Effect of dry needling on radial tunnel syndrome: A case report

This case report describes a 45-year-old male who presented with chronic right lateral elbow pain managed unsuccessfully with conservative treatment that included anti-inflammatory medication, injection, massage, exercise, bracing, taping, electro-physical agents, and manual therapy. Diagnosis of radial tunnel syndrome (RTS) was based on palpatory findings, range of motion testing, resisted isometrics, and a positive upper limb neural tension test 2b (radial nerve bias). Conventionally, the intervention for this entrapment has been surgical decompression, with successful outcomes. This is potentially a first-time report, describing the successful management of RTS with dry needling (DN) using a recently published DN grading system. Immediate improvements were noted in all the outcome measures after the first treatment, with complete pain-resolution maintained at a 6-month follow-up. A model is proposed describing the mechanism by which DN could be used to intervene for nerve entrapment interfaces.     

腕管综合征和肘管综合征的超声影像学研究

目的探讨超声在腕管综合征和肘管综合征中的诊断价值。方法80例健康者为对照组,临床疑诊27例腕管综合征和32例肘管综合征患者,超声测量其正中神经、尺神经的前后径、左右径及横截面积,同时测定神经传导速度。结果腕管综合征和肘管综合征组正中神经、尺神经的前后径、左右径及横截面积均大于对照组（P〈0．01）,腕管综合征和肘管综合征组的病变神经横截面积均与运动传导速度呈负相关（r分别为-0．76、-0．80）。结论超声可为腕管综合征和肘管综合征的诊断提供影像学依据,并对其治疗及疗效评价有重要价值。     

超声对腕管综合征和肘管综合征的诊断价值

目的探讨超声对腕管综合征、肘管综合征的诊断价值。方法 25例体检健康者为对照组,临床疑诊35例腕管综合征和22例尺神经卡压患者为病变组,超声探查正中神经豌豆骨水平横断面积及其前后径(D1)、钩骨勾水平前后径(D2)、钩骨勾水平远端前后径(D3),肘部尺神经横断面积,计算D1与D2差值(D),D3与D2差值(d),将病变组超声检查结果与术中所见进行比较。结果超声可显示正中神经、尺神经卡压后的形态变化,病变组正中神经横断面积、D、d及尺神经横断面积均大于对照组(P0.03)。与术中所见比较,超声诊断腕管综合征、肘管综合征准确率分别为97.9%、95.4%。结论超声能有效诊断腕管综合征和肘管综合征。     

肘管,腕管的超声解剖及其临床应用

目的　探讨高频超声对肘管、腕管综合征的诊断价值。方法　应用高频超声观察30例正常人的肘管及腕管的超声解剖并对20例肘管综合征、10例腕管综合征患者术前行超声检查。结果　高频超声不仅能清晰显示构成肘管及腕管的骨质、软组织及其内容物,而且能够明确肘管和腕管综合征的病因以及尺神经和正中神经的形态学变化。结论　高频超声在肘管、腕管综合征的诊断及鉴别诊断中具有重要价值     

神经传导速度测定对糖尿病合并肘管综合征的诊断意义

目的对糖尿病并发肘管综合征患者的神经传导速度测定结果进行分析。方法对85例糖尿病患者行神经传导速度及肌电图检测,统计糖尿病周围神经损害及肘管综合征的比率。结果 85例患者中周围神经损害36例,符合肘管综合征诊断11例(12.9%),其中糖尿病周围神经损害合并肘管综合征7例,单纯肘管综合征4例,双侧均有损害的3例。肘管综合征表现为肘下-肘上运动神经传导速度减慢(同上臂比较>10m/s),并有腕—小指感觉神经电位波幅降低8例,肘下-肘上运动电位波幅降低(>50%)伴小指展肌、第一骨间肌出现自发电位3例。结论糖尿病患者中并发肘管综合征的患者并不少见,可能存在卡压机制,并且神经传导速度测定可以及早发现糖尿病并发的肘管综合征,使患者能及时得到治疗。     

The elbow: diagnosis and treatment of common injuries

This article deals with common injuries to the elbow. Elbow anatomy is reviewed. Diagnosis and treatment of pronator syndrome,lateral epicondylitis (tennis elbow), radial tunnel syndrome, posterior interosseous nerve syndrome, medial epicondylitis (golfer's elbow), ulnar collateral ligament injury, cubital tunnel syndrome,posterolateral rotatory instability, distal biceps injuries, tricepstendon injuries, and posterior elbow impingement are discussed.     

