Loose body causing transient median nerve compression: a case report and literature review

Compression of median nerve at elbow secondary to loose body is very rare, only two cases have been reported in literature. Elbow swelling in this case led us to the cause of our patient’s median nerve dysfunction. A simple day case elbow arthroscopy procedure, and removal of loose body provided a cure for the elbow symptoms and the neuropathy. Compression neuropathy at the elbow, while rare, should be considered in the differential diagnosis of hand paraesthesia.     

Acute median nerve compression neuropathy from a foreign body in the forearm

Acute compression of the median nerve in the forearm usually occurs from compartment syndrome. A case of acute compression neuropathy of the median nerve from a foreign body, where there was no evidence of compartment syndrome, is reported. The diagnosis was made from the patient’s symptoms and radiographs. Early recognition and decompression of the forearm with removal of the foreign body led to full recovery.     

Synovial osteochondromatosis at the elbow producing ulnar and median nerve palsy. Case report and review of the literature

The authors present the case of a 53-year-old woman suffering from synovial osteochondromatosis of her right elbow responsible for ulnar and median nerve entrapment neuropathy. This condition is characterised by the formation of multiple cartilaginous nodules in the metaplastic synovium of otherwise normal joints, bursae or tendon sheaths. Treatment consisted of partial synovectomy, removal of loose bodies and microscopic nerve release. Synovial osteochondromatosis complicated by nerve compression syndromes has been rarely reported, usually with ulnar tunnel syndrome at the elbow. The literature on this subject is reviewed.     

Multiplicity of neurilemomas in the upper extremity

Multiple neurilemomas in two patients show that these tumors may indeed be multiple, may involve the same nerve trunk, may occur over a period of years, and may involve different regions of the body. Twelve neurilemomas were removed from the right upper extremity of a patient over a 3-year period. They varied in size from 0.5 cm to 4 cm in diameter and had the typical histopathologic appearance of neurilemomas. The second patient had median nerve compression and at operation a neurilemoma was found compressing the nerve. Two years later, the patient had evidence of median nerve compression in the opposite extremity, and again a neurilemoma was found. Both of these patients had evidence of peripheral nerve compression, but the existence of multiple neurilemomas was not apparent on initial examination. These cases show that patients with neurilemomas may have additional sequential tumors discovered at a later date that were not apparent initially.     

Median nerve compression in the palm of the hand by an anomalously enlarged ulnar artery

Median nerve compression in the carpal tunnel by a thrombosed persistent median artery and a large aberrant artery substituting for the radial artery has been described but there have been no reports of median nerve compression in the palm of the hand by an anomalously enlarged ulnar artery. A 46 year old man is described who presented with clinical and electrophysiological features consistent with a median neuropathy at the wrist but surgical exploration revealed median nerve compression in the palm of the hand by an anomalously enlarged palmar branch of the ulnar artery. This case highlights another treatable cause of median nerve compression and illustrates that symptoms suggestive of carpal tunnel syndrome may be produced by median nerve compression in the palm of the hand.     

Bilateral median nerve compression at the level of Struthers' ligament. Case report

Struthers' ligament syndrome is a rare cause of median nerve entrapment. Bilateral compression of the median nerve is even more rare. It presents with pain, sensory disturbance, and/or motor function loss at the median nerve's dermatomal area. The authors present the case of a 21-year-old woman with bilateral median nerve compression caused by Struthers' ligament. She underwent surgical decompression of the nerve on both sides. To the authors' knowledge, this case is the first reported bilateral compression of the median nerve caused by Struthers' ligament. The presentation and symptomatology of Struthers' ligament syndrome must be differentiated from median nerve compression arising from other causes.     

Isolated volar fracture-dislocation of the scaphoid with acute carpal tunnel syndrome: a case report

Dislocations and fracture-dislocations of the scaphoid are rare injuries. When they occur in a volar direction, they may be complicated by median nerve compression. While volar dislocations and fracture-dislocations of the scaphoid presenting late with median nerve compression have been reported, such injuries presenting with acute median nerve compression have not been reported. We describe a case of volar fracture-dislocation of the proximal half of the scaphoid causing median nerve compression and presenting with acute carpal tunnel syndrome. Urgent open reduction and internal fixation of the scaphoid along with decompression of the median nerve achieved prompt relief of the neurological symptoms.     

