桡神经深支旋后肌卡压综合征23例临床分析

目的探讨桡神经深支旋后肌卡压综合征的临床特点和诊治方法。方法对23例确诊为桡神经深支旋后肌卡压综合征的患者,根据具体病情分别采取旋后肌腱弓切开减压术和变形桡神经段切除、断端显微修复缝合术。回顾性分析患者的临床资料。结果 23例患者均顺利完成手术,术后均获3~5个月随访,22例患者桡神经深支功能恢复正常。切开旋后肌腱弓减压的3例患者中,1例患者手功能恢复不满意,尚需进一步手术治疗。结论桡神经深支旋后肌卡压综合征可根据临床症状、体征和电生理检查明确诊断。一旦诊断成立,即应手术治疗,术后桡神经深支功能恢复较好。     

ROC曲线评估高频超声与肌电图诊断上肢神经卡压征的价值

目的 探讨ROC曲线对高频超声和肌电图检查在上肢神经卡压征中的诊断价值。方法 选取本院2016年3月-2018年2月收治的97例上肢神经卡压征患者为研究对象,均经过高频超声和肌电图检查并经手术确诊,同时另取30例健康志愿者为对照组; 采用高频超声检查肘管尺神经、腕管正中神经入口前后径、左右径及横截面积(CSA),采用受试者工作特征(receiver operating characteristic,ROC)曲线评估高频超声对上肢神经卡压征的诊断价值,采用四线格分析肌电图及联合检查对上肢神经卡压征的诊断价值。结果 肘管综合征患者尺神经入口处前后径、左右径及CSA均显著高于对照组(P<0.05),卡压处神经变细变弯,出现肿胀,神经纤维束回声消失,CSA诊断肘管综合征的AUC为0.851,最佳截点为9.25 mm²,灵敏度为90.1%,特异度为83.3%; 肌电图检查诊断肘管综合征的灵敏度为88.88%,特异度为80.00%,准确度为87.27%。腕管综合征患者卡压处神经炎性肿胀,内部回声不均匀,正中神经卡压处弯曲,周围组织结构发生改变,正中神经入口处前后径、左右径及CSA均显著高于对照组(P<0.05),CSA诊断腕管综合征的AUC为0.885,最佳截点为10.24 mm²,灵敏度为90.80%,特异度为80.00%; 肌电图检查诊断腕管综合征的灵敏度为89.58%,特异度为78.57%,准确度为87.09%。联合检测诊断肘管综合征灵敏度为93.33%,特异度为90.00%,准确度为92.73%; 诊断腕管综合征灵敏度为93.75%,特异度为85.71%,准确度为91.94%。结论 高频超声联合肌电图检查对上肢神经卡压征具有较高的诊断价值。     

MR在尺神经卡压综合征诊疗中的应用

目的探讨MR在尺神经卡压综合征(CuTS)术前评估、术式选择、术后疗效评估中的应用价值。方法对470例CuTS患者,按Dellon术式对卡压神经行尺神经显微松解减压术。所有患者术前4周病侧组和健侧组尺神经行MR检测对照,术前、术后病侧组尺神经MR检测指标对照。结果 MR显示受累神经肿胀、增粗,信号减低,神经内线状结构消失,肿胀部位(内上髁沟、穿尺侧腕屈肌处)明显受到旋前圆肌、指浅屈肌、肘管、屈肌总腱等组织卡压;神经横截面积(CSA)相比较于健侧差异显著;术前、术后对照:MR尺神经检测结果提示神经卡压明显缓解。结论 MR能够从形态学角度提供神经卡压程度、部位等信息,同时可以清晰显示卡压神经周围解剖,适用于辅助术前评估,指导手术操作,评价手术效果。     

神经电生理联合MRI在尺神经卡压综合征诊疗中的应用

目的 探讨神经电生理联合MRI在尺神经卡压综合征中的应用价值.方法 回顾性分析470例尺神经卡压综合征病人的临床资料,均采用尺神经显微减压术治疗.病人手术前后进行神经电生理及MRI检查,检测并分析不同时间点病侧、健侧的感觉传导速度(sensory conduction velocity,SCV)、运动传导速度(movement conduction velocity,MCV)和尺神经横截面积(cross sectional area,CSA).采用MRI观察健侧和病侧尺神经结构.结果 健侧和术前病侧的MCV、SCV、CSA差异均具有统计学意义(均P ＜0.05).术前和术后4周病侧的MCV、SCV、CSA差异均具有统计学意义(均P＜0.05).MCV与CSA呈负相关(r=-0.813),SCV与CSA呈负相关(r=-0.844).MRI显示:受损尺神经明显肿胀,神经呈现高低不等的信号,肿胀部位(内上髁沟、尺侧腕屈肌)明显受到旋前圆肌、指浅屈肌、肘管、屈肌总腱等组织卡压.结论 神经电生理适用于早期诊断尺神经卡压综合征,MRI适用于制定手术方案,两者联合有助于评价手术效果,提高手术疗效.     

