efficacy of nerve regeneration. Results Cultured ADSCs became morphologically homogeneous with a bipolar, spindle-like shape after ex vivo expansion. Implantation of ADSCs into the rat models led to (i) improved walking behaviour as measured by footprint analysis, (ii) increased conservation of muscle-mass ratio of gastrocnemius and soleus muscles, (iii) increased nerve conduction velocity, and (iv) increased number of myelinated fibres within the graft. Conclusions Adipose-derived stem cells could promote peripheral nerve repair in a rat model. Although the detailed mechanism by which ADSCs promote peripheral nerve regeneration is being investigated in our lab, our results suggest that ADSCs transplantation represents a powerful therapeutic approach for peripheral nerve injury.

Liu, Gui-Bo; Cheng, Yong-Xia; Feng, Yu-Kuan; Pang, Chao-Jian; Li, Qi; Wang, Ying; Jia, Hua; Tong, Xiao-Jie



Parkinson disease affects peripheral sensory nerves in the pharynx.  


Dysphagia is very common in patients with Parkinson disease (PD) and often leads to aspiration pneumonia, the most common cause of death in PD. Current therapies are largely ineffective for dysphagia. Because pharyngeal sensation normally triggers the swallowing reflex, we examined pharyngeal sensory nerves in PD patients 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 (cranial 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 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 greater in PD patients with dysphagia versus those without dysphagia. In addition, ?-synuclein-immunoreactive nerve fibers in the ISLN were much more abundant than those in cranial nerve IX and PSB-X. These findings suggest that pharyngeal sensory nerves are directly affected by pathologic processes in PD. These abnormalities may decrease pharyngeal sensation, thereby impairing swallowing and airway protective reflexes and contributing to dysphagia and aspiration. PMID:23771215

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



Etifoxine improves peripheral nerve regeneration and functional recovery  

PubMed Central

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.

Girard, Christelle; Liu, Song; Cadepond, Francoise; Adams, David; Lacroix, Catherine; Verleye, Marc; Gillardin, Jean-Marie; Baulieu, Etienne-Emile; Schumacher, Michael; Schweizer-Groyer, Ghislaine



Optic Nerve Elongation  

PubMed Central

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

Alvi, Aijaz; Janecka, Ivo P.; Kapadia, Silloo; Johnson, Bruce L.; McVay, William



Enhanced expression of E-selectin on the vascular endothelium of peripheral nerve in critically ill patients with neuromuscular disorders  

Microsoft Academic Search

Neuropathic complication often occurs in critically ill patients, and changes in the microcirculation of the peripheral nerve have been suggested to play a role in the pathogenesis of the nerve lesion. We report the results of a pathological and immunohistochemical study of superficial peroneal nerve biopsy specimens in a series of 22 critically ill patients with sepsis and neuromuscular disorders.

Flavio Fenzi; Nicola Latronico; Nicola Refatti; Nicolò Rizzuto



The influence of predegenerated nerve grafts on axonal regeneration from prelesioned peripheral nerves.  

PubMed Central

Recent in vitro work has indicated that predegenerated segments of peripheral nerve are more capable of supporting neurite growth from adult neurons than fresh segments of nerve, whereas previous in vivo studies which investigated whether predegenerated nerve segments used as grafts are capable of enhancing axonal regeneration produced conflicting results. We have reinvestigated this question by using predegenerated nerve grafts in combination with conditioning lesions of the host nerve to determine the optimal conditions for obtaining the maximal degree of regeneration of myelinated axons. The sciatic nerve of adult Dark Agouti rats were sectioned at midthigh level, and the distal portion was allowed to predegenerate for 0, 6 or 12 d in situ. 10-15 mm lengths of these distal nerve segments were then syngenically grafted onto the central stumps of sciatic nerves which had themselves received a conditioning lesion 0, 6, and 12 d previously, making a total of 9 different donor-host combinations. The grafts were assessed histologically 3 or 8 wk after grafting. Axonal regeneration in the 9 different donor-host combinations was determined by counting the numbers of myelinated axons in transverse sections through the grafts. All grafts examined contained regenerating myelinated axons. The rats given a 3 wk postgrafting survival period had an average of between 1400 and 5300 such axons. The rats given an 8 wk postgrafting survival period had between about 13,000 and 25,000 regenerating myelinated axons. Analysis of variance revealed significant main effects for both the Donor and Host conditions as well as Weeks (i.e. survival period after grafting). These results indicate that both a conditioning lesion of the host neurons and the degree of predegeneration of peripheral nerve segments to be used as grafts are of importance in influencing the degree of axonal regeneration. Of these 2 factors the conditioning lesion of the host appears to have the greater effect on the final number of regenerating myelinated axons. Images Figs 1-3 Figs 4-6

Hasan, N A; Neumann, M M; de Souky, M A; So, K F; Bedi, K S



Ulnar head implant arthroplasty: an intermediate term review of 1 surgeon's experience.  


Ulnar head arthroplasty has been an emerging alternative for salvage of resection arthroplasty at the distal radioulnar joint (DRUJ) since the early 1990s. Recently, it has been offered for initially treating painful arthrosis or instability of the DRUJ. This follow-up study reports a surgeon's experience treating DRUJ disorders with ulnar head arthroplasty. Twenty-two wrists in 20 patients (11 females, 9 males), 6 with no prior wrist procedures were treated between 1995 and 2006 for painful DRUJ disorders with either Herbert-Martin (Martin Medizin-Technik, Tuttingen, Germany) or Avanta (Small Bone Innovations, New York, NY) head prosthesis. Follow-up averaged 54.3 months. A standardized telephone survey determined preoperative /postoperative verbal analog pain scores and a modified Mayo Wrist Score (delineating poor, fair, good, or excellent outcomes). Data suggest that ulnar head implant arthroplasty is a reasonable treatment option for DRUJ-related pain, loss of function, or salvage of failed distal ulna resection procedures. The analog pain score statistically significant decreased by 1.68 points when comparing preoperative to postoperative scores. Average Modified Mayo Wrist Scores were good, independent of whether the procedure was primary or salvaged. No significant difference was seen between the primary or salvage group modified Mayo Wrist Scores. Whereas averaged modified Mayo scores for both the primary and salvage groups were in the good category, prostheses used as primary procedures may be associated with fewer poor or fair outcomes. Two good and 1 excellent outcome of 3 wrists requiring revision procedures suggest that even with revision of the implant arthroplasty, satisfactory results may be expected. PMID:19730047

Yen Shipley, Nancy; Dion, Greg R; Bowers, William H



Outcome of Ulnar Collateral Ligament Reconstruction of the Elbow in 1281 AthletesResults in 743 Athletes With Minimum 2Year Follow-up  

Microsoft Academic Search

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

E. Lyle Cain; James R. Andrews; Jeffrey R. Dugas; Kevin E. Wilk; Christopher S. McMichael; James C. Walter; Renee S. Riley; Scott T. Arthur



Composite implant of native bovine bone morphogenetic protein (BMP), collagen carrier and biocoral in the treatment of resistant ulnar nonunions: report of five preliminary cases  

Microsoft Academic Search

Introduction Bone morphogenetic protein (BMP) has been shown to induce bone formation and union in long bone defects and nonunions. There are, however, no previous reports of BMP being used for ulnar nonunions. We report on five cases of resistant ulnar nonunions treated with a composite implant consisting of a biocoral frame, collagen carrier, and bovine BMP. Materials and methods

Sauli Kujala; Timo Raatikainen; Jorma Ryhänen; Outi Kaarela; Pekka Jalovaara



Crohn's Disease Initially Accompanied by Deep Vein Thrombosis and Ulnar Neuropathy without Metronidazole Exposure  

PubMed Central

Extraintestinal manifestations are not uncommon in Crohn's disease, and a thromboembolic event is a disastrous potential complication. Deep vein thrombosis is the most common manifestation of a thromboembolic event and typically occurs in association with active inflammatory disease. Peripheral neuropathy in Crohn's disease has rarely been reported and is considered an adverse effect of metronidazole therapy. Here, we describe a patient who was initially diagnosed with Crohn's disease complicated with deep vein thrombosis and ulnar neuropathy without metronidazole exposure. The simultaneous occurrence of these complications in the early stage of Crohn's disease has never been reported in the English literature.

Kim, Woohyeon; Kang, Borami; Kim, Joon Sung; Lee, Hae-Mi; Lim, Eun-Joo; Kim, Jong In; Kang, Bong-Koo; Ji, Jeong-Seon; Lee, Bo-In; Choi, Hwang



Rupture of the ulnar collateral ligament of the thumb - a review  

PubMed Central

Skier’s thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier’s thumb. This article provides a review of the relevant anatomy, the correct method of physical examination and the options for additional imaging and treatment with attention to possible pitfalls.



Hamato-lunate impingement: an uncommon cause of ulnar-sided wrist pain.  


It has been reported that almost 50% of lunates have a separate medial facet on the distal surface for articulation with the hamate; about a quarter of these have erosion of the cartilage with exposed subchondral bone on the proximal pole of the hamate. We describe 4 cases of ulnar-sided wrist pain caused by hamato-lunate impingement that resulted in chondromalacia. The pain could be reproduced by a modification of the Lichtman test. The diagnosis was confirmed by arthroscopy. All 4 patients responded favorably to resection of the head of the hamate. PMID:10882452

Thurston, A J; Stanley, J K


Lipofibromatous hamartoma of the median nerve  

PubMed Central

Lipofibromatous hamartoma is a rare tumour of peripheral nerves which is characterised by an excessive infiltration of the epineurium and perineurium by fibroadipose tissue. To the best of our knowledge, only approximately 88 cases are reported in the literature. We report a rare case of lipofibromatous hamartoma of the median nerve causing secondary carpal tunnel syndrome in a 25 year old patient. This patient was treated conservatively with decompression and biopsy and experienced a complete resolution of symptoms post-operatively. Magnetic resonance imaging may be used to diagnose this lesion as it has very distinctive characteristics. Multiple conditions have been associated with this lesion and a greater understanding of these associations may clarify the pathogenesis. The architecture of the tumour makes excision very challenging and the surgical management remains controversial. A review of the literature regarding the etiology, pathogenesis and surgical management of lipofibromatous hamartoma is included.



Erectile dysfunction occurs following substantia nigra lesions in the rat  

Microsoft Academic Search

Erectile function was assessed 6 weeks following uni- and bilateral injections of 6-hydroxydopamine in the substantia nigra nucleus of the brain. Behavioral apomorphine-induced penile erections were reduced (5\\/8) and increased (3\\/8) in uni- and bilateral lesioned animals. Intracavernous pressures, following electrical stimulation of the cavernous nerve, decreased in lesioned animals. Lesions of the substantia nigra were confirmed by histology. Concentration

AR Zahran; N Simmerman; S Carrier; P Vachon



Gastric mucosal nerve density  

PubMed Central

Background: Autonomic neuropathy is a frequent diagnosis for the gastrointestinal symptoms or postural hypotension experienced by patients with longstanding diabetes. However, neuropathologic evidence to substantiate the diagnosis is limited. We hypothesized that quantification of nerves in gastric mucosa would confirm the presence of autonomic neuropathy. Methods: Mucosal biopsies from the stomach antrum and fundus were obtained during endoscopy from 15 healthy controls and 13 type 1 diabetic candidates for pancreas transplantation who had secondary diabetic complications affecting the eyes, kidneys, and nerves, including a diagnosis of gastroparesis. Neurologic status was evaluated by neurologic examination, nerve conduction studies, and skin biopsy. Biopsies were processed to quantify gastric mucosal nerves and epidermal nerves. Results: Gastric mucosal nerves from diabetic subjects had reduced density and abnormal morphology compared to control subjects (p < 0.05). The horizontal and vertical meshwork pattern of nerve fibers that normally extends from the base of gastric glands to the basal lamina underlying the epithelial surface was deficient in diabetic subjects. Eleven of the 13 diabetic patients had residual food in the stomach after overnight fasting. Neurologic abnormalities on clinical examination were found in 12 of 13 diabetic subjects and nerve conduction studies were abnormal in all patients. The epidermal nerve fiber density was deficient in skin biopsies from diabetic subjects. Conclusions: In this observational study, gastric mucosal nerves were abnormal in patients with type 1 diabetes with secondary complications and clinical evidence of gastroparesis. Gastric mucosal biopsy is a safe, practical method for histologic diagnosis of gastric autonomic neuropathy.

Selim, M.M.; Wendelschafer-Crabb, G.; Redmon, J.B.; Khoruts, A.; Hodges, J.S.; Koch, K.; Walk, D.; Kennedy, W.R.



[Facial nerve paralysis and mandibular fracture].  


The authors describe three cases of peripheral facial nerve paralysis in patients with a mandibular fracture. In two cases, in which the onset of palsy was uncertain, the facial nerve injury was contralateral to the fractured side. Topodiagnostic tests showed neural damage at the third intrapetrosal portion and at the genicular ganglion. In one of the two patients tomography revealed a fracture line through the anterio-superior wall of the external auditory canal homolateral to the facial palsy. In the third subject palsy set in immediately after the trauma and was ipsilateral to the mandibular fracture; the facial lesion was localized at the genicular ganglion. In the first two cases, functional recovery was spontaneous (40 and 0 days after the trauma respectively). In the third subject, the nerve was decompressed surgically with a complete functional recovery two months later. The functional and clinical findings of these three cases show that a contralateral facial palsy secondary to a mandibular fracture resolves spontaneously while the traumatic displacement of the mandibular condyle may determine a temporal bone fracture sometimes followed by a lesion in the intratemporal portion of the facial nerve. An event such as the latter may delay functional recovery and thus warrant surgery such as in cases of Bell's palsy. PMID:1298156

Salonna, I; Fanizzi, P; Quaranta, A


Role of Immunity in Recovery from a Peripheral Nerve Injury  

Microsoft Academic Search

Motoneurons are large multipolar neurons with cell bodies located in the brainstem and spinal cord, and peripheral axons ending\\u000a in neuromuscular junctions. Peripheral nerve damage, outside the blood-brain barrier (BBB), results in both retrograde changes\\u000a centrally and anterograde changes along the length of the axon distal to the lesion site. Often, peripheral nerve damage is\\u000a accompanied by motoneuron cell death,

Virginia M. Sanders; Kathryn J. Jones



Epidemiology of iatrogenic facial nerve injury: A decade of experience.  


