Nerve Entrapment Syndromes 1091

Total Page:16

File Type:pdf, Size:1020Kb

Nerve Entrapment Syndromes 1091 1090 Part VIII Septic and Nontraumatic Conditions may present with well-defi ned symptoms of ulnar CHAPTER 80 nerve compression at the elbow; electrical studies, however, may have normal results in the ulnar nerve but reveal changes of carpal tunnel syndrome (which Nerve Entrapment may be either subclinical or less symptomatic to the patient). Post-traumatic thickening of the brachial Syndromes fascia in the distal arm can produce a simultaneous median and lateral antebrachial nerve compression. When more than one nerve is suspected in the neural Robert J. Spinner compression process, a more proximal lesion such as the brachial plexus, must be ruled out as the site of the pathologic process. 2. A nerve can be compressed at more than one level; INTRODUCTION that is, a “double crush” lesion may exist. This most commonly occurs at the neck and the wrist but can The diagnosis of a nerve entrapment lesion arising at also occur at other locations such as the thoracic the elbow can be relatively straightforward if the history, outlet and the cubital tunnel. physical examination, electromyographic (EMG), and 3. Two separate neurologic processes may coexist. For imaging studies, when indicated, all confi rm the diagno- example, a patient who is wheelchair-bound from a sis and the localization of the lesion.12,32,47,87,93,138 However, syrinx may develop hand atrophy, which represents when the history and physical examination do not cor- new bilateral ulnar nerve compression rather than respond or the electrophysiologic or imaging studies do progression of the syrinx. Thus, on occasion, it is nec- not support a specifi c clinical diagnosis, then problems essary to direct one’s conservative or surgical atten- can arise. Therefore, one must apply the same system- tion to two nerves, two sites on one nerve, or even atic, thoughtful approach to the care of every patient. two neurologic conditions to address the patient’s One can then put all of the data of the clinical puzzle presenting symptoms and new neurologic fi ndings. together to offer appropriate treatment. Sometimes, historical information can be misleading. Some patients are prone or predisposed to sequential For example, it is not uncommon for an elderly patient neural compression lesions. There are predisposing to say that his or her fi ngers are “stiff” when in reality factors for multiple neural entrapment lesions. A group the fi ngers are numb. Stiffness suggests an arthritic of substances, such as sorbitol, can cause an increase in process, whereas numbness suggests involvement of the intrafascicular pressure, which can predispose a patient peripheral neurologic system in the pathologic process. with diabetes mellitus to a neural compression lesion. Other times, physical fi ndings may be diffi cult to Hereditary neuropathies also occur; despite genetic interpret. Persistent pain about the lateral aspect of the advances, the mechanism of dysfunction is not fully elbow that is resistant to all forms of conservative treat- understood. Congenital anomalies of the elbow, such as ment as well as operative treatment directed to the lateral from a lacertus fi brosus variant or a ligament of Struthers, epicondyle may represent resistant lateral epicondylitis, may result in nerve compression lesions. Developmental entrapment of the posterior interosseous nerve alone, or changes from hypertrophied muscles may lead to com- both entities. In this instance, EMG studies, more com- pressive neuropathies, such as a pronator syndrome in monly than not, do not help establish the diagnosis of an athlete. Trauma may induce a nerve compression resistant “tennis elbow” due to posterior interosseous syndrome either acutely or chronically, either from nerve compression or localize the pathologic process. If bony or associated soft tissue changes. both conditions are believed to be present on clinical Recurrent neural compression lesions also occur. A grounds, then management of both lesions needs to be physician may successfully care for an individual’s addressed simultaneously to relieve the patient’s neural compression only for another nerve compression symptoms. to arise a few months or years later that affects the same Other issues may confound the clinical picture and peripheral nerve or another nerve.132,139,198 Usually, tech- the treating physician: nical factors at surgery can prevent recurrent lesions. Free gliding of the nerve with elbow fl exion and exten- 1. Simultaneous peripheral nerve compressions may sion and forearm rotation helps prevent late postopera- occur, whether from related or unrelated causes.25 For tive symptoms. If a nerve is fi xed by adhesions or example, a diabetic patient may present with symp- scarring or at a fracture site, it is not just a matter of toms related to concurrent carpal tunnel syndrome entrapment. A traction neuritis can exist as well. As the and cubital tunnel syndrome. An active individual joint moves, the nerve is tethered and can be stretched. Chapter 80 Nerve Entrapment Syndromes 1091 If the ulnar nerve is transposed