DOCSLIB.ORG

Anterior Interosseous Nerve Palsy: Spontaneous Recovery in Two Patients

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Anterior Interosseous Nerve Palsy: Spontaneous Recovery in Two Patients J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.37.10.1146 on 1 October 1974. Downloaded from Journal of Neurology, Neurosurgery, and Psychiatry, 1974, 37, 1146-1150 Anterior interosseous nerve palsy: spontaneous recovery in two patients CHRISTOPHER GARDNER-THORPE' From the Regional Neurological Centre, Newcastle General Hospital, Newcastle upon Tyne SYNOPSIS The case histories of two patients who developed an anterior interosseous nerve palsy apparently as a result of an external pressure injury are reported. Both patients recovered fully without surgical exploration, one 19 months and the other nine months after the onset. It is stressed that complete recovery may occur spontaneously. interosseous fingers, together with weakness of pronation Palsy due to lesions of the anterior guest. Protected by copyright. nerve is rare. Most of the literature on the sub- when the elbow is flexed (in order to minimize ject stems from orthopaedic sources: in particu- pronation due to the action of pronator teres lar, the work of Spinner (1972) is noteworthy. which is not weak). Sensory testing is normal as However, anterior interosseous nerve palsy may is power in the other muscles supplied by the present to the neurologist as well as to the ortho- median nerve-for example, abductor pollicis paedic surgeon. The purpose of this paper is to brevis. The characteristic clinical picture, there- report the case histories of two patients who fore, is weakness of pinch together with developed it probably as a result of external inability actively to flex the interphalangeal pressure and to draw attention to the spon- joint of the thumb and the terminal inter- taneous recovery which may occur and which phalangeal joint of the index finger. These joints renders surgical exploration unnecessary. become hyperextended and the proximal inter- phalangeal joints flexed. The index finger con- USUAL ANATOMICAL FINDINGS (Davies and Coup- tacts the pulp of the thumb at a point situated land, 1967) The anterior interosseous nerve more proximally than is normal. In some arises from the median nerve where the latter patients, pain and tenderness may be found in passes between the two heads of the pronator the proximal part of the forearm. teres just below the elbow. The anterior inter- osseous nerve passes down the forearm and Anatomical anomalies Anomalies in the dis- http://jnnp.bmj.com/ supplies three muscles-flexor pollicis longus, tribution of the anterior interosseous nerve are flexor digitorum profundus to the index and not uncommon (Wilson, 1954). The Martin- middle fingers, and pronator quadratus. Sensory Gruber anastomosis (Martin, 1763; Gruber, fibres in the nerve arise from end-organs in the 1870) is a communication between the motor distal radio-ulnar joint and the wrist joint. The fibres of the median nerve or its branches and the anterior interosseous nerve does not convey ulnar nerve in the forearm which occurs in 15% fibres from in the skin and it of limbs (Thompson, 1893). Approximately one sensory end-organs on September 24, 2021 by may be regarded as a pure motor nerve for Martin-Gruber anastomosis in two arises from practical clinical purposes. the anterior interosseous nerve and therefore a Palsy of the anterior interosseous nerve is lesion of that nerve can sometimes cause weak- characterized by weakness of flexion of the inter- ness of the ulnar-innervated small muscles of the phalangeal joint of the thumb and terminal hand (Mannerfelt, 1966). The part of the flexor interphalangeal joints of the index and middle digitorum profundus muscle which controls the index finger is usually supplied by the anterior 1 Present address: Department of Neurology, Royal Devon and Exeter Hospital (Wonford), Barrack Road, Exeter EX2 5DW. interosseous nerve (Sunderland, 1945) but the 1146 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.37.10.1146 on 1 October 1974. Downloaded from Anzterior interosseous nerve palsy: spontaneous recovery in two patienits 1147 part which controls the middle finger may be the medial root of the median nerve. The prona- supplied by the median nerve, the ulnar nerve, tor syndrome (Seyffarth, 1951) may easily be or both. Flexor pollicis longus may also receive distinguished, since the main trunk of the median a branch directly from the median nerve but it nerve is compromised. O'Brien and Upton (1972) seems that pronator quadratus is always sup- were the first to describe the detailed clinical plied by the anterior interosseous nerve (Sunder- neurophysiological investigation of a patient land, 1968). with anterior interosseous nerve palsy. CAUSES OF PALSY OF ANTERIOR INTEROSSEOUS Prognosis and treatment Many of the patients NERVE These may be summarized as follows: discussed in the early case reports did not receive any specific treatment. Recovery was 1. Injury slow and the pathology not always known. Of a. Penetrating injuries Knife wounds, bullet