OBJECTIVES/HYPOTHESIS: To determine the procedure-specific incidence, risk factors, and injury patterns in patients with iatrogenic facial nerve injury as seen at a tertiary care facial nerve center. STUDY DESIGN: Retrospective chart review. METHODS: Facial Nerve Center patient records from 2002 to 2012 were reviewed for cases of iatrogenic facial nerve injury. These were analyzed by type of inciting procedure, injury location, patient demographics, and referral pattern. RESULTS: Out of 1,810 patient records, 102 were identified that involved iatrogenic facial nerve injury. Oral and maxillofacial surgical procedures accounted for 40% of injuries, resections of head and neck lesions 25%, otologic procedures 17%, cosmetic procedures 11%, and other procedures 7%. The most common operation resulting in facial nerve injury was temporomandibular joint replacement. The most frequent pattern of injury was total hemifacial weakness. CONCLUSIONS: Iatrogenic facial nerve injury occurs most commonly in temporomandibular joint replacement, mastoidectomy, and parotidectomy. Direct visualization of the nerve may decrease the incidence of injury, and early referral for facial nerve exploration may result in improved outcomes. LEVEL OF EVIDENCE: 2b. Laryngoscope, 2013. PMID:23606475

Hohman, Marc H; Bhama, Prabhat K; Hadlock, Tessa A



Interleukin1 regulates synthesis of nerve growth factor in non-neuronal cells of rat sciatic nerve  

Microsoft Academic Search

The Schwann cells and fibroblast-like cells of the intact sciatic nerve of adult rats synthesize very little nerve growth factor (NGF) (ref. 1). After lesion, however, there is a dramatic increase in the amounts of both NGF-mRNA and NGF protein synthesized by the sciatic non-neuronal cells1,2. This local increase in NGF synthesis partially replaces the interrupted NGF supply from the

Dan Lindholm; Rolf Heumann; Michael Meyer; Hans Thoenen



Fatigue in the forearm resulting from low-level repetitive ulnar deviation.  


This study measured low-frequency fatigue (LFF) in the extensor carpi ulnaris (ECU) muscle while workers completed a repetitive ulnar deviation task. Using a repeated measures design, 10 healthy women participated in three conditions, each lasting 2 consecutive days: a control condition in which subjects remained inactive, and two repetitive work conditions involving repeated ulnar deviation of the wrist at 20 and 25 repetitions per minute at individual workloads deemed acceptable for 8 hours through a psychophysical protocol. LFF of the ECU muscle and self-reported levels of fatigue were recorded eight times throughout the control and workdays before (time 0), during (2, 4.25, 6.75, 8 hours), and after (9, 10, and 11 hours) exposure. The ratio of the isometric force produced by electrical stimulus at 20 pulses per second (pps) to the isometric force produced by 50 pps provided the measure of LFF. The ratios were lower on workdays compared with the control days, indicating the presence of LFF during repetitive work. During repetitive work the ratios decreased during the day, indicating the muscles fatigued as the day progressed. The psychophysically determined workloads, although not creating noticeable discomfort to the subjects, were high enough to create low levels of muscle fatigue. PMID:14674796

Dennerlein, Jack Tigh; Ciriello, Vincent M; Kerin, Kirsty J; Johnson, Peter W


Simulation of extension, radial and ulnar deviation of the wrist with a rigid body spring model.  


A novel computational model of the wrist that predicts carpal bone motion was developed in order to investigate the complex kinematics of the human wrist. This rigid body spring model (RBSM) of the wrist was built using surface models of the eight carpal bones, the bases of the five metacarpal bones, and the distal parts of the ulna and radius, all obtained from computed tomography (CT) scans of a cadaver upper limb. Elastic contact conditions between the rigid bodies modeled the influence of the cartilage layers, and ligamentous structures were constructed using nonlinear, tension-only spring elements. Motion of the wrist was simulated by applying forces to the tendons of the five main wrist muscles modeled. Three wrist motions were simulated: extension, ulnar deviation and radial deviation. The model was tested and tuned by comparing the simulated displacement and orientation of the carpal bones with previously obtained CT-scans of the same cadaver arm in deviated (45 degrees ulnar and 15 degrees radial), and extended (57 degrees ) wrist positions. Simulation results for the scaphoid, lunate, capitate, hamate and triquetrum are presented here and provide credible prediction of carpal bone movement. These are the first reported results of such a model. They indicate promise that this model will assist in future wrist kinematics investigations. However, further optimization and validation are required to define and guarantee the validity of results. PMID:19406404

Fischli, S; Sellens, R W; Beek, M; Pichora, D R



Mouse TBX3 mutants suggest novel molecular mechanisms for Ulnar-mammary syndrome.  


The transcription factor TBX3 plays critical roles in development and TBX3 mutations in humans cause Ulnar-mammary syndrome. Efforts to understand how altered TBX3 dosage and function disrupt the development of numerous structures have been hampered by embryonic lethality of mice bearing presumed null alleles. We generated a novel conditional null allele of Tbx3: after Cre-mediated recombination, no mRNA or protein is detectable. In contrast, a putative null allele in which exons 1-3 are deleted produces a truncated protein that is abnormally located in the cytoplasm. Heterozygotes and homozygotes for this allele have different phenotypes than their counterparts bearing a true null allele. Our observations with these alleles in mice, and the different types of TBX3 mutations observed in human ulnar-mammary syndrome, suggest that not all mutations observed in humans generate functionally null alleles. The possibility that mechanisms in addition to TBX3 haploinsufficiency may cause UMS or other malformations merits investigation in the human UMS population. PMID:23844108

Frank, Deborah U; Emechebe, Uchenna; Thomas, Kirk R; Moon, Anne M



Protecting the genitofemoral nerve during direct/extreme lateral interbody fusion (DLIF/XLIF) procedures.  


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

Jahangiri, Faisal R; Sherman, Jonathan H; Holmberg, Andrea; Louis, Robert; Elias, Jeff; Vega-Bermudez, Francisco



Correlation of nerve ultrasound, electrophysiological, and clinical findings in post Guillain-Barré syndrome.  


We aimed to correlate functional disability, electrophysiology, and nerve ultrasound in patients after Guillain-Barré syndrome (GBS). Seventy-five healthy controls and 41 post-GBS patients (mean 3.4?years, SD ± 2.91?years after onset) underwent clinical, sonographic, and electrophysiological evaluation. Compared to healthy controls, the post-GBS patients showed: (1) a mean Rasch-built Overall Disability Scale score of 31.8 (SD ± 11.6), modified Rasch-built fatigue severity scale score of 15.6 (SD ± 3.2), Medical Research Council sum score of 22 (SD ± 5.6); (2) electrophysiological signs of permanent axonal loss in the majority of the peripheral nerves; (3) sonographical evidence of higher cross-sectional area values (CSA) of the ulnar (elbow, p?nerve (popliteal fossa, p?nerve ultrasound nor electrophysiology correlated with muscle strength, overall disability, and fatigue scale. Compared to healthy controls, post-GBS patients had significant functional disability. Despite significant abnormalities in both electrophysiology and ultrasound compared to healthy controls, neither electrophysiology nor nerve ultrasound correlated with functional disability of these patients. PMID:24028191

Kerasnoudis, Antonios; Pitarokoili, Kalliopi; Behrendt, Volker; Gold, Ralf; Yoon, Min-Suk



Poor electroneurography but excellent hand function 31 years after nerve repair in childhood.  


Children, in contrast to adults, show an excellent clinical recovery after a peripheral nerve injury, which may be explained by better peripheral nerve regeneration and a superior plasticity in the young brain. Our aim was to study the long-term electrophysiological outcome after nerve repair in children and young adults and to compare it with the clinical outcome. Forty-four patients, injured at an age younger than 21 years, were assessed by electrophysiology (amplitude, conduction velocity and distal motor latency) at a median of 31 years after a complete median or ulnar nerve injury at the level of the forearm. Electrophysiological evaluation showed pathology in all parameters and in all patients, irrespective of age at injury. No significant differences were observed in the electrophysiological results between those injured in childhood, that is, before the age of 12 years, and those injured in adolescence, that is, between 12 and 20 years of age. In contrast, the clinical nerve function was significantly better for those injured in childhood (87% of complete recovery, P=0.002) compared with those injured in adolescence. We conclude that the mechanism behind the superior clinical outcome in children is not located at the periphery, but is explained by cerebral plasticity. PMID:23142851

Chemnitz, Anette; Andersson, Gert; Rosén, Birgitta; Dahlin, Lars B; Björkman, Anders



Nerve and Blood Vessels  

Microsoft Academic Search

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

Maura Valle; Maria Pia Zamorani


Radiation therapy for primary optic nerve meningiomas  

SciTech Connect

Optic nerve sheath meningiomas, formerly thought to be rare, have been encountered with surprising frequency since the widespread use of computed tomography. Early diagnosis led to an enthusiastic surgical approach to these lesions, but this has been tempered by the realization that even in the best of hands, blindness followed such surgery with distressing frequency. Optic nerve sheath meningiomas may be divided into primary, secondary, and multiple meningioma groups. Five patients with primary optic nerve sheath meningiomas treated with irradiation therapy are presented in this report. Improvement in visual acuity, stabilization to increase in the visual field, and decrease in size to total regression of optociliary veins, have been documented following irradiation therapy of the posterior orbital and intracanalicular portions of the optic nerve in some of these cases. Although each patient must be carefully individualized, there is no question that visual palliation can be achieved in some cases of optic nerve sheath meningioma. Further investigation of this therapeutic modality in selected cases in advised.

Smith, J.L.; Vuksanovic, M.M.; Yates, B.M.; Bienfang, D.C.



Total facial nerve decompression: technique to avoid complications.  


Exposure of the facial nerve from the brainstem to the parotid can be accomplished without injury to the nerve, tympanic membrane, external auditory canal, ossicular chain, inner ear or structures within the cerebello-pontine angle. The procedure has reliably provided good results for patients who have had the proper indications with facial paralysis from Bell's palsy, herpes zoster oticus, infection, hemi-facial spasm, temporal bone fracture and tumors. The current technique for exposure through the mastoid, middle cranial fossa and retrolabyrinthine combined approaches are described. This technique, properly performed, is a valuable treatment for facial nerve lesions. PMID:8764701

Pulec, J L



Case report of high origin of radial, ulnar, and profunda brachii arteries, its clinical implications and review of the literature Relato de caso de origem alta das artérias radial, ulnar e braquial profunda, suas implicações clínicas e revisão de literatura  

Microsoft Academic Search

Arterial variations in the arm are of potential clinical implications as it is a frequent site of injury and also involved in many surgical and in- vasive procedures. During a dissection of the right upper extremity, an abnormal high origin of the radial and ulnar arteries was found. The brachial artery had a very short segment without any branches, divided

Sampath Madhyastha; Soubhagya R. Nayak; Ashwin Krishnamurthy; Sujatha D'Costa; Asha Anu Jose; Kumar M. R. Bhat



Avian enteric nerve plexuses  

Microsoft Academic Search

The enteric nerve plexuses of the domestic fowl (Gallus domesticus) were investigated in sections and stretch preparations by means of the cholinesterase and glyoxylic acid fluorescence histochemical techniques. Cholinesterase-positive and varicose and non-varicose fluorescent nerve fibres were distributed at all levels of the gut in myenteric, submucosal, muscle and mucosal plexuses, and in a perivascular plexus. The density of the

H. A. Ali; J. McLelland



Nerves of Simplicial Complexes.  

National Technical Information Service (NTIS)

If a simplicial complex K is considered as covered by its maximal (closed) faces, its nerve N(K) may be defined in the usual manner. Generalizing known results on interchange graphs of graphs, simplicial complexes which are nerves of d-dimensional simplic...

B. Grunbaum



Peripheral nerve and muscle.  


This review of the past year's literature on neurophysiology of muscles and peripheral nerves emphasizes areas with direct clinical interest. The subject is diversified but will be discussed under the following major headings: nerve conduction studies, electromyography, magnetic motor evoked potentials, quantitative sensory testing, assessment of peripheral pain fibers, and autonomic function assessment. PMID:8293143

Jamal, G A; Mann, C



[Obturator nerve block].  


Obturator nerve block is commonly used for transurethral resections of the bladder in order to inhibit reflectory adductor muscle reaction during electrocoagulation and to reduce the risk of bladder wall perforation during transurethral surgery. Furthermore, obturator block is used to complete regional blocks for major knee surgery in addition to femoral and sciatic nerve blocks. Continuous techniques are sometimes used to treat chronic pain problems such as adductor spasm. During a so called "3 in 1" block (femoral nerve block) the obturator nerve will only be anaesthetized in 0-62% of the patients. Therefore, a specific approach to the obturator nerve is deemed appropriate. In addition, an accessory branch of the obturator nerve will accompany the femoral nerve in 10-30% of the patients. The classical approach uses the tuberculum pubicum as an anatomical landmark, inserting the needle approximately 1.5cm lateral and caudal until bone contact is established. After laterocaudal redirection the canalis obturatorius is reached and the local anaesthetic is injected. The alternative approach is more often used: At the proximal tendon insertion of the adductor longus muscle the needle is introduced and advanced towards the anterior superior iliac spine. For both approaches a nerve stimulator is used and 15-20ml of local anaesthetic solution are injected. PMID:20455186

Freisburger, Christian; Nachtigall, Bernd; Wulf, Hinnerk



Recognition of an incidental abscess and a hematoma during ultrasound-guided femoral nerve block.  


Ultrasound guidance for femoral nerve blockade allows visualization of normal and abnormal anatomy. Two cases of femoral nerve blockade under ultrasound guidance are presented where a major perineural pathologic lesion was incidentally revealed. These pathologic lesions, an abscess and a hematoma, resulted in significant adaptations in clinical care and have not been reported previously. We review and discuss incidental pathologic lesions that can be found in the femoral region. Identification of these 2 pathologic lesions facilitated our perioperative management strategies in two separate cases. PMID:21697688

Auyong, David B; Tokeshi, Jay; Joshi, Sonali; Anderson, Corrie T M


Nerves as Embodied Metaphor in the Canada\\/Mexico Seasonal Agricultural Workers Program  

Microsoft Academic Search

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

Avis Mysyk; Margaret England; Juan Arturo Avila Gallegos



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.  


