Chapter 30 When It Is Not Cervical Radiculopathy: Thoracic Outlet Syndrome—A Prospective Study on Diagnosis and Treatment
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Radiculopathy Vs. Spinal Stenosis: Evocative Electrodiagnosis Identifies the Main Pain Generator
Functional Electromyography Loren M. Fishman · Allen N. Wilkins Functional Electromyography Provocative Maneuvers in Electrodiagnosis 123 Loren M. Fishman, MD Allen N. Wilkins, MD College of Physicians & Surgeons Manhattan Physical Medicine Columbia University and Rehabilitation New York, NY 10028, USA New York, NY 10013, USA [email protected] ISBN 978-1-60761-019-9 e-ISBN 978-1-60761-020-5 DOI 10.1007/978-1-60761-020-5 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2010935087 © Springer Science+Business Media, LLC 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. -
Brachial-Plexopathy.Pdf
Brachial Plexopathy, an overview Learning Objectives: The brachial plexus is the network of nerves that originate from cervical and upper thoracic nerve roots and eventually terminate as the named nerves that innervate the muscles and skin of the arm. Brachial plexopathies are not common in most practices, but a detailed knowledge of this plexus is important for distinguishing between brachial plexopathies, radiculopathies and mononeuropathies. It is impossible to write a paper on brachial plexopathies without addressing cervical radiculopathies and root avulsions as well. In this paper will review brachial plexus anatomy, clinical features of brachial plexopathies, differential diagnosis, specific nerve conduction techniques, appropriate protocols and case studies. The reader will gain insight to this uncommon nerve problem as well as the importance of the nerve conduction studies used to confirm the diagnosis of plexopathies. Anatomy of the Brachial Plexus: To assess the brachial plexus by localizing the lesion at the correct level, as well as the severity of the injury requires knowledge of the anatomy. An injury involves any condition that impairs the function of the brachial plexus. The plexus is derived of five roots, three trunks, two divisions, three cords, and five branches/nerves. Spinal roots join to form the spinal nerve. There are dorsal and ventral roots that emerge and carry motor and sensory fibers. Motor (efferent) carries messages from the brain and spinal cord to the peripheral nerves. This Dorsal Root Sensory (afferent) carries messages from the peripheral to the Ganglion is why spinal cord or both. A small ganglion containing cell bodies of sensory NCS’s sensory fibers lies on each posterior root. -
Piriformis Syndrome Is Overdiagnosed 11 Robert A
American Association of Neuromuscular & Electrodiagnostic Medicine AANEM CROSSFIRE: CONTROVERSIES IN NEUROMUSCULAR AND ELECTRODIAGNOSTIC MEDICINE Loren M. Fishman, MD, B.Phil Robert A.Werner, MD, MS Scott J. Primack, DO Willam S. Pease, MD Ernest W. Johnson, MD Lawrence R. Robinson, MD 2005 AANEM COURSE F AANEM 52ND Annual Scientific Meeting Monterey, California CROSSFIRE: Controversies in Neuromuscular and Electrodiagnostic Medicine Loren M. Fishman, MD, B.Phil Robert A.Werner, MD, MS Scott J. Primack, DO Willam S. Pease, MD Ernest W. Johnson, MD Lawrence R. Robinson, MD 2005 COURSE F AANEM 52nd Annual Scientific Meeting Monterey, California AANEM Copyright © September 2005 American Association of Neuromuscular & Electrodiagnostic Medicine 421 First Avenue SW, Suite 300 East Rochester, MN 55902 PRINTED BY JOHNSON PRINTING COMPANY, INC. ii CROSSFIRE: Controversies in Neuromuscular and Electrodiagnostic Medicine Faculty Loren M. Fishman, MD, B.Phil Scott J. Primack, DO Assistant Clinical Professor Co-director Department of Physical Medicine and Rehabilitation Colorado Rehabilitation and Occupational Medicine Columbia College of Physicians and Surgeons Denver, Colorado New York City, New York Dr. Primack completed his residency at the Rehabilitation Institute of Dr. Fishman is a specialist in low back pain and sciatica, electrodiagnosis, Chicago in 1992. He then spent 6 months with Dr. Larry Mack at the functional assessment, and cognitive rehabilitation. Over the last 20 years, University of Washington. Dr. Mack, in conjunction with the Shoulder he has lectured frequently and contributed over 55 publications. His most and Elbow Service at the University of Washington, performed some of the recent work, Relief is in the Stretch: End Back Pain Through Yoga, and the original research utilizing musculoskeletal ultrasound in order to diagnose earlier book, Back Talk, both written with Carol Ardman, were published shoulder pathology. -