the 36 patients with neuralgic amyotrophy dis- wounds, and forearm venous injections. In one cussed by Parsonage and Turner (1948) six had case, the palsy appeared 10 years after a stab isolated weakness of flexor pollicis longus and wound (Spinner, 1972). flexor digitorum profundus: one patient re- b. Supracondylar fracture of humerus in covered in a few months but the prognosis in the children Probably due to traction on the other five is not known. Partial recovery anterior interosseous nerve (Spinner and Schrei- occurred after 12 and 23 months in the two ber, 1969) rather than to pressure on the patients reported by Kiloh and Nevin (1952) and guest. Protected by copyright. posterior fibres of the median nerve (Lipscomb the two patients described by Thomas (1962) and Burleson, 1955). recovered almost completely. Return of function c. Midshaft fracture of radius (Spinner, 1972). started four to six weeks after a closed fracture d. Operative procedure for the relief of flexion of the forearm in the two patients described by contracture in the forearm (Page, 1923). Warren (1963) and power was normal after five and seven months. Partial recovery occurred 2. Muscle abnormality after six and 18 months in the patients reported a. Tendinous origin of the deep head ofpronator by Farber and Bryan (1968): one patient had teres, flexor digitorum profundus or palmaris worn a plaster cast for recurrent dislocation of longus (Spinner, 1972). the humerus before the anterior interosseous b. Accessory head of flexor pollicis longus- palsy developed. Gantzer's (1813) muscle-or accessory muscle The first description of an operation for this and tendon between flexor digitorum super- palsy has been attributed to Fearn and Good- ficialis and flexor pollicis longus. fellow (1965) who divided a fibrous band and 3. Vascular abnormality showed complete recovery after three months. a. Scarring and swelling of muscle in Volkmann's However, Lipscomb and Burleson (1955) de- ischaemia (Lipscomb and Burleson, 1955). scribed the operations performed in four patients http://jnnp.bmj.com/ b. Aberrant radial artery. with a supracondylar fracture of the humerus c. Thrombosis of ulnar collateral vessels. primarily to relieve brachial artery compression but the outcome, so far as the anterior inter- 4. Neuralgic amyotrophy osseous nerve was concerned, was the same- Usually with evidence of involvement of other complete recovery of function. Fibrous bands roots or nerves (Parsonage and Turner, 1948). have been divided by other workers (Stern et al., Mills et 1967; Sharrard, 1968, al., 1969; Schmidt on September 24, 2021 by 5. Enlarged bicipital bursa and Eiken, 1971) and recovery has followed after DIFFERENTIAL DIAGNOSIS Other conditions may periods ranging from 10 days to four months. mimic anterior interosseous palsy. The more Spinner (1970, 1972) and Spinner and important of these include congenital absence of Schreiber (1969) advocated exploration immedi- the deep flexor muscles (Spinner, 1972), rupture ately after penetrating wounds and after an of the flexor tendons in rheumatoid disease and interval of six to eight weeks in other cases when Kienbock's disease (James, 1949), and lesions of there had not been any clinical or electromyo- J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.37.10.1146 on 1 October 1974. Downloaded from 1148 Christopher Gardner-Thorpe graphic evidence of recovery. Spinner also Case I Positive sharp wave potentials were pointed out that nerve and tendon transplant recorded from pronator quadratus where motor unit operations may help to normalize the function potentials were of reduced amplitude in contrast to of the limb. the normal potentials recorded from abductor pollicis brevis and flexor pollicis longus. The inter- ference pattern on maximum voluntary activity was CASE 1 reduced both in density and amplitude in pronator M.B. (N46796), a 35 year old housewife, first quadratus and flexor pollicis longus: it was normal noticed pain in the left cubital fossa in February in abductor pollicis brevis. 1972. At about that time she had frequently been lifting her baby's carrycot into and out of the car, Case 2 Fibrillation potentials were recorded from through the driver's door (right hand drive) and on pronator quadratus. The interference pattern was to the back seat, but she does not recall whether she reduced in flexor digitorum profundus and pronator held the carrycot straps over her forearm. A few quadratus but the remainder of the examination, days after the appearance of the pain, which was including the abductor pollicis brevis, was normal. accentuated by extension of the elbow, she noticed difficulty in moving the distal joints of the thumb and MOTOR NERVE CONDUCTION Motor nerves were index finger although sensation in the hand and digits stimulated with saline-soaked pads placed on the was quite normal. Typewriting, sewing, knitting, skin overlying the nerves. The responses were re- filing the nails, turning a key, lifting coins from a corded from concentric needle electrodes placed in purse, and fastening buttons were particularly diffi- the appropriate muscles.
