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Electrophysiological Changes in Patients with Impaired Glucose Tolerance
Turkish Journal of Endocrinology and Metabolism, (2000) 4 : 123-128 ORIGINAL ARTICLE Electrophysiological Changes in Patients with Impaired Glucose Tolerance Serdar Güler* Dilek Berker** Hüseyin Tu¤rul Atasoy*** Bekir Çak›r** Hilmi Uysal*** Yalç›n Aral* Ankara Education and Research Hospital, Departments, Ankara, Turkey * Endocrinology and Metabolism ** Internal Medicine *** Neurology The effect of impaired glucose tolerance on neuropathy is not well characterized. This study is performed to clarify the status of peripheral neuropathy in patients with impaired glucose tolerance with no symptoms of neuropathy. Twenty-two patients with impaired glucose tolerance with no signs of neuropathy, and 11 healthy controls are examined with electromyoneurography. We have found electrophysiological changes in 13 of 22 patients with IGT, and in only one case of the 11 subjects in the control group. Mean H reflex latencies of the right and left medial vastus muscles were significantly longer in the patient group than the control group (17.0±1.7 vs. 15.6±2.5 msec, p<0,02; and 17.1±1.8 vs. 15.7±2.4 msec; p<0,01, respectively). Our results indicate that electrophysiological changes of the peripheral nerves are very common in patients with impaired glucose tolerance. Early diagnosis and mana- gement of impaired glucose tolerance may be particularly important in order to prevent the development of chronic complications. Key words: Impaired glucose tolerance, polyneuropathy, electromyoneurography, electrophysiological studies, electrophysiological abnormalities Introduction Activation of polyol pathway, nonenzymatic gly- cosylation, epineural vascular atherosclerosis, endo- Diabetes Mellitus (DM) is one of the most fre- neurial microvascular disease, dysfunction of endo- quent causes of peripheral neuropathy (1). -
Notalgia Paresthetica: Cervical Spine Disease and Neuropathic Pruritus
Open Access Case Report DOI: 10.7759/cureus.12975 Notalgia Paresthetica: Cervical Spine Disease and Neuropathic Pruritus Ayesha Akram 1 1. Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK Corresponding author: Ayesha Akram, [email protected] Abstract Notalgia paresthetica (NP) is a dermatologic condition with predominant, primarily left unilateral pruritus and hyperpigmentation that typically occurs on the upper and middle back. The etiology remains largely elusive. A 57-year-old female with a history of neck pain presented with refractory NP since six months. Through diagnostic x-ray, cervical degenerative changes were discovered at the C5-C6 level, and she was prescribed a course of cervical traction. The cervical theory of NP is presented and is supported with x-ray findings in this case. Categories: Dermatology, Neurology Keywords: notalgia paresthetica, cervical spondylosis, enigmatic link Introduction Notalgia paresthetica (NP) is a cutaneous sensory neuropathy that predominantly affects females, with onset at middle age or older [1,2]. Although it is common, patients underestimate their symptoms, and physicians present an inertia to consider the possibility of NP, and far fewer know about the neuropathic itch. Doubtless, many cases go largely unrecognized, underdiagnosed, or overlooked in the routine clinical practice [3,4]. Pruritus is the overwhelming clinical symptom in the majority of patients [1,5]. A left-sided and posterior location matches well with the location of NP; almost always, NP is unilateral [1]. Hyperpigmentation in the affected area often results from scratching itchy, desensate skin [1]. Along with the pruritus, patients may also experience burning, tingling, coldness, hyperesthesia, hypoesthesia, numbness, or nerve pain in the area where pruritus appeared [6]. -
Median Nerve Compression at Pronator Teres