New York Chapter American College of Physicians Annual
New York Chapter American College of Physicians Annual Scientific Meeting Poster Presentations Saturday, October 12, 2019 Westchester Hilton Hotel 699 Westchester Avenue Rye Brook, NY New York Chapter American College of Physicians Annual Scientific Meeting Medical Student Clinical Vignette 1 Medical Student Clinical Vignette Adina Amin Medical Student Jessy Epstein, Miguel Lacayo, Emmanuel Morakinyo Touro College of Osteopathic Medicine A Series of Unfortunate Events - A Rare Presentation of Thoracic Outlet Syndrome Venous thoracic outlet syndrome, formerly known as Paget-Schroetter Syndrome, is a condition characterized by spontaneous deep vein thrombosis of the upper extremity. It is a very rare syndrome resulting from anatomical abnormalities of the thoracic outlet, causing thrombosis of the deep veins draining the upper extremity. This disease is also called “effort thrombosis― because of increased association with vigorous and repetitive upper extremity activities. Symptoms include severe upper extremity pain and swelling after strenuous activity. A 31-year-old female with a history of vascular thoracic outlet syndrome, two prior thrombectomies, and right first rib resection presented with symptoms of loss of blood sensation, dull pain in the area, and sharp pain when coughing/sneezing. When the patient had her first blood clot, physical exam was notable for swelling, venous distension, and skin discoloration. The patient had her first thrombectomy in her right upper extremity a couple weeks after the first clot was discovered. Thrombolysis with TPA was initiated, and percutaneous mechanical thrombectomy with angioplasty of the axillary and subclavian veins was performed. Almost immediately after the thrombectomy, the patient had a rethrombosis which was confirmed by ultrasound. -
Lumbosacral Plexus Entrapment Syndrome. Part One: a Common Yet Little-Known Cause of Chronic Pelvic and Lower Extremity Pain
3-A Running head: ANAESTHESIA, PAIN & INTENSIVE CARE www.apicareonline.com ORIGINAL ARTICLE Lumbosacral plexus entrapment syndrome. Part one: A common yet little-known cause of chronic pelvic and lower extremity pain Kjetil Larsen, CES, George C. Chang Chien, D O2 ABSTRACT Corrective exercise specialist, Training & Rehabilitation, Oslo Lumbosacral plexus entrapment syndrome (LPES) is a little-known but common cause Norway of chronic lumbopelvic and lower extremity pain. The lumbar plexus, including the 2 Director of pain management, lumbosacral tunks emerge through the fibers of the psoas major, and the proximal Ventura County Medical Center, sciatic nerve beneath the piriformis muscles. Severe weakness of these muscles may Ventura, CA 93003, USA. lead to entrapment plexopathy, resulting in diffuse and non-specific pain patterns Correspondence: Kjetil Larsen, CES, Corrective throughout the lumbopelvic complex and lower extremities (LPLE), easily mimicking Exercise Specialist, Training & other diagnoses and is therefore likely to mislead the interpreting clinician. It is a Rehabilitation, Oslo Norway; pathology very similar to that of thoracic outlet syndrome, but for the lower body. This Kjetil@trainingandrehabilitation. two part manuscript series was written in an attempt to demonstrate the existence, com; pathophysiology, diagnostic protocol as well as interventional strategy for LPES, and Tel.: +47 975 45 192 its efficacy. Received: 23 November 2018, Reviewed & Accepted: 28 Key words: Pelvic girdle; Pain, Pelvic girdle; Lumbosacral plexus entrapment syndrome; February 2019 Piriformis syndrome; Nerve entrapment; Double-crush; Pain, Chronic; Fibromyalgia Citation: Larsen K, Chien GCC. Lumbosacral plexus entrapment syndrome. Part one: A common yet little-known cause of chronic pelvic and lower extremity pain. -