Unusual cause of carpal tunnel syndrome: a case report.

An unusual case of compression of median nerve at the wrist is described due to a foreign body. In unusual presentation of carpal tunnel syndrome, ultrasonography of the wrist is recommended to rule out a foreign body in the region.     

Fracture of the body of the hamate bone associated with compartment syndrome and dorsal decompression of the carpal tunnel

Fracture of the body of the hamate is rare. A case is reported where a crushing injury produced disruption of the carpus and a compartment syndrome of wrist and forearm. The median nerve escaped compression by the dorsal decompression produced by the injury. The fracture was fixed with wires and a good recovery followed.     

Increased median nerve latency at the carpal tunnel of patients with "trigger finger": Comparison of 62 patients and 13 controls

An association between symptomatic compression neuropathy of the median nerve at the carpal tunnel and "trigger finger" has been reported in endocrine and metabolic disorders. We assessed the incidence of increased median nerve latency in subjects with "trigger finger". 62 consecutive patients with "trigger finger" and no signs or symptoms of median nerve compression underwent nerve conduction studies of the median nerve. 13 healthy adults served as controls. 39/62 patients had increased distal motor latency in the median nerve. Only 1 of 13 subjects in the control group had a borderline value of distal motor latency.     

Increased median nerve latency at the carpal tunnel of patients with "trigger finger": comparison of 62 patients and 13 controls

An association between symptomatic compression neuropathy of the median nerve at the carpal tunnel and "trigger finger" has been reported in endocrine and metabolic disorders. We assessed the incidence of increased median nerve latency in subjects with "trigger finger". 62 consecutive patients with "trigger finger" and no signs or symptoms of median nerve compression underwent nerve conduction studies of the median nerve. 13 healthy adults served as controls. 39/62 patients had increased distal motor latency in the median nerve. Only 1 of 13 subjects in the control group had a borderline value of distal motor latency.     

Increased median nerve latency at the carpal tunnel of patients with "trigger finger": Comparison of 62 patients and 13 controls

An association between symptomatic compression neuropathy of the median nerve at the carpal tunnel and "trigger finger" has been reported in endocrine and metabolic disorders. We assessed the incidence of increased median nerve latency in subjects with "trigger finger".

62 consecutive patients with "trigger finger" and no signs or symptoms of median nerve compression underwent nerve conduction studies of the median nerve. 13 healthy adults served as controls. 39/62 patients had increased distal motor latency in the median nerve. Only 1 of 13 subjects in the control group had a borderline value of distal motor latency.     

Compression neuropathy of the cubital nerve at the elbow]

Compression neuropathy of the ulnar nerve at the elbow has numerous known etiologies, and the anatomy of the ulnar nerve around the elbow leaves it vulnerable to compression at numerous sites. The compression may be extrinsic such as in occupational neuropathy or in cases of postanesthesia neuropathy. The so-called idiopathic compression may be favored by some anatomic variations. The cubital tunnel retinaculum may be loose, leading to ulnar nerve dislocation or subluxation or tight compression of the nerve during flexion of the elbow. Bulging of the synovium in the floor of the tunnel may be the cause of compression in rheumatoid arthritis, whereas osteophytes may be the cause in degenerative osteoarthritis. Cubitus valgus or instability due to a pseudarthrosis of the lateral epicondyle or to ligamentous injury may stretch the nerve. The choice of a surgical technique must be based on (i) the pathophysiology of chronic nerve compression at the elbow, (ii) an understanding of the etiology of the nerve compression in the particular patient's case, and (iii) the knowledge of the potential technical drawbacks of the various operative procedures. Simple decompression is the first choice in case of minimal compression without instability of the nerve. Decompression of the nerve with a medial epicondylectomy is indicated in case of instability of the nerve and is the first choice in case of pseudarthrosis or malunion of the medial epicondyle. Ulnar nerve transposition is technically the most demanding procedure. Inadequate surgical technique creates new sites of compression.(ABSTRACT TRUNCATED AT 250 WORDS)     

Postoperative edema after vascular access causing nerve compression secondary to the presence of a perineuronal lipoma: case report