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

Buonocore, M; Camuzzini, N; Cecini, M; Dalla Toffola, E



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

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.

Buonocore, M.; Camuzzini, N.; Cecini, M.; Dalla Toffola, E.



Intraneural ganglion of the posterior interosseous nerve with lateral elbow pain  

Microsoft Academic Search

We report an intraneural ganglion of the posterior interosseous nerve causing lateral elbow pain. The cystic lesion was identified by magnetic resonance imaging, and surgical exploration using the microscope permitted complete extirpation of the cyst without damage to nerve tissue. The patient experienced complete relief from pain, with full preservation of function.

H. Hashizume; K. Nishida; Y. Nanba; H. Inoue; T. Konishiike



Experimental Studies on Surgical Treatment of Avulsed Spinal Nerve Roots in Brachial Plexus Injury  

Microsoft Academic Search

This review summarises studies aiming at a surgical treatment of spinal nerve root avulsions from the spinal cord in brachial plexus lesions. After dorsal root injury, regrowth of nerve fibres into the spinal cord occurs only in the immature animal. After ventral root avulsion and subsequent implantation into the spinal cord, neuroanatomical and neurophysiological data show that motoneurons are capable




Bilateral pupil-sparing third nerve palsies as the presenting sign of multiple sclerosis.  


We report the case of a young man who presented with bilateral third nerve palsies without pupillary involvement. Brain MRI demonstrated lesions in the region of the oculomotor nerves, and further evaluation led to the diagnosis of multiple sclerosis. Our case documents a rare initial clinical presentation of this demyelinating disease. PMID:21436730

Seery, Loren S; Hurliman, Elisabeth; Erie, Jay C; Leavitt, Jacqueline A



Conservative management of ulnar tunnel syndrome: secondary to excessive healing tissue; a rare complication after flexor tendon injury--a case report.  


The ulnar tunnel syndrome occurs usually from ganglions, lipoma, cysts, chronic repetitive trauma, bicycling, and the activities that require either prolonged wrist hyper extension or continued pressure on the hypothenar eminence. The ulnar tunnel syndrome after flexor tendon repair is a rare complication. We report on a 24-year-old man with ulnar tunnel syndrome after a flexor tendon repair secondary to girder cut injury. The patient was managed conservatively for his hypertrophic scar for 9 weeks. After 9 weeks, the patient presented with no clawing and complete closure of the hand. PMID:22627928

Sudhagar, G; Le blanc, Monique



Recurrent Laryngeal Nerve Injury in Thyroid Surgery  

PubMed Central

Objectives Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve (RLNI) is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerve injury, still the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the present study is to assess the risk factors of recurrent laryngeal nerve injury during thyroid surgery. Methods Patients who had thyroid surgery between 1990 and 2005 and were admitted to the surgical department of King Fahd hospital of the University, Al-Khobar, Saudi Arabia were enrolled for this retrospective review, Factors predisposing to recurrent laryngeal nerve injury were evaluated such as pathology of the lesions and the type of operations and identification of recurrent laryngeal nerve intra-operatively. Preoperative and postoperative indirect laryngoscopic examinations were performed for all patients. Results 340 patients were included in this study. Transient unilateral vocal cord problems occurred in 11 (3.2%) cases, and in 1 (0.3%) case, it became permanent (post Rt. Hemithyroidectomy). Bilateral vocal cord problems occurred in 2 cases (0.58%), but none became permanent. There were significant increases in the incidence of recurrent laryngeal nerve injury in secondary operation (21.7% in secondary vs. 2.8% in primary, p=0.001), total/near total thyroidectomy (7.2% in total vs. 1.9% in subtotal, p=0.024), non-identification of RLN during surgery (7.6% in non-identification vs. 2.6% in identification, p=0.039) and in malignant disease (12.8% in malignant vs. 2.9% in benign, p=0.004). However, there was no significant difference in the incidence of recurrent laryngeal nerve injury with regards to gender (4.1% in male vs 3.8% in female, p=0.849). Conclusion The present study showed that thyroid carcinoma, re-operation for recurrent goiter, non-identification of RLN and total thyroidectomy were associated with a significantly increased risk of operative recurrent laryngeal nerve injury.

Zakaria, Hazem M.; Al Awad, Naif A.; Al Kreedes, Ali S.; Al-Mulhim, Abdul Mohsin A.; Al-Sharway, Mohammed A.; Hadi, Maha Abdul; Al Sayyah, Ahmed A.



A Variation of the Cords of the Brachial Plexus on the Right and a Communication between the Musculocutaneous and Median Nerves on the Left Upper Limb: A Unique Case.  


During routine anatomical dissection of the upper extremity of a 64-year-old cadaver for educational purposes, we observed variations in the brachial plexus on each side. On the right an anomaly of cord formation was present and on the left there was a communication between the musculocutaneous nerve (MCN) and median nerve (MN). On the right side the brachial plexus showed two trunks, superior (C5 and C6) and inferior (C7, C8, and T1); the middle trunk was absent. The superior trunk bifurcated into anterior and posterior divisions, the anterior division continued as the lateral cord forming the MCN. The posterior division gave off the subscapular branch. The inferior trunk trifurcated into radial, median, and ulnar nerves. The radial nerve gave off the axillary and thoracodorsal nerves. The ulnar nerve gave off the median cutaneous nerves of the arm and forearm. The median nerve received a small ascending branch from the MCN. On the right side, there was a communicating branch from the MCN to the MN in the lower third of the arm region. This communicating branch also gave rise to a muscular branch to the brachialis muscle and the lateral cutaneous nerve of forearm. No additional heads of the biceps brachii muscle were observed in either upper limb. Knowledge of the variations of the brachial plexus in humans can be valuable for operations of the shoulder joint and its repair for providing an effective block or treatment for anesthetists and also for explaining otherwise incomprehensible clinical signs for neurologists. PMID:23444130

Kirazl?, Ozlem; Tatarl?, Necati; Ceylan, Davut; Hac?o?lu, Hüsniye; Uygun, Seda; Seker, A?k?n; Kele?, Evren; Cavdar, Safiye



A Nerve Cuff Electrode for Controlled Reshaping of Nerve Geometry  

Microsoft Academic Search

The purpose of this study is the development of a nerve electrode that reorganizes nerve geometry slowly and controllably. The Flat Interface Nerve Electrode (FINE) can reshape the nerve into an elongated oval and provide selective stimulation. However, the rate of closure of this electrode is difficult to control. The Slowly Closing - FINE (SC-FINE) is designed with an opening

Anthony V. Caparso; Dominique M. Durand; Joseph M. Mansour



Whole sensory nerve recordings with spiral nerve cuff electrode  

Microsoft Academic Search

We have used a self-curling nerve cuff electrode to record sensory information from a cutaneous nerve. This type of cuffs has previously been used only for stimulation, but its mechanical properties could make it very suitable for recording also, since it can be fitted closer to the nerve than traditional cuffs without compromising the nerve. In this study we show

T. Sinjar; B. Hinge; A. Jorgensen; M. L. Jensen; M. Haugland



Percutaneous peripheral nerve stimulation.  


Since its inception in the 1970s, peripheral neuromodulation has become an increasingly common procedure to treat chronic neuropathic disorders. Historically, peripheral nerve stimulation (PNS) originated with the placement of large surface cuff electrodes, which was refined by the introduction of functional nerve mapping with circumferential electrical stimulation. This substantially improved the targeting of sensory fascicles. Surgical placement of spinal cord stimulation (SCS) 'button type' paddle electrodes was replaced when the introduction of percutaneous cylindrical SCS electrodes expanded the spectrum of PNS applications and improved the ability to target afferent sensory fibers as well as reducing the complication rate. To further refine functional mapping for the placement of these percutaneous electrodes, radiofrequency needle probes have more recently been employed to elicit paresthesias in awake patients to map the pain generators and guide treatment. In this chapter, we provide a description of the development and basic mechanisms of peripheral nerve stimulation, as well as a more detailed description of the two most commonly employed forms of peripheral nerve stimulation: occipital nerve stimulation for occipital neuralgia, and subcutaneous peripheral nerve field stimulation to stimulate free nerve endings within the subcutaneous tissue when the pain is limited to a small, well-localized area. The closely related ideas of internal and external targeted subcutaneous stimulation are also discussed. PMID:21422775

Aló, Kenneth M; Abramova, Marina V; Richter, Erich O



Concomitant Meningioma and Glioma Within the Same Optic Nerve in Neurofibromatosis Type 1.  


A patient with neurofibromatosis type 1 and the rare finding of concomitant meningioma and optic pathway glioma within the same optic nerve is presented. A 4-year-old boy was admitted to our hospital with right-sided proptosis. He also had numerous café-au-lait macules and axillary freckling on physical exam. According to National Institutes of Health (NIH) criteria, he met the diagnostic criteria for neurofibromatosis type 1. On magnetic resonance imaging (MRI), a mass originating from the right optic nerve sheath with normal appearance of the optic nerve was observed, which was consistent with optic nerve sheath meningioma. Another mass lesion was observed in the prechiasmatic region of the same optic nerve, which was consistent with optic nerve glioma. Two different types of optic pathway tumors in the same optic nerve is an extraordinary case. It is important to recognize imaging findings of these tumors and make correct diagnosis. PMID:23420652

Büyükkapu-Bay, Sema; Akça, Ahmet; Karadogan, Meriban; Corapçioglu, Funda; Anik, Yonca



Ultrasound diagnosis of bony nerve entrapment: Case series and literature review.  


Introduction: Nerve entrapment due to osseous callus formation is a rare complication after bone fracture. Electrodiagnostic studies and routine radiographic imaging often fail to demonstrate the pathology. The diagnosis is difficult and is often made incidentally upon surgical exploration. Nerve ultrasonography has not been used routinely to assess such lesions. Methods: We report 5 cases of nerve entrapment in osseous callus after fractures that occurred in 2011 and 2012. The diagnosis was made by ultrasound (US). We then performed a review of the relevant literature. Conclusions: US is becoming an invaluable tool for diagnosing peripheral nerve entrapments. The current cases suggest that nerve US should be strongly considered as an adjunctive diagnostic tool for nerve palsies developing after trauma. Muscle Nerve 48: 445-450, 2013. PMID:23512616

Erra, Carmen; Granata, Giuseppe; Liotta, Giovanna; Podnar, Simon; Giannini, Mauro; Kushlaf, Hani; Hobson-Webb, Lisa D; Leversedge, Fraser J; Martinoli, Carlo; Padua, Luca



Glossopharyngeal Nerve Schwannoma  

PubMed Central

Complete resection with conservation of cranial nerves is the primary goal of contemporary surgery for lower cranial nerve tumors. We describe the case of a patient with a schwannoma of the left glossopharyngeal nerve, operated on in our Neurosurgical Unit. The far lateral approach combined with laminectomy of the posterior arch of C1 was done in two steps. The procedure allowed total tumor resection and was found to be better than classic unilateral suboccipital or combined supra- and infratentorial approaches. The advantages and disadvantages of the far lateral transcondylar approach, compared to the other more common approaches, are discussed. ImagesFigure 1Figure 2

Puzzilli, F.; Mastronardi, L.; Agrillo, U.; Nardi, P.



Suprascapular nerve entrapment.  


It is important to be aware of neuropathy involving the suprascapular nerve. While direct trauma to the suprascapular nerve is the usual cause (direct blow to the base of the neck or posterior shoulder, shoulder dislocation or fracture), the problem may result from overuse injuries (such as repetitive tennis serving or spiking of a volley ball), excessive horizontal adduction, weight lifting, backpacking or no apparent reason. These last three years we have operated 8 cases of suprascapular nerve neurolysis at the level of suprascapular incision, and section of the transverse scapular ligament through the back supraspinal approach. PMID:15830964

Corò, L; Azuelos, A; Alexandre, A



Combined effect of motor imagery and peripheral nerve electrical stimulation on the motor cortex.  


Although motor imagery enhances the excitability of the corticospinal tract, there are no peripheral afferent inputs during motor imagery. In contrast, peripheral nerve electrical stimulation (ES) can induce peripheral afferent inputs; thus, a combination of motor imagery and ES may enhance the excitability of the corticospinal tract compared with motor imagery alone. Moreover, the level of stimulation intensity may also be related to the modulation of the excitability of the corticospinal tract during motor imagery. Here, we evaluated whether a combination of motor imagery and peripheral nerve ES influences the excitability of the corticospinal tract and measured the effect of ES intensity on the excitability induced during motor imagery. The imagined task was a movement that involved touching the thumb to the little finger, whereas ES involved simultaneous stimulation of the ulnar and median nerves at the wrist. Two different ES intensities were used, one above the motor threshold and another above the sensory threshold. Further, we evaluated whether actual movement with afferent input induced by ES modulates the excitability of the corticospinal tract as well as motor imagery. We found that a combination of motor imagery and ES enhanced the excitability of the motor cortex in the thenar muscle compared with the other condition. Furthermore, we established that the modulation of the corticospinal tract was related to ES intensity. However, we found that the excitability of the corticospinal tract induced by actual movement was enhanced by peripheral nerve ES above the sensory threshold. PMID:23591692

Saito, Kei; Yamaguchi, Tomofumi; Yoshida, Naoshin; Tanabe, Shigeo; Kondo, Kunitsugu; Sugawara, Kenichi



Whole nerve recordings with the spiral nerve cuff electrode  

Microsoft Academic Search

The feasibility of whole nerve recordings from the hypoglossal (HG) nerve is demonstrated in acute cats using the spiral nerve cuff electrode. A good contact between the nerve and the electrodes, provided by the spiral nerve cuff due to its self-coiling property, should improve the signal-to-noise ratio. An instrumentation amplifier with very low input noise characteristics is also utilized. The

Mesut Sahin; Dominique M. Durand; Musa A. Haxhiu



Skin lesion of coccidioidomycosis  


... skin. The skin rash, or skin lesions, include erythema nodosum or erythema multiforme . They are thought to be ... the initial (primary) infection Erythema multiforme (target lesions) Erythema nodosum Papular rash Skin lesion of widespread (disseminated) disease: ...


