Carpal tunnel syndrome due to heterotopic ossification

We report a rare case of carpal tunnel syndrome due to heterotopic ossification in the carpal tunnel in a 34-year-old woman without antecedents of neurological injury, musculoskeletal trauma, or metabolic disorder. To our knowledge, this is the first reported case. Incomplete excision of heterotopic ossification resulted in partial relief of symptoms.     

神经根型颈椎病与神经卡压综合征的鉴别

单侧上肢疼痛、无力、感觉减退,总会考虑神经根型颈椎病、神经卡压综合征、胸腔出口综合征,许多病也会产生类似的疼痛症状。例如:肩袖撕裂、肩峰下滑囊炎、冻结肩、盂肱关节撞击综合征、网球肘等。但这些疾患不会有神经通道方面的异常表现。本文讲述神经根型颈椎病与神经卡压的鉴别。1相关解剖复习颈部脊神经以稍向下斜的方式经椎间孔出椎管,腰椎椎间孔像炮孔状,而颈段椎间孔向外侧走行呈槽沟状,形成颈椎侧块。颈椎间盘突出和骨刺的形成在孔的内侧,神经节背侧根近侧。了解后侧主要分支是很重要的,也称之为背侧支,起自椎间孔外侧端神经节背侧根以远,神经在该处发出感觉支至背后正中皮肤。相当重要的是,发出运动支至椎旁肌,因此颈椎间盘     

神经根型颈椎病与神经卡压综合征的鉴别

单侧上肢疼痛、无力、感觉减退,总会考虑神经根型颈椎病、神经卡压综合征、胸腔出口综合征,许多病也会产生类似的疼痛症状。例如:肩袖撕裂、肩峰下滑囊炎、冻结肩、盂肱关节撞击综合征、网球肘等。但这些疾患不会有神经通道方面的异常表现。本文讲述神经根型颈椎病与神经卡压的     

三种方法治疗肩胛上神经卡压综合征

目的:探讨不同方法治疗肩胛上神经卡压综合征的疗效。方法:肩胛上神经卡压综合征患者41例,男32例,女9例;年龄32～74岁,平均48岁;右侧29例,左侧12例;病程2个月～2.5年,平均9个月。30例采用局部封闭治疗,13例采用小针刀松解(其中包括局部封闭无效者7例),8例采用手术松解(其中包括小针刀松解无效3例)。局部封闭应用1%利多卡因5ml加曲安奈德40mg,每周1次,连续2～4次;小针刀采用切断肩胛上或下横韧带,肩胛岗上孔、岗下孔松解;手术在局麻直视下行肩胛上或下横韧带切断、松解肩胛上神经。结果:41例获随访,时间3个月～1年,依据疗效标准评定治疗效果。局部封闭组30例中,治愈2例,有效16例,无效12例;小针刀组13例中,治愈5例,有效5例,无效3例;手术松解组8例中,治愈6例,有效2例。结论:病程短、症状轻的患者应首选患者易接受的局部封闭治疗;症状严重且保守治疗无效者,采取小针刀松解或手术直视下神经松解,尤其是伴有肌萎缩者手术直视下松解更有必要。     

The surgical treatment of tarsal tunnel syndrome

Tarsal tunnel syndrome is an entrapment neuropathy involving the posterior tibial nerve within the tarsal canal. Typical symptoms include burning pain and paraesthesia along the medial ankle and plantar aspect of the foot. Although potential causes of tarsal tunnel syndrome include trauma, varicosities, tenosynovitis, space-occupying lesions, and hindfoot deformity, in most cases the aetiology is idiopathic. Surgical release of the posterior tibial nerve and its terminal branches is indicated if symptoms persist despite non-operative treatment. In this article, we discuss the pre-operative evaluation of these patients and illustrate in detail our preferred technique for surgical release.     

A rare case of an accessory flexor hallucis longus causing tarsal tunnel syndrome

Tarsal tunnel syndrome (TTS) is a rare entrapment neuropathy of the tibial nerve within the fibro-osseous tarsal tunnel for which multiple etiologies, including trauma, congenital foot abnormalities and space occupying lesions, have been described. We present an unusual case of TTS caused by an accessory Flexor Hallucis Longus (FHL) tendon. Surgical excision led to a complete resolution of symptoms and improved the quality of life of our patient.     