anteriorly (especially if during ulnar nerve transposition and median nerve it has not been transposed in a straight line), ulnar decompression, and the posterior cutaneous nerve of neuritis can develop at a later date. Similarly, if the the forearm is at risk with posterior interosseous nerve medial epicondyle is resected and the nerve becomes neurolysis. In the majority of cases of nerve compres- adherent to the medial epicondylectomy site, resistant sion, external neurolysis is the usual operative interven- ulnar nerve neuritis can develop after the primary tion. Internal neurolysis, when indicated, should be surgery. limited to the neural segment and the internal region Certain principles apply to the surgical management clinically involved. The perineurium should rarely, if of entrapment lesions. Wide exposure is often necessary ever, be violated. Nerves should be placed in healthy to defi ne the normal anatomy and the pathologic region. beds away from scar tissue. Intraoperative nerve action The nerve should be identifi ed in a healthy region potentials may help in the management of more proximally and distally both grossly and microscopi- advanced lesions. Postoperative care should emphasize cally; only then should the nerve be traced to the early mobilization. Early motion can improve neural pathologic region. Surgery should be guided by the use gliding. The development of a stiff joint can undo an of internervous planes, and gentle handling of the nerve otherwise successful nerve decompression. is critical. During the wide decompression, care must be A detailed understanding of the complex normal given to the cutaneous nerves. Patients who have anatomy of this region and the “common” variants is entrapment lesions are prone to develop symptomatic essential for proper diagnosis and treatment of these postoperative skin neuromata; their initial symptoms conditions (Fig. 80-1). Careful history, serial examina- related to the nerve compression lesion may disappear tions and EMG studies, and at times, imaging modalities postoperatively to be replaced by a different type of can usually localize the lesion or lesions. Early, accurate neuromatous pain. In particular, at the elbow level, the diagnosis and treatment are important for effective medial cutaneous nerve of the forearm is susceptible overall management of nerve compression lesions. Biceps and bicipital aponeurosis Brachialis Median n. Radial n. Brachial a. Pronator teres, Brachioradialis humeral head Radial recurrent a. Flexor carpi radialis and palmaris longus Deep and superficial Pronator teres, ulnar head branches of radial n. Ulnar n. Supinator Ant. and post. Extensor carpi radialis ulnar recurrent aa. longus Ulnar a. Common Flexor digitorum interosseous a. superficialis Posterior and anterior Pronator teres interosseous aa. Anterior Radial a. interosseous n. Flexor carpi ulnaris Flexor pollicis Flexor digitorum longus profundus Dorsal branch of ulnar n. Ant. interosseous a. and n. FIGURE 80-1 Major neurovascular and Pronator quadratus Ulnar a. and n. muscular relationships of the elbow region. Abductor pollicis Median n. (Redrawn from Hollinshead, W. H.: Anatomy longus for Surgeons, 3rd ed. Vol. 3. New York, Harper & Row, 1982.) 1092 Part VIII Septic and Nontraumatic Conditions Understanding the degree of nerve injury can help There appear to be several types of fi rst-degree injury. a physician predict recovery patterns and guide These lesions are correlated best when both the nerve management. fi ber pathologic processes and the clinical recovery fol- lowing neurolysis are analyzed temporally. There are ionic96 and vascular40,109,117 lesions of nerve fi bers that NEUROPHYSIOLOGY OF NERVE respond to release by prompt recovery within, at times, COMPRESSION LESIONS hours of surgery. There is a structural fi rst-degree lesion, described by Gilliatt and colleagues64 and Ochoa,136 in Nerve compression may be categorized as fi rst-, which there is segmental injury to the nerve fi ber con- second-, third-, or fourth-degree neural lesions. This sisting of segmental demyelination and remyelinization method was fi rst described by Sir Sydney Sunderland.184 of just a few nodal segments of the fi bers. In this The earlier classifi cation of Sir Herbert Seddon (1943)157 instance, the entire recovery process takes 30 to 60 days. uses the terms neurapraxia, axonotmesis, and neurotmesis and The clinical implications of this particular lesion are as can be correlated with Sunderland’s classifi cation in the follows: whether the lesion is high or low in the nerve, following manner. A fi rst-degree lesion is a neurapractic it takes 30 to 60 days for neural function to be lesion. A second-degree or mild third-degree lesion is restored. an axonotmetic lesion. The neurotmetic lesion encom- In contrast, in the second-degree lesion of nerve passes all of the fourth-degree lesions (the neuroma in compression, there is degeneration from the point of continuity) and the advanced third-degree lesions. I injury distally. Regeneration of the nerve fi bers occurs prefer using Sunderland’s classifi cation when correlating within the intact basement membrane.