1 Median Nerve Compression at Pronator Teres Surgical Indications and Considerations Anatomical Considerations: The median nerve and brachial artery travel together down the arm. Therefore, one must be very careful not to interfere with either the median nerve or the brachial artery, especially when conducting surgical procedures. In the area of the pronator teres, there are many tendons as well. It is important to identify, as much as possible, the correct site of compression. Pathogenesis: The median nerve can get entrapped or compressed by several structures in the arm. The pronator teres muscle is the most common. Others entrapment sites include the flexor digitorum superficialis arch, the lacertus fibrosis (bicipital aponeurosis), and ligament of Struthers (frequency occurs in that order). For compression of the median nerve at the pronator teres and flexor digitorum superficialis, the cause is almost always due to hypertrophy of the respected muscle. This hypertrophy is from quick, forceful and repeated movements to the involved muscle. Examples include a carpenter or a baseball batter. As the muscle hypertrophies, the signal from the median nerve is diminished resulting in paresthesias in the median nerve distribution (lateral arm and hand) distal to the site of compression. Pain in the volar part of the forearm, often aggravated by repetitive supination and pronation, is a common symptom of pronator involvement. Another indicator is forearm pain with the compression of muscle such as pain in the volar part of the forearm implicating pronator teres. Onset is typically insidious and diagnosis is usually delayed 9 months to 2 years. Epidemiology: Pronator teres syndrome is the second most common cause of median nerve compression behind carpal tunnel syndrome. -
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. -
Neurological Complications of Cancer Immunotherapy
Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2021 Neurological complications of cancer immunotherapy Roth, Patrick ; Winklhofer, Sebastian ; Müller, Antonia M S ; Dummer, Reinhard ; Mair, Maximilian J ; Gramatzki, Dorothee ; Le Rhun, Emilie ; Manz, Markus G ; Weller, Michael ; Preusser, Matthias Abstract: Immunotherapy has emerged as a powerful therapeutic approach in many areas of clinical on- cology and hematology. The approval of ipilimumab, a monoclonal antibody targeting the immune cell receptor CTLA-4, has marked the beginning of the era of immune checkpoint inhibitors. In the mean- time, numerous antibodies targeting the PD-1 pathway have expanded the class of clinically approved immune checkpoint inhibitors. Furthermore, novel antibodies directed against other immune checkpoints are currently in clinical evaluation. More recently, bispecific antibodies, which link T cells directly to tumor cells as well as adoptive T cell transfer with immune cells engineered to express a chimeric antigen receptor, have been approved in certain indications. Neurological complications associated with the use of these novel immunotherapeutic concepts have been recognized more and more frequently. Immune check- point inhibitors may cause various neurological deficits mainly by alterations of the peripheral nervous system’s integrity. These include radiculopathies, neuropathies, myopathies as well as myasthenic syn- dromes. Side effects involving the central nervous system are less frequent but may result in severe clinical symptoms and syndromes. The administration of chimeric antigen receptor (CAR) T cell is subject to rigorous patient selection and their use is frequently associated with neurological complications includ- ing encephalopathy and seizures, which require immediate action and appropriate therapeutic measures. -
Piriformis Syndrome: the Literal “Pain in My Butt” Chelsea Smith, PTA