不同压力对兔坐骨神经内离子含量变化的实验研究

目的：探讨不同压力对兔坐骨神经内离子含量的变化及其病理改变的关系。方法：用特制的气囊压迫装置，对３５条兔坐骨神经进行急性压迫实验。压力分别为０、４、８、１２ｋＰａ（０、３０、６０、９０ｍｍＨｇ），持续加压１小时，术后一周取受压神经段，行病理形态学观察和原子吸收分光法进行离子定量分析。结果：受压神经段内Ｋ、Ｎａ、Ｃａ离子的含量明显高于对照组（Ｐ＜０．０１）。不同压力下受压神经段均发生节段性脱髓鞘改变。随压力增加受压神经段内离子含量进一步升高，脱髓鞘改变进一步加重。结论：受压神经段内钙离子增高可能加重神经组织继发性损害。周围神经嵌压后的病理变化与其电解质分布异常可能相互影响。     

A touch pressure sensory assessment of the surgical treatment of the tarsal tunnel syndrome

Background

Decompressive tarsal tunnel surgery may improve dysfunctional plantar foot sensation in, patients with tarsal tunnel syndrome and peripheral neuropathy. However, quantitative sensory, assessment is lacking.

Method

Quantitative sensory threshold evaluation of 42 feet in 37 consecutive (29 non-diabetic and 8 diabetic) patients was done before and after surgical decompression for tarsal tunnel syndrome. Insensitivity was documented quantitatively (grams force) before and after surgery using a graded series of twenty Semmes–Weinstein monofilaments applied to the anatomic nerve regions of the plantar aspect of the foot.

Results

Sensory evaluation at an average of 12 months after surgery showed significant improvement, of mean sensory threshold, compared with preoperative values, for medial calcaneal, medial plantar, and lateral plantar nerves.

Conclusion

Quantitative sensory assessment with a graded series of twenty Semmes–Weinstein, monofilaments showed significant sensory improvement in the medial calcaneal, medial plantar, and, lateral plantar nerves after posterior tibial nerve decompression.     

Lambert-Eaton myasthenic syndrome revealing an abdominal neuroblastoma

Lambert-Eaton myasthenic syndrome is a paraneoplastic syndrome that may reveal a primitive tumor. Neuroblastoma in children and small cell lung carcinoma in adults are the leading tumors revealed or expressed by paraneoplastic phenomena. The clinical neurologic manifestations of Lambert-Eaton myasthenic syndrome are muscular weakness, sleepiness, absence of reflexes, and dysautonomia. Neurologic manifestations are explained by the induction of an autoimmune response because of the presence of antigens that are expressed by the tumor. Neurologic paraneoplastic disorders may also be the result of toxicity of drugs, coagulopathy, infection, or metabolic diseases. We describe the case of a 13-month-old child with unusual neurologic symptoms because of the presence of an abdominal neuroblastoma.     

Diagnosis and surgical management of popliteal artery entrapment syndrome

BACKGROUND: The purpose of the present study was to report the authors' experience of surgically treating eight limbs in six patients for popliteal artery entrapment syndrome (PAES), over a 10-year period. METHODS: From 1995 to 2004, six patients (eight limbs) underwent surgery for PAES at a single institution. The patients' data were collected retrospectively from the case records and operative notes. RESULTS: There were six patients with a mean age of 34 years (range, 27-38 years) at diagnosis and five of them were male. Two patients were found to have bilateral involvement. Both patients had symptoms involving both limbs and underwent bilateral surgery. Intermittent claudication was the most frequent presenting symptom (seven of eight limbs). All the patients had Delaney's type III PAES. Popliteal artery release was performed in all eight limbs and this was combined with a vein patch or a reversed long saphenous vein bypass graft in four limbs because the arteries in these four limbs were diseased or occluded. At a median follow up of 15 months (range, 40 days-9 years), five (seven limbs) of the six patients (eight limbs) were cured of their symptoms. One patient who presented late with rest pain and dusky toes underwent popliteal artery release, endarterectomy and a vein patch repair for an occluded popliteal artery. However, her limb could not be salvaged and her affected limb had to be amputated. CONCLUSION: Popliteal artery entrapment syndrome is a rare but important cause of peripheral vascular insufficiency especially in young patients. Early diagnosis and surgical intervention is imperative for good operative outcome and to prevent limb loss.     