Optic nerve diffusion tensor imaging in optic neuritis  

Microsoft Academic Search

Diffusion tensor magnetic resonance imaging (DT-MRI) provides in vivo information about the pathology of multiple sclerosis lesions. Increases in mean diffusivity (MD) and reductions in fractional anisotropy (FA) have been found and may represent axonal disruption. The optic nerve is an ideal structure for study by DT-MRI but previous clinical studies did not obtain the full diffusion tensor necessary to

S. Anand Trip; Claudia Wheeler-Kingshott; Stephen J. Jones; Wai-Yung Li; Gareth J. Barker; Alan J. Thompson; Gordon T. Plant; David H. Miller



Nerve root hypertrophy in chronic inflammatory demyelinating polyneuropathy.  


A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) and central demyelinating disease is described in whom striking nodular filling defects on multiple lumbar-sacral nerve roots, mimicking neurofibromata, were observed at myelography and magnetic resonance imaging. We suggest that these lesions are secondary to recurrent segmental demyelination and remyelination and that the differential diagnosis of this radiological feature should include CIDP. PMID:8114785

De Silva, R N; Willison, H J; Doyle, D; Weir, A I; Hadley, D M; Thomas, A M



Pre-operative cerebellar mutism secondary to vagus nerve schwannoma.  


Cerebellar mutism, also known as 'posterior fossa syndrome,' is an uncommon condition often reported after posterior fossa tumour resection in the paediatric population. It is infrequently associated with other intrinsic cerebellar pathologies. We hereby report a rare case of pre-operative cerebellar mutism associated with an extrinsic posterior fossa lesion - vagus nerve schwannoma. PMID:22111953

Muthappan, Muthupalaniappaan; Correia, Jason; Muthu, Thirayan; Hussain, Zakier



Complications of peripheral nerve blocks.  


Complications of peripheral nerve blocks are fortunately rare, but can be devastating for both the patient and the anaesthesiologist. This review will concentrate on current knowledge about peripheral nerve injury secondary to nerve blocks, complications from continuous peripheral nerve catheter techniques, and local anaesthetic systemic toxicity. PMID:21148659

Jeng, C L; Torrillo, T M; Rosenblatt, M A



Multibacillary nerve histology in clinically diagnosed borderline tuberculoid leprosy patients.  


The classification of leprosy into multibacillary (MB) and paucibacillary (PB) patients in almost all clinics is entirely dependent on clinical examination. In a study of 21 patients clinically classified as borderline tuberculoid (BT) and, therefore, belonging to the PB group, skin smears and skin and nerve biopsies were examined. Four patients did not have any histopathological evidence of leprosy. Skin smears showed that 1 patient was positive for acid-fast bacilli (AFB), 2 skin biopsies belonged to the borderline lepromatous (BL) category and showed AFB in their lesions, and AFB were present in 10 nerve biopsies classified as BL. It is possible that reported relapses among PB patients may be in those patients with demonstrable AFB in the lesions, including nerves. A careful follow-up study of this particular group of patients after PB multidrug therapy is suggested to resolve this question. PMID:8862266

Ebenezer, G J; Suneetha, S; Mohandas, R; Arunthathi, S



Light and electron microscopic immunohistochemical observations of p75 nerve growth factor receptor-immunoreactive dermal nerves in prurigo nodularis.  


Prurigo nodularis is an inflammatory skin disease characterized by neurohyperplasia. Neurotrophins and their receptors play a critical role in nerve growth, differentiation, maturation and maintenance, including cutaneous nerve fiber growth and innervation. They may also be responsible for events related to the growth and differentiation control of keratinocytes. To explore the exact distribution of the p75 low-affinity nerve growth factor receptor (p75 NGFr) in the cutaneous nerve components, p75 NGFr immunofluorescence as well as ultrastructural immunohistochemical studies were performed on prurigo nodularis lesional skin and normal human skin samples. The immunofluorescence results revealed that nerve fibers and bundles were increased in number and size in lesional upper dermis with stronger p75 NGFr immunoreactivity than in the corresponding normal tissue. At the ultrastructural level, a lot of nerve fibers clustered together in the prurigo nodularis dermal tissue. The axons were enlarged and branched, but the axons themselves seldom showed any NGFr immunoreactivity. The Schwann cell bodies were extended and irregularly shaped, and tended to separate into many branches enveloping the axons. The Schwann cell membrane showed strong p75 NGFr immunoreactivity. The perineurium cells also revealed strong p75 NGFr immunoreactivity. The Schwann cells inside the perineurium were less p75 NGFr-immunoreactive than those outside the perineurium. The membrane of certain basal keratinocytes showed NGFr immunoreactivity as well. The present results indicate that overexpression of p75 NGFr in Schwann cells and perineurium cells could contribute to the neurohyperplasia in prurigo nodularis. PMID:10025723

Liang, Y; Marcusson, J A; Johansson, O



Understanding facial nerve paralysis.  


Facial nerve paralysis has many causes and can be acute or chronic. Understanding the signs and symptoms, performing a careful patient evaluation, and obtaining appropriate diagnostic testing can help guide clinicians and improve outcomes. PMID:24153089

Matthaeus, Jaime; Hayden, Richard; Kim, Michael; Donald, Carrlene



Cervical Radiculopathy (Pinched Nerve)  


... Copyright 2010 American Academy of Orthopaedic Surgeons Cervical Radiculopathy (Pinched Nerve) Some people have neck pain that ... The medical term for this condition is cervical radiculopathy. Understanding your spine and how it works can ...


Diabetic Nerve Problems  


... 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 ...


Experimental interfascicular nerve grafting.  


Twenty-nine adult rhesus monkeys underwent complete laceration of both tibial nerves at mid-thigh level and repair by different methods to study the relative efficacy of autogenous interfascicular nerve grafts. Sixteen animals in Group I had an interfascicular graft repair using short sural nerve autografts on one limb and fascicular repair without grafts on the other limb. Thirteen animals in Group II, after having a 1-cm segment of tibial nerve resected, had an interfascicular graft repair without tension in one limb and an epineurial repair under moderate tension in the other limb. Evoked nerve and muscle action potentials and muscle strenght in response to repetitive and tetanic stimulation were recorded as baseline values prelaceration and then on re-exploration at 4, 6, 9, or 12 months. All nerves were examined by light and electron microscopy. Electrophysiological data, particularly muscle strength response, showed non-graft repairs to be superior at 4 and 6 months of regeneration. However, by 9 and 12 months the graft repairs had caught up and were equal to the non-graft repairs. Histologically, it was observed that many axons missed the graft segments and were present in extrafascicular connective tissues. Nonetheless, enough axons regenerated to the distal nerve to explain the success of these relatively short grafts. From the results of these experiments, it is concluded that use of autogenous interfascicular grafts offers no advantage over end-to-end non-graft repair. When and end-to-end repair cannot be achieved, use of short interfascicular nerve grafts is feasible and will work. PMID:224152

Bratton, B R; Kline, D G; Coleman, W; Hudson, A R



Traumatic facial nerve injury.  


Facial nerve trauma can be a devastating injury resulting in functional deficits and psychological distress. Deciding on the optimal course of treatment for patients with traumatic facial nerve injuries can be challenging, as there are many critical factors to be considered for each patient. Choosing from the great array of therapeutic options available can become overwhelming to both patients and physicians, and in this article, the authors present a systematic approach to help organize the physician's thought process. PMID:24138740

Lee, Linda N; Lyford-Pike, Sofia; Boahene, Kofi Derek O



Cranial Nerve VIII  

PubMed Central

Cranial nerve VIII brings sound and information about one's position and movement in space into the brain. The auditory and vestibular systems subserve several functions basic to clinical medicine and to psychiatry. This article covers the basics of cranial nerve VIII, hearing and vestibular systems, including common problems with hearing and balance, problems with hearing and balance that tend to be found in psychiatric patients, and some simple assessments of value in clinical practice.

Sanders, Richard D



Tolerance of cranial nerves of the cavernous sinus to radiosurgery  

SciTech Connect

Stereotactic radiosurgery is becoming a more accepted treatment option for benign, deep seated intracranial lesions. However, little is known about the effects of large single fractions of radiation on cranial nerves. This study was undertaken to assess the effect of radiosurgery on the cranial nerves of the cavernous sinus. The authors examined the tolerance of cranial nerves (II-VI) following radiosurgery for 62 patients (42/62 with meningiomas) treated for lesions within or near the cavernous sinus. Twenty-nine patients were treated with a modified 6 MV linear accelerator (Joint Center for Radiation Therapy) and 33 were treated with the Gamma Knife (University of Pittsburgh). Three-dimensional treatment plans were retrospectively reviewed and maximum doses were calculated for the cavernous sinus and the optic nerve and chiasm. Median follow-up was 19 months (range 3-49). New cranial neuropathies developed in 12 patients from 3-41 months following radiosurgery. Four of these complications involved injury to the optic system and 8 (3/8 transient) were the result of injury to the sensory or motor nerves of the cavernous sinus. There was no clear relationship between the maximum dose to the cavernous sinus and the development of complications for cranial nerves III-VI over the dose range used (1000-4000 cGy). For the optic apparatus, there was a significantly increased incidence of complications with dose. Four of 17 patients (24%) receiving greater than 800 cGy to any part of the optic apparatus developed visual complications compared with 0/35 who received less than 800 cGy (p = 0.009). Radiosurgery using tumor-controlling doses of up to 4000 cGy appears to be a relatively safe technique in treating lesions within or near the sensory and motor nerves (III-VI) of the cavernous sinus. The dose to the optic apparatus should be limited to under 800 cGy. 21 refs., 4 tabs.

Tishler, R.B.; Loeffler, J.S.; Alexander, E. III; Kooy, H.M. (Harvard Medical School, Boston, MA (United States)); Lunsford, L.D.; Duma, C.; Flickinger, J.C. (Univ. of Pittsburgh Medical Center, PA (United States))



Sound-induced facial synkinesis following facial nerve paralysis.  


Facial synkinesis (or synkinesia) (FS) occurs frequently after paresis or paralysis of the facial nerve and is in most cases due to aberrant regeneration of (branches of) the facial nerve. Patients suffer from inappropriate and involuntary synchronous facial muscle contractions. Here we describe two cases of sound-induced facial synkinesis (SFS) after facial nerve injury. As far as we know, this phenomenon has not been described in the English literature before. Patient A presented with right hemifacial palsy after lesion of the facial nerve due to skull base fracture. He reported involuntary muscle activity at the right corner of the mouth, specifically on hearing ringing keys. Patient B suffered from left hemifacial palsy following otitis media and developed involuntary muscle contraction in the facial musculature specifically on hearing clapping hands or a trumpet sound. Both patients were evaluated by means of video, audio and EMG analysis. Possible mechanisms in the pathophysiology of SFS are postulated and therapeutic options are discussed. PMID:18539550

Ma, Ming-San; van der Hoeven, Johannes H; Nicolai, Jean-Philippe A; Meek, Marcel F



Rathke's cleft cyst presenting as bilateral abducens nerve palsy.  


We present a patient with a Rathke's cleft cyst who presented with rapidly progressive bilateral 6th nerve palsy. A 20-year-old woman with a history of cleft palate, hypertension, and hydronephrotic kidneys presented with a one month history of headache, associated with dizziness and diplopia on horizontal gaze. Examination was significant for profound bilateral 6th nerve palsies. Magnetic resonance imaging showed a hypodense mass that filled the sella and compressed the right cavernous sinus without contacting the optic chiasm. Pituitary function was normal. An endoscopic, transnasal transsphenoidal resection of the lesion was performed; microscopic examination revealed a Rathke's cleft cyst. Surgical excision resulted in near complete resolution of the bilateral 6th nerve palsy. Rathke's cleft cysts are an unusual cause of bilateral sixth nerve palsy and represent a potential cause of cranial neuropathy. PMID:19621262

Grover, Vinni; Hamrahian, Amir H; Prayson, Richard A; Weil, Robert J



Bilateral ptosis due to mesencephalic lesions with relative preservation of ocular motility.  


Three cases of bilateral ptosis with relatively normal ocular motility are presented. In two of the patients, neuroimaging demonstrated lesions in the region of the third cranial nerve subnuclei. These unusual clinical presentations are due to isolated involvement of the central caudal nucleus supplying the bilateral levator muscles, with, virtually complete sparing of other third cranial nerve structures. PMID:8956161

Martin, T J; Corbett, J J; Babikian, P V; Crawford, S C; Currier, R D



Probable trigeminal nerve schwannoma in a dog.  


A 7-year-old male Husky dog developed atrophy of the right masseter muscle and pruritus of the right side of the face. A myogenic origin was excluded using muscular biopsy. Electrophysiologically, there was involvement of the motor and sensory fibers of the trigeminal nerve, suggesting a lesion located between the brainstem and the trigeminal ganglion. On MRI examination, a nodular mass was detected in the right caudal fossa. This mass was characterized by intense enhancement after injection of contrast medium. Because of the progressive clinical signs, electrophysiology, and MRI results, a presumptive diagnosis of a trigeminal nerve schwannoma was made. The animal's condition improved slightly with corticosteroids. The dog underwent euthanasia 3 months after initial presentation. Necropsy was not performed. PMID:9845193

Saunders, J H; Poncelet, L; Clercx, C; Snaps, F R; Flandroy, P; Capasso, P; Dondelinger, R F


Bilateral LMAN lesions cancel differences in HVC neuronal recruitment induced by unilateral syringeal denervation  

Microsoft Academic Search

Twenty-six-day-old male zebra finches received (1) unilateral section of their tracheosyringeal nerve, (2) bilateral lesions of the lateral magnocellular nucleus of the anterior neostriatum (LMAN), and (3) both operations. All birds were kept with an adult, singing male as a tutor until day 65. Tracheo-syringeal nerve-cut birds were able to imitate this model, but LMAN-lesioned birds were not. Bromodeoxyuridine, a

L. Wilbrecht; T. Petersen; F. Nottebohm



Central regulation of motor cortex neuronal responses to forelimb nerve inputs during precision walking in the cat  

PubMed Central

The responses of neurones in forelimb motor cortex to impulse volleys evoked by single pulse electrical stimulation (at 1.5 or 2 times the threshold for most excitable nerve fibres) of the superficial radial (SR) and ulnar (UL) nerves of the contralateral forelimb were studied in awake cats both resting quietly and walking on a horizontal ladder. Nerve volley amplitude was monitored by recording the compound action potential elicited by the stimulus. In the resting animal 34/82 (41 %) cells yielded statistically significant responses to SR stimulation, and 20/72 (28 %) responded to UL stimulation. Some responses were confined to or began with an increase in firing probability (‘excitatory’ responses) and others with a decrease in firing (‘inhibitory’ responses), typically including a brief interruption of the spike train (zero rate). Cells responding to both nerves usually yielded responses similar in type. Most (78 %) response onset latencies were less than 30 ms. Responses involved the addition or subtraction of from 3.4 to 0.1 impulses stimulus?1 (most < 1 impulse stimulus?1). The distribution of response sizes was continuous down to the smallest values, i.e. there was no ‘gap’ which would represent a clear separation into ‘responsive’ and ‘unresponsive’ categories. Responses were commonest in the lateral part of the pericruciate cortex, and commoner among pyramidal tract neurones (PTNs) than non-PTNs. During ladder walking most cells generated a rhythmic step-related discharge; in assessing the size of responses to nerve stimulation (20 studied, from 13 cells) this activity was first subtracted. Response onset latencies (90 % < 30 ms) and durations showed little or no change. Although most cells were overall more active than during rest both ‘excitatory’ and ‘inhibitory’ responses in both PTNs and non-PTNs were often markedly reduced in large parts of the step cycle; over some (usually brief) parts responses approached or exceeded their size during rest, i.e. response size was step phase dependent. Such variations occurred without parallel change in the nerve compound action potential, nor were they correlated with the level of background firing at the time that the response was evoked. When responses to both nerves were studied in the same neurone they differed in their patterns of phase dependence. The findings are interpreted as evidence for central mechanisms that, during ‘skilled’, cortically controlled walking, powerfully regulate the excitability of the somatic afferent paths from forelimb mechanoreceptors (including low threshold cutaneous receptors) to motor cortex. Retention (or enhancement) of responsiveness often occurred (especially for ulnar nerve) around footfall, perhaps reflecting a behavioural requirement for sensory input signalling the quality of the contact established with the restricted surface available for support.