Load more

Recommended publications
  • Cubital Tunnel Syndrome
    Cubital Tunnel Syndrome What many people call the “funny bone” really is a nerve. This ulnar nerve runs behind a bone in the elbow through a space Figure 1: Ulnar Nerve at elbow joint (inner side of elbow) called the “cubital tunnel” (Figure 1). Although “banging the funny bone” usually causes temporary symptoms, chronic pressure on or stretching of the nerve can affect the blood supply to the ulnar nerve, causing numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand. This is called “cubital tunnel syndrome.” Humerus Causes There are a few causes of this ulnar nerve problem. These include: Pressure. Because the nerve runs through that “funny bone” groove and has little padding over it, direct pressure (like leaning your arm on an arm rest) can compress the nerve, causing your arm and hand—especially the ring and small fingers—to Ulnar Nerve “fall asleep.” Stretch. Keeping the elbow bent for a long time can stretch Medial Epicondyle the nerve behind the elbow. This usually happens during sleep. Anatomy. Sometimes, the ulnar nerve does not stay in its place and snaps back and forth over a bony bump as the elbow is moved. Repetitive snapping can irritate the nerve. Sometimes, the soft tissues over the nerve become thicker or there is an Ulna “extra” muscle over the nerve that can keep the nerve from working correctly. Treatment Signs and Symptoms The first treatment is to avoid actions that cause symptoms. Cubital tunnel syndrome can cause pain, loss of sensation, Wrapping a pillow or towel around the elbow or wearing a splint and/or tingling.
    [Show full text]
  • Cubital Tunnel Syndrome)
    DISEASES & CONDITIONS Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome) Ulnar nerve entrapment occurs when the ulnar nerve in the arm becomes compressed or irritated. The ulnar nerve is one of the three main nerves in your arm. It travels from your neck down into your hand, and can be constricted in several places along the way, such as beneath the collarbone or at the wrist. The most common place for compression of the nerve is behind the inside part of the elbow. Ulnar nerve compression at the elbow is called "cubital tunnel syndrome." Numbness and tingling in the hand and fingers are common symptoms of cubital tunnel syndrome. In most cases, symptoms can be managed with conservative treatments like changes in activities and bracing. If conservative methods do not improve your symptoms, or if the nerve compression is causing muscle weakness or damage in your hand, your doctor may recommend surgery. This illustration of the bones in the shoulder, arm, and hand shows the path of the ulnar nerve. Reproduced from Mundanthanam GJ, Anderson RB, Day C: Ulnar nerve palsy. Orthopaedic Knowledge Online 2009. Accessed August 2011. Anatomy At the elbow, the ulnar nerve travels through a tunnel of tissue (the cubital tunnel) that runs under a bump of bone at the inside of your elbow. This bony bump is called the medial epicondyle. The spot where the nerve runs under the medial epicondyle is commonly referred to as the "funny bone." At the funny bone the nerve is close to your skin, and bumping it causes a shock-like feeling.
