RESUMEN
PURPOSE: The brachioradialis muscle (BRM) belongs to the lateral group of forearm muscles and contributes to the elbow flexion. Accessory brachioradialis muscle (ABRM) or "brachioradialis accessorius" represents an uncommon BRM variant, not been enough studied. The present study investigates the prevalence of the ABRM, along with its origin, insertion, and innervation. MATERIALS: Eighty-three upper limbs were meticulously dissected at the arm, forearm, and cubital fossa to investigate the ABRM presence. When the variant muscle was identified, morphometric measurements were obtained. RESULTS: The ABRM was identified in two upper limbs (2/83, 2.4%), in a male cadaver, bilaterally. Its origin was located along with the typical BRM, and its insertion was identified into the anterior surface of the radius (proximal third). The ABRM was innervated by the radial nerve, coursing posteriorly (deeply). CONCLUSIONS: In the current study, the variant muscle was observed in 2.4%. Radial nerve compression, at the forearm, is not an uncommon entrapment neuropathy. The relationship between the radial nerve and the ABRM could precipitate radial neuropathy.
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Variación Anatómica , Cadáver , Antebrazo , Músculo Esquelético , Humanos , Masculino , Músculo Esquelético/anomalías , Músculo Esquelético/anatomía & histología , Músculo Esquelético/inervación , Prevalencia , Antebrazo/inervación , Antebrazo/anomalías , Antebrazo/anatomía & histología , Femenino , Nervio Radial/anatomía & histología , Nervio Radial/anomalías , Anciano , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/diagnóstico , Disección , Anciano de 80 o más AñosRESUMEN
Lower limb entrapment neuropathies comprise a wide range of disorders, including less common conditions like tarsal tunnel syndrome, Morton neuroma, obturator nerve entrapment syndrome, superior gluteal nerve entrapment, and cluneal nerve entrapment syndrome. Despite being less prevalent, these syndromes are equally significant, presenting with symptoms such as pain, dysesthesia, muscular weakness, and distinct physical signs. Accurate diagnosis of these less common disorders is crucial for successful therapy and patient recovery, as they can sometimes be mistaken for lumbar plexopathies, radiculopathies, or musculotendinous diseases. This narrative review highlights the significance of identifying and diagnosing these particular neuropathies through a comprehensive assessment of the patient's medical history, detailed physical examination, and the use of electrodiagnostic and/or ultrasound investigations. When the diagnosis is uncertain, advanced imaging techniques like magnetic resonance neurography or magnetic resonance imaging are necessary to confirm the diagnosis. A positive diagnosis ensures prompt and targeted treatments, preventing further nerve impairments and muscle wasting. This article explores the epidemiology, anatomy, pathophysiology, etiology, clinical presentation, and electrodiagnostic interpretation of lower limb entrapment neuropathies, highlighting the importance of precise diagnosis in achieving favorable patient outcomes.
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Extremidad Inferior , Síndromes de Compresión Nerviosa , Humanos , Síndromes de Compresión Nerviosa/diagnóstico , Extremidad Inferior/inervación , Síndrome del Túnel Tarsiano/diagnóstico , Síndrome del Túnel Tarsiano/terapiaRESUMEN
OBJECTIVES: Chronic abdominal pain is occasionally caused by an abdominal wall entity such as anterior cutaneous nerve entrapment syndrome (ACNES). This syndrome is thought to occur due to intercostal nerve branches (T7-12) that are entrapped in the rectus abdominis muscles. The diagnosis is largely based on subjective clues in patient history and physical examination. A test referred to as the scratch collapse test (SCT) is used as an additional diagnostic tool in peripheral nerve entrapment syndromes such as the carpal tunnel syndrome. The aim of the present study is to investigate whether an SCT was positive in patients with suspected ACNES. If so, this finding may support its hypothesized neuropathic character. METHODS: A prospective, case-control study was performed among patients with ACNES (n = 20) and two control groups without ACNES (acute intra-abdominal pathology n = 20; healthy n = 20), all were consecutively included. ACNES was diagnosed based on previously published criteria. The SCT test was executed at the painful abdominal area in both patient groups and at a corresponding area in healthy controls. Predictive values, sensitivity, and specificity were calculated. Videos of tests were evaluated by blinded observers. RESULTS: SCT was judged positive in 19 of 20 ACNES patients but not in any of the 40 controls. A 95% sensitivity (confidence interval [CI]: 75-99) and optimal specificity (100%; CI: 83-100) were calculated. CONCLUSIONS: The positive SCT supports the hypothesis that ACNES is an entrapment neuropathy. A positive SCT should be considered a major diagnostic criterion for ACNES.