Piriformis Syndrome: the literal “pain in my butt” Chelsea Smith, PTA Aside from the monotony of day-to-day pains and annoyances, piriformis syndrome is the literal “pain in my butt” that may not go away with sending the kids to grandmas and often takes the form of sciatica. Many individuals with pain in the buttock that radiates down the leg are experiencing a form of sciatica caused by irritation of the spinal nerves in or near the lumbar spine (1). Other times though, the nerve irritation is not in the spine but further down the leg due to a pesky muscle called the piriformis, hence “piriformis syndrome”. The piriformis muscle is a flat, pyramidal-shaped muscle that originates from the front surface of the sacrum and the joint capsule of the sacroiliac joint (SI joint) and is located deep in the gluteal tissue (2). The piriformis travels through the greater sciatic foramen and attaches to the upper surface of the greater trochanter (or top of the hip bone) while the sciatic nerve runs under (and sometimes through) the piriformis muscle as it exits the pelvis. Due to this close proximity between the piriformis muscle and the sciatic nerve, if there is excessive tension (tightness), spasm, or inflammation of the piriformis muscle this can cause irritation to the sciatic nerve leading to symptoms of sciatica (pain down the leg) (1). Activities like sitting on hard surfaces, crouching down, walking or running for long distances, and climbing stairs can all increase symptoms (2) with the most common symptom being tenderness along the piriformis muscle (deep in the gluteal region) upon palpation. -
A Case Report of Refractory Notalgia Paresthetica Treated with Lidocaine
ISSN 1941-5923 © Am J Case Rep, 2017; 18: 1225-1228 DOI: 10.12659/AJCR.905676 Received: 2017.06.07 Accepted: 2017.06.28 A Case Report of Refractory Notalgia Published: 2017.11.20 Paresthetica Treated with Lidocaine Infusions Authors’ Contribution: BEF 1 Yaroslava Chtompel 1 Department of Anesthesiology and Chronic Pain Management, University Study Design A ABE 2 Marzieh Eghtesadi Hospital of Montreal (CHUM), Montreal, QC, Canada Data Collection B 2 Department of Chronic Pain and Headache Medicine, University Hospital of Statistical Analysis C ADE 1 Grisell Vargas-Schaffer Montreal (CHUM), Montreal, QC, Canada Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G Corresponding Author: Yaroslava Chtompel, e-mail: [email protected] Conflict of interest: None declared Patient: Female, 50 Final Diagnosis: Notalgia parethetica Symptoms: Hyperalgesia • Pruritus Medication: — Clinical Procedure: Intravenous lidocaine infusion Specialty: Anesthesiology Objective: Unusual or unexpected effect of treatment Background: Notalgia paresthetica is a neuropathic condition that manifests as a chronic itch in the thoraco-dorsal region. It is often resistant to treatment, and specific guidelines for its management are lacking. As such, we present a treatment approach with intravenous lidocaine infusions. Case Report: The case involves a 50-year-old woman with spinal cord injury caused by an epidural abscess. The patient de- veloped notalgia paresthetica and sublesional neuropathic pain following its drainage. -
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. -
Clinical Musculoskeletal Upper Limb Anatomy and Assessment
Clinical Musculoskeletal Upper Limb Anatomy and Assessment Dr Matthew Szarko and Jeshni Amblum-Almér www.belmatt.co.uk 0207 692 8709 Email: [email protected] Contents: Shoulder Clinical Shoulder Anatomy Clinical Shoulder Assessment Clinical Case Studies of the Shoulder Elbow Clinical Elbow Anatomy Clinical Elbow Assessment Clinical Case Studies of the Elbow Wrist and Hand Clinical Wrist and Hand Anatomy Clinical Wrist and Hand Assessment Clinical Case Studies of the Wrist and Hand Clinical Shoulder Anatomy: The shoulder is the most mobile joint in the human body. Ranges of Movement - In which two of the following are we most mobile? Flexion, Extension, Abduction, Adduction Internal Rotation, External Rotation Clavicle o S-Shaped, double curved bone o Protects underlying brachial plexus and vascular structures. o Elevates along with upper limb elevation. Most clavicular fractures occur between the lateral 1/3 and medial 2/3. What is the characteristic deformity that results from a fractured clavicle? How does this affect mechanics of the shoulder? Clavicular Joints • Sternoclavicular joint • Acromioclavicular joint • Coracoacromial ligament What is the role of the acromion and coracoacromial ligament in maintaining glenohumeral stability? Scapula • Glenoid fossa • Spine • Acromion • Coracoid process • Supraglenoid tubercle • Infraglenoid tubercle • Supraspinous fossa • Infraspinous fossa • Subscapular fossa • Scapular notch Scapulothoracic Articulation Provides the following movements: Protraction, Retraction, Elevation, Rotation (during shoulder abduction): Proximal Humerus • Head • Anatomical neck • Surgical neck • Greater tubercle • Lesser tubercle • Intertubercular sulcus (bicipital groove) • Deltoid tuberosity • Spiral groove Glenohumeral Joint • Glenoid fossa • Glenoid labrum Extends the depth of the glenoid fossa to confer more stability. SLAP Tear - Detachment of Superior Labrum with Anterior-Posterior extension can occur from repetitive overhead activities or a sudden pull on the arm or compression (fall on outstretched arm). -