Marple-Horvat, D E; Armstrong, D M



Static progressive orthosis for patients with limited radial and/or ulnar deviation: an innovative orthotic design.  


After injury to the wrist and forearm, therapists and patients frequently work to regain the motions of wrist flexion/extension and forearm pronation/supination. Although these motions play a vital role in everyday functioning, for some, limitations in wrist radial/ulnar deviation can also present functional challenges. These authors describe the creation and utilization of a static progressive orthosis to assist a patient in regaining wrist radioulnar deviation PMID:22704326

Grenier, Marie-Lyne; Chinchalkar, Shrikant J; Pipicelli, Joey G



Benign breast lesions: Ultrasound  

PubMed Central

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.

Masciadri, N.; Ferranti, C.



Refining the Sensory and Motor Ratunculus of the Rat Upper Extremity Using fMRI and Direct Nerve Stimulation  

PubMed Central

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.

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.



Stump nerve signals during transcranial magnetic motor cortex stimulation recorded in an amputee via longitudinal intrafascicular electrodes.  


Do central and peripheral motor pathways associated with an amputated limb retain at least some functions over periods of years? This problem could be addressed by evaluating the response patterns of nerve signals from peripheral motor fibers during transcranial magnetic stimulation (TMS) of corticospinal tracts. The aim of this study was to record for the first time TMS-related responses from the nerves of a left arm stump of an amputee via intrafascicular longitudinal flexible multi-electrodes (tfLIFE4) implanted for a prosthetic hand control. After tfLIFE4 implant in the stump median and ulnar nerves, TMS impulses of increasing intensity were delivered to the contralateral motor cortex while tfLIFE4 recordings were carried out. Combining TMS of increasing intensity and tfLIFE4 electrodes recordings, motor nerve activity possibly related to the missing limb motor control and selectively triggered by brain stimulation without significant electromyographic contamination was identified. These findings are entirely original and indicate that tfLIFE4 signals are clearly driven from M1 stimulation, therefore witnessing the presence in the stump nerves of viable motor signals from the CNS possibly useful for artificial prosthesis control. PMID:21390489

Rossini, P M; Rigosa, Jacopo; Micera, Silvestro; Assenza, Giovanni; Rossini, Luca; Ferreri, Florinda



Cortical disinhibition occurs in chronic neuropathic, but not in chronic nociceptive pain  

Microsoft Academic Search

BACKGROUND: The aim of this study was to examine the relationship between chronic neuropathic pain after incomplete peripheral nerve lesion, chronic nociceptive pain due to osteoarthritis, and the excitability of the motor cortex assessed by transcranial magnetic stimulation (TMS). Hence in 26 patients with neuropathic pain resulting from an isolated incomplete lesion of the median or ulnar nerve (neuralgia), 20

Peter Schwenkreis; Andrea Scherens; Anne-Kathrin Rönnau; Oliver Höffken; Martin Tegenthoff; Christoph Maier



Glial responses after chorda tympani nerve injury.  


The chorda tympani (CT) nerve innervates lingual taste buds and is susceptible to damage during dental and inner ear procedures. Interruption of the CT results in a disappearance of taste buds, which can be accompanied by taste disturbances. Because the CT usually regenerates to reinnervate taste buds successfully within a few weeks, a persistence of taste disturbances may indicate alterations in central nervous function. Peripheral injury to other sensory nerves leads to glial responses at central terminals, which actively contribute to abnormal sensations arising from nerve damage. Therefore, the current study examined microglial and astrocytic responses in the first central gustatory relay, the nucleus of the solitary tract (nTS), after transection of the CT. Damage to the CT resulted in significant microglial responses in terms of morphological reactivity and an increased density of microglial cells from 2 to 20 days after injury. This increased microglial population resulted primarily from microglial proliferation from 1.5 to 3 days, which was supplemented by microglial migration within subdivisions of the nTS between days 2 and 3. Unlike other nerve injuries, CT injury did not result in recruitment of bone marrow-derived precursors. Astrocytes also reacted in the nTS with increased levels of glial fibrillary acidic protein (GFAP) by 3 days, although none showed evidence of cell division. GFAP levels remained increased at 30 days, by which time microglial responses had resolved. These results show that nerve damage to the CT results in central glial responses, which may participate in long-lasting taste alterations following CT lesion. PMID:22315167

Bartel, Dianna L



Cranial Nerves III, IV, and VI  

PubMed Central

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.

Sanders, Richard D.




PubMed Central

Standard light microscope histological evaluation of peripheral nerve lesions has been used routinely to assess peripheral nerve demyelination; however, the development of magnetic resonance (MR) methodology for assessing peripheral nerve may provide complimentary information, with less expense and in less time than nerve histology methods. In this study, the utility of multicomponent NMR T2 relaxation analysis for assessing myelin injury in toxicology studies was examined using two dithiocarbamates, N,N-diethyldithiocarbamate (DEDC) and pyrrolidine dithiocarbamate (PDTC), known to produce myelin injury and elevate copper in the nervous system. T2 analysis was used in conjunction with standard histological methods to assess myelin injury and determine if dithiocarbamate-mediated copper accumulation in peripheral nerve was associated with more severe myelin lesions. Male Sprague-Dawley rats were administered i.p. DEDC for 8 weeks and maintained on either a diet containing normal (13 ppm) or elevated (200 ppm) copper. Another group of male Sprague-Dawley rats was administered oral PDTC and a 200 ppm copper diet, with controls given only the 200 ppm copper diet, for 47 weeks. Following exposures, the morphology of sciatic nerve was evaluated using light microscopy and multicomponent T2 analysis of excised fixed nerves; and copper levels in sciatic nerve were determined using ICP-AES. Light microscopy demonstrated the presence of a primary myelinopathy in dithiocarbamate-exposed rats characterized by intramyelinic edema, demyelination, and secondary axonal degeneration. Both the nerve copper level and number of degenerated axons, as ascertained by ICP-AES and microscopy respectively, were augmented by dietary copper supplementation in conjunction with administration of DEDC or PDTC. T2 analysis revealed a decreased contribution from the shortest T2 component in multicomponent T2 spectra obtained from animals administered DEDC or PDTC, consistent with decreased myelin content; and the decrease of the myelin water component was inversely correlated to the levels of nerve copper and myelin lesion counts. Also, the T2 analysis showed reduced variability compared to histological assessment. These studies support multicomponent T2 analysis as a complementary method to light microscopic evaluations that may also be applicable to in vivo assessments.

Valentine, Holly L.; Does, Mark D.; Marshall, Vivian; Tonkin, Elizabeth G.; Valentine, William M.



Acellular Nerve Allografts in Peripheral Nerve Regeneration: A Comparative Study  

PubMed Central

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.

Moore, Amy M.; MacEwan, Matthew; Santosa, Katherine B.; Chenard, Kristofer E.; Ray, Wilson Z.; Hunter, Daniel A.; Mackinnon, Susan E.; Johnson, Philip J.



Motor nerve lengths of twenty-seven muscles in upper extremity.  


The purpose of this study is to determine the lengths of motor nerves in the upper extremity. Motor nerves of 27 muscles in 10 cadavers (16 extremities) were dissected from their roots at the level of intervertebral foramen to the entry point of the nerves to the corresponding muscles. Distance between acromion and the lateral epicondyle of the humerus was also measured in all cadavers. Nerve length of the coracobrachialis muscle was the shortest (18.26 ± 1.64 cm), while the longest was the nerve of the extensor indicis (59.51 ± 4.80 cm). The biceps brachii, the extensor digitorum communis, and the brachialis muscles showed highest coefficient of variation that makes these nerve lengths of muscles inconsistent about their lengths. This study also offers quotients using division of the lengths of each nerve to acromion-the lateral epicondyle distance. Knowledge of the nerve lengths in the upper extremity may provide a better understanding the reinnervation sequence and the recovery time in the multilevel injuries such as brachial plexus lesions. Quotients may be used to estimate average lengths of nerves of upper extremity in infants and children. Moreover, reliability of the biceps brachii as a determinant factor for surgery in obstetrical brachial plexus lesions should be reconsidered due to its highest variation coefficient. PMID:21898604

Kendir, Simel; Sen, Tülin; Firat, Tüzün; Leblebicio?lu, A Gürsel; Türker, Tolga; Tekdemir, Ibrahim; Elhan, Alaittin



Nerve globins in invertebrates.  


The expression of nerve hemoglobins in invertebrates is a well-established fact, but this occurrence is uncommon. In the species where nerve globins occur, they probably function as an oxygen store for sustaining activity of the nerves during anoxic conditions. Although invertebrate nerve globins are functionally similar with respect to O2 affinity, they are by no means uniform in structure and can differ in size, cellular localization and heme-coordination. The best-studied nerve globin is the mini-globin of Cerebratulus lacteus, which belongs to a class of globins containing the polar TyrB10/GlnE7 pair in the distal pocket. The amide and phenol side chains normally cause low rates of O2 dissociation and ultra-high O2 affinity by forming strong hydrogen bonds with bound ligands. Cerebratulus hemoglobin, however, has a moderate O2 affinity, due to the presence of a third polar amino-acid in its active site, ThrE11, which inhibits hydrogen bonding to bound oxygen by the B10 tyrosine side chain. PMID:15804828

Geuens, E; Dewilde, S; Hoogewijs, D; Pesce, A; Nienhaus, K; Nienhaus, G U; Olson, J; Vanfleteren, J; Bolognesi, M; Moens, L


A Spiral Nerve Cuff Electrode for Peripheral Nerve Stimulation  

Microsoft Academic Search

A new type of newe cuff electrode consisting of conduc- tive segments embedded within a self-curling sheath of biocompatihle insulation has been developed. This spiral nerve cuff is biased to self- wrap around peripheral nerves and possesses a \\




Single lesion multibacillary leprosy, a treatment enigma: a case report  

Microsoft Academic Search

INTRODUCTION: Leprosy exhibits a wide spectrum of presentation, varying from the tuberculoid to the lepromatous pole, with immunologically unstable borderline forms in-between, depending upon the immune status of the individual. The clinical system of classification for the purpose of treatment includes the number of skin lesions and nerves involved as the basis for classifying the patients into multibacillary and paucibacillary.

Bishwa R Sapkota; Kapil D Neupane; Ram K Maharjan



Pulsed radiofrequency lesioning for treatment of chronic breast neuropathic pain after breast reduction -A case report-  

PubMed Central

Breast surgery is a common procedure performed in women. Many women who undergo breast surgery suffer from ill-defined pain syndromes. A nerve block is used in the treatment of the acute and chronic pain, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency lesioning (PRF) has proved a successful treatment for chronic refractory pain involving the peripheral nerves. We experienced a case of a 52-year-old female patient complaining of chronic breast neuropathic pain after breast reduction, which was relieved after PRF lesioning of the 4th thoracic spinal nerve and its root.

Kim, Hyung Tae; Kim, Kwang Yong; Kim, Yeon Dong



A new syndrome, congenital extraocular muscle fibrosis with ulnar hand anomalies, maps to chromosome 21qter  

PubMed Central

Objective: To describe a new autosomal recessive syndrome of CFEOM and ulnar hand abnormalities, and localise the disease causing gene. Methods: Clinical evaluation of the affected members and positional mapping. Results: Six affected patients with CFEOM/U (aged 2 to 29 years) from a large consanguineous Turkish family were studied. Ophthalmological involvement was characterised by non-progressive restrictive ophthalmoplegia with blepharoptosis of the right eye. The postaxial oligodactyly/oligosyndactyly of the hands was more severe on the right side. A genome-wide scan established linkage of this new autosomal recessive syndrome to a locus on chromosome 21qter. The multipoint LOD score was 4.53 at microsatellite marker D21S1259, and fine mapping defined a ?1.5 Mb critical region between microsatellite marker D21S1897 and the telomere of the long arm. Conclusions: CFEOM/U maps to a 1.5 Mb region at chromosome 21qter. Future identification of the disease causing gene may provide insights into the development of the extraocular muscles and brain stem ? motor neurones, as well as anteroposterior limb development.

Tukel, T; Uzumcu, A; Gezer, A; Kayserili, H; Yuksel-Apak, M; Uyguner, O; Gultekin, S; Hennies, H; Nurnberg, P; Desnick, R; Wollnik, B



In vivo assessment of forearm bone mass and ulnar bending stiffness in healthy men.  