    [Show full text]
  • Cubital Tunnel Anatomy
    Ultrasound Imaging of the Ulnar Nerve Cubital Tunnel Syndrome Benjamin M. Sucher, D.O., FAOCPMR-D, FAAPMR EMG LABs of AARA [email protected] North Phoenix, Mesa, Glendale, West Phoenix Cubital Tunnel Anatomy Arcade of Struthers Ulnar Groove ME (‘sulcus’) Cubital Tunnel O Authors also think it includes the ulnar groove Retroepicondylar (RTC) groove Humeroulnar aponeurotic arcade (HUA) Deep forearm Flexorpronator Aponeurosis Why Ulnar Nerve is so Vulnerable at the Elbow? 1. Frequent motion exposes nerve to excess mechanical force 2. Flexion stretches/tethers nerve against medial epicondyle 3. Ulnar collateral ligament bulges medially against nerve 4. FCU aponeurosis tightens against nerve – adds to pressure 5. Subluxation exposes to friction against medial epicondyle 6. Less connective tissue protecting nerve funiculi; topography 7. Triceps intrusion compresses nerve and increases pressure 8. ‘Snapping triceps’ ‘pushes’ nerve out of the groove 1 Cubital Tunnel FCU - Proximal aponeurotic compression of ulnar nerve; During elbow flexion, FCU tightens against nerve Cubital Tunnel Snapping Triceps Spinner & Goldner, JBJS, 1998 Snapping Triceps Syndrome Spinner and Goldner, JBJS, 1998 2 Triceps Intrusion Into the Ulnar Sulcus and Ulnar Nerve Subluxation Ulnar nerve Extension Ulnar nerve (subluxed) Flexion Miller and Reinus, AJR, 2010 DIAGNOSTIC ULTRASOUND of NORMAL Ulnar Nerves Normal CSA: 8-10mm 2 maximum upper limit [Mild = 10-14; Mod = 15-19; Severe >20] Axonal loss = larger nerve size Bayrak, et al: M&N; 2010 Normal CSA: Beekman, et al: M&N, 2011 <7mm 2 definitely normal in Females Omejec and Podnar: M&N; 2015 (8-11 mm 2) <8mm 2 definitely normal in Males Peer and Bodner, 2008 Normal CSA: Strakowski, 2014 8-9mm 2 maximum upper limit [9 = males; 8 = females] Cartwright, et al: Arch Phys Med Rehabil; 2007 DIAGNOSTIC ULTRASOUND OF Ulnar Nerve Injury Patient H&P: 55 y/o male complains of pain, numbness and weakness in the hand for 4 months.
    [Show full text]
  • Csph0114 V1 Nov19 Ulnar Nerve A4.Pmd
    What is an Ulnar Nerve Entrapment? Ulnar nerve entrapment occurs when the ulnar nerve in the arm becomes compressed or irritated. The ulnar nerve is one of the three main nerves in your arm. It travels from your neck down into your hand and can be constricted in several places along the way, such as underneath the collarbone or at the wrist. The most common place for compression of the nerve is the inside of the elbow. Ulnar nerve compression at the elbow is called “cubital tunnel syndrome.” In many cases of cubital tunnel syndrome, the exact cause is not known. The ulnar nerve is especially vulnerable to compression at the elbow because it must travel through a narrow space with very little soft tissue to protect it. Diagram with the permission of American Academy of Orthopaedic Surgeons (AAOS) What are the symptoms? • Aching pain on the inside of the elbow. Most of the symptoms, however, occur in your hand. • Numbness and tingling in the ring finger and little finger are common. Often, these symptoms come and go. They happen more often when the elbow is bent, such as when driving or holding the phone. Some people wake up at night because their fingers are numb. • Weakening of the grip and difficulty with finger coordination (such as typing or playing an instrument) may occur. • In later stages, the numbness is constant and the hand becomes weaker. There may be a visible loss of muscle bulk in severe cases, particularly noticeable on the back of the hand between the thumb and first finger, with loss of strength and dexterity Who gets it? People that have: • Prior fracture or dislocations of the elbow • Bone spurs/ arthritis of the elbow • Swelling of the elbow joint • Cysts near the elbow joint • An occupation or activities that require the elbow to be bent or flexed Leaflet No: csph0114 v1 Review Date 11/19 Page 1 of 2 Things that can help relieve the symptoms Rest and activity modification - Overuse of the affected hand and elbow can often result in an increase in your symptoms.