Recommended publications
  • Ultrasonograpic Assessment of Relationship Between the Palmaris Longus Tendon and the Flexor Retinacular Ligament and the Palmar Aponeurosis of the Hand
    Original Article Ultrasonograpic Assessment of Relationship Between the Palmaris Longus Tendon and the Flexor Retinacular Ligament and the Palmar Aponeurosis of the Hand Kadir Ertem1, Ahmet Sığırcı2, Salih Karaca1, Aykut Sığırcı3, Yunus Karakoç4, Saim Yoloğlu5 İnonu University, Faculty of Medicine, ABSTRACT Departments of Orthopedics and Trauma- tology1, Radioloy2, Physiology4 and Biosta- Aim: This study aimed to evaluate the presence of the Palmaris Longus tistics5, Malatya, Turkey Tendon (PLT) and the relationship between the Flexor Retinacular Ligament (FRL) and the Palmar Aponeurosis (PA) of the hand. 319 Mayıs University, Faculty of Medicine, Departments of Orthopaedics and Trauma- Method: 62 voluntary subjects (31 female, 31 male students and per- tology, Samsun, Turkey sonnel from the Inonu University, at the average age 28.38 ± 6.86 years ranging from 19 to 48 years) took part in this study using ultrasound. Eur J Gen Med 2010;7(2):161-166 Received: 16.05.2009 Result: Significant differences were found in the PA p-m-d diameters of subjects between with and without PLT bilaterally, on the right Accepted: 06.07.2009 and the left hand (p<0.05), whereas there was no meaningful differ- ence considering FRL diameters (p>0.05). Furthermore, this ultraso- nographic assessment revealed the continuity of collagen bunches of the PL tendon up to FRL, but not PA. Conclusion: Although not demonstrated by ultrasonography here, the increased thickness of the PA in subjects with a PLT supports the find- ings in the literature in which the structural
    [Show full text]
  • Anatomical Considerations of Fascial Release in Ulnar Nerve Transposition: a Concept Revisited
    LABORATORY INVESTIGATION J Neurosurg 123:1216–1222, 2015 Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited Mark A. Mahan, MD,1 Jaime Gasco, MD,2 David B. Mokhtee, MD,3 and Justin M. Brown, MD4 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; 2Division of Neurological Surgery, University of Texas Medical Branch, Galveston, Texas; 3Tulsa Bone and Joint Associates, Tulsa, Oklahoma; and 4Division of Neurosurgery, University of California, San Diego, La Jolla, California OBJECT Surgical transposition of the ulnar nerve to alleviate entrapment may cause otherwise normal structures to become new sources of nerve compression. Recurrent or persistent neuropathy after anterior transposition is commonly attributable to a new distal compression. The authors sought to clarify the anatomical relationship of the ulnar nerve to the common aponeurosis of the humeral head of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) muscles following anterior transposition of the nerve. METHODS The intermuscular septa of the proximal forearm were explored in 26 fresh cadaveric specimens. The fibrous septa and common aponeurotic insertions of the flexor-pronator muscle mass were evaluated in relation to the ulnar nerve, with particular attention to the effect of transposition upon the nerve in this region. RESULTS An intermuscular aponeurosis associated with the FCU and FDS muscles was present in all specimens. Transposition consistently resulted in angulation of the nerve during elbow flexion when this fascial septum was not released. The proximal site at which the nerve began to traverse this fascial structure was found to be an average of 3.9 cm (SD 0.7 cm) from the medial epicondyle.