Effect of dry needling on myofascial pain syndrome of the quadratus femoris: A case report

This case report describes a 40-year-old male who presented with posterior thigh pain managed unsuccessfully with massage therapy, chiropractic adjustments, and physical therapy. The diagnosis of myofascial pain syndrome (MPS) involving the quadratus femoris (QF) was purely clinical, based on palpatory findings and ruling out other conditions through deductive reasoning. This is potentially a first time report, describing the successful management of MPS of the QF with dry needling (DN) using a recently published DN grading system. Immediate improvements were noted in all the outcome measures after the first treatment, with complete pain-resolution maintained at a 4-month follow-up.     

The ultrasonographic and electrodiagnostic findings of ulnar neuropathy at the elbow

OBJECTIVE: To evaluate and compare the morphologic changes of the ulnar nerve at the elbow, using ultrasonography, between patients with cubital tunnel syndrome and retrocondylar compression syndrome determined with electrodiagnosis. DESIGN: Prospective study using electrodiagnosis and ultrasonography. SETTING: An outpatient rehabilitation clinic in a tertiary university hospital in South Korea. PARTICIPANTS: Thirteen patients (8 men, 5 women; mean age, 48.2y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: In the electrodiagnostic study, we used the inching technique to localize the ulnar nerve lesion at the elbow. In the ultrasonography study, we measured the length of the swollen ulnar nerve and the ratio of the nerve diameter between the proximal end of the medial epicondyle to the elbow joint level and the tip of medial epicondyle to the elbow joint level. RESULTS: The mean length of the swollen ulnar nerve segment in retrocondylar compression syndrome (2.58+/-0.58cm) was significantly longer than that of cubital tunnel syndrome (1.64+/-0.31cm). The mean ratio of the nerve diameter between the proximal end of medial epicondyle and the elbow joint level was significantly larger in retrocondylar compression syndrome (1.52+/-0.25) than that of cubital tunnel syndrome (1.06+/-0.06). CONCLUSIONS: Ultrasonography detected the morphologic changes and the extent of the ulnar nerve lesion at the elbow, and it can become a screening and follow-up imaging modality in patients with ulnar neuropathy at the elbow.     

高频超声诊断肘管综合征

目的 探讨高频超声检查在诊断肘管综合征中的作用.方法 以42例初步诊断为肘管综合征患者(43肘)为研究对象(患侧组),以其中15例患者的健侧肘(自身对照组)、15名健康志愿者30肘为正常对照组,进行肘部超声检查,并将患侧组检查结果 与术前肌电图检查结果 和术中所见进行比较.结果 高频超声可显示尺神经卡压后的形态变化及某些致病因素,患侧组卡压近端尺神经的测量值均大于正常组和健侧组,尺神经横截面积(CSA)和CSA肿胀率的诊断阈值分别为0.11 cm~2、141.50%;与术中所见比较,超声诊断肘管综合征的灵敏度为92.86%,与术前肌电图联合后,灵敏度可达100%.结论 高频超声可作为诊断肘管综合征的有效检查手段.     

鼠神经生长因子在周围神经卡压症治疗中的应用

目的 探讨鼠神经生长因子(mNGF )对周围神经卡压症的辅助治疗作用.方法 对中重度腕管综合征和肘管综合征各30 例患者,随机分为手术治疗组和联合治疗组,分别通过单纯神经松解术和神经松解术联合使用mNGF 的二种治疗方法,比较患者神经功能及手功能的恢复情况.结果 腕管综合征联合治疗组患者拇短展肌CMAP 的潜伏期(LAT )由术前的(8.0±0.2)ms 降至术后的(4.6±0.2)ms,手功能优良率达93.3% ;手术治疗组患者拇短展肌CMAP 的LAT 由术前的(7.8±0.1)ms 降至术后的(5.9±0.4)ms,手功能优良率达73.3%,两组术后LAT 和优良率比较差异有统计学意义(P<0.05 ).肘管综合征联合治疗组患者尺神经传导速度(MNCV )由术前的(31.3±0.4)m/s 增至术后的(40.8±0.3)m/s,手功能优良率达86.7% ;手术治疗组患者MNCV 由术前的(29.7±0.7)m/s 增至术后的(37.1±0.5)m/s,手功能优良率达66.7%.两组术后MNCV 和优良率比较差异有统计学意义(P<0.05 ).结论 手术联合使用mNGF 对受累神经和手功能恢复的效果均优于单纯手术治疗,且mNGF 临床应用安全有效.     