    [Show full text]
  • Electrodiagnosis of Brachial Plexopathies and Proximal Upper Extremity Neuropathies
    Electrodiagnosis of Brachial Plexopathies and Proximal Upper Extremity Neuropathies Zachary Simmons, MD* KEYWORDS Brachial plexus Brachial plexopathy Axillary nerve Musculocutaneous nerve Suprascapular nerve Nerve conduction studies Electromyography KEY POINTS The brachial plexus provides all motor and sensory innervation of the upper extremity. The plexus is usually derived from the C5 through T1 anterior primary rami, which divide in various ways to form the upper, middle, and lower trunks; the lateral, posterior, and medial cords; and multiple terminal branches. Traction is the most common cause of brachial plexopathy, although compression, lacer- ations, ischemia, neoplasms, radiation, thoracic outlet syndrome, and neuralgic amyotro- phy may all produce brachial plexus lesions. Upper extremity mononeuropathies affecting the musculocutaneous, axillary, and supra- scapular motor nerves and the medial and lateral antebrachial cutaneous sensory nerves often occur in the context of more widespread brachial plexus damage, often from trauma or neuralgic amyotrophy but may occur in isolation. Extensive electrodiagnostic testing often is needed to properly localize lesions of the brachial plexus, frequently requiring testing of sensory nerves, which are not commonly used in the assessment of other types of lesions. INTRODUCTION Few anatomic structures are as daunting to medical students, residents, and prac- ticing physicians as the brachial plexus. Yet, detailed understanding of brachial plexus anatomy is central to electrodiagnosis because of the plexus’ role in supplying all motor and sensory innervation of the upper extremity and shoulder girdle. There also are several proximal upper extremity nerves, derived from the brachial plexus, Conflicts of Interest: None. Neuromuscular Program and ALS Center, Penn State Hershey Medical Center, Penn State College of Medicine, PA, USA * Department of Neurology, Penn State Hershey Medical Center, EC 037 30 Hope Drive, PO Box 859, Hershey, PA 17033.
    [Show full text]
  • Cubital Tunnel Syndrome Multimedia Health Education
    Cubital Tunnel Syndrome Multimedia Health Education Disclaimer This movie is an educational resource only and should not be used to manage Orthopaedic Health. All decisions about Cubital Tunnel Syndrome must be made in conjunction with your Physician or a licensed healthcare provider. Cubital Tunnel Syndrome Multimedia Health Education MULTIMEDIA HEALTH EDUCATION MANUAL TABLE OF CONTENTS SECTION CONTENT 1 . Introduction a. Introduction b. Normal Elbow Anatomy c. Biomechanics 2 . Cubital Tunnel Syndrome a. What is Cubital Tunnel Syndrome? b. Signs and Symptoms c. Causes d. Diagnosis e. Conservative Treatment Options 3 . Surgical Procedure a. Introduction b. Surgical Treatment c. Post Operative Care d. Risks and Complications Cubital Tunnel Syndrome Multimedia Health Education INTRODUCTION The cubital tunnel is a narrow, fixed passageway in the elbow that houses and protects the ulnar nerve. This is the nerve responsible for the sensation you feel when you hit your “funny bone”. Cubital Tunnel Syndrome, also called Ulnar Nerve Entrapment, involves tearing or inflammation of the ulnar nerve. To learn more about Cubital Tunnel Syndrome, it is important to understand the normal anatomy of the elbow. Cubital Tunnel Syndrome Multimedia Health Education Unit 1: Introduction Introduction The elbow in the human body consists of Bones Joints Muscles Ligaments and Tendons Numerous blood vessels, nerves, and soft tissue. Bones (Refer fig. 1) (Fig. 1) Joints (Refer fig. 2) (Fig. 2) Muscles (Refer fig. 3) (Fig. 3) Cubital Tunnel Syndrome Multimedia Health Education Unit 1: Introduction Ligaments and Tendons (Refer fig. 4) (Fig. 4) Numerous Blood vessels, nerves, and soft tissue. (Refer fig. 5) (Fig. 5) Normal Elbow Anatomy The arm in the human body is made up of three bones that join together to form a hinge joint called the elbow.