    [Show full text]
  • Supplemental Methods
    Supplemental Methods: Patients: Inclusion criteria were patients 18 years of age and older with a lower trunk or C8-T1 pattern of brachial plexus injury and a minimum of 6 months postoperative follow-up. The indication for brachialis to FDP muscle transfer was a lack of active finger flexion in patients with a history of lower trunk or C8-T1 pattern of brachial plexus injury at greater than 9 months from injury with no sign of nerve recovery on clinical exam as well as electromyogram. Additionally, triceps motor function of BRMC grade 2+ or greater was required to provide significant antagonist force to balance the elbow flexion force generated with firing of the brachialis muscle transfer. Patients were excluded if they were younger than 18 years of age, had a triceps of grade 2 or less, or sustained other injuries which precluded the use of the brachialis or FDP for tendon transfers. Patient demographic data including age, sex, BMI, smoking status, age at time of injury, mechanism of injury, co-morbidities, and history of previous reconstructive surgery. Patients were follow-up at regular intervals following surgery for functional assessment until their functional level had plateaued. Patients initially received a full evaluation for motor strength by the three senior authors (AYS, ATB, RJS), including but not limited to trapezius, supraspinatus, infraspinatus, deltoid, biceps, triceps, pronator teres, flexor digitorum profundus, extensor digitorum communis, extensor carpi radialis longus and brevis, and first dorsal interosseous motor strength. Motor strength was graded using a modified British Medical Research Council Grade (BMRC) 2,15. BMRC grading is reported as follows: M0 – no contraction, no joint motion, and no EMG reinnervation; M1 – EMG reinnervation, but no joint motion; M2 – perceptible joint motion, however insufficient power to act against gravity; M3 – muscle act against gravity; M4 – muscle acts against resistance; and M5 – muscle acts against strong resistance.
    [Show full text]
  • The Impact of Palmaris Longus Muscle on Function in Sports: an Explorative Study in Elite Tennis Players and Recreational Athletes
    Journal of Functional Morphology and Kinesiology Article The Impact of Palmaris Longus Muscle on Function in Sports: An Explorative Study in Elite Tennis Players and Recreational Athletes Julie Vercruyssen 1,*, Aldo Scafoglieri 2 and Erik Cattrysse 2 1 Faculty of Physical Education and Physiotherapy, Master of Science in Manual therapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium 2 Faculty of Physical Education and Physiotherapy, Department of Experimental Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; [email protected] (A.S.); [email protected] (E.C.) * Correspondence: [email protected]; Tel.: +32-472-741-808 Academic Editor: Giuseppe Musumeci Received: 21 February 2016; Accepted: 24 March 2016; Published: 13 April 2016 Abstract: The Palmaris longus muscle can be absent unilateral or bilateral in about 22.4% of human beings. The aim of this study is to investigate whether the presence of the Palmaris longus muscle is associated with an advantage to handgrip in elite tennis players compared to recreational athletes. Sixty people participated in this study, thirty elite tennis players and thirty recreational athletes. The presence of the Palmaris longus muscle was first assessed using different tests. Grip strength and fatigue resistance were measured by an electronic hand dynamometer. Proprioception was registered by the Flock of Birds electromagnetic tracking system. Three tests were set up for measuring proprioception: joint position sense, kinesthesia, and joint motion sense. Several hand movements were conducted with the aim to correctly reposition the joint angle. Results demonstrate a higher presence of the Palmaris longus muscle in elite tennis players, but this was not significant.
    [Show full text]
  • Fascia, Septa, Tendon Sheaths and the Potential Spaces of the Hand These Fascial Layers Are Continuous with the Fascial Sleeve of the Forearm
    This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. Fascia, Septa, Tendon Sheaths and the Potential Spaces of the Hand These fascial layers are continuous with the fascial sleeve of the forearm. Centrally the fascia of the palm thickens in the centre, where the palmaris Palmaris Longus tendon longs tendon attaches to it, which is All merge into the also where it merges with the flexor Palmar Aponeurosis Antebrachial Fascia retinaculum. This whole thickened Flexor retinaculum area is called the palmar aponeurosis. Distally, the palmar aponeurosis divides into four bands which attach to the bases of the proximal phalanges, and there it becomes a part of the digital sheaths The Thenar Space Palmar Aponeurosis so thick and tough that any infections in the palmar spaces will actually cause the weaker DORSAL fascia to bulge out. In Dupuytren’s contracture, the palmar aponeurosis becomes nodular, Thenar fascia fibrosed, and thickened The Midpalmar Space Palmar Aponeurosis Unlike the thenar space, this one is Hypothenar fascia continuous with the anterior compartment of the forearm- it communicates with it via the carpal tunnel. Lateral fibrous septum of the palm Medial fibrous septum of Digital Synovial Sheaths which stretches from the palmar the palm which stretches from the palmar aponeurosis to the 3rd metacarpal aponeurosis to the 5th metacarpal Of the two septa, the LATERAL is the strongest The common flexor sheath continues to the th 5 digit. The other digits have their own Digital Synovial Sheaths Synovial sheath for Flexor Pollicis Longus Common flexor sheath: FDS and FDP Synovial sheath for Flexor Carpi Radialis .