骨间后神经卡压综合征的临床及神经电生理诊断

目的:探讨骨间后神经卡压综合征的临床和神经电生理特点.方法:回顾性分析2006年2月至2010年2月临床疑诊骨间后神经卡压综合征患者的资料,结合神经电生理检查确诊共23例,分析其临床和神经电生理诊断特点.结果:所有患者虽然临床发病过程、病情轻重有所不同,但23例肌电图都有异常:重点检查食指固有伸肌、伸指总肌及尺侧伸腕肌...     

臂丛上干卡压征合并同侧上臂桡神经鞘瘤1例报告

<正>臂丛上干卡压征合并同侧上臂桡神经鞘瘤临床少见,现报告1例如下。1病例男,61岁因"右腕桡背侧、虎口疼痛2年余"于2013年5月13日入院。患者2年前无明显诱因下出现右腕桡背侧、虎口疼痛,夜间加剧,症状渐加重,门诊EMG示:右侧桡浅神经损害。入院后查体:右腕背桡侧及手背虎口区麻木、感觉异常(桡浅神经支配区),上臂桡神经沟处Tinel征(+)。     

糖尿病合并肘管综合征

目的研究糖尿病患者出现周围神经损害及合并肘管综合征比率,探讨糖尿病与肘管综合征之间可能的联系。方法对79例糖尿病患者行神经传导速度及肌电图检查,统计出现糖尿病周围神经损害及肘管综合征的比率。结果 79例患者中周围神经损害34例,符合肘管综合征诊断10例（12.6%）,其中糖尿病周围神经损害伴肘管综合征6例,单纯肘管综合征4例,双侧损害3例。肘管综合征出现腕一小指和手背尺侧皮神经感觉神经电位波幅降低及肘下一肘上运动神经传导速度减慢（同上臂比较〉10 m/s）7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。结论糖尿病出现糖尿病周围神经损害和肘管综合征比率均较高,可能存在卡压机制。     

肘关节骨性关节炎合并尺神经卡压综合征临床分析

目的 报告一组继发于肘关节骨性关节炎的尺神经卡压综合征的诊治经验.方法 对56例骨性关节炎合并尺神经卡压综合征患者的临床资料和术中所见进行研究分析.结果 49例肘管弓状韧带存在肥厚增生,占本组病例的87.5%;56例均发现尺神经沟骨性增生、骨赘形成及关节囊肥厚,卡压尺神经.48例术前进行肌电图检查,均发现不同程度的尺神经损害.结论 肘部的反复轻微创伤及慢性劳损可以导致肘关节骨性关节炎,引起尺神经卡压磨损,多见于重体力劳动者.治疗可采用保守和积极手术的方法,如果出现手部功能的减退,应高度可疑有继发尺神经卡压的可能,一旦确诊,手术治疗要持积极的态度.     

骨间后神经卡压综合征病因分析和治疗方法

目的分析骨间后神经卡压综合征常见病因、临床表现和治疗方法。方法回顾性分析我科2010-11-2015-10手术治疗骨间后神经卡压综合征患者38例的临床资料,分析导致神经卡压的病因、临床治疗方法和效果。结果 38例均随访6~18个月,30例术后上肢运动功能恢复正常,8例恢复效果欠佳,再次行肌腱转位术治疗,伸指功能恢复理想。结论旋后肌浅层Frohse腱膜弓、旋后肌肌管,骨间后神经周围腱鞘囊肿等压迫是引起骨间后神经卡压综合征的主要病因。早期手术探查、松解治疗骨后背神经卡压综合征方法确切、有效。     