The cross-sectional bending stiffness EI of the ulna was measured in vivo by mechanical resistance tissue analysis (MRTA) in 90 men aged 19-89 years. MRTA measures the impedance response of low-frequency vibrations to determine EI, which is a reflection of elastic modulus E and moment of inertia I for the whole ulna. EI was compared to conventional estimates of bone mineral content (BMC), bone width (BW), and BMC/BW, which were all measured by single-photon absorptiometry. Results obtained from the nondominant ulna indicate that BW increases (r = 0.27, p = 0.01) and ulnar BMC/BW decreases (r = -0.31, p < or = 0.005) with age. Neither BMC nor EI declined with age. The single best predictor of EI was BW (r2 = 0.47, p = 0.0001), and further small but significant contributions were made by BMC (r2 = 0.53, p = 0.0001) and grip strength (r2 = 0.55, p = 0.0001). These results suggest that the resistance of older men to forearm fracture is related to age-associated changes in the moment of inertia achieved by redistributing bone mineral farther from the bending axis. We conclude that the in vivo assessment of bone geometry offers important insights to the comprehensive evaluation of bone strength. PMID:1466258

Myburgh, K H; Zhou, L J; Steele, C R; Arnaud, S; Marcus, R



Clinical analysis of a large kindred with the pallister ulnar-mammary syndrome  

SciTech Connect

The ulnar-mammary syndrome (UMS) is an autosomal dominant disorder characterized by posterior limb deficiencies or duplications, apocrine/mammary gland hypoplasia and/or dysfunction, abnormal dentition, delayed puberty in males, and genital anomalies. We present the clinical descriptions of 33 members of a six generation kindred with UMS. The number of affected individuals in this family is more than the sum of all previously reported cases of UMS. The clinical expression of UMS is highly variable. While most patients have limb deficiencies, the range of abnormalities extends from hypoplasia of the terminal phalanx of the 5th digit to complete absence of the ulna and 3rd, 4th, and 5th digits. Moreover, affected individuals may have posterior digital duplications with or without contralateral limb deficiencies. Apocrine gland abnormalities range from diminished axillary perspiration with normal breast development and lactation, to complete absence of the breasts and no axillary perspiration. Dental abnormalities include misplaced or absent teeth. Affected males consistently undergo delayed puberty, and both sexes have diminished to absent axillary hair. Imperforate hymen were seen in some affected women. A gene for UMS was mapped to chromosome area 12q23-q24.1. A mutation in the gene causing UMS can interfere with limb patterning in the proximal/distal, anterior/posterior, and dorsal/ventral axes. This mutation disturbs development of the posterior elements of forearm, wrist, and hand while growth and development of the anterior elements remain normal. 24 refs., 4 figs., 1 tab.

Bamshad, M.; Root, S.; Carey, J.C. [Univ. of Utah Health Sciences Center, Salt Lake City, UT (United States)



[Peripheral facial nerve palsy].  


Facial palsy can be defined as a decrease in function of the facial nerve, the primary motor nerve of the facial muscles. When the facial palsy is peripheral, it affects both the superior and inferior areas of the face as opposed to central palsies, which affect only the inferior portion. The main cause of peripheral facial palsies is Bell's palsy, which remains a diagnosis of exclusion. The prognosis is good in most cases. In cases with significant cosmetic sequelae, a variety of surgical procedures are available (such as hypoglossal-facial anastomosis, temporalis myoplasty and Tenzel external canthopexy) to rehabilitate facial aesthetics and function. PMID:23627995

Pons, Y; Ukkola-Pons, E; Ballivet de Régloix, S; Champagne, C; Raynal, M; Lepage, P; Kossowski, M



An artificial nerve fiber for evaluation of nerve cuff electrodes  

Microsoft Academic Search

The different applications of natural sensors for feedback in rehabilitation systems using functional electrical stimulation (FES) require specialised and optimised designs of nerve cuff electrodes for recording of the sensory information. This paper describes a simple artificial nerve fiber for evaluation of nerve cuff electrode designs, cuff recording configurations and noise reduction methods in a controlled environment. The idea is

Lotte N. S. Andreasen; Johannes J. Struijk; Morten Haugland



Repetitive nerve stimulation for the evaluation of peripheral nerve hyperexcitability  

Microsoft Academic Search

Objective: To examine the utility of repetitive nerve stimulation (RNS) in the evaluation of peripheral nerve hyperexcitability (PNH). Background: PNH describes a group of disorders characterized by muscle cramps, twitching and stiffness. When severe, PNH may be characterized by the presence of continuous muscle fiber activity on routine needle electromyography (EMG). In milder forms of the disease, nerve hyperexcitability may

Michael Benatar; Kristine M Chapman; Seward B Rutkove



Interleukin6 and nerve growth factor levels in peripheral nerve and brainstem after trigeminal nerve injury in the rat  

Microsoft Academic Search

Earlier studies have demonstrated that inflammation plays a role in the development of evoked pain following partial nerve injury. In this report, we demonstrate bilateral changes in interleukin-6 (IL-6) and nerve growth factor (nerve growth factor) levels following unilateral infraorbital nerve (infraorbital nerve) constriction. infraorbital nerve constriction resulted in an initial period of decreased mechanical sensitivity (1 and 3 days),

Leigh C Anderson; Ramesh D Rao



Entrapment of the lateral cutaneous nerve of the calf.  


Isolated lesion of lateral cutaneous nerve of the calf (LCNC), particularly due to entrapment, is rarely reported in the literature. Patients usually present with sensory symptoms in the lateral aspect of the calf. Treatment is usually by local applications or local steroid/anaesthetic injection. We report the first case of LCNC entrapment in a 35-year-old man which is documented by nerve conduction studies. The patient had a temporary improvement following a local anaesthetic/steroid injection. Owing to the recurrence of symptoms, the patient opted for surgery. About 1 year after surgery, the symptoms disappeared completely. PMID:23821626

Khalil, Nofal M; Nicotra, Alessia; Kaplan, Charles; O'Neill, Kevin S



Bilateral Optic Nerve Sheath Meningioma with Intracanalicular and Intracranial Component in a 25-year-old Saudi Patient  

PubMed Central

Bilateral optic nerve sheath meningioma is rare. A meningioma is a benign neoplastic lesion from meningothelial cells of the meninges. They usually involve the intracanalicular portion of the optic nerve but may extend into the optic canal and through it to occupy the intracranial space. We present a case of 25-year-old Saudi female with bilateral optic nerve sheath meningioma. The diagnosis was delayed more than six years from initial symptoms.

Badr, Maha A.; Elkhamary, Sahar M.; Al Sabbagh, Samira; Al Turjoman, Abdulsalam



Mediation of spinal nerve injury induced tactile allodynia by descending facilitatory pathways in the dorsolateral funiculus in rats  

Microsoft Academic Search

Evidence exists to indicate that tactile allodynia arising from peripheral nerve injury is integrated predominately at supraspinal, rather than spinal, sites. In the present experiments, the possibility that disruption of descending pathways through the dorsolateral funiculus (DLF) might alter expression of nerve-injury induced tactile allodynia was explored. Male, Sprague–Dawley rats received L5\\/L6 spinal nerve ligation (SNL). Lesions to the DLF

Michael H Ossipov; Hong Sun T; Phil Malan; Josephine Lai; Frank Porreca



Conditional deletion of the Itgb4 integrin gene in Schwann cells leads to delayed peripheral nerve regeneration  

Microsoft Academic Search

Several different integrins participate in the complex interactions that promote repair of the peripheral nervous system. The role of the integrin alpha6beta4 in peripheral nerve regeneration was investigated in mice by cre-mediated deletion of the Itgb4 (beta4) gene in Schwann cells. After a crush lesion of the sciatic nerve, the recovery of motor, but not that of sensory, nerve function

C. E. E. M. van der Zee; M. Kreft; G. Beckers; A. Kuipers; A. Sonnenberg



Optic nerve hypoplasia in children.  

PubMed Central

Optic nerve hypoplasia (ONH) is characterised by a diminished number of optic nerve fibres in the optic nerve(s) and until recently was thought to be rare. It may be associated with a wide range of other congenital abnormalities. Its pathology, clinical features, and the conditions associated with it are reviewed. Neuroendocrine disorders should be actively sought in any infant or child with bilateral ONH. Early recognition of the disorder may in some cases be life saving. Images

Zeki, S. M.; Dutton, G. N.



Degeneration and regeneration in rabbit peripheral nerve with long-term nerve cuff electrode implant: a stereological study of myelinated and unmyelinated axons  

Microsoft Academic Search

Selective and dynamically co-ordinated functional electrical stimulation (FES) of paralysed\\/paretic limbs in upper motor\\u000a neuron lesioned people depends on optimal contact at the neural interface. Implanted nerve cuff electrodes may form a stable\\u000a electrical neural interface, but may also inflict nerve damage. In this study the immediate and long-term effects of cuff\\u000a implantation on the number and sizes of myelinated

Jytte Overgaard Larsen; Morten Thomsen; Morten Haugland; Thomas Sinkjær



An improved method for avulsion of lumbar nerve roots as an experimental model of nitric oxide-mediated neuronal degeneration  

Microsoft Academic Search

A root avulsion lesion on the spinal nerve of adult animals is a useful technique to make a model for axotomy-induced motoneuronal degeneration, which is thought to be mediated by nitric oxide (NO). Here, we show a simplified version of extravertebral avulsion in the young adult rat. The L4 nerve always runs under the transverse process of the L5 vertebra,

Jian-wen He; Kazuho Hirata; Akio Kuraoka; Masaru Kawabuchi



Lumbar sympathectomy failed to reverse mechanical allodynia and hyperalgesia-like behavior in rats with L5 spinal nerve injury  

Microsoft Academic Search

The L5 spinal nerve ligation model of neuropathic pain in rats has been proposed as a model for sympathetically maintained pain (SMP) based on the effects of surgical or chemical sympathectomy on nerve injury induced behavior. In an attempt to confirm that the lesion produces an animal model of SMP, surgical sympathectomies were independently conducted in two different laboratories (Johns

Matthias Ringkamp; Sebastian Eschenfelder; Erich J Grethel; Heinz-Joachim Häbler; Richard A Meyer; Wilfrid Jänig; Srinivasa N Raja



An investigation of modifying effects of single nucleotide polymorphisms in metabolism-related genes on the relationship between peripheral nerve function and mercury levels in urine and hair.  


Mercury (Hg) is a potent neurotoxicant. We hypothesized that single nucleotide polymorphisms (SNPs) in genes coding glutathione-related proteins, selenoproteins and metallothioneins may modify the relationship of mercury biomarkers with changes in peripheral nerve function. Dental professionals (n=515) were recruited in 2009 and 2010. Sensory nerve function (onset latency, peak latency and amplitude) of the median, ulnar and sural nerves was recorded. Samples of urine, hair and DNA were collected. Covariates related to demographics, nerve function and elemental and methyl-mercury exposure were also collected. Subjects included 244 dentists (47.4%) and 269 non-dentists (52.2%; mostly dental hygienists and dental assistants). The mean mercury levels in urine (1.06 ?g/L) and hair (0.51 ?g/g) were not significantly different from the US general population (0.95 ?g/L and 0.47 ?g/g, respectively). In multivariate linear models predicting nerve function adjusting for covariates, only 3 out of a total of 504 models showed stable and statistically significant interaction of SNPs with mercury biomarkers. Overall, given the possibility of false positives, the results suggested little evidence of effect modification of the SNPs on the relationship between mercury biomarkers with peripheral nerve function at exposure levels that are relevant to the general US population. PMID:22236634

Wang, Yi; Goodrich, Jaclyn M; Werner, Robert; Gillespie, Brenda; Basu, Niladri; Franzblau, Alfred



Spontaneous lesions in subchronic neurotoxicity testing of rats.  


Male and female Fischer 344 rats, 30 weeks of age, were examined for neuropathologic changes after a 13-week inhalation neurotoxicologic study. Tissues were preserved by whole-body perfusion with 1.5% glutaraldehyde/4% formaldehyde solution. An extensive set of neural tissues was embedded in paraffin, sectioned, and stained with hematoxylin and eosin, luxol fast blue/periodic acid-Schiff/hematoxylin, Sevier-Munger silver, and cresyl echt violet. Lesions in the central and peripheral nervous system were comparable between sexes and between control and treated animals. Bilateral swollen axons were present in the medial aspect of the nucleus gracilis adjacent to the area postrema. Occasional swollen axons also were observed in the dorsal and ventral funiculi of the spinal cord. Degeneration of individual nerve fibers was present in the trapezoid body, vestibular nerve root, trigeminal nerve, cerebellar peduncles, and the funiculi of the spinal cord. Individual nerve fiber degeneration also was present in the spinal nerve roots, sciatic and tibial nerves. Nerve fiber degeneration was characterized by myelin disruption and degeneration, vacuoles and axonal fragmentation. Similar spontaneous neuropathology may be encountered in rats from other subchronic neurotoxicologic studies and must be differentiated from treatment-related toxicity. PMID:2367808

Eisenbrandt, D L; Mattsson, J L; Albee, R R; Spencer, P J; Johnson, K A



Visual field defects in vascular lesions of the lateral geniculate body  

Microsoft Academic Search

Corresponding retinal nerve fibres begin their path in the eyes and end in a single visual cortical cell. Because of this arrangement, lesions in the anterior visual pathway produce incongruent visual field defects and in the posterior pathway congruent field defects. The lateral geniculate body is on the anterior third of the visual pathway. A lesion of this nucleus produces

C Luco; A Hoppe; M Schweitzer; X Vicuña; A Fantin



Optic nerve head segmentation  

Microsoft Academic Search

Reliable and efficient optic disk localization and segmentation are important tasks in automated retinal screening. General-purpose edge detection algorithms often fail to segment the optic disk due to fuzzy boundaries, inconsistent image contrast or missing edge features. This paper presents an algorithm for the localization and segmentation of the optic nerve head boundary in low-resolution images (about 20 ?\\/pixel). Optic

James Lowell; Andrew Hunter; David Steel; Ansu Basu; Robert Ryder; Eric Fletcher; Lee Kennedy



Isolated cranial nerve palsies in multiple sclerosis  

Microsoft Academic Search

During a 10 year period 24 patients with definite multiple sclerosis with isolated cranial nerve palsies were studied (third and fourth nerve: one patient each, sixth nerve: 12 patients, seventh nerve: three patients, eighth nerve: seven patients), in whom cranial nerve palsies were the presenting sign in 14 and the only clinical sign of an exacerbation in 10 patients. MRI