    [Show full text]
  • Anatomical Study of Myofascial Continuity in the Anterior Region of the Upper Limb
    ARTICLE IN PRESS Journal of Bodywork and Movement Therapies (2009) 13,53–62 Journal of Bodywork and Movement Therapies www.intl.elsevierhealth.com/journals/jbmt HUMAN ANATOMY Anatomical study of myofascial continuity in the anterior region of the upper limb Antonio Steccoa, Veronica Macchib, Carla Steccoc, Andrea Porzionatob, Julie Ann Dayd, Vincent Delmase, Raffaele De Carob,Ã aPhysical Medicine and Rehabilitation Clinic, University of Padova, Italy bSection of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Italy cSection of Orthopedics, Department of Medical Surgical Specialisations, University of Padova, Italy dPhysical Medicine and Rehabilitation Clinic, Ospedale dei Colli, Padova, Italy eInstitut d’Anatomie, Universite´ Paris Descartes, France Received 18 March 2007; received in revised form 27 April 2007; accepted 27 April 2007 KEYWORDS Summary Fifteen unembalmed cadavers were dissected in order to study the Myofascial ‘‘anatomical continuity’’ between the various muscles involved in the movement of continuity; flexion of the upper limb. This study demonstrated the existence of specific Fascia; myofascial expansions, with a nearly constant pattern, which originate from the Proprioception; flexor muscles and extend to the overlying fascia. The clavicular part of the Chaıˆnes musculaires; pectoralis major sends a myofascial expansion, with a mean length of 3.6 cm, to Meridians; the anterior region of the brachial fascia, and the costal part sends one to the Anatomy trains; medial region of the brachial fascia (mean length: 6.8 cm). The biceps brachii Sequences presents two expansions: the lacertus fibrosus, oriented medially, with a mean height of 4.7 cm and a base of 1.9 cm, and a second, less evident, longitudinal expansion (mean length: 4.5 cm, mean width: 0.7 cm).
    [Show full text]
  • A Study of Variations of the Triceps Brachii Muscle in North Karnataka Population
    Original Research Article DOI: 10.18231/2455-846X.2017.0030 A study of variations of the triceps brachii muscle in north Karnataka population Pratik Khona1, Ashwini C2,* 1,2Assistant Professor, Dept. of Anatomy, Gadag Institute of Medical Sciences, Gadag, Karnataka *Corresponding Author: Email: [email protected] Abstract Introduction: Triceps brachii muscle is the only muscle of posterior compartment of arm, consisting of three heads–long, lateral and medial. Radial nerve and profunda brachii artery run in the radial groove that separate lateral and medial head. Triceps brachii is a site for intramuscular injections. Evolutionarily triceps has many sub heads which have either fused or disappeared. Therefore, the knowledge of muscle is essential anthropologically and clinically and this study aims to study the anatomical variations of triceps brachii muscle. Materials & Methods: In the present study, 60 upper limbs from the Department of Anatomy, Belagavi Institute of Medical Sciences, Belagavi and Gadag Institute of Medical Sciences, Gadag were examined for the variations of triceps brachii muscle during routine dissections of undergraduate students. The variations found where neatly dissected and photographs taken wherever necessary. Result: Out of 60 upper limbs dissected 2 specimens presented with variations of triceps muscle. Discussion: Both variations seen were fourth head of origin of muscle seen in two different male cadavers in respectively right and left arm. The variations present were seen only unilaterally in both cadavers. The details of these variations will be discussed in the article. Conclusion: The variations of triceps brachii muscles are mentioned in literature, but are uncommon and if tendinous fourth head are present over the neurovascular bundles they may lead to compression syndrome.