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Síndromes de Compresión Nerviosa , Humanos , Síndromes de Compresión Nerviosa/diagnóstico , Estudios de Casos y Controles , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Adulto , Dolor Abdominal , Sensibilidad y Especificidad , Nervios Intercostales , AncianoRESUMEN
Ultrasound and magnetic resonance neurography are useful modalities to aid in the assessment of compressive neuropathies, although they are still limited in their resolution of nerve microstructure and their capacity to monitor postoperative nerve recovery. Optical coherence tomography, a preclinical imaging modality, is promising in its ability to better identify structural and potential physiologic changes to peripheral nerves, but requires additional testing and research prior to widespread clinical implementation. Further advances in nerve imaging may elucidate the ability to visualize the zone of nerve injury intraoperatively, monitor the progression of nerve regeneration, and localize problems during nerve recovery.
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Imagen por Resonancia Magnética , Síndromes de Compresión Nerviosa , Tomografía de Coherencia Óptica , Humanos , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/diagnóstico por imagen , UltrasonografíaRESUMEN
BACKGROUND: Superior/middle cluneal nerve entrapment (CN-E) is an elicitor of low back pain (LBP). The painDETECT questionnaire is used to characterize CN-E symptoms. METHODS: Nineteen consecutive patients with LBP caused by CN-E (superior CN-E = 7; middle CN-E = 12) participated in a Japanese language painDETECT questionnaire survey before surgery. A score of 12 or lower was recorded as 'neuropathic component unlikely', a score of 19 or higher as 'neuropathic pain likely', and scores between 13 and 18 as 'neuropathic pain possible'. LBP severity was recorded on a numerical rating scale, the Roland-Morris Disability Questionnaire, and the EuroQol-5 dimension-5 level. RESULTS: The mean painDETECT score was 11.8 and did not significantly differ between the superior CN-E and middle CN-E groups. We classified low back pain as unlikely to have a neuropathic component in 13 patients, as likely to have a neuropathic component in 2 patients, and as possibly neuropathic in 4 patients. There was no significant difference in the pain level of patients with scores of ≤12 and ≥13 on painDETECT. All patients reported trigger pain; the positive rate was high for electric shock pain, radiating pain, and pain attacks and low for a burning or tingling sensation, pain elicited by a light touch, and pain caused by cold or hot stimulation. CONCLUSION: The painDETECT questionnaire may not reliably identify LBP caused by superior/middle CN-E as neuropathic pain. A diagnosis of LBP due to CN-E must be made carefully because symptoms resemble nociceptive pain.
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Dolor de la Región Lumbar , Síndromes de Compresión Nerviosa , Dimensión del Dolor , Humanos , Dolor de la Región Lumbar/diagnóstico , Femenino , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Dimensión del Dolor/métodos , Anciano , Reproducibilidad de los Resultados , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/complicaciones , Adulto , Índice de Severidad de la Enfermedad , Neuralgia/diagnóstico , Neuralgia/etiologíaRESUMEN
ABSTRACT: Some patients present with clinical symptoms of localized tenderness and pain associated with a specific peripheral nerve, such as the ulnar nerve at the elbow or the sciatic nerve, which has been called, although rarely, "Valleix point" or "Valleix phenomenon". The purpose of this article was to translate and research the 719-page book "Traité des névralgies ou affections douloureuses des nerfs" dated 1841, dedicated solely to nerve pain (neuralgia), written by the French physician François Louis Isidore Valleix (1807-1855). He may have been the first person to observe and describe this phenomenon of localized pain, but he was probably also the first to describe distal nerve radiation, which he called "élancement" or lancinating, or stabbing. He described the phenomenon of a nerve producing pain at points along its course that we now understand to be sites of compression, clearly describing cubital and fibular tunnel syndromes, which he called neuralgias. He also described some rarer sites of compression, such as supraorbital and occipital neuralgia, notalgia paresthetica, and ACNES, but he did not describe the most common site of compression today, the median nerve at the wrist. Valleix's descriptions are clear and precede the classic 1915 reports of Hoffmann's and Tinel's signs by 74 years.