Nerve entrapment around elbow

Entrapment neuropathy around elbow is a common cause of disability across all age groups. The major nerves that traverse the elbow are ulnar, median and radial nerves and their branches. Cubital tunnel syndrome leading to ulnar nerve compression can often present with significant pain, paresthesia or weakness. Median and Radial nerve compression around the elbow, albeit less frequent, can also lead to significant morbidity and must be kept in the differential diagnosis when dealing with patients complaining of persistent pain around the elbow and weakness of forearm/hand muscles. Electrodiagnostic studies can be a useful adjunct to clinical examination, to help localize the site and quantify the grade of compression. Management should involve a trial of conservative treatment and failing that, surgical treatment should be considered. We hereby provide an overview of nerve entrapments around the elbow including their applied anatomy, etiology, clinical assessment and overview of the current concepts in surgical treatment.     

Cheiralgia paresthetica — entrapment of the superficial branch of the radial nerve: a report of 15 cases

Attention is drawn to the relatively rare and poorly appreciated clinical featues of entrapment of the superficial sensory branch of the radial nerve (SBR) in the forearm. In a series of 15 patients with cheiralgia paresthetica, alleviation of pain and discomfort was achieved in 66.6% of the conservatively-treated patients and in 80% of the five non-responsive patients who required neurolysis of the nerve. Job-related symptoms were exhibited by 33.3% of the patients, which subsided upon job modification or less hand-intensive work and conservative treatment. We suggest that modalities of treatment should be appropriate for the pathophysioloy of the SBR injury, while early recognition of the syndrome reduces the necessity for surgery.     

铍针治疗颈肩部皮神经卡压综合征

目的：探讨皮神经卡压综合征的发病机制和铍针的治疗机制。方法：采用铍针治疗78例颈肩部皮神经卡压综合征的患者，枕大皮神经卡压综合征18例，枕小皮神经卡压综合征5例，肩胛上皮神经卡压综合征27例，颈横皮神经卡压综合征4例．锁骨上皮神经卡压综合征24例。其中男35例，女43例；年龄19～63岁，平均39．8岁。根据治疗前后患者颈肩部疼痛的改变判定疗效。结果：临床痊愈54例；显效16例；有效8例。结论：通过铍针对皮下组织、筋膜和肌肉的切割，使筋膜表面张力降低，松解粘连，消除瘢痕，消除感觉神经末梢所受的刺激和压迫，缓解疼痛。     

Brown-Sequard syndrome revealing intradural thoracic disc herniation

Brown-Sequard syndrome (BSS) is a rare form of severe myelopathy characterised by a clinical picture reflecting hemisection of the spinal cord. This syndrome is mostly due to a penetrating injury to the spine but many other non-traumatic causes have been described. Intradural thoracic disc herniation (TDH) is one of the rare aetiologies of this syndrome. Despite progress in imaging techniques, diagnosis and treatment remain difficult. We retrospectively reviewed one of the largest reported series of six patients with BSS revealing intradural TDH between 2003 and 2007. There was a marked female predominance and the mean age was 44 years. Before surgery, half of the patients had a severe neurological deficit. The mean duration of symptoms until surgery was 8.5 months (range 0.5–24 months). Spine magnetic resonance imaging (MRI) or spine computer tomography scan showed calcified TDH between T5–T6 and T9–T10. The intradural location of the thoracic herniation was strongly suspected from the clinical data. All the patients underwent posterolateral transpedicular surgery with an operative microscope to open the dura mater. The intradural location of the herniation was overlooked in one case and the patient underwent a second procedure. The dura mater was carefully closed. Two patients’ condition worsened immediately after the surgery before slowly improving. All the other patients improved their neurological status immediately after the surgery and at 12 months follow-up. BSS with TDH on the spine MRI scan may be a warning symptom of the intradural location of the herniated disc. In such cases, spine surgeons are advised to use an operative magnification and to open the dura mater to avoid missing this potentially curable cause of severe myelopathy.     