    [Show full text]
  • Incidence of Palamris Longus Muscle and Tendon Variations: a Cadaveric Study
    Original Research Article DOI: 10.5958/2394-2126.2016.00125.0 Incidence of palamris longus muscle and tendon variations: a cadaveric study Pabbati Raji Reddy Associate Professor, RVM Institute of Medical Sciences & Research Center, Telangana Email: [email protected] Abstract Introduction: Palmaris longus muscle is one of the most variable muscles of the human body. Complete agenesis, variation in the location and form of the fleshy portion, aberrancy in attachment, duplication or triplication, accessory tendinous slips, replacing elements are some of the variations commonly encountered. Due to the large variability of the Palmaris longus muscle, we had undertaken this study to estimate the prevalence of this variation in our geographical area. Materials and Methods: A total of 32 cadavers, i.e. 64 upper limbs were dissected for the assessment of Palmaris longus muscle. The length and the circumference of the muscle belly of the Palmaris longus muscle, was noted. The most distal point on the muscle tendon to the point where the tendon crosses the line joining the pisiform bone and the tubercle of the scaphoid bone was measured to assess the length of the muscle. The width of the tendon was measured based on the aponeurosis. Finally, the length of the forearm was measured from the tip of the olecranon process to the styloid process of the ulna. Results: Out of the 32 cadavers, 23 were males with a total of 46 upper limbs which were used for discussion, 9 were females with 18 upper limbs. The mean length of the muscle in males was 124mm while in females, it was only 86.2mm.
    [Show full text]
  • Special Areas in the Upper Limb and Their Borders the AXILLA O a PYRAMIDAL Space: Has a Flat Apex, 4 Walls, and a Base
    This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. Special Areas in the Upper Limb and their Borders THE AXILLA o A PYRAMIDAL space: has a flat apex, 4 walls, and a base. Superior border of scapula APEX First rib Clavicle Scapula POSTERIOR Subscapularis WALL Teres major Clavipectoral fascia LATERAL WALL Pectoralis minor ANTERIOR WALL Intertubercular groove of Pectoralis major the humerus; Thus also the tendon of Anterior axillary fold the long head of biceps MEDIAL WALL Chest wall and serratus anterior CONTENTS Axillary artery and its branches Axillary vein and its tributaries- brachial vein, basilic vein and thoracoepigastric vein Lymphatic vessels and axillary lymph nodes Cords and branches of the brachial plexus BOUNDARIES - Apex Medial wall – o Cervicoaxillary canal; passageway into the neck - Rib cage, chest wall – ribs 1-4 and o Bounded by the 1st rib, clavicle, and superior edge of the scapula the intercostal muscles o The vessel and nerve’s gateway into the arm - Serratus anterior - Base o Axillary fossa: fat, fascia, skin Lateral wall – - Anterior Wall– - Narrow wall; intertubercular groove o Pectoralis major, pectoralis minor, pectoral and clavipectoral fascia of the humerus o The inferior part is the anterior axillary fold - Posterior wall – o Scapula and subscapularis o Inferior border is the teres major and latissmus dorsi This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. The Medial Triangular Space, Lateral Triangular Space, and the Quadrangular Space These are gaps in the posterior wall of the axilla.
    [Show full text]
  • The Pronator Teres Syndrome: Compressive Neuropathy
    ;ry " he tO Copyright1981 by The Journalof Boneand Joint Surgery, Incorporated hy ar- The Pronator Teres Syndrome: ior tal Compressive Neuropathy of the Median Nerve* .~nt dl, BY CHARLES R. HARTZ, M.D.’~, RONALD L. LINSCHEID, M.D.’~, R. REED GRAMSE, M.D.’~, AND JASPER R. DAUBE, M.D.J’, ROCHESTER, MINNESOTA ior in From the Departments of Orthopedics, Physical Medicine and Rehabilitation, and Neurology, MayoClinic and MayoFoundation, Rochester at- ~re ABSTRACT:Thirty-nine patients with a clinical gically g, an anomalous fibrous band that compressed the the diagnosis of the pronator teres syndrome were seen median nerve was identified and cut. Since then, the syn- during a seven-year period. They typically complained drome has been recognized with increasing frequen- FIS, of aching discomfort in the forearm, weakness in the cy2,’,’,9,1e, ¯ it hand, and numbness in the thumb and index finger. We are reporting a study of thirty-nine patients in as Cyclic stress usually brought on the symptoms. The whomwe diagnosed the pronator teres syndrome and at- the distinctive physical finding was tenderness overthe tempted to identify the factors by which one can differ- ’ tO proximal part of the pronator teres, which was aggra- entiate this disorder from other lesions. SO vated by resisted pronation of the forearm, flexion of To the elbow, and occasionally by resisted contraction of Clinical Material ~al- the flexor superficialis of the long finger..Elec- From 1972 to 1979, thirty-nine patients seen at the der trophysiological testing of the median nerve showed Mayo Clinic were diagnosed as having the pronator teres caft abnormalities in a few patients, but localization of the syndrome.