The Efficacy and Safety of Gabapentin in Carpal Tunnel Patients: Open Label Trial
Original Article The efficacy and safety of gabapentin in carpal tunnel patients: Open label trial A. Kemal Erdemoglu Ayhan Varlibas, Kirikkale University, Faculty of Medicine, Department of Neurology, Kirikkale, 07100, Turkey Abstract Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by median nerve compression at the wrist. It results in loss of considerable man days and the effectiveness the various treatment modalities are still debated. Aim: To study the efficacy of gabapentin in patients with CTS. The study aim is to investigate the efficacy of gabapentin in patients with CTS patients who were refractory to the other conservative measures or unwilling for the surgical procedure. Materials and Methods: Forty one patients diagnosed as idiopathic CTS were included in the study. Patients were assessed with symptom severity scale (SSS) and functional status scale (FSS) scores of Boston Carpal Tunnel Questionnaire (BCTQ) before and at 1, 3, and 6 months of the treatment. Response to therapy was determined by using SSS and FSS scores of Address for correspondence: BCTQ. Results: The median dosage of gabapentin was 1800 mg/daily. Side effects Dr. A. Kemal Erdemoglu were mild and transient. There was a statistically significant difference in both symptom Kirikkale University, Faculty of Medicine, SSS and FSS scores between before and after treatment in patient groups at the end Department of Neurology, of six months (P < 0.001). According to grading the changes in subscales of BCTQ, Kirikkale, 07100, TURKEY. of 41 patients, 34.1 and 29.3 had a ≥ 40% decrease in SSS and FSS, respectively. E-mail: [email protected] Conclusion: Gabapentin was found to be partially effective and safe in symptomatic treatment of CTS patients. -
Wrist and Hand Examina[On
Wrist and Hand Examinaon Daniel Lueders, MD Assistant Professor Physical Medicine and Rehabilitaon Objecves • Understand the osseous, ligamentous, tendinous, and neural anatomy of the wrist and hand • Outline palpable superficial landmarks in the wrist and hand • Outline evaluaon of and differen.aon between nerves to the wrist and hand • Describe special tes.ng of wrist and hand Wrist Anatomy • Radius • Ulna • Carpal bones Wrist Anatomy • Radius • Ulna • Carpal bones Wrist Anatomy • Radius • Ulna • Carpal bones Wrist Anatomy • Radius • Ulna • Carpal bones Inspec.on • Ecchymosis • Erythema • Deformity • Laceraon Inspec.on • Common Finger Deformies • Swan Neck Deformity • Boutonniere Deformity • Hypertrophic nodules • Heberden’s, Bouchard’s Inspec.on • Swan Neck Deformity • PIP hyperextension, DIP flexion • Pathology is at PIP joint • Insufficiency of volar/palmar plate and suppor.ng structures • Distally, the FDP tendon .ghtens from PIP extension causing secondary DIP flexion • Alternavely, extensor tendon rupture produces similar deformity Inspec.on • Boutonniere Deformity • PIP flexion, DIP hyperextension • Pathology is at PIP joint • Commonly occurs from insufficiency of dorsal and lateral suppor.ng structures at PIP joint • Lateral bands migrate volar/palmar, creang increased flexion moment • Results in PIP “buTon hole” effect dorsally Inspec.on • Nodules • Osteoarthri.c • Hypertrophic changes of OA • PIP - Bouchard’s nodule • DIP - Heberden’s nodule • Rheumatoid Arthri.s • MCP joints affected most • Distal radioulnar joint can also be affected -
Thoracic Outlet Syndrome: Evaluation and Management
nalytic A al & B y i tr o s c i h e Kocyigi and Kuyucu, Biochem Anal Biochem 2016, m m Biochemistry & e i h s c t 5:2 r o i y B DOI: 10.4172/2161-1009.1000274 ISSN: 2161-1009 Analytical Biochemistry Review Article Open Access Thoracic Outlet Syndrome: Evaluation and Management Figen Kocyigi T1* and Ersin Kuyucu2 1School of Physical Therapy and Rehabilitation, Pamukkale University, Turkey 2Department of Orthopaedics and Traumatology, Istanbul Medipol University, Faculty of Medicine, Istanbul, Turkey *Corresponding author: Figen Kocyigi T, School of Physical Therapy and Rehabilitation, Pamukkale University, 20070, Denizli, Turkey, Tel: +90-258-4444295; Fax: +90-258-2964494; E-mail: [email protected] Rec date: March 04, 2016; Acc date: May 21, 2016; Pub date: May 24, 2016 Copyright: © 2016 Kocyıgı T et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Thoracic outlet syndrome is an umbrella term that describes the potential compression of the brachial plexus, subclavian vein or subclavian artery by different clinical disorders. This review covers the classification, clinical findings, physical examination findings and management of this challenging syndrome under the light of recent scientific research. Various medical specialties can encounter TOS within their field of expertise. TOS should not be viewed as a single clinical entity that simply manifests variations from one patient to another. TOS is composed of three very discrete subgroups, and treatment should be individualized after diagnosis is definite. -
ICD9 & ICD10 Neuromuscular Codes
ICD-9-CM and ICD-10-CM NEUROMUSCULAR DIAGNOSIS CODES ICD-9-CM ICD-10-CM Focal Neuropathy Mononeuropathy G56.00 Carpal tunnel syndrome, unspecified Carpal tunnel syndrome 354.00 G56.00 upper limb Other lesions of median nerve, Other median nerve lesion 354.10 G56.10 unspecified upper limb Lesion of ulnar nerve, unspecified Lesion of ulnar nerve 354.20 G56.20 upper limb Lesion of radial nerve, unspecified Lesion of radial nerve 354.30 G56.30 upper limb Lesion of sciatic nerve, unspecified Sciatic nerve lesion (Piriformis syndrome) 355.00 G57.00 lower limb Meralgia paresthetica, unspecified Meralgia paresthetica 355.10 G57.10 lower limb Lesion of lateral popiteal nerve, Peroneal nerve (lesion of lateral popiteal nerve) 355.30 G57.30 unspecified lower limb Tarsal tunnel syndrome, unspecified Tarsal tunnel syndrome 355.50 G57.50 lower limb Plexus Brachial plexus lesion 353.00 Brachial plexus disorders G54.0 Brachial neuralgia (or radiculitis NOS) 723.40 Radiculopathy, cervical region M54.12 Radiculopathy, cervicothoracic region M54.13 Thoracic outlet syndrome (Thoracic root Thoracic root disorders, not elsewhere 353.00 G54.3 lesions, not elsewhere classified) classified Lumbosacral plexus lesion 353.10 Lumbosacral plexus disorders G54.1 Neuralgic amyotrophy 353.50 Neuralgic amyotrophy G54.5 Root Cervical radiculopathy (Intervertebral disc Cervical disc disorder with myelopathy, 722.71 M50.00 disorder with myelopathy, cervical region) unspecified cervical region Lumbosacral root lesions (Degeneration of Other intervertebral disc degeneration, -
Neurogenic Thoracic Outlet Syndrome: Current Diagnostic Criteria and Advances in MRI Diagnostics
NEUROSURGICAL FOCUS Neurosurg Focus 39 (3):E7, 2015 Neurogenic thoracic outlet syndrome: current diagnostic criteria and advances in MRI diagnostics Stephen T. Magill, MD, PhD,1 Marcel Brus-Ramer, MD, PhD,2 Philip R. Weinstein, MD,1 Cynthia T. Chin, MD,2 and Line Jacques, MD1 Departments of 1Neurological Surgery and 2Radiology and Biomedical Imaging, University of California, San Francisco, California Neurogenic thoracic outlet syndrome (nTOS) is caused by compression of the brachial plexus as it traverses from the thoracic outlet to the axilla. Diagnosing nTOS can be difficult because of overlap with other complex pain and entrapment syndromes. An nTOS diagnosis is made based on patient history, physical exam, electrodiagnostic studies, and, more recently, interpretation of MR neurograms with tractography. Advances in high-resolution MRI and tractography can confirm an nTOS diagnosis and identify the location of nerve compression, allowing tailored surgical decompression. In this report, the authors review the current diagnostic criteria, present an update on advances in MRI, and provide case examples demonstrating how MR neurography (MRN) can aid in diagnosing nTOS. The authors conclude that improved high-resolution MRN and tractography are valuable tools for identifying the source of nerve compression in patients with nTOS and can augment current diagnostic modalities for this syndrome. http://thejns.org/doi/abs/10.3171/2015.6.FOCUS15219 KEY WORDS neurogenic thoracic outlet syndrome; MRI; MR neurogram; DTI; MR tractography; diffusion tensor imaging EUROGENIC thoracic outlet syndrome (nTOS) is a Both syndromes have similar symptoms, but diagnosing rare condition that consists of a constellation of nTOS requires identification of a direct source of compres- symptoms resulting from compression of the bra- sion, while patients without a clear source of compression Nchial plexus as it travels from the thoracic outlet to the fall into the disputed TOS category and may not respond axilla. -