Focal Entrapment Neuropathies in Diabetes
Reviews/Commentaries/Position Statements REVIEW ARTICLE Focal Entrapment Neuropathies in Diabetes 1 1 AARON VINIK, MD, PHD LAWRENCE COLEN, MD millimeters]) is a risk factor (8,9). It used 1 2 ANAHIT MEHRABYAN, MD ANDREW BOULTON, MD to be associated with work-related injury, but now seems to be common in people in sedentary positions and is probably re- lated to the use of keyboards and type- MONONEURITIS AND because the treatment may be surgical (2) writers (dentists are particularly prone) ENTRAPMENT SYNDROMES — (Table 1). (10). As a corollary, recent data (3) in 514 Peripheral neuropathies in diabetes are a patients with CTS suggest that there is a diverse group of syndromes, not all of CARPAL TUNNEL threefold risk of having diabetes com- which are the common distal symmetric SYNDROME — Carpal tunnel syn- pared with a normal control group. If rec- polyneuropathy. The focal and multifocal drome (CTS) is the most common entrap- ognized, the diagnosis can be confirmed neuropathies are confined to the distribu- ment neuropathy encountered in diabetic by electrophysiological studies. Therapy tion of single or multiple peripheral patients and occurs as a result of median is simple, with diuretics, splints, local ste- nerves and their involvement is referred nerve compression under the transverse roids, and rest or ultimately surgical re- to as mononeuropathy or mononeuritis carpal ligament. It occurs thrice as fre- lease (11). The unaware physician seldom multiplex. quently in a diabetic population com- realizes that symptoms may spread to the Mononeuropathies are due to vasculitis pared with a normal healthy population whole hand or arm in CTS, and the signs and subsequent ischemia or infarction of (3,4). -
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. -
Anatomical, Clinical, and Electrodiagnostic Features of Radial Neuropathies
Anatomical, Clinical, and Electrodiagnostic Features of Radial Neuropathies a, b Leo H. Wang, MD, PhD *, Michael D. Weiss, MD KEYWORDS Radial Posterior interosseous Neuropathy Electrodiagnostic study KEY POINTS The radial nerve subserves the extensor compartment of the arm. Radial nerve lesions are common because of the length and winding course of the nerve. The radial nerve is in direct contact with bone at the midpoint and distal third of the humerus, and therefore most vulnerable to compression or contusion from fractures. Electrodiagnostic studies are useful to localize and characterize the injury as axonal or demyelinating. Radial neuropathies at the midhumeral shaft tend to have good prognosis. INTRODUCTION The radial nerve is the principal nerve in the upper extremity that subserves the extensor compartments of the arm. It has a long and winding course rendering it vulnerable to injury. Radial neuropathies are commonly a consequence of acute trau- matic injury and only rarely caused by entrapment in the absence of such an injury. This article reviews the anatomy of the radial nerve, common sites of injury and their presentation, and the electrodiagnostic approach to localizing the lesion. ANATOMY OF THE RADIAL NERVE Course of the Radial Nerve The radial nerve subserves the extensors of the arms and fingers and the sensory nerves of the extensor surface of the arm.1–3 Because it serves the sensory and motor Disclosures: Dr Wang has no relevant disclosures. Dr Weiss is a consultant for CSL-Behring and a speaker for Grifols Inc. and Walgreens. He has research support from the Northeast ALS Consortium and ALS Therapy Alliance.