神经肌电图对特发性面瘫临床及预后评估的研究

目的 探讨特发性面瘫的神经电图和肌电图的特点及临床意义。方法 采用Sapphire Ⅱ肌电图仪对92例特发性面瘫患者进行病侧和健侧的神经电图和肌电图检查，并对结果进行对比分析。结果 神经电图测提示患侧面神经运动传导潜伏期延长、波幅降低，与健侧比较有极显著差异（P＜0．01）。肌电图检查显示患侧面神经募集减弱，可见有纤颤电位或／和正锐波。结论 神经电图和肌电图有助于特发性面瘫定性及定量诊断，能指导治疗及预后评价。     

Surgical treatment of common entrapment neuropathies in the upper limbs

Entrapment neuropathies of the upper extremity are common, debilitating conditions. Most patients with these neuropathies are readily diagnosed on purely clinical grounds and may be effectively managed with nonoperative measures. However, the broad differential diagnosis often necessitates electrodiagnostic testing and radiographic imaging to clarify the situation. This review focuses on three of the most common entrapment neuropathies in the upper limbs: carpal tunnel syndrome (median nerve entrapment at the wrist), cubital tunnel syndrome (ulnar nerve entrapment at the elbow), and radial tunnel syndrome (posterior interosseous nerve entrapment). Anatomical considerations, patient evaluation, indications for surgical intervention, options for surgical approaches, outcomes, and complications are discussed.     

Anterior interosseous nerve syndrome. Electromyographic characteristics (2 cases) and review of the literature (62 cases)

The anterior interosseous nerve syndrome is a rare entrapment neuropathy of the median nerve. It is a pure motor deficit characterized by pinch loss. Anterior interosseous nerve lesions are easily assessed by EMG. The data from literature being incomplete in a majority of cases (85%), we propose EMG criteria to assert the presence of an anterior interosseous nerve syndrome and to exclude other diagnoses. The study of the anterior interosseous nerve in 20 healthy patients shows that the difference in motor potential latency between the healthy and the non-healthy side is the most predictive stimulo-detection sign. Detection, however, remains the most important element for diagnosis.     

Upper arm radial nerve palsy after muscular effort: report of three cases.

Three healthy men were engaged in continuous repetitive arm exercise when a sudden forceful contraction and stretch of the arm muscles led to a delayed upper arm radial nerve palsy. Radial nerve "entrapment" at the lateral head of the triceps muscles is a recognizable occupational nerve injury.     

Value of somatosensory evoked potentials in saphenous entrapment neuropathy.

Neuralgia of the saphenous nerve (SN) is a rare clinical syndrome simulating a vascular disorder of the lower extremities. In four cases, the presenting complaint was persistent pain on the medial aspect of the knee. Examination revealed tenderness over the site of exit of the SN form the femoral canal. Femoral nerve motor conduction, quadriceps H-reflex and EMG of the leg muscles were normal. The sensory nerve action potential of the SN in the leg was not obtained in some patients, even in the unaffected leg. SEP were therefore preferred for diagnosis and performed at the infrapatellar and descending branches of the right and left SN and recordings from the Cz'-Fz electrode. Latency and amplitude differences were evaluated and compared with a control group of healthy subjects. An alteration in the SEP from one branch was observed on the painful side. Posterior tibial responses were normal. In one case, pain resolved immediately after neurolysis, confirming SN entrapment above the femoral canal, before its division. Pain resolved in two other cases and persisted in the last after medical treatment. SEP studies are valuable in the diagnosis of an isolated lesion of the SN.     

Neurophysiological investigation of posterior interosseous nerve entrapment causing lateral elbow pain

Entrapment of the posterior interosseous nerve has been distinguished as one cause of 'lateral elbow' pain. However, this diagnosis has been confirmed by routine neurophysiological techniques in rather few cases. In order to investigate if a more elaborate neurophysiological technique would lend further support to the entrapment diagnosis, a study was undertaken including determination of the nerve conduction during active contraction of the supinator muscle and a quantified analysis of EMG. Motor conduction velocity of the deep radial nerve at rest did not differ from normal contol subjects. On active resisted supination patients showed a higher frequency of conduction time prolongation at low and moderate contraction strengths. Motor unit analysis showed a significant increase of amplitude, duration, and number of phases among EDC motor units in patients as compared with controls. The study supports the possibility of an entrapment aetiology in cases with lateral elbow pain in combination with local tenderness of the posterior interosseous nerve where it passes through the supinator muscle.     