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Neuralgia , Humanos , Historia del Siglo XIX , Neuralgia/historia , Síndromes de Compresión Nerviosa/historia , Síndromes de Compresión Nerviosa/diagnósticoRESUMEN
PURPOSE: Radial tunnel syndrome (RTS) is a controversial diagnosis due to non-specific exam findings and frequent absence of positive electromyography (EMG) and nerve conduction study (NCS) findings. The purpose of this study was to identify the methods used to diagnose RTS in the literature. METHODS: We queried PubMed, Embase, Web of Science, and Cochrane databases per PRISMA guidelines. Extracted data included article and patient characteristics, diagnostic assessments utilized and their respective findings, and treatments. Objective data were summarized descriptively. The relationship between reported diagnostic findings (i.e., physical exam and diagnostic tests) and treatments was assessed via a descriptive synthesis. RESULTS: Our review included 13 studies and 391 upper extremities. All studies utilized physical exam in diagnosing RTS; most commonly, patients had tenderness over the radial tunnel (381/391, 97%). Preoperative EMG/NCS was reported by 11/13 studies, with abnormal findings in 8.9% (29/327) of upper extremities. Steroid and/or lidocaine injection for presumed lateral epicondylitis was reported by 9/13 studies (46/295 upper extremities, 16%), with RTS being diagnosed after patients received little to no relief. It was also common to inject the radial tunnel to make the diagnosis (218/295, 74%). The most common reported intraoperative finding was narrowing of the PIN (38/137, 28%). The intraoperative compressive site most commonly reported was the arcade of Frohse (142/306, 46%). CONCLUSIONS: There is substantial heterogeneity in modalities used to diagnose RTS and the reported definition of RTS. This, in conjunction with many patients having concomitant lateral epicondylitis, makes it difficult to compare treatment outcomes for RTS. LEVEL OF EVIDENCE: Level III. Systematic review of retrospective and prospective cohort studies.
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Electromiografía , Conducción Nerviosa , Neuropatía Radial , Humanos , Electromiografía/métodos , Neuropatía Radial/diagnóstico , Examen Físico/métodos , Nervio Radial/fisiopatología , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/cirugíaRESUMEN
PURPOSE: To assess the effectiveness of tocilizumab in reverting the signs and symptoms of dysthyroid optic neuropathy (DON) in thyroid eye disease and the need for emergency orbital decompression. The secondary outcomes are to identify the optimal number of tocilizumab cycles to achieve the primary outcome, to analyze the association between thyroid stimulating immunoglobulin (TSI), clinical activity score (CAS) and proptosis in response to the treatment and the need for rehabilitative orbital decompression. METHODS: Prospective longitudinal cohort study that included 13 patients who had unilateral or bilateral dysthyroid optic neuropathy (DON) due to severe and progressive sight-threatening thyroid eye disease based on the CAS system. Patients were seen in this facility starting from July 2017, and all had received intravenous tocilizumab. RESULTS: Initial visual acuity mean was 0.52 ± 0.38 and the final were 0.93 ± 0.11 with a mean difference of 0.41 and P < 0.00245. The mean CAS prior to the initiation of the treatment was 7.92 ± 0.66 and the final was 2.85 ± 1.03 with mean difference of 5.07 and P < 0.00001. Initial mean proptosis was 24.85 ± 2.31 and the final was 21.78 ± 2.18 with a mean difference of 3.07 and P < 0.000497. No emergency orbital decompression was performed. TSI was high initially in all cases with a wide range of 2.4 to 40 IU/L and with a mean of 10.70 ± 13.40. The final TSI mean was 2.90 ± 3.90 with a mean difference of 7.81 and significant P value (P < 0.0272). CONCLUSION: Tocilizumab use in optic nerve compression showed promising results as it can be the primary or an alternative treatment option.