Frank Thömke; Eckart Lensch; Kurt Ringel; Hanns Christian Hopf



Will the untreated ulnar styloid fracture influence the outcome of unstable distal radial fracture treated with external fixation when the distal radioulnar joint is stable  

PubMed Central

Background The ulnar styloid is an important supportive structure for the triangular fibrocartilage complex. However, it remains inconclusive whether or not a fractured ulnar styloid should be fixed in an unstable distal radius fracture (DRF) with a stable distal radioulnar joint (DRUJ). The purpose of this study is to evaluate the effect of an untreated ulnar styloid fracture on the outcome of unstable DRF treated with transarticular external fixation when the DRUJ is stable. Methods 106 patients with an unstable DRF and a stable DRUJ were included in this study following external fixation. The patients were divided into the non-fracture, the tip-fracture and the base-fracture groups according to the location of the ulnar styloid fracture at the time of injury. Postoperative evaluation included the range of wrist motion, the radiological index, the grip strength, the PRWE-HK scores, the wrist pain scores, and the instability of DRUJ at the external fixator removal time, three months postoperatively and the final follow-up visit. Results The patients were followed for 12 to 24 months (15 months in average). Sixty-two of 106 patients (58%) had ulnar styloid fracture and 16 patients (26%) showed radiographic evidence of union of ulnar styloid fractures at the final follow-up visit. No significant difference in the radiological findings, the range of wrist motion, the grip strength, the PRWE-HK scores, and the wrist pain scores among three patient groups was detected at the external fixator removal time, three months postoperatively, or the final follow-up visit. Six of the 106 patients (5.7%) complained of persistent ulnar-side wrist pain during daily activities. One patient (0.9%) showed a positive sign in a stress-test, three patients (2.8%) showed a positive sign in a provocative-test, and five patients (4.7%) showed a positive sign in a press-test. There was no significant difference in the percentages of patients who complained of persistent ulnar-side wrist pain or showed a positive sign in the physical examination of the distal radioulnar joint among the three groups at the final follow-up time points. Conclusion When the DRUJ is stable, an untreated ulnar styloid fracture does not affect the wrist outcome of the patient with an unstable DRF treated with external fixation.



Skin lesion KOH exam  


Potassium hydroxide examination of skin lesion ... The health care provider scrapes the lesion off your skin, using a blunt edge such as the edge of a microscope slide. The scrapings from the skin ...


Inhibin-A immunoreactivity in nervous system lesions.  


To evaluate inhibin-A immunoreactivity and its utility in the differential diagnosis of nervous system neoplasms and non-neoplastic lesions. An immunohistochemical study of 252 central and peripheral nervous system tumors and 40 non-neoplastic lesions was undertaken. Brain lesions included the basic spectrum of astrocytic, oligodendroglial, and ependymal neoplasms, as well as glioneuronal, pineal parenchymal, choroid plexus, and embryonal. Meningeal neoplasms, basic peripheral nerve tumors, and uncommon sellar lesions were also assessed. Non-neoplastic lesions included demyelinating disease, progressive multifocal leukoencephalopathy, organizing infarct, and reactive gliosis. Diffuse cytoplasmic, membranous, and perinuclear cytoplasmic staining patterns were observed. Significant immunoreactivity was noted in glioblastoma (12 of 20), pleomorphic xanthoastrocytoma (6 of 10), ganglioglioma (8 of 10), meningioma (14 of 20), and hemangioblastoma (10 of 10). Peripheral nerve and sellar tumors as well as non-neoplastic lesions were entirely immunonegative. In our study that investigated the inhibin-A immunoreactivity in a broad spectrum of nervous system lesions, inhibin-A positivity was established in various low-grade and high-grade central nervous system tumors. Thus, inhibin-A is not a specific marker of hemangioblastoma and may be of limited utility in the differential diagnosis of astrocytic and meningothelial neoplasms. Its pathophysiologic role in these various tumors remains to be determined. Further evaluation of the possible significance of staining patterns and degrees of reactivity relative to pathobiology and/or prognosis significance is required. PMID:22505009

Gurses, Iclal; Scheithauer, Bernd W



Elevated expression of CAPON and neuronal nitric oxide synthase in the sciatic nerve of rats following constriction injury.  


Neuronal nitric oxide synthase (nNOS) has been implicated in peripheral nerve lesions and regeneration. The CAPON adaptor protein interacts with the PDZ domain of nNOS, helping to regulate nNOS activity at post-synaptic sites in neurones, but it is not known whether its expression is altered in sciatic nerves after chronic nerve constriction injury. In the present study, the spatiotemporal expression of CAPON was determined in chronically constricted rat sciatic nerves. Similar to the level of protein expression, CAPON mRNA was significantly up-regulated for almost 5weeks following sciatic nerve injury. Immunohistochemistry demonstrated that increased CAPON was found mainly in S-100-positive Schwann cells. In addition, co-immunoprecipitation demonstrated an interaction between CAPON and nNOS in Schwann cells and the interaction was enhanced in injured sciatic nerves. CAPON may be involved in peripheral nerve regeneration through regulation of nNOS activity. PMID:20202870

Cui, Zhiming; Lv, Qingshan; Yan, Meijuan; Cheng, Chun; Guo, Zhiqin; Yang, Junling; Chen, Mengling; Xia, Yinyin; Zhang, Li; Shen, Aiguo



Use of bone morphogenetic protein-2 in the rabbit ulnar nonunion model.  


The ability of the osteoinductive protein and recombinant human bone morphogenetic protein-2, combined with polylactic glycolic acid porous microspheres and autologous blood clot to heal a large segmental defect was tested in a rabbit diaphyseal defect model. Two centimeter nonuniting defects were surgically created in the bilateral ulnae of 50 male New Zealand white rabbits. Each defect was then implanted with a pastelike polylactic glycolic acid/blood clot combination that was mixed with 5 different concentrations of recombinant human bone morphogenetic protein-2. The forearms were radiographically assessed on a biweekly schedule for 8 weeks. At 8 weeks, all animals were sacrificed and forearms radiographed. Radiographs were then scored by 3 independent observers for bone formation and union rates. United limbs were tested in torsion for mechanical strength using a Burstein torsion tester. All nonunited limbs were analyzed histologically as were 2 united limbs from each dosage group. Radiographic evaluation revealed that there was a dose dependent response in healing of the ulnar defect with a higher bone formation rate in the 2 higher dose limbs than in the lower dose limbs. Union was achieved in 100% of the highest dose limbs, whereas only 50% of the lowest dose limbs achieved bony union. No defects implanted with carrier alone achieved union. Biomechanical studies revealed significantly stiffer bone than age matched controls. Histologic analysis demonstrated normal bone formation with abundant normal appearing osteoid. These dose response data further support the role of recombinant human bone morphogenetic protein-2 as a potent morphogen in bone regeneration. PMID:8641074

Bostrom, M; Lane, J M; Tomin, E; Browne, M; Berberian, W; Turek, T; Smith, J; Wozney, J; Schildhauer, T



Bilateral eventration of sciatic nerve.  


During routine dissection of a 60 years male cadaver, it was observed that the two divisions of sciatic nerve were separate in the gluteal region on both the sides with the tibial nerve passing below the piriformis and the common peroneal nerve piercing the piriformis muscle. The abnormal passage of the sciatic nerve (SN), the common peroneal nerve (CPN), and the tibial nerve (TN), either through the piriformis or below the superior gemellus may facilitate compression of these nerves. Knowledge of such patterns is also important for surgeons dealing with piriformis syndrome which affects 5-6% of patients referred for the treatment of back and leg pain. A high division may also account for frequent failures reported with the popliteal block. PMID:22049898

Sharma, T; Singla, R K; Lalit, M


Unilateral carpal tunnel syndrome and space-occupying lesions.  


To assess the association between unilateral carpal tunnel syndrome and space-occupying lesions, 128 patients have been reviewed. They were divided into bilateral, subclinical (unilateral signs and symptoms, and bilateral slowing in the median nerve conduction) and unilateral carpal tunnel syndrome. Space-occupying lesions were investigated on the basis of physical examination and wrist imaging using plain radiographs and ultrasonograms. Of 20 patients with unilateral carpal tunnel syndrome, space-occupying lesions were found in seven (occult ganglion in five and occult calcified mass in two). In contrast, none of 89 patients with bilateral carpal tunnel syndrome and 19 with subclinical carpal tunnel syndrome had space-occupying lesions. We conclude that careful examination and wrist imaging on suspicion of local pathology, especially a space-occupying lesion, are needed when the condition is unilateral and the aetiology is not clear from the history and on physical examination. PMID:8308434

Nakamichi, K; Tachibana, S



Chest wall lesions.  


Chest wall lesions in childhood include a wide range of pathologies. Benign lesions include lipoma, neurofibroma, lymphangioma, haemangioma and mesenchymal hamartoma. Malignant lesions include neuroblastoma, rhabdomyosarcoma, Ewings sarcoma, Askin tumour and primitive neuroectodermal tumours. Manifestations of systemic diseases such as leukaemia, lymphoma, Langerhans cell histocytosis and infections such as tuberculosis and actinomycosis may also cause chest wall lesions. The imaging characteristics of the above are reviewed but only a minority of lesions show diagnostic imaging characteristics. Most lesions require biopsy and histopathological examination for definitive diagnosis. The role of different imaging modalities is discussed, with an emphasis on magnetic resonance imaging for demonstrating lesion morphology and local spread, with computed tomography and nuclear medicine being used mainly to assess remote disease. PMID:12457604

Watt, Andrew J B



Clinical Follow-up of Professional Baseball Players Undergoing Ulnar Collateral Ligament Reconstruction Using the New Kerlan-Jobe Orthopaedic Clinic Overhead Athlete Shoulder and Elbow Score (KJOC Score)  

Microsoft Academic Search

Background: There are no validated outcome measures consistently used in the literature to report results of ulnar collateral ligament reconstruction in overhead athletes.Hypothesis: The Kerlan-Jobe Orthopaedic Clinic Overhead Athlete Shoulder and Elbow score (KJOC score) will correlate with other validated scores for upper extremity assessment but will be more accurate in evaluating ulnar collateral ligament reconstruction outcomes in professional baseball

Benjamin G. Domb; J. T. Davis; Frank G. Alberta; Karen J. Mohr; Adam G. Brooks; Neal S. ElAttrache; Lewis M. Yocum; Frank W. Jobe



Presymptomatic brain lesions on MRI in a patient with intravascular malignant lymphomatosis.  


A 58-year-old man with a intravascular malignant lymphomatosis initially developed myeloradiculopathy without cerebral symptoms. His MRI, however, demonstrated solid, wedge-shaped, and well-demarcated lesions in the deep white matter and a string-shaped lesion along with nerve fibers in the splenium of corpus callosum. A variety of cerebral symptoms manifested a month afterward. The possibility of this disease should be considered in cases of undiagnosed myeloradiculopathy with such silent brain lesions. PMID:9557152

Hashimoto, H; Naritomi, H; Kazui, S; Yamamoto, H; Kinugawa, H; Miyashita, K; Abe, S; Sawada, T



Sinus polyp-associated soft tissue lesion and unilateral blindness: complications of extraction in leukemic patient  

Microsoft Academic Search

A case of an inflammatory polyp-associated lesion extending through an extraction socket appearing as an intraoral nodular lesion and unilateral blindness secondary to leukemic optic nerve head infiltration is reported. The patient was a 28-year-old male whose his upper first molar had been extracted fifteen days previously. The lesion was an asymptomatic soft tissue mass, red in color and hot

A. Açikgöz; S. Kayipmaz; G. Cayir Keles



Chemotherapy-induced bone marrow nerve injury impairs hematopoietic regeneration.  


Anticancer chemotherapy drugs challenge hematopoietic tissues to regenerate but commonly produce long-term sequelae. Chemotherapy-induced deficits in hematopoietic stem or stromal cell function have been described, but the mechanisms mediating hematopoietic dysfunction remain unclear. Administration of multiple cycles of cisplatin chemotherapy causes substantial sensory neuropathy. Here we demonstrate that chemotherapy-induced nerve injury in the bone marrow of mice is a crucial lesion impairing hematopoietic regeneration. Using pharmacological and genetic models, we show that the selective loss of adrenergic innervation in the bone marrow alters its regeneration after genotoxic insult. Sympathetic nerves in the marrow promote the survival of constituents of the stem cell niche that initiate recovery. Neuroprotection by deletion of Trp53 in sympathetic neurons or neuroregeneration by administration of 4-methylcatechol or glial-derived neurotrophic factor (GDNF) promotes hematopoietic recovery. These results demonstrate the potential benefit of adrenergic nerve protection for shielding hematopoietic niches from injury. PMID:23644514

Lucas, Daniel; Scheiermann, Christoph; Chow, Andrew; Kunisaki, Yuya; Bruns, Ingmar; Barrick, Colleen; Tessarollo, Lino; Frenette, Paul S



Multiple Myeloma Manifesting as a Fluctuating Sixth Nerve Palsy  

PubMed Central

We report a case of multiple myeloma that presented as a fluctuating sixth cranial nerve palsy in the absence of widespread signs of systemic disease. A 63-year-old woman presented with horizontal diplopia of two weeks duration that subjectively changed over time. Ocular examination showed a fluctuating sixth nerve palsy. A computed tomography (CT) scan of the brain showed multiple, enhancing, soft tissue, mass-like lesions involving the left cavernous sinus and the apex of both petrous bones. Based on bone marrow biopsy and hematologic findings, she was diagnosed with multiple myeloma. Multiple myeloma may be included in the differential diagnosis of a fluctuating sixth nerve palsy, and although ophthalmic signs are rare and generally occur late in the course of multiple myeloma, they can still be its first signs.

Park, Shin Hae



Spontaneous ulnar dislocation of the index, long, ring and small finger extensor tendons at the metacarpophalangeal joints: a case report.  


