Pudendal nerve entrapment as source of intractable perineal pain

Perineal pain caused by pudendal nerve entrapment is a rarely reported entity, with only a handful of cases in the modern literature. A 25-yr-old male medical student had refractory unilateral orchialgia for 32 mo and concomitant proctalgia for 14 mo. Pain was positional in nature, exacerbated by sitting and partially relieved when standing or recumbent. Pudendal nerve entrapment was diagnosed clinically, with computed tomography-guided nerve blocks providing temporary relief. A prolonged left pudendal nerve distal motor latency on electrodiagnostic testing later confirmed the diagnosis. At surgery, the left pudendal nerve was found flattened in the pudendal canal of Alcock and in contact with the sharp inferior border of the sacrospinous ligament. After surgical decompression and rehabilitation, the patient experienced significant relief of pain and returned to medical school. This case suggests pudendal nerve entrapment should be considered in the differential diagnosis of chronic urogenital or anorectal pain, particularly if the pain is aggravated by sitting or if there is a history of bicycle riding.     

Medial calcaneal nerve entrapment as a cause for chronic heel pain

Clinicians often have difficulty correctly identifying the etiology of heel pain. The purpose of the case report was to demonstrate differential diagnosis and possible interventions for heel pain. The article describes the diagnosis and management of a 36-year-old female patient with an 8-year history of heel pain. After all mechanical etiologies were ruled out, it was determined that her heel pain was the result of entrapment of the medical calcaneal branch of the tibial nerve. Correct diagnosis led to an intervention that resulted in complete symptom relief. The case presents an example for how careful differential diagnosis of heel pain is essential for achieving the desired intervention outcomes.     

Medial calcaneal nerve entrapment as a cause for chronic heel pain

Clinicians often have difficulty correctly identifying the etiology of heel pain. The purpose of the case report was to demonstrate differential diagnosis and possible interventions for heel pain. The article describes the diagnosis and management of a 36-year-old female patient with an 8-year history of heel pain. After all mechanical etiologies were ruled out, it was determined that her heel pain was the result of entrapment of the medical calcaneal branch of the tibial nerve. Correct diagnosis led to an intervention that resulted in complete symptom relief. The case presents an example for how careful differential diagnosis of heel pain is essential for achieving the desired intervention outcomes.     

White-eyed blowout fracture with muscle entrapment misdiagnosed as increased intracranial pressure: An important clinical lesson

Patients with white-eyed blowout fracture with muscle entrapment in the pediatric population may be misdiagnosed as increased intracranial pressure (ICP) due to the similarity in presenting symptoms. A delay in the correct diagnosis can lead to permanent sequelae including diplopia, permanent loss of vision, and death.In this case report we discuss the treatment of a male pediatric patient who presented in the ED with nausea, confusion, and restricted eye gaze. He was misdiagnosed with increased intracranial pressure and was admitted to the PICU. Subsequent consultation by ophthalmology allowed for the correct diagnosis of a trapdoor fracture. The patient was taken to the OR for emergent orbitotomy with reduction of the fracture and release of the entrapped muscle.Symptoms of white-eyed orbital blowout fractures with muscle entrapment easily mimic symptoms of head trauma with increased ICP. Misdiagnosis of trapdoor orbital fractures with entrapment can be avoided by ordering and critically reviewing an orbital CT and requesting an ophthalmologic consultation in the ED to evaluate extraocular movement. This report should help to increase awareness of symptoms of white-eyed orbital blowout fractures with muscle entrapment, prevent confusion with elevated ICP, and assist accurate and timely diagnosis in the ED to arrange appropriate management and surgical intervention to ensure best outcomes.     

Linguistic prominence and Broca's area: the influence of animacy as a linearization principle

Previous neuroimaging findings suggest a sensitivity of the pars opercularis of the left inferior frontal gyrus (i.e. a core subregion of Broca's area) to a number of linguistic dependencies governing the linear sequencing of information in a sentence (e.g. subjects should precede objects; the participant role hierarchy should be respected). The present study used event-related fMRI to examine the hitherto untested hypothesis that the violation of a linearization principle that is purely semantic in nature (animate arguments should precede inanimate arguments) would also lead to increased pars opercularis activation. To this end, we manipulated the features animacy and argument order in German sentences and found a significant increase of activation in the pars opercularis for a violation of the animacy principle even when the other factors mentioned above were controlled for. This result therefore calls for a "supra-syntactic" account of pars opercularis function in the real-time understanding of sentences.     

Intercostobrachial nerve entrapment syndrome

Five patients with intercostobrachial nerve entrapment syndrome are reported. The pain in this syndrome has three aspects: somatic stimulus, perceptual surround, and behavioral response. Each must be dealt with appropriately. The distribution of the pain, its anatomic basis, and its treatment are discussed.     

Laparoscopic organ entrapment sack

The development of the surgical entrapment sack has facilitated the removal of large intra-abdominal organs laparoscopically. Herein, we describe our technique for laparoscopic introduction of the surgical entrapment sack, placement of the dissected kidney specimen within the sack, and removal of the sack and tissue from the abdomen.     