Ulnar nerve and cubital tunnel ultrasound in ulnar neuropathy at the elbow

Yoon JS, Hong S-J, Kim B-J, Kim SJ, Kim JM, Walker FO, Cartwright MS. Ulnar nerve and cubital tunnel ultrasound in ulnar neuropathy at the elbow.

Objective

To determine the accuracy of the ultrasonographic measurement of ulnar nerve to cubital tunnel area for diagnosis of ulnar neuropathy at the elbow.

Design

Patients with confirmed ulnar neuropathy at the elbow and normative, healthy volunteers were evaluated with high-resolution ultrasound. The cross-sectional areas (CSAs) of the ulnar nerve and cubital tunnel were measured with the elbow extended and flexed, and results from the 2 groups were compared.

Setting

Electromyography laboratory and radiology department of a tertiary care center.

Participants

Twenty-seven patients with ulnar neuropathy at the elbow and 20 controls.

Interventions

Not applicable.

Main Outcome Measure

The ratio of ulnar nerve to cubital tunnel CSA with the elbow flexed.

Results

The ulnar nerve, with the elbow flexed, was larger in those with ulnar neuropathy at the elbow, and this group also had larger cubital tunnels than did controls. In those with ulnar neuropathy at the elbow, the ratio of the ulnar nerve to cubital tunnel was .31, and in the controls it was .32, which was not significantly different (P=.89).

Conclusions

The ratio of ulnar nerve to cubital tunnel did not differentiate those with ulnar neuropathy at the elbow from controls.     

Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals

This case report describes the effectiveness of thrust manipulation to the elbow and carpals in the management of a patient referred with a medical diagnosis of cubital tunnel syndrome (CuTS). The patient was a 45-year-old woman with a 6-week history of right medial elbow pain, ulnar wrist pain, and intermittent paresthesia in the ulnar nerve distribution. Upon initial assessment, she presented with a positive elbow flexion test and upper limb neurodynamic test with ulnar nerve bias. A biomechanical assessment of the elbow and carpals revealed a loss of lateral glide of the humerus on the ulna and a loss of palmar glide of the triquetral on the hamate. After the patient received two thrust manipulations of the elbow and one thrust manipulation of the carpals over the course of four sessions, her pain and paresthesia were resolved. This case demonstrates that the use of thrust manipulation to the elbow and carpals may be an effective approach in the management of insidious onset CuTS. This patient was successfully treated with thrust manipulation when joint dysfunction of the elbow and wrist were appropriately identified. This case report may shed light on the examination and management of insidious onset CuTS.     

综合康复治疗肘管综合征的临床疗效观察

目的:观察术中电刺激、生物蛋白胶、术后分米波综合措施治疗肘管综合征的临床疗效,以探索尺神经损伤较佳的治疗方法。方法:肘管综合征患者64例,随机分为两组:综合治疗组(A组):术中应用电刺激+生物蛋白胶,术后行分米波辐射治疗。对照组(B组):术后口服甲钴胺。两组均行尺神经松解+前置术。观察两组的运动、感觉功能和电生理变化。结果:术后6个月,A组有效率为84.38%,治愈率为46.88%;B组有效率为59.38%,治愈率为21.88%;术后12个月,A组有效率为93.75%,治愈率为68.75%;B组有效率为75.00%,治愈率为43.75%。两组比较均为P<0.05。术后6个月,两组间再生电位、运动电位、MCV及SCV比较差异有显著性意义(P<0.05);术后12个月,两组间再生电位、运动电位比较差异有显著性意义(P<0.05),两组间MCV、SCV比较差异无显著性意义(P>0.05)。结论:综合措施是治疗肘管综合征较为理想的方法。     