OBJECTIVE AND IMPORTANCE: Median nerve neuropathy can be clinically devastating to a patient. It can be caused by compression of the median nerve anywhere along its course. We present the case of delayed median nerve neuropathy after the placement of a vascular graft in the arm. CLINICAL PRESENTATION: An arm shunt was placed in the nondominant upper extremity in a 60-year-old man with end-stage renal disease. Twelve hours postoperatively, the patient developed neurapraxia in the median nerve distribution in the hand. INTERVENTION: Exploration of the arm revealed a lipoma coursing along and deep to the median nerve. Resection of the lipoma decompressed the nerve. CONCLUSION: In this patient, median nerve neuropathy was caused by a lipoma and postoperative swelling from placement of the vascular graft. The swelling that occurred after the shunt placement unmasked subclinical compression of the nerve by a lipoma deep to the median nerve. To our knowledge, this report is unique in documenting damage to the median nerve after vascular graft placement as a result of an occult mass.     

Median nerve compression within the humeral head of pronator teres

We describe a case of the pronator syndrome caused by compression of the median nerve by a fibrous band as the nerve passed through the humeral head of origin of pronator teres. This rare anatomical arrangement resulted in displacement of the median nerve to the anterior aspect of the medial humeral epicondyle and, as far as we are aware, has not previously been described as a site of compression neuropathy.     

Lacertus fibrousus compression of the median nerve. Case report

A 47-year-old guitar player presented with inability to use his right hand because of progressive weakness and numbness. Examination suggested compression neuropathy of the median nerve at the elbow. Exploration of the median nerve revealed compression by a tight aponeurosis of the biceps tendon. Release resulted in prompt recovery of function.     

Entrapment neuropathy of the median nerve at the level of the ligament of Struthers

The presence of a supracondylar process and Struthers' ligament is a rare congenital anomaly that may cause compression of either the median nerve, the brachial artery, or both. The authors present a case in which the supracondylar process and Struthers' ligament compressed both the median nerve and the brachial artery. This case is unusual, in that the symptoms of compression of the brachial artery increased--namely, the pulse intensity decreased and the pain increased with elbow flexion.     

Evaluation of microsurgical internal neurolysis in a primate median nerve model of chronic nerve compression

This study evaluates the effect of internal neurolysis on a chronically compressed primate median nerve as compared with a simple decompression procedure. In 11 adult, cynomologous monkeys, the median nerve in the carpal tunnel was banded with a silicone tube. After 6 months of nerve compression (mild to moderate compression in our model) in eight monkeys, a microneurosurgical internal neurolysis was carried out on the median nerve of one hand and a simple decompression (removal of band) was carried out on the median nerve of the other hand. Histologic, morphologic, and electrophysiologic evaluation was carried out 6 months later. Six control animals were similarly evaluated after 0, 6, and 12 months of nerve compression. The degree of compression produced was not severe in that it did not cause Wallerian degeneration. Histologic and electrophysiologic improvement was produced in both treatment groups over the two chronically compressed groups (6 and 12 months of compression). While internal neurolysis did not cause intraneural scarring or nerve fiber damage as compared with simple decompression alone, there was no difference noted between the effects of these two treatment methods on the chronically compressed nerve.     

Median nerve compression by a radially inserted palmaris longus tendon after release of the antebrachial fascia: A complication of carpal tunnel release

We describe a case that had recurrent median nerve compression after release of the antebrachial fascia in carpal tunnel release. The nerve was compressed by a palmaris longus tendon that was inserted radially into the thenar fascia. After decompression (detachment of the tendon) the patient had symptom relief. Release of the antebrachial fascia in the presence of this tendon variant carries a risk of median nerve compression by the tendon.     

Musculoaponeurotic variations along the course of the median nerve in the proximal forearm

31 cadaver arms have been dissected to study the variations in the anatomy of the muscles and fibrous arches which might cause compression of the median nerve in the forearm. Pronator teres always had a superficial head and usually a deep head. Flexor digitorum superficialis varied greatly in its site of origin. The median nerve might be crossed by two, one or no fibro-aponeurotic arches. Gantzer's muscle, an accessory head of flexor pollicis longus, was present in 45% of cadavers. No ligament of Struthers was found. Possible sites and causes of nerve compression are discussed.