Popliteal artery entrapment syndrome

The purpose of this article was to describe popliteal artery entrapment syndrome, which is a cause of intermittent claudication in a young person, and to illustrate the importance of early diagnosis for successful treatment of this entity. A case report of a 28-year-old man with popliteal artery entrapment syndrome is presented. This patient had a classic history of calf pain that worsened with walking and was relieved by rest, running, or bicycle riding. Physical examination revealed evidence of ischemia in the distal extremity, and arteriography demonstrated signs of chronic occlusive disease. Early treatment might have included surgical release of the popliteal artery and arterial grafting. Due to extensive vascular disease, grafting was not possible and a below-knee amputation was performed. It is therefore essential to diagnose popliteal artery syndrome early for appropriate management.     

Peripheral nerve entrapment syndromes

Peripheral nerve entrapment syndromes must be identified early through careful clinical examination and appropriate diagnostic studies. These neuropathies cause significant pain and disability, but the impairment of nerve function is usually reversible in the early stages. Electromyography and nerve conduction studies are helpful in the differential diagnosis and in localizing the site of entrapment. The carpal tunnel is the most common site of median nerve entrapment, and the cubital tunnel is the most frequent site of ulnar nerve compression.     

Median nerve anatomy and entrapment syndromes: a review

Clinicians commonly observe upper extremity signs and symptoms which result from median nerve entrapment and can develop at multiple sites along this nerve. Median nerve entrapment may occur at the distal humerus when the rarely present ligament of Struthers connects an anomalous bony spur of the humeral shaft to its medial epicondyle. The pronator syndrome refers to compromise of the median nerve in the proximal forearm region. This may result from entrapment between the 2 heads of the pronator teres, between the pronator teres and the flexor digitorum sublimis, or by the lacertus fibrosus extension from the biceps tendon. The anterior interosseous branch of the median nerve is subject to compromise near its origin. As a motor nerve it produces signs of weakness as indicators of anterior interosseous syndrome. This syndrome usually occurs spontaneously, but can be caused by fractures and fibrous bands. The carpal tunnel is a narrow fibro-osseous tunnel through which the median nerve passes with 9 tendons. Carpal tunnel syndrome is the most common of the median nerve entrapments. Its causes are many: anything which increases the volume of the tunnel contents or decreases the size of the tunnel. Electrodiagnostic abnormalities exist more frequently when this entrapment is present than for other median nerve entrapments. Anatomic variations of the median nerve occur frequently and may lead to diagnostic confusion if not recognized. Successful diagnosis and treatment of median nerve entrapment syndromes require awareness of possible involved sites and detailed knowledge of related anatomy.     

Linguistic diversity as sociodemographic predictor of nursing program progression and completion

Attrition from undergraduate nursing programs continues to warrant investigation particularly in the climate of nursing shortages and fiscal reflection on academic institutional programs. This three-year study used a prospective longitudinal survey design to determine entry characteristics of students, attrition, progression and completion in an undergraduate program. Students were surveyed in the first three weeks of commencing their program and gave permission for academic grades to be collected during their six session, three year Bachelor of Nursing program. Of the 740 students enrolled 48% (357 students) were surveyed and 352 students (99%) gave consent for their grades to be collected. One-third of the student cohort graduated in the expected three-year timeframe, one-third had dropped out and one-third was still completing their studies. A higher Grade Point Average and being a native English speaker were most predictive of students completing their course in the minimum expected timeframe.     

Does a herniated lumbar disk with nerve root entrapment require surgical intervention: Are alternative treatments as effective?

The usefulness of surgery versus nonoperative measures in managing the patient with a herniated lumbar disk presenting with sciatica is somewhat controversial. Although most patients improve with nonoperative measures and time, some continue to have symptoms that impact on their ability to work and perform daily activities. Lumbar diskectomy, although widely used, remains problematic for surgeons due to uncertainties regarding its risks, benefits, indications, and optimal technique.The purpose of this article is to assess the outcome of conventional diskectomy techniques and compare them with nonoperative therapies.     

Double crush syndrome: chiropractic care of an entrapment neuropathy

Upton and McComas first proposed the existence of the "double crush syndrome." Their hypothesis was that neural function could be impaired when single axons, having been compressed in one region, become especially susceptible to damage in another. A case report of a man with both cervical radiculopathy and carpal tunnel syndrome, i.e., "double crush syndrome" is presented. Conservative management consisting of chiropractic manipulative therapy as well as ultrasound, electrical nerve stimulation, traction and a wrist splint is outlined. The experimental basis, clinical evidence, etiology, symptomatology and findings of this condition are discussed.     

Tibial nerve entrapment by a Baker cyst: case report

We report a rare case of degenerative joint disease of both knees, complicated by a Baker cyst. Our emphasis is on the role of electromyography and electrodiagnosis in the localization of this nerve entrapment syndrome. The patient presented with pain and swelling; venography revealed deep venous thrombosis of the right calf, including the popliteal and proximal superficial femoral vessels. The patient responded well to bed rest, analgesics, intravenous heparin and subsequent Coumadin anticoagulation, and was discharged two weeks later. Five weeks after onset of these acute problems, nerve conduction studies were done, leading to a diagnosis of Baker cyst with nerve entrapment. He responded well to knee joint aspiration and intraarticular prednisolone injection. Some evidence of improvement in the flexor hallicus longus muscle was detected at three-month follow-up.