肘管综合征的临床及电生理特点分析

目的　探讨肘管综合征 (CTS)患者的临床及电生理特点。方法　总结 15 0例CTS患者 (患者组 ,共 173侧肢体受累 )的临床及电生理资料 ,并与 76例正常人 (对照组 )的电生理数据进行分析比较。结果　肌电图示CTS患者分别有 114侧及 91侧肢体出现小指展肌纤颤电位及正向电位 ,第一骨间背侧肌分别有 5 0侧和 48侧出现纤颤电位及正向电位。尺神经运动传导速度肘上至肘下段为 ( 3 4.6± 9.75 )m/s ,动作电位潜伏期较对照组延长、波幅降低 ,感觉神经传导速度为 ( 45 .99± 9.65 )m/s ,与对照组比较 ,差异有极显著性意义。患者组共有 3 7侧肢体在尺神经运动传导检测时未引出波形 ,有 89侧肢体在感觉传导检测时未引出波形。结论　神经电生理检测为诊断肘管综合征的可靠手段 ,可早期确诊及准确定位尺神经受损部位及损伤程度 ,为提高其敏感性及定位的准确性 ,在电生理检查方法上还需更进一步探讨     

Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals

Abstract

This case report describes the effectiveness of thrust manipulation to the elbow and carpals in the management of a patient referred with a medical diagnosis of cubital tunnel syndrome (CuTS). The patient was a 45-year-old woman with a 6-week history of right medial elbow pain, ulnar wrist pain, and intermittent paresthesia in the ulnar nerve distribution. Upon initial assessment, she presented with a positive elbow flexion test and upper limb neurodynamic test with ulnar nerve bias. A biomechanical assessment of the elbow and carpals revealed a loss of lateral glide of the humerus on the ulna and a loss of palmar glide of the triquetral on the hamate. After the patient received two thrust manipulations of the elbow and one thrust manipulation of the carpals over the course of four sessions, her pain and paresthesia were resolved. This case demonstrates that the use of thrust manipulation to the elbow and carpals may be an effective approach in the management of insidious onset CuTS. This patient was successfully treated with thrust manipulation when joint dysfunction of the elbow and wrist were appropriately identified. This case report may shed light on the examination and management of insidious onset CuTS.     

肘管综合征误诊神经根型颈椎病9例分析

目的:探讨肘管综合征的误诊原因及诊疗方法。方法 :对误诊为神经根型颈椎病的9例肘管综合征行手术治疗,观察术后患肢运动、感觉等症状恢复情况。结果:9例分别获得随访3个月~2年,疗效评定结果:痊愈6例,显效2例,无效1例。结论:肘管综合征与神经根型颈椎病的症状容易混淆,详细正确的临床查体结合病史及合理的影像学检查,是可以避免误诊的。     

Clinical results versus subjective improvement with anterior transposition in cubital tunnel syndrome

This study was conducted to compare the results of anterior transposition methods and to determine the time needed to attain subjective well-being in patients with cubital tunnel syndrome. A total of 49 cases were retrospectively evaluated. Patients were called for follow-up, completed a questionnaire, and were reexamined. They were assigned to one of 3 groups: subcutaneous transposition (SCT), submuscular transposition (SMT), or intramuscular transposition (IMT). The McGowan classification and Wilson-Krout criteria were used for classification and outcomes assessments. Categorical variables were analyzed with the chi2 test, and metric variables by analysis of variance or through Kruskal-Wallis variance analysis. Improvement of at least 1 McGowan grade was observed in 87.63% of patients. The least responsive group was assigned a McGowan grade of III. The most effective procedure for resolving clawing was SMT. Clinical results were excellent in 26 patients (53.06%), good in 12 (24.48%), fair in 4 (8.16%), and poor in 7 (14.28%). At the latest follow-up, overall grip and pinch strength had improved by 23% and 34%, respectively, compared with the contralateral side. Thirty-six patients exhibited an improvement in grip power and 38 in fine dexterity. Complete resolution of numbness was observed in 32 patients, and complete resolution of pain was noted in 30 patients. The preoperative mean visual analog scale score of 6.82 improved to 3.36 postoperatively. Clawing improved in 4 patients and atrophy in 7. The mean time to subjective improvement was shortest in the SMT group and longest in the IMT group. The greatest pain relief was reported in the IMT group and the least in the SMT group. One case with IMT required reoperation because of recompression of the nerve. The most frequent complication in the SMT and IMT groups was muscular tenderness. In conclusion, SCT offers an alternative to other anterior transposition methods because of its simplicity and quicker recovery time, especially in mild to moderate cases.     