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Anticuerpos Monoclonales Humanizados , Oftalmopatía de Graves , Agudeza Visual , Humanos , Estudios Prospectivos , Masculino , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/uso terapéutico , Femenino , Oftalmopatía de Graves/complicaciones , Oftalmopatía de Graves/tratamiento farmacológico , Persona de Mediana Edad , Adulto , Enfermedades del Nervio Óptico/etiología , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/tratamiento farmacológico , Descompresión Quirúrgica/métodos , Estudios de Seguimiento , Anciano , Resultado del Tratamiento , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/tratamiento farmacológico , Síndromes de Compresión Nerviosa/diagnósticoRESUMEN
Meralgia paresthetica is a common but probably underrecognized syndrome caused by dysfunction of the lateral femoral cutaneous nerve. The diagnosis is based on the patient's description of sensory disturbance, often painful, on the anterolateral aspect of the thigh, with normal strength and reflexes. Sensory nerve conduction studies and somatosensory evoked potentials may be used to support the diagnosis, but both have technical limitations, with low specificity and sensitivity. Risk factors for meralgia paresthetica include obesity, tight clothing, and diabetes mellitus. Some cases are complications of hip or lumbar spine surgery. Most cases are self-limited, but a small proportion of patients remain with refractory and disabling symptoms. Treatment options include medications for neuropathic pain, neurolysis, neurectomy, and radioablation, but controlled trials to compare efficacy are lacking.
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Neuropatía Femoral , Humanos , Neuropatía Femoral/terapia , Neuropatía Femoral/diagnóstico , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/terapiaRESUMEN
Pectoralis minor syndrome (PMS) and quadrilateral space syndrome (QSS) are uncommon neurovascular compression disorders affecting the upper extremity. PMS involves compression under the pectoralis minor muscle, and QSS results from compression in the quadrilateral space-both are classically observed in overhead-motion athletes. Diagnosing PMS and QSS may be challenging due to variable presentations and similarities with other, more common, upper-limb pathologies. Although there is no gold standard diagnostic, local analgesic muscle-block response in a patient with the appropriate clinical context is often all that is required for an accurate diagnosis after excluding more common etiologies. Treatment ranges from conservative physical therapy to decompressive surgery, which is reserved for refractory cases or severe, acute vascular presentations. Decompression generally yields favorable outcomes, with most patients experiencing significant relief and restored baseline function. In conclusion, PMS and QSS, although rare, can cause debilitating upper-extremity symptoms; accurate diagnosis and appropriate treatment offer excellent outcomes, alleviating pain and disability.
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Descompresión Quirúrgica , Síndromes de Compresión Nerviosa , Músculos Pectorales , Extremidad Superior , Humanos , Resultado del Tratamiento , Extremidad Superior/irrigación sanguínea , Extremidad Superior/inervación , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/fisiopatología , Síndromes de Compresión Nerviosa/cirugía , Recuperación de la Función , Masculino , Femenino , AdultoRESUMEN
Somatic nerve entrapment caused by endometriosis is an underrecognized and often misdiagnosed issue that leads to many women suffering unnecessarily. While the classic symptoms of endometriosis are well-known to the gynaecologic surgeon, the dermatomal-type pain caused by endometriosis impacting neural structures is not within gynecologic day-to-day practice, which often complicates diagnosis and delays treatment. A thorough understanding of pelvic neuroanatomy and a neuropelveologic approach is required for accurate assessments of patients with endometriosis and nerve entrapment. Magnetic resonance imaging is the preferred imaging modality for this presentation of endometriosis. Surgical management with laparoscopic or robotic-assisted techniques is the preferred approach to treatment, with excellent long-term results reported after nerve detrapment and endometriosis excision. The review calls for increased awareness and education on the links between endometriosis and the nervous system, advocating for patient-centered care and further research to refine the diagnosis and treatment of this challenging condition.
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Endometriosis , Imagen por Resonancia Magnética , Síndromes de Compresión Nerviosa , Humanos , Endometriosis/complicaciones , Endometriosis/terapia , Endometriosis/diagnóstico , Femenino , Síndromes de Compresión Nerviosa/terapia , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/diagnóstico , Dolor Pélvico/etiología , Dolor Pélvico/terapia , Laparoscopía , Procedimientos Quirúrgicos RobotizadosRESUMEN
INTRODUCTION: The purpose of this study was to evaluate YouTube videos on meralgia paresthetica (MP) for reliability, quality, and differences between quality levels. METHODS: We analyzed 59 videos related to MP. We evaluated several video characteristics, including views, likes, dislikes, duration, and speaker profile. We used view ratio, like ratio, Video Power Index (VPI), Global Quality Scale (GQS), JAMA criteria, and modified DISCERN (mDISCERN) to assess viewer engagement, popularity, educational quality, and reliability. RESULTS: The videos received a total of 4,009,141 views (average 67,951.54), with 25.4% focused on exercise training and 23.7% focused on disease information. Mean scores were mDISCERN 2.4, GQS 2.8, and JAMA 2.1. Physician-led videos had higher mDISCERN scores, while allied health worker-led videos had more views, likes, dislikes, view ratios, and VPI. Poor and high-quality videos differed in views, likes, view ratio, VPI, and duration. Positive correlations existed among mDISCERN, JAMA, and GQS scores, with video duration positively correlated with GQS. CONCLUSION: The content of YouTube videos discussing diseases significantly influences viewer engagement and popularity. To enhance the availability of valuable content on YouTube, which lacks a peer review process, medical professionals must contribute high-quality educational materials tailored to their target audience.