Limited longitudinal sliding of the median nerve in patients with carpal tunnel syndrome

During normal movements or changes in position of the limbs, nerve structures must accommodate the resulting changes in length of the nerve path. In patients with carpal tunnel syndrome, we monitored electrophysiologically the longitudinal adjustment of the median nerve to positions of extreme flexion and extreme extension of the wrist and elbow, by measuring the differences induced in the latency of the sensory nerve action potential (SNAP) recorded in the forearm and upper arm. In patients, the latency difference was significantly shorter than in normal subjects (0.196 ± 0.084 ms vs. 0.088 ± 0.059 ms in the forearm, and 0.485 ± 0.122 ms vs. 0.129 ± 0.086 ms in the upper arm). These results indicate that the displacement of the source of the median nerve SNAP with movements of flexion and extension is limited in patients with carpal tunnel syndrome. Such an abnormality may partly underlie the pathophysiology of entrapment syndromes. © 1995 John Wiley & Sons, Inc.     

Nerve conduction studies in the superficial radial nerve entrapment syndrome

This report reviews the syndrome of entrapment of the superficial branch of the radial nerve (SBRN) in the forearm, and electrodiagnostic techniques to aid in diagnosis are presented. Normal mean radial sensory conduction in the forearm was found to be 61.4 +/- 3.1 m/sec. Three patients are presented. In two of these comparison of conduction in the SBRN to the lateral antebrachial cutaneous nerve (LACN) and contralateral SBRN was abnormal, whereas the absolute SBRN conduction appeared normal. Normal LACN-SBRN difference in the same arm was 1.9 +/- 1.6 m/sec, with a range of 0-7.0 m/sec; mean SBRN difference in opposite arms of the same subject was 1.8 +/- 1.6 m/sec.     

Clinical Features of Wrist Drop Caused by Compressive Radial Neuropathy and Its Anatomical Considerations

Objective

Posture-induced radial neuropathy, known as Saturday night palsy, occurs because of compression of the radial nerve. The clinical symptoms of radial neuropathy are similar to stroke or a herniated cervical disk, which makes it difficult to diagnose and sometimes leads to inappropriate evaluations. The purpose of our study was to establish the clinical characteristics and diagnostic assessment of compressive radial neuropathy.

Methods

Retrospectively, we reviewed neurophysiologic studies on 25 patients diagnosed with radial nerve palsy, who experienced wrist drop after maintaining a certain posture for an extended period. The neurologic presentations, clinical prognosis, and electrophysiology of the patients were obtained from medical records.

Results

Subjects were 19 males and 6 females. The median age at diagnosis was 46 years. The right arm was affected in 13 patients and the left arm in 12 patients. The condition was induced by sleeping with the arms hanging over the armrest of a chair because of drunkenness, sleeping while bending the arm under the pillow, during drinking, and unknown. The most common clinical presentation was a wrist drop and paresthesia on the dorsum of the 1st to 3rd fingers. Improvement began after a mean of 2.4 weeks. Electrophysiologic evaluation was performed after 2 weeks that revealed delayed nerve conduction velocity in all patients.

Conclusion

Wrist drop is an entrapment syndrome that has a good prognosis within several weeks. Awareness of its clinical characteristics and diagnostic assessment methods may help clinicians make diagnosis of radial neuropathy and exclude irrelevant evaluations.     

Neuralgic Amyotrophy Manifesting as Mimicking Posterior Interosseous Nerve Palsy

The upper trunk of the brachial plexus is the most common area affected by neuralgic amyotrophy (NA), and paresis of the shoulder girdle muscle is the most prevalent manifestation. Posterior interosseous nerve palsy is a rare presentation in patients with NA. It results in dropped finger on the affected side and may be misdiagnosed as entrapment syndrome or compressive neuropathy. We report an unusual case of NA manifested as PIN palsy and suggest that knowledge of clinical NA phenotypes is crucial for early diagnosis of peripheral nerve palsies.     

Subakutes proximales Engpasssyndrom des N. radialis im Hiatus radialis

Endogenous lesions of the radial nerve at the upper arm level and in the canalis spiralis are exceptional. Entrapment of the radial nerve in the hiatus radialis following forced arm movements, stretching, or as a consequence of pathologies of the surrounding tissue is known. We observed two patients suffering from a painful subacute middle radial nerve palsy with complete axonal degeneration caused by a lesion at the hiatus radialis, demonstrated by EMG, sonography, MRI, and surgical exploration. Successful nerve repair, in one case with a nerve graft, was performed. In both cases the most appropriate explanation was a focal neuritis with swelling of the nerve followed by strangulation at the hiatus radialis. In one case acute neuroborreliosis was the reason for the neuritis.