Carpal tunnel syndrome caused by cysticercosis

We present a case of carpal tunnel syndrome (CTS) due to compression of the median nerve within the carpal tunnel, caused by cysticercosis. Nerve conduction studies revealed severe CTS. Magnetic resonance imaging suggested an inflammatory mass compressing the median nerve in carpal tunnel. The histological diagnosis was consistent with cysticercosis. The case resolved with conservative treatment. Such solitary presentation of entrapment median neuropathy as CTS caused by cysticercosis is extremely rare. To our knowledge, this is the only case of its kind reported in literature till date.     

铍针治疗臀中皮神经卡压综合征

目的 :探讨在臀中皮神经卡压综合征中张力与疼痛的相关性 ,铍针减张治疗的有效性。方法 :用张力计测量铍针减张治疗臀中皮神经卡压综合征前后软组织的张力 ,并对软组织张力变化加以比较分析。结果 :经 1～ 12个月的随访 ,平均 6 3个月 ,其中治愈 2 1例 ,显效 6例 ,有效 3例 ,无效 2例 ,总有效率 93 75 %。所有患者治疗前测软组织张力指数为 3 14± 0 78,治疗后为 2 10± 0 93,经统计学处理治疗前后张力指数间的差异有非常显著意义 (P <0 0 1)。结论 :铍针可以切刺限制张力释放的纤维结缔组织如筋膜等 ,释放过高的筋膜腔内张力 ,或通过局部流体静压的调整缓解了对末梢神经的刺激     

Questionnaire survey about the effects of new lifestyles during the pandemic of COVID-19 on upper limb diseases

BackgroundThe novel coronavirus (COVID-19) that emerged in 2019 and spread globally in 2020 has resulted in the imposition of lockdowns or a state of emergency in many cities worldwide. In Japan, a “new lifestyle” is being advocated. We hypothesize that the new lifestyle has changed people's use of their upper limbs during the COVID-19 pandemic. Therefore, through this questionnaire study, we aimed to determine the factors associated with exacerbation of symptoms during the pandemic and to investigate the current status of patients who require hand surgery.MethodsThis study was a prospective multi-center questionnaire survey. This study was conducted in Japan from December 2020 to July 2021 at university and general hospitals in nine prefectures. A questionnaire was administered to patients who visited a hospital with symptoms of nerve entrapment syndrome, osteoarthritis, or tenosynovitis.ResultsA total of 502 patients with a mean age of 63.8 years responded. The 240 patients who experienced exacerbation (exacerbated and markedly exacerbated) were compared with other patients (unchanged, improved, and markedly improved). An increase in the time spent on personal computers and smartphones was associated with exacerbation of hand symptoms. Patients who wanted to undergo surgery but were postponed due to COVID-19 accounted for 23.5% of the outpatients. The mean scores for pain, jitteriness, and anxious depression in these patients were significantly higher than those of patients who did not want surgery.ConclusionsOur results suggest that an increase in the time spent on personal computers and smartphones is associated with exacerbation of hand symptoms during the COVID-19 pandemic. Patients who wanted to undergo surgery but were postponed by COVID-19 experienced greater pain, jitteriness, and anxious depression.     

骨间前神经卡压征的电生理研究

目的分析总结骨间前神经卡压征的神经电生理特点,探讨其对骨间前神经卡压征的诊断意义。方法对12例骨间前神经卡压征患者进行神经电生理检测：（1）惠侧及对侧骨间前神经运动潜伏期及复合肌肉动作电位波幅：（2）患侧正中神经运动、感觉传导速度及复合肌肉动作电位、感觉动作电位波幅：（3）患侧拇短展肌、指浅屈肌、旋前方肌、拇长屈肌肌电图。结果10例骨间前神经运动潜伏期延长;12例骨间前神经复合肌肉动作电位波幅降低;12例正中神经运动、感觉传导速度及复合肌肉动作电位、感觉动作电位波幅正常：12例旋前方肌、10例拇长屈肌肌电图示神经性损害;12例拇短展肌、指浅屈肌肌电图正常。结论骨间前神经卡压征的神经电生理表现特点为：骨间前神经运动传导潜伏期延长及复合肌肉动作电位波幅降低,其支配肌肉肌电图示神经性损害,而正中神经运动及感觉传导正常．其支配肌肉肌电图正常。骨间前神经卡压征的神经电生理表现可为该病提供客观、准确的诊断与鉴别诊断依据。