    [Show full text]
  • Upper and Lower Extremity Nerve Conduction Studies Kelly G
    2019 Upper and Lower Extremity Nerve Conduction Studies Kelly G. Gwathmey October 18, 2019 Virginia Commonwealth University 2019 Financial Disclosure I have received speaking and consulting honoraria from Alexion Pharmaceuticals. 2019 Warning Videotaping or taking pictures of the slides associated with this presentation is prohibited. The information on the slides is copyrighted and cannot be used without permission and author attribution. 2019 Outline for Today’s talk • Upper extremity nerve conduction studies o Median nerve o Ulnar nerve o Radial nerve o Median comparison studies o Medial antebrachial cutaneous nerve o Lateral antebrachial cutaneous nerve • Lower extremity nerve conduction studies o Fibular nerve o Tibial nerve o Sural nerve o Femoral nerve • Saphenous • Lateral femoral cutaneous • Phrenic nerve • Facial nerve • Anomalous Innervations 2019 Median nerve anatomy • Median nerve is formed by a combination of: o Lateral cord (C6-7) supplies the sensory fibers to the thumb, index, middle finger, proximal median forearm, and thenar eminence. o Medial cord (C8-T1) provides motor fibers to the distal forearm and hand. • The median nerve innervates the pronator teres, then gives branches to the flexor carpi radialis, flexor digitorum superficialis, and palmaris longus. • Anterior Interosseus Nerve (AIN)- innervates the flexor pollicis longus, flexor digitorum profundus (FDP) (digits 2 and 3), and pronator quadratus. Preston, David C., MD; Shapiro, Barbara E., MD, PhD. Published January 1, 2013. Pages 267-288. © 2013. 2019 Median nerve anatomy • Proximal to the wrist- the palmar cutaneous sensory branch (sensation over the thenar eminence) • Through the carpal tunnel- Motor division goes to first and second lumbricals o Recurrent thenar motor branch the thenar eminence (opponens, abductor pollicis brevis, and superficial head of flexor pollicis brevis) • Sensory branch that goes through the carpal tunnel supplies the medial thumb, index finger, middle finger and lateral half of the ring finger.
    [Show full text]
  • Cubital Tunnel Syndrome
    Oxford University Hospitals NHS Trust Hand & Plastics Physiotherapy Department Cubital Tunnel Syndrome Information for patients This leaflet has been developed to answer any questions you may have regarding your recent diagnosis of cubital tunnel syndrome. What is the Cubital Tunnel? The cubital tunnel is made up of the bones in your elbow and the forearm muscles which run across the elbow joint. Your ulnar nerve passes through the tunnel to supply sensation to your fingers, and information to the muscles to help move your hand. What causes Cubital Tunnel Syndrome? Symptoms occur when the nerve becomes restricted by pressure within the tunnel. The reason is usually unknown, but possible causes can include: swelling of the lining of the tendons, joint dislocation, fractures or arthritis. Fluid retention during pregnancy can also sometimes cause swelling in the tunnel. Symptoms are made worse by keeping the elbow bent for long periods of time. What are the symptoms? Symptoms include numbness, tingling and/or pain in the arm, hand and/or fingers of the affected side. The symptoms are often felt during the night, but may be noticed during the day when the elbow is bent for long periods of time. You may have noticed a weaker grip, or clumsiness when using your hand. In severe cases sensation may be permanently lost, and some of the muscles in the hand and base of the little finger may reduce in size. page 2 Diagnosis A clinician may do a test such as tapping along the line of the nerve or bending your elbow to see if your symptoms are brought on.
    [Show full text]
  • Ulnar Nerve Decompression
    Ulnar nerve decompression This information aims to help you gain the maximum benefit and understanding of your operation. It includes the following information: • Key points • About your elbow • What is ulnar neuritis • Treatment options • About the operation including the risks and alternative solutions • Frequently asked questions • Exercises • Contact details • Useful links Key points If you are considering having an ulnar nerve decompression, remember these key points: 1. Nearly all are done as day case surgery (home the same day). 2. You will have a general anaesthetic (you will be asleep). 3. You will be in a sling for just the first 2 or 3 days. 4. You will not be driving for 1 to 2 weeks. 5. You will return to work about 1-2 weeks after the operation or longer if you are a manual worker. 6. You can return to sport gradually. 7. This is a safe, reliable and effective operation for 90% of people. 8. This is not a quick fix operation – it may take many months for symptoms to improve. 9. www.shoulderdoc.co.uk is a reputable and useful British website for further information. The ulnar nerve The ulnar nerve (or nervus ulnaris) runs around the inner side of the elbow in a groove just behind a bony prominence (medial epicondyle). The nerve, where it lies in the groove, is covered by a tough layer of tissue that forms a tunnel (cubital tunnel). It is important as it controls the small muscles in the hand which are particularly important for fine movements such as doing up buttons and it is also responsible for normal feeling in the little and ring fingers.