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Medios de Comunicación Sociales , Grabación en Video , Humanos , Estudios Transversales , Medios de Comunicación Sociales/normas , Reproducibilidad de los Resultados , Neuropatía Femoral , Síndromes de Compresión Nerviosa/diagnósticoRESUMEN
Anterior cutaneous nerve entrapment syndrome (ACNES) is a cause of moderate to severe chronic pain, hyperesthesia/hypoesthesia, and altered perception of heat/cold in a specific region of the anterior abdominal wall, referable to the territory of innervation of one or more anterior branches of the intercostal nerves. None of the therapeutic options currently available has proved to be effective in the long term or decisive. In recent years, we have begun to treat purely sensory neuropathies, such as this, with the implantation of wireless peripheral nerve stimulators (PNS), achieving the safety of modular and personalized analgesia. We report the case of a 41-year-old man suffering from ACNES of the 8th intercostal nerve for two years. We first performed two consecutive ultrasound-guided diagnostic blocks of the anterior cutaneous branch of the 8th intercostal right nerve and then elected the patient for ultrasound-guided nerve decompression followed by neuromodulation and pulsed-radiofrequency (PRF). Taking into account full employment, young age, and the likelihood of having to repeat the treatment several times, we considered him for Peripheral Nerve Stimulation (PNS) implantation under ultrasound guidance, and we implanted the wireless lead at the anterior branch of the right 8th intercostal nerve, and programmed tonic stimulation 100 Hz PW 200 ms. The patient reported immediate pain relief and never took medication for this problem again, at two years follow-up. PNS has had an increasing role in the management of chronic neuropathic pain, especially in merely sensitive neuropathies like ACNES. We support future research on this theme.
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Dolor Crónico , Síndromes de Compresión Nerviosa , Neuralgia , Masculino , Humanos , Adulto , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Dolor Abdominal/terapia , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/cirugía , Neuralgia/terapia , Neuralgia/complicaciones , Dolor Crónico/terapia , Nervios Intercostales/cirugíaRESUMEN
Although surgical release of upper extremity nerve compression syndromes is highly effective, persistence or recurrence of symptoms and signs may occur. Thorough investigation is necessary in this situation before treatment is recommended. If the symptoms cannot be explained by other pathology than compression of the affected nerve and if conservative management has not provided improvement, reoperation may be considered. This review provides an overview of the diagnostic and surgical considerations in the revision of carpal tunnel syndrome, cubital tunnel syndrome and thoracic outlet syndrome.Level of evidence: V.
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Síndrome del Túnel Carpiano , Síndrome del Túnel Cubital , Reoperación , Síndrome del Desfiladero Torácico , Humanos , Síndrome del Túnel Carpiano/cirugía , Síndrome del Túnel Cubital/cirugía , Síndrome del Túnel Cubital/diagnóstico , Síndrome del Desfiladero Torácico/cirugía , Síndrome del Desfiladero Torácico/diagnóstico , Descompresión Quirúrgica/métodos , Síndromes de Compresión Nerviosa/cirugía , Síndromes de Compresión Nerviosa/diagnóstico , Extremidad Superior/cirugía , Extremidad Superior/inervaciónRESUMEN
Predicting prognosis after nerve injury and compression can be challenging, even for the experienced clinician. Although thorough clinical assessment can aid diagnosis, we cannot always be precise about long-term functional recovery of either motor or sensory nerves. To evaluate the severity of nerve injury, surgical exploration remains the gold standard, particularly after iatrogenic injury and major nerve injury from trauma, such as brachial plexus injury. Recently, advances in imaging techniques (ultrasound, magnetic resonance imaging [MRI] and MR neurography) along with multimodality assessment, including electrodiagnostic testing, have allowed us to have a better preoperative understanding of nerve continuity and prediction of nerve health and possible recovery. This article outlines the current and potential roles for clinical assessment, exploratory surgery, electrodiagnostic testing ultrasound and MRI in entrapment neuropathies, inflammatory neuritis and trauma. Emphasis is placed on those modalities that are improving in diagnostic accuracy of nerve assessment before any surgical intervention.