Carpal Tunnel Syndrome: a Review of the Recent Literature I
The Open Orthopaedics Journal, 2012, 6, (Suppl 1: M8) 69-76 69 Open Access Carpal Tunnel Syndrome: A Review of the Recent Literature I. Ibrahim*,1, W.S. Khan1, N. Goddard2 and P. Smitham1 1University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK 2 Department of Trauma & Orthopaedics, Royal Free Hospital, Pond Street, London, NW3 2QG, UK Abstract: Carpal Tunnel Syndrome (CTS) remains a puzzling and disabling condition present in 3.8% of the general population. CTS is the most well-known and frequent form of median nerve entrapment, and accounts for 90% of all entrapment neuropathies. This review aims to provide an overview of this common condition, with an emphasis on the pathophysiology involved in CTS. The clinical presentation and risk factors associated with CTS are discussed in this paper. Also, the various methods of diagnosis are explored; including nerve conduction studies, ultrasound, and magnetic resonance imaging. Keywords: Carpal tunnel syndrome, median nerve, entrapment neuropathy, pathophysiology, diagnosis. WHAT IS CARPAL TUNNEL SYNDROME? EPIDEMIOLOGY First described by Paget in 1854 [1], Carpal Tunnel CTS is the most frequent entrapment neuropathy [2], Syndrome (CTS) remains a puzzling and disabling condition believed to be present in 3.8% of the general population [14]. 1 commonly presented to Rheumatologists and Orthopaedic in every 5 subjects who complains of symptoms such as pain, Hand clinicians. It is a compressive neuropathy, which is numbness and a tingling sensation in the hands is expected to defined as a mononeuropathy or radiculopathy caused by have CTS based on clinical examination and electrophysio- mechanical distortion produced by a compressive force [2]. -
Musculoskeletal Clinical Vignettes a Case Based Text
Leading the world to better health MUSCULOSKELETAL CLINICAL VIGNETTES A CASE BASED TEXT Department of Orthopaedic Surgery, RCSI Department of General Practice, RCSI Department of Rheumatology, Beaumont Hospital O’Byrne J, Downey R, Feeley R, Kelly M, Tiedt L, O’Byrne J, Murphy M, Stuart E, Kearns G. (2019) Musculoskeletal clinical vignettes: a case based text. Dublin, Ireland: RCSI. ISBN: 978-0-9926911-8-9 Image attribution: istock.com/mashuk CC Licence by NC-SA MUSCULOSKELETAL CLINICAL VIGNETTES Incorporating history, examination, investigations and management of commonly presenting musculoskeletal conditions 1131 Department of Orthopaedic Surgery, RCSI Prof. John O'Byrne Department of Orthopaedic Surgery, RCSI Dr. Richie Downey Prof. John O'Byrne Mr. Iain Feeley Dr. Richie Downey Dr. Martin Kelly Mr. Iain Feeley Dr. Lauren Tiedt Dr. Martin Kelly Department of General Practice, RCSI Dr. Lauren Tiedt Dr. Mark Murphy Department of General Practice, RCSI Dr Ellen Stuart Dr. Mark Murphy Department of Rheumatology, Beaumont Hospital Dr Ellen Stuart Dr Grainne Kearns Department of Rheumatology, Beaumont Hospital Dr Grainne Kearns 2 2 Department of Orthopaedic Surgery, RCSI Prof. John O'Byrne Department of Orthopaedic Surgery, RCSI Dr. Richie Downey TABLE OF CONTENTS Prof. John O'Byrne Mr. Iain Feeley Introduction ............................................................. 5 Dr. Richie Downey Dr. Martin Kelly General guidelines for musculoskeletal physical Mr. Iain Feeley examination of all joints .................................................. 6 Dr. Lauren Tiedt Dr. Martin Kelly Upper limb ............................................................. 10 Department of General Practice, RCSI Example of an upper limb joint examination ................. 11 Dr. Lauren Tiedt Shoulder osteoarthritis ................................................. 13 Dr. Mark Murphy Adhesive capsulitis (frozen shoulder) ............................ 16 Department of General Practice, RCSI Dr Ellen Stuart Shoulder rotator cuff pathology ...................................