    [Show full text]
  • Nerve-Transfers-Lee
    Review Article Nerve Transfers for the Upper Extremity: New Horizons in Nerve Reconstruction Abstract Steve K. Lee, MD Nerve transfers are key components of the surgeon’s Scott W. Wolfe, MD armamentarium in brachial plexus and complex nerve reconstruction. Advantages of nerve transfers are that nerve regeneration distances are shortened, pure motor or sensory nerve fascicles can be selected as donors, and nerve grafts are generally not required. Similar to the principle of tendon transfers, expendable donor nerves are transferred to denervated nerves with the goal of functional recovery. Transfers may be subdivided into intraplexal, extraplexal, and distal types; each has a unique role in From the Hospital for Special the reconstructive process. A thorough diagnostic workup and Surgery and Weill Cornell Medical intraoperative assessment help guide the surgeon in their use. College, New York, NY. Nerve transfers have made a positive impact on the outcomes of Dr. Lee or an immediate family nerve surgery and are essential tools in complex nerve member has received royalties from, is a member of a speakers’ bureau reconstruction. or has made paid presentations on behalf of, and serves as a paid consultant to or is an employee of Arthrex; serves as an unpaid lthough not a new concept, neurotization should be reserved to consultant to Synthes; has received Anerve transfers have become an describe the direct implantation of a research or institutional support from increasingly important technique in divided donor nerve into muscle, Arthrex, DePuy Mitek, Integra LifeSciences, Medartis, Axogen, and the strategic algorithm for nerve re- which has shown promise in an ani- 1,2 Checkpoint; and serves as a board construction.
    [Show full text]
  • Journal of Brachial Plexus and Peripheral Nerve Injury Biomed Central
    Journal of Brachial Plexus and Peripheral Nerve Injury BioMed Central Research article Open Access Rapid recovery of serratus anterior muscle function after microneurolysis of long thoracic nerve injury Rahul K Nath* and Sonya E Melcher Address: Texas Nerve and Paralysis Institute, Houston, Texas, USA Email: Rahul K Nath* - [email protected]; Sonya E Melcher - [email protected] * Corresponding author Published: 9 February 2007 Received: 20 November 2006 Accepted: 9 February 2007 Journal of Brachial Plexus and Peripheral Nerve Injury 2007, 2:4 doi:10.1186/1749-7221-2- 4 This article is available from: http://www.JBPPNI.com/content/2/1/4 © 2007 Nath and Melcher; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Injury to the long thoracic nerve is a common cause of winging scapula. When the serratus anterior muscle is unable to function, patients often lose the ability to raise their arm overhead on the affected side. Methods: Serratus anterior function was restored through decompression, neurolysis, and tetanic electrical stimulation of the long thoracic nerve. This included partial release of constricting middle scalene fibers and microneurolysis of epineurium and perineurium of the long thoracic nerve under magnification. Abduction angle was measured on the day before and the day following surgery. Results: In this retrospective study of 13 neurolysis procedures of the long thoracic nerve, abduction is improved by 10% or greater within one day of surgery.
    [Show full text]
  • Surgical Anatomy of the Carpal Tunnel
    Surgical anatomy of the carpal tunnel Allan H. Friedman, M.D. Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina The author describes and details the anatomy of the carpal tunnel and surrounding structures pertinent to the surgical treatment of carpal tunnel syndrome. Potential complications of both open and endoscopic carpal tunnel release are discussed as well as techniques to avoid or minimize poor patient outcomes. Key Words * carpal tunnel * surgical anatomy * carpal tunnel release Release of the flexor retinaculum for the treatment of carpal tunnel syndrome (CTS) can be one of the most straightforward and satisfying procedures performed by a neurosurgeon. Complication rates for both open (OCTR) and endoscopic carpal tunnel release (ECTR) procedures are usually low. Many of the potential complications that occur during CTR surgery can be avoided if the surgeon has a good grasp of the anatomy of the carpal tunnel and its possible anomalies. Surface Anatomy Several authors have pointed out the relationship between the wrinkles embedded in the palm and the structures that lie beneath the skin.[8] Kaplan's cardinal line is drawn from the apex of the first web space (between the thumb and index finger) toward the ulnar side of the hand, parallel with the proximal palmar crease.[40] Kaplan's cardinal line transects a line drawn as a continuation of the ulnar border of the ring finger over the hook of the hamate (Fig. 1).[35] Unauthenticated | Downloaded 09/27/21 04:41 AM UTC Fig. 1. In this illustration Kaplan's cardinal line (1) is drawn from the apex of the first interdigital fold toward the ulnar side of the hand parallel to the proximal palmar crease.
    [Show full text]