Nerve entrapment syndromes in the upper extremity contralateral to amputation

Five cases are reported of upper extremity amputation with no metabolic disease. Patients experienced pain, paresthesia and weakness in the intact extremity associated with electrophysiologic evidence of entrapment neuropathies. All patients did heavy manual work, and all had carpal tunnel syndrome. One patient also had cubital tunnel syndrome and compression of the medial cord of the brachial plexus in the axilla, and another patient had cubital tunnel syndrome and axillary neuropathy. Surgery did not relieve symptoms of carpal tunnel and cubital tunnel syndromes for prosthesis users until the figure-8 harness was changed. Patients who did not use a prosthesis felt relief of symptoms following surgical release. Possible mechanisms which produce nerve entrapment syndromes in patients with upper extremity amputations are use of one limb for heavy manual work over prolonged periods, direct compression of neural structures from the axilla loop of a figure-8 harness, and compression of neural structures in the axilla resulting in entrapment at a distal site. Changing the figure-8 harness should be considered prior to surgical decompression for patients who have upper extremity amputations with entrapment syndromes.     

Cubital tunnel syndrome: diagnosis by high-resolution ultrasonography.

The purpose of this study was to evaluate the morphologic changes in the ulnar nerve in cubital tunnel syndrome with high-resolution ultrasonography. The mean values of the short axis (cm) x long axis (cm) at the arm, epicondyle, and forearm levels were 0.057 +/- 0.01, 0.068 +/- 0.019, and 0.062 +/- 0.01 in control group; 0.069 +/- 0.04, 0.139 +/- 0.06, and 0.066 +/- 0.023 in the symptomatic side in patients with cubital tunnel syndrome; and 0.063 +/- 0.029, 0.068 +/- 0.029, and 0.057 +/- 0.012 in the normal side in patients with cubital tunnel syndrome. No significant difference was found in the area (short axis x long axis) of the ulnar nerve at the arm, epicondyle and forearm levels between the left and right ulnar nerve in the control group and between the control group and the normal side in symptomatic patients. However, the mean value of the area of the ulnar nerve at the epicondyle level in symptomatic patients was significantly larger than that of the control group and that of the contralateral side in patients, and the P value was less than 0.001. High resolution ultrasonography can detect morphologic changes in the ulnar nerve accurately, and it could therefore be useful as a screening and even follow-up modality in patients with cubital tunnel syndrome.     

Reduced longitudinal excursion of the median nerve in carpal tunnel syndrome

OBJECTIVE: To determine if longitudinal excursion of the median nerve is reduced in patients with carpal tunnel syndrome (CTS). DESIGN: Case-control study. SETTING: University human movement laboratory. PARTICIPANTS: Nineteen patients with CTS (8 men, 11 women; mean age, 57+/-15 y), and 37 healthy controls (8 men, 29 women; mean age, 48+/-10 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Longitudinal excursion of the median nerve, and the ratio of nerve to flexor digitorum superficialis tendon excursion at the carpal tunnel evoked by finger extension. Measurements were taken using a validated Doppler ultrasound technique, and tests were conducted with the elbow positioned in extension and flexion. RESULTS: Mean longitudinal excursion of the median nerve was significantly greater in controls (11.2+/-2.8 mm) than patients (8.3+/-2.6 mm) with the elbow extended (P=.013), but not with the elbow flexed (controls, 12.5+/-2.5 mm; patients, 10.2+/-3.1 mm; P=.089). Mean nerve/tendon excursion ratios were significantly greater in controls (.32+/-.07) than patients (.23+/-.06), with the elbow extended (P<.001), and flexed (controls, .36+/-.06; patients, .28+/-.10; P=.019). Discriminant analysis identified that 11 (58%) of the 19 patients and 3 (8%) of the 37 controls showed a nerve/tendon excursion ratio of .25 or less when tested with the elbow in extension. CONCLUSIONS: Reduced longitudinal excursion of the median nerve at the carpal tunnel was identified in a substantial proportion of patients with CTS. Further studies are merited to determine if reduced median nerve excursion at the carpal tunnel is clinically relevant in CTS, and can be influenced by movement-based interventions.