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Síndromes de Compresión Nerviosa , Traumatismos de los Nervios Periféricos , Humanos , Traumatismos de los Nervios Periféricos/diagnóstico , Síndromes de Compresión Nerviosa/diagnóstico , Imagen por Resonancia Magnética , Electrodiagnóstico , UltrasonografíaRESUMEN
UNCOMMON NERVE COMPRESSION SYNDROMES: In regard to the complex anatomical relationship of peripheral nerves and muscles, tendons, fasciae as well as their long course within those anatomical structures and additional close contact to bony structures, they are prone to suffer from local compression syndromes. Hence creating a vast majority of entrapment syndromes - well described in literature for almost every single nerve. The purpose of this article is to give an overview of symptoms, signs, diagnostic studies and treatment options, addressing especially the less known syndromes. Compression syndromes of the upper arm and shoulder region include the suprascapular nerve syndrome the compression of the axillary nerve within the spatium quadrilaterale and the compression of the long thoracic nerve at the chest wall. The upper extremity offers a variety of infrequent entrapment syndromes, as the pronator teres syndrome and anterior interosseus syndrome, both resulting from pressure to the median nerve in the forearm. Compression neuropathy in the course of the radial nerve in the distal upper extremity is also known as supinator syndrome. Guyon's canal syndrome is the ulnar side equivalent to the well-known carpal tunnel syndrome. In the case of a Cheiralgia paresthetica, a compression of a sensory branch of the superficial radial nerve can be seen. In the lower extremities, a variety of nerves especially in the groin and thigh area can be compressed as they pass through the narrow spaces between the abdominal muscles or underneath the inguinal ligament. Compression of the lateral femoral cutaneous nerve is the most common syndrome. Compression syndromes of the femoral and obturator nerves are most often iatrogenic. Pain around the knee, especially the lateral part and following orthopedic procedures of the knee, can arise from a compression or a lesion of a small infrapatellar branch of the saphenous nerve. Another probably underdiagnosed syndrome is piriformis syndrome, resulting from an entrapment of the sciatic nerve as it passes through certain muscular structures. In the distal lower extremity, the peroneal and tibial nerves can be compressed at multple sites, clinically known as peroneal nerve paralysis resulting from nerve compression around the fibular head, the anterior and posterior tarsal tunnel syndrome, and Morton's metatarsalgia.
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Síndrome del Túnel Carpiano , Neuropatía Mediana , Síndromes de Compresión Nerviosa , Humanos , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/cirugía , Síndromes de Compresión Nerviosa/patología , Brazo/patología , Nervio Mediano , Extremidad Superior/patologíaRESUMEN
INTRODUCTION: A supracondylar process is a bony spur on the distal anteromedial surface of the humerus, and it is considered an anatomical variant with a prevalence of 0.4-2.7% according to anatomical studies. In almost all cases, it is associated with a fibrous, sometimes ossified ligament, which extends from the supracondylar process to the medial epicondyle. This ligament is known in the literature as the ligament of Struthers, named after the Scottish anatomist who first described it in detail in 1854. In rare cases, the supracondylar process can be a clinically relevant finding as a cause of nerve compression syndrome. The median and ulnar nerve can be trapped by the ring-shaped structure formed by the ligament of Struthers and the supracondylar process. CASE REPORT: A 59-year-old patient with symptoms of a cubital tunnel syndrome and additional ipsilateral sensory deficits in his thumb was referred to our clinic. Electroneurography showed no signs of an additional carpal tunnel syndrome. Preoperative x-ray and CT scans of the upper arm revealed a supracondylar process, which led us to suspect an associated entrapment of the median nerve. An MRI scan of the upper arm showed a ligament of Struthers and signs of a related median nerve compression as we initially assumed. We performed a surgical decompression of the median nerve in the distal upper arm and of the ulnar nerve in the cubital tunnel. Intraoperatively, there was evidence of compression of the median nerve due to the supracondylar process and the ligament of Struthers. The latter was cleaved and then resected along with the supracondylar process. Three months after surgery, the patient had no motor or sensory deficits. SUMMARY: The ring-shaped structure formed by the supracondylar process and ligament of Struthers represents a rare cause of compression syndrome of the median and ulnar nerve. Its incidence remains unknown so far. This anatomical variant should be considered a differential diagnosis in case of possibly related nerve entrapment symptoms after ruling out other, more frequent nerve compression causes. Moreover, the supracondylar process should be completely resected including the periosteum during surgery to minimise the risk of recurrence.