    [Show full text]
  • Characteristics of Fascia in Reference to Treatment Possibilities of Chosen Hand Diseases
    Mini Review ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2020.29.004874 Characteristics of Fascia in Reference to Treatment Possibilities of Chosen Hand Diseases Alicja Jurecka1*, Maciej Papież2 and Artur Gądek1 1Jagiellonian University Medical College, Faculty of Health Sciences, Department of Orthopedics and Physiotherapy, Poland 2Emirates Specialty Hospital, Dubai Healthcare City, Dubai *Corresponding author: Alicja Jurecka, Jagiellonian University Medical College, Faculty of Health Sciences, Department of Orthopedics and Physiotherapy, Poland ARTICLE INFO ABSTRACT Received: August 13, 2020 The patomechanism of changes encountered in many movement system dysfunctions gives a basis for applying manual techniques, which have an impact on fascia’s structure, Published: August 31, 2020 onKeywords: treatment Fascia; of chosen Orthopedics; orthopedics Hand afflictions. diseases; Myofascial therapy; Physiotherapy Citation: Reference Alicjato Treatment Jurecka, PossibilitiesMaciej Papież, of ChosenArtur Gądek. Hand Diseases.Characteristics Biomed of J SciFascia & Tech in Res 29(5)-2020. BJSTR. MS.ID.004874. Introduction and plastic, and also resistant to mechanic stimulus. The current An architecture of fascia and its precise connections with many od movement system components creates a basis for putting transmission [5]. Collagen layers of the fascia are separated from forward presumptions of prospects of applying a fascial modelling definition of the fascia emphasizes its meaning in tensional force each other by fatty tissue [2]. The outermost layer of the fascia is Three-dimensional fascial web covers and penetrates such as an important element in many orthopedic afflictions treatment. is the investing fascia, also known as the deep fascia [6]. The structures as: muscles, intermuscular septum’s, tendons, ligaments, known as pinnacular or superficial.
    [Show full text]
  • The Course of Posterior Antebrachial Cutaneous Nerve: Anatomical and Sonographic Study with a Clinical Implication
    International Journal of Environmental Research and Public Health Article The Course of Posterior Antebrachial Cutaneous Nerve: Anatomical and Sonographic Study with a Clinical Implication Jose García-Martínez 1,2,*, Maribel Miguel-Pérez 2,*, Albert Pérez-Bellmunt 3,4 , Sara Ortiz-Miguel 2,3,4 and Ginés Viscor 5 1 Horta Osteopathic Clinic, 08031 Barcelona, Spain 2 Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, 08907 Hospitalet del Llobregat, Spain; [email protected] 3 Basic Sciences Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain; [email protected] 4 ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain 5 Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; [email protected] * Correspondence: [email protected] (J.G.-M.); [email protected] (M.M.-P.) Abstract: The course of the posterior antebrachial cutaneous nerve (PACN) was studied via ultra- sound (US) and dissection. The aim of this study was to reveal the anatomical relationships of PACN with the surrounding structures along its pathway to identify possible critical points of compression. Nineteen cryopreserved cadaver body donor upper extremities were explored via US and further dissected. During US exploration, two reference points, in relation with the compression of the nerve, were marked using dye injection: (1) the point where the RN pierces the lateral intermuscular septum Citation: García-Martínez, J.; (LIMS) and (2) the point where the PACN pierces the deep fascia. Anatomical measurements referred Miguel-Pérez, M.; Pérez-Bellmunt, A.; to the lateral epicondyle (LE) were taken at these two points.
    [Show full text]