Finger extensor tendon dislocation at the metacarpophalangeal joint is caused by various etiologies, such as trauma, congenital anomaly, or rheumatoid arthritis. When the dislocation occurs with no etiology, this is called spontaneous dislocation. Although spontaneous extensor tendon dislocation in one, two or three fingers has been described, to our knowledge, simultaneous dislocation in four fingers has not been reported. In this paper, we report a spontaneous ulnar dislocation of all the extensor tendons in the index, long, ring, and small fingers. Repair of the radial sagittal bands of the extensor digitorum communis of the middle and ring fingers reduced dislocation of all the extensor tendons in four fingers. PMID:21548159

Tanabe, Katsuhisa; Nakajima, Takaya; Sogo, Eiji



The management of distal ulnar fractures in adults: a review of the literature and recommendations for treatment  

PubMed Central

The distal ulna represents the fixed point around which the radius and the hand acts in daily living. The significance of distal ulnar fractures is often not appreciated and often results in inadequate treatment in comparison to its larger counterpart; the radius. There is little guidance in the current literature as how to manage these fractures and their associated injuries. This paper aims to critically review the current literature and combine it with treatment suggestions based on the experience of the authors to help guide investigation and management of these often complex injuries.

Lindau, T. R.



Local substitution of GDF-15 improves axonal and sensory recovery after peripheral nerve injury.  


The growth/differentiation factor-15, GDF-15, has been found to be secreted by Schwann cells in the lesioned peripheral nervous system. To investigate whether GDF-15 plays a role in peripheral nerve regeneration, we substituted exogenous GDF-15 into 10-mm sciatic nerve gaps in adult rats and compared functional and morphological regeneration to a vehicle control group. Over a period of 11 weeks, multiple functional assessments, including evaluation of pinch reflexes, the Static Sciatic Index and of electrophysiological parameters, were performed. Regenerated nerves were then morphometrically analyzed for the number and quality of regenerated myelinated axons. Substitution of GDF-15 significantly accelerated sensory recovery while the effects on motor recovery were less strong. Although the number of regenerated myelinated axons was significantly reduced after GDF-15 treatment, the regenerated axons displayed advanced maturation corroborating the results of the functional assessments. Our results suggest that GDF-15 is involved in the complex orchestration of peripheral nerve regeneration after lesion. PMID:22955564

Mensching, Leonore; Börger, Ann-Kathrin; Wang, Xialong; Charalambous, Petar; Unsicker, Klaus; Haastert-Talini, Kirsten



Opioids and Sensory Nerves  

Microsoft Academic Search

\\u000a This chapter reviews the expression and regulation of opioid receptors in sensory neurons and the interactions of these receptors\\u000a with endogenous and exogenous opioid ligands. Inflammation of peripheral tissues leads to increased synthesis and axonal transport\\u000a of opioid receptors in dorsal root ganglion neurons. This results in opioid receptor upregulation and enhanced G protein coupling\\u000a at peripheral sensory nerve terminals.

Christoph Stein; Christian Zöllner


Transfection of Nerve Cells  

Microsoft Academic Search

Transfection is a method of transforming cells based on the introduction into living cells of plasmids encoding a particular\\u000a protein or RNA. This review describes the main methods of transfection and considers their advantages and disadvantages. Most\\u000a attention is paid to lentivirus transduction as one of the most efficient methods for transforming nerve cells. The development\\u000a of current transfection systems

S. V. Salozhin; A. P. Bol’shakov



Optic nerve hypoplasia  

PubMed Central

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).

Kaur, Savleen; Jain, Sparshi; Sodhi, Harsimrat B. S.; Rastogi, Anju; Kamlesh



Ulnar-sided wrist pain due to isolated disk tear of triangular fibrocartilage complex within the distal radioulnar joint: two case reports.  


Wrist arthroscopy has been successfully used with many modifications and improvements. However, distal radioulnar joint (DRUJ) arthroscopy is still uncommon. We experienced 2 cases of ulnar-sided wrist pain due to isolated triangular fibrocartilage complex (TFCC) disk tear within the DRUJ. DRUJ arthroscopy in these cases showed horizontal tear and fibrillation of TFCC disk without TFCC tear at the radiocarpal joint. Foveal attachment was intact in both cases. These were treated with debridement, which relieved pain after surgery and achieved good functional recovery. Although DRUJ arthroscopy is technically difficult, it is mandatory for making a diagnosis and treating ulnar-sided wrist pain. PMID:21548155

Abe, Yukio; Tominaga, Yasuhiro



Orbital Cystic Schwannoma Originating from the Frontal Nerve  

PubMed Central

Schwannomas of the orbit are very rare benign neoplasms. Intraorbital cystic schwannomas originating from the frontal nerve are even rarer, with only 1 case reported to date. This is most likely due to the fact that, in most cases, the origin of the orbital schwannoma cannot be identified intraoperatively. The nerve origin is usually speculated from histological examination of the specimen and the postoperative neurological deficits of the patient. Here, we present the case of a 65-year-old woman with a one-month history of exophthalmos, whose orbital cystic lesion was completely removed by microsurgical transcranial operation. Intraoperatively, the continuity between the tumor and frontal nerve was seen macroscopically, leading us to confirm the frontal nerve as an origin of the tumor, which was consistent with the postoperative neurological findings. The diagnosis of the tumor was established as schwannoma from the histological examination. As a differential diagnosis of the orbital cystic lesions, the possibility of schwannomas should be kept in mind.

Hayashi, Yasuhiko; Watanabe, Takuya; Kita, Daisuke; Hayashi, Yutaka; Takahira, Masayuki; Hamada, Jun-ichiro



Spinal pathways mediating respiratory influences on sympathetic nerves.  


The location of spinal pathways mediating the respiratory modulation of sympathetic nerve activity was determined. Left inferior cardiac sympathetic, phrenic, and external intercostal (T1) nerve activities were recorded in 16 alpha-chloralose-anesthetized, vagotomized, paralyzed cats. Baroreceptor reflex activation of sympathetic activity was tested by bilateral carotid occlusion. Eight cats received C6-C7 level ventral spinal cord hemisections followed by cumulative lesions leading to total spinal cord transection. Eight other cats received C6-C7 level dorsolateral funiculus (DLF) lesions followed by dorsal spinal cord hemisection and subsequent spinal cord transection. The respiratory modulation of sympathetic activity was quantitatively assessed using respiration-triggered computer summation of sympathetic activity. Ventral hemisection had no significant effect on the respiratory modulation of sympathetic activity or bilateral carotid occlusion responses. In contrast, bilateral DLF lesions eliminated both the respiratory modulation and bilateral carotid occlusion responses. Unilateral disruption of DLF pathways ipsilateral to the recorded sympathetic nerve indicated spinal level decussations. Thus bilaterally descending DLF pathways with spinal level decussations mediate the respiratory modulation of sympathetic activity. PMID:4014500

Connelly, C A; Wurster, R D



Ultrastructural alterations in peripheral nerve trunks of rats subchronically treated with chlorphentermine or perhexiline.  


The present study deals with the effects of two lipidosis-inducing drugs (chlorphentermine and perhexiline) upon the ultrastructure of large nerve trunks (sciatic and plantar nerves) of adult rats. Subchronic oral administration of high doses of either drug led to comparatively mild lipidosis-like alterations in Schwann cells and in other cell types of both nerve trunks. In addition, plantar nerves, and more rarely sciatic nerves, showed some unspecific lesions such as myelin whorls and ovoids within the outer Schwann cell cytoplasm, intra-axonal accumulations of polymorphous material, and single degenerating fibres. The pathogenetic mechanisms responsible for the non-specific lesions remain to be elucidated. Chlorphentermine was, in all respects, more potent than perhexiline. In general, the drug-induced lesions developing in the fibres of large nerve trunks were less dramatic when compared a) with the severe lipidosis known to occur in neuronal perikarya, and b) with the severe alterations known to develop in preterminal or terminal axon portions of rats kept under similar experimental conditions. PMID:6681963

Albert, C; Lüllmann-Rauch, R



Effects of ulnar deviation of the wrist combined with flexion/extension on the maximum voluntary contraction of grip.  


Work-related musculoskeletal disorders (WMSDs) is related with the frequency of exertion for repetitive tasks requiring heavy load. Different researchers have reported that a poor posture is very much responsible for WMSD if combined with increased load and/or frequency. In the assembly tasks in different industries involve the gripping very commonly. Therefore in the present study it was tried to find the effect of a wrist posture on grip strength. For design of experiment, subjects, flexion/extension and ulnar deviation of the wrist were taken as independent variables and the dependent variable was maximum voluntary contraction (MVC) of grip. The results showed that the effect of flexion/extension angle, ulnar angle and the subject on MVC grip were highly significant (i.e., p<0.001, 0.001 and 0.002 respectively). The two-way interaction effect of flexion/extension angle of the wrist and the subject on MVC grip was also found significant at p<0.001. The other interaction effects were not found significant. MVC grip was found maximum at the neutral wrist posture. PMID:20034313

Haque, Serajul; Khan, Abid Ali



Dissection of intercostal nerves by means of assisted video thoracoscopy: experimental study  

PubMed Central

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).



Resolution of isolated unilateral hypoglossal nerve palsy following microvascular decompression of the intracranial vertebral artery.  


Isolated hypoglossal nerve paresis due to mechanical compression from a vascular lesion is very rare. We present a case of a 32-year-old man who presented with spontaneous abrupt-onset dysarthria, swallowing difficulty and left-sided tongue atrophy. Brain computed tomographic angiography and magnetic resonance imaging of the brainstem demonstrated an abnormal course of the left vertebral artery compressing the medulla oblongata at the exit zone of the hypoglossal rootlets that was relieved by microvascular decompression of the offending intracranial vertebral artery. This case supports the hypothesis that hypoglossal nerve palsy can be due to nerve stretching and compression by a pulsating normal vertebral artery. Microvascular decompression of the intracranial nerve and careful evaluation of the imaging studies can resolve unexpected isolated hypoglossal nerve palsy. PMID:21556237

Cheong, Jin Hwan; Kim, Jae Min; Yang, Moon Sul; Kim, Choong Hyun



Sacral nerve stimulation: Interstim therapy.  


Sacral nerve stimulation is a young but promising technique in the treatment of chronic voiding dysfunctions. Electrical stimulation of the S3 nerve--using a pacemaker device--is able to treat a wide range of pelvic floor dysfunctions. This article gives a brief review on the indications, mechanisms of action and possible complications of this technique. Furthermore, new evolutions in the domain of sacral nerve modulation are discussed. PMID:16288588

Peeren, Frederick; Hoebeke, Piet; Everaert, Karel



Neurophysiology of Nerve Conduction Studies  

Microsoft Academic Search

The methodology for performing standard nerve conduction studies has been established by identifying the most helpful and\\u000a consistent physiological data obtainable while being constrained by a variety of technical and practical limitations. Nerve\\u000a stimulation occurs underneath the negatively charged anode of the applied stimulator and simultaneous hyperpolarization of\\u000a the nerve occurs beneath the positively charged cathode. Referential or bipolar recording

James B. Caress; Gregory J. Esper; Seward B. Rutkove


Altered thermal sensitivity in injured and demyelinated nerve  

PubMed Central

Electrophysiological studies were performed on frog and guinea-pig peripheral nerves to determine the effect of temperature on conduction at the site of pressure and demyelinating lesions. An increased susceptibility to thermally-induced conduction blockade has been demonstrated. In pressure-injured frog and guinea-pig nerves, conduction blocks occur at temperatures approximately 6°C lower than in normal nerves. A similar phenomenon occurs in guinea-pig demyelinated nerve (experimental allergic neuritis) and in some cases at temperatures around 15°C lower than in controls. It is suggested that these effects are the result of a critical lowering by temperature of an already markedly depressed conduction safety factor. In support of this, it has been shown that calcium ion depletion, which would be expected to increase the conduction safety factor by lowering the threshold for excitation, counteracts the increased thermal sensitivity of frog pressure-injured nerve. These findings are discussed in relation to well-known temperature effects in multiple sclerosis. They add support to an earlier proposed hypothesis that the changes in signs and symptoms with a change of body temperature in multiple sclerosis may be caused by an effect of temperature on axonal conduction. Images

Davis, Floyd A.; Jacobson, Samuel



Dichloroacetylene: effects on the rat trigeminal nerve somatosensory evoked potential.  


Humans overexposed to trichloroethylene (TCE), under specific conditions, were reported to develop trigeminal nerve dysfunction. A degradation byproduct dichloroacetylene (DCA), however, has been suggested as the probable neurotoxicant rather than TCE. Studies in mice, rats, and rabbits support the hypothesis of DCA-induced trigeminal neurotoxicity. This study, therefore, was conducted to characterize DCA-induced trigeminal nerve dysfunction in rats using the electrodiagnostic procedure trigeminal nerve-stimulated somatosensory evoked potential (TSEP). A group of six rats was exposed once to DCA (approximately 300 ppm) or room air for 2.25 h and a separate group of six rats was not exposed and served as controls. Trigeminal nerve somatosensory evoked potentials (TSEPs) were collected before exposure and 2, 4, and 7 days postexposure. Because DCA was manufactured from TCE with acetylene added as a stabilizer, another group of rats was exposed to TCE and acetylene without generation of DCA. TSEPs from DCA-exposed rats were smaller and slower compared to their baseline recordings and to the concurrent negative controls. TSEPs from the controls and the TCE/acetylene-exposed rats were unchanged. Neuropathology did not reveal treatment-related lesions. It was concluded that the rat is mildly to markedly susceptible to DCA-induced trigeminal nerve dysfunction as assessed by TSEP, but that the kidney was the likely target organ based on gross observations and the DCA literature. PMID:9088008

Albee, R R; Nitschke, K D; Mattsson, J L; Stebbins, K E


Practical magnetic resonance imaging evaluation of peripheral nerves in children: magnetic resonance neurography.  


Magnetic resonance (MR) imaging is an excellent tool for the evaluation of peripheral nerves in children not only because of its excellent soft tissue contrast resolution but also because it is noninvasive and does not use ionizing radiation. In nonconclusive cases, MR neurography can be complementary to physical examination and electromyography in identifying a specific affected nerve and the site of the lesion. This article reviews the MR imaging technique used in the evaluation of peripheral nerves (ie, MR neurography), its major indications, and the common pathologic conditions encountered in the pediatric population. PMID:23830792

Cortes, Cesar; Ramos, Yanerys; Restrepo, Ricardo; Restrepo, Jose Andres; Grossman, John A I; Lee, Edward Y