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Síndrome del Túnel Carpiano , Síndromes de Compresión Nerviosa , Humanos , Persona de Mediana Edad , Nervio Mediano/cirugía , Ligamentos/cirugía , Húmero/diagnóstico por imagen , Húmero/cirugía , Húmero/inervación , Brazo , Nervio Cubital/cirugía , Síndrome del Túnel Carpiano/diagnóstico , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/cirugíaRESUMEN
Anterior, lateral, and posterior cutaneous nerve entrapment syndromes have been proposed as etiologies of trunk pain. However, while these syndromes are analogous, comprehensive reports contrasting the three subtypes are lacking. We therefore reviewed the literature on anterior, lateral, and posterior cutaneous nerve entrapment syndrome. We searched the PubMed and Cochrane Library databases twice for relevant articles published between March and September 2022. In addition to 16 letters, technical reports, and review articles, a further 62, 6, and 3 articles concerning anterior, lateral, and posterior cutaneous nerve entrapment syndromes, respectively, were included. These syndromes are usually diagnosed based solely on unique history and examination findings; however, the diagnostic process may be prolonged, and multiple re-evaluations are required. The most common first-line treatment is trigger point injection; however, the management of refractory cases remains unclear. Awareness of this disease should be expanded to medical departments other than general medicine.
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Síndromes de Compresión Nerviosa , Humanos , Síndromes de Compresión Nerviosa/diagnóstico , Piel/inervación , Piel/patología , Puntos DisparadoresRESUMEN
PURPOSE: Anterior cutaneous nerve entrapment (ACNES) is characterized by neuropathic pain in a predictable, circumscript abdominal area. The diagnostic delay is long, with half of ACNES-affected individuals reporting nausea, bloating, or loss of appetite mimicking visceral disease. The aim of this study was to describe these phenomena and to determine whether treatment could successfully reverse the visceral symptoms. METHODS: This prospective observational study was conducted between July 2017 and December 2020 at SolviMáx, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Máxima Medical Center, Eindhoven. Adult patients who fulfilled published criteria for ACNES and reported at least one visceral symptom at intake were eligible for the study. A self-developed Visceral Complaints ACNES Score (VICAS) questionnaire that scores several visceral symptoms (minimum 1 point, maximum 9 points) was completed before and after therapy. The success of treatment was defined as at least 50% reduction in pain. RESULTS: Data from 100 selected patients (86 females) aged 39 ± 5 years were available for analysis. Frequently reported symptoms were abdominal bloating (78%), nausea (66%) and altered defecation (50%). Successful treatment significantly reduced the number of visceral symptoms, with a VICAS before of 3 (range 1-8) and after of 1 (range 0-6) (p < 0.001). A low baseline VICAS was associated with successful treatment outcome (OR 0.738, 95% CI 0.546-0.999). CONCLUSION: Patients with ACNES may report a variety of visceral symptoms. Successful treatment substantially reduces these visceral symptoms in selected patients.
Asunto(s)
Síndromes de Compresión Nerviosa , Neuralgia , Adulto , Femenino , Humanos , Dolor Abdominal/etiología , Dolor Abdominal/cirugía , Diagnóstico Tardío , Herniorrafia , Náusea/etiología , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/cirugía , MasculinoRESUMEN
The elbow is a joint extremely susceptible to stiffness, even after a trivial trauma. As for other joints, several factors can generate stiffness such as immobilisation, joint incongruity, heterotopic ossification, adhesions, or pain. Prolonged joint immobilisation, pursued to assure bony and ligamentous healing, represents the most acknowledged risk factor for joint stiffness. The elbow is a common site of nerve entrapment syndromes. The reasons are multifactorial, but peculiar elbow anatomy and biomechanics play a role. Passing from the arm into the forearm, the ulnar, median, and radial nerves run at the elbow in close rapport with the joint, fibrous arches and through narrow fibro-osseous tunnel. The elbow joint, in fact, has a large range of flexion which exposes nerves lying posterior to the axis of rotation to traction and those anterior to compression.