Compression neuropathy of the median nerve caused by a loose body in the elbow

We present a case of median nerve compression at the elbow associated with an intra-capsular loose body cured by arthroscopic removal of the loose body. This is a rare but eminently treatable cause of median nerve compression.     

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)     

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.     

Pisiform-hamate synostosis with ulnar neuropathy. Case report

Entrapment of the ulnar nerve at the wrist is rare compared with the more commun site at the elbow. This condition was secondary to reccurent blunt trauma, ganglion cyst, vasculitic disorders, and fibrous bands. Compression of the ulnar nerve caused by pisiform-hamate coalition is rare entity. One case of this condition is reported.     

Compression du rameau superficiel du nerf radial par un kyste synovial du coude (À propos d’un cas et revue de littérature)

Compression of the radial nerve at the elbow is quite rare; entrapment of its superficial branch is exceptional. Extrinsic compression is the most frequent etiology. Magnetic resonance imaging plays a major role in the diagnosis, and early surgical excision or echoguided drainage – in case of synovial ganglion – allows a total recovery. The authors report the case of a compression of the superficial branch of radial nerve by an elbow synovial cyst treated by surgical resection.     

Subtotal medial epicondylectomy as a surgical option for treatment of cubital tunnel syndrome

Ulnar nerve compression at the elbow is commonly accepted as the second most frequent compressive peripheral neuropathy. The unique anatomic location of the ulnar nerve directly posterior to the medial epicondyle at the elbow places it at risk for injury. With normal motion of the elbow, the ulnar nerve is subjected to compression, traction, and frictional forces. Compression can occur at any of the 5 sites that begin proximally at the arcade of Struthers and end distally where the nerve exits the flexor carpi ulnaris in the forearm. Initial treatment of compressive neuropathy is nonoperative, usually consisting of rest, modification, and/or restriction of elbow or wrist movement. If symptoms persist, especially when accompanied by muscle weakness, surgery is usually indicated. Surgical options include decompression in situ, medial epicondylectomy, transposition of the ulnar nerve (subcutaneous, intramuscular, or submuscular), and/or a combination of these procedures. Careful decompression with a subtotal medial epicondylectomy is a valuable procedure that allows decompression at all levels with minimal risk of devascularizing the nerve or creating elbow instability.     

Superficial radial nerve compression caused by a parosteal lipoma of proximal radius: a case report.

The superficial radial nerve might be compressed or injured at various anatomical sites along its course in the forearm. Most of the superficial radial nerve neuropathy are caused by pathological lesions such as trauma, a mass or tight band at the distal third of the forearm. Wartenberg's syndrome is the most common cause of sensory radial entrapment at the distal forearm. Compression of superficial radial nerve occurring at the proximal third of forearm is unusual. We present a rare case of superficial radial nerve compression due to a parosteal lipoma of proximal radius. Results of complete physical and radiological examinations are also presented. Surgical intervention of the tumour mass was performed for nerve decompression. The patient reported total relief of the neurological symptom post-operatively. This rare case demonstrates the unique characteristics of parosteal lipoma with unusual superficial radial nerve neuropathy at the proximal radius. This report reminds us that there is the possibility of superficial nerve compression caused by tumour mass over the proximal third of forearm.     

Processus Supracondyloidea Humeri with Concomitant Compression of the Median Nerve and the Ulnar Nerve

Compression of the median nerve and the ulnar nerve due to the anatomical anomaly processus supracondyloidea humeri is a rare condition. a case of combined median and ulnar nerve compression is described. Diagnostics and treatment are discussed in the light of the present case history and those described in the literature. The conclusion is that the treatment should be subperiosteal resection of the process together with the origin of the pronator teres muscle.     

Surgical treatment of a tomaculous neuropathy

Compressive neuropathy of the ulnar nerve at the elbow is the second most common nerve entrapment in the upper limb. Eight possible anatomical points of constriction have been identified. The most common constriction being the intermuscular septum proximally or between the two heads of the flexor carpi ulnaris in the cubital canal distally. Surgical release is successful in 80-90% of cases. Certain rare genetic conditions can predispose susceptible peripheral nerves to similar compressive neuropathies but there is no literature on surgical treatment of such patients. We present a case of hereditary neuropathy with liability to pressure palsy (HNPP) often known as 'tomaculous' neuropathy, in a patient with ulnar nerve symptoms who underwent a surgical release.     

46例肘关节镜手术并发症的分析——10年269例肘关节镜手术回顾

目的探讨肘关节镜手术并发症发生情况及其原因。方法回顾研究1998年6月-2008年11月269例肘关节镜中46例（17.1％）并发症的发生、处理及预后。男32例,女14例,年龄（32．9±15．1）岁（13-6l岁）。其中骨关节炎20例,关节粘连8例,肱骨外上髁炎4例,类风湿关节炎4例,急性创伤5例,肱骨内上髁炎1例,剥脱性骨软骨炎2例,色素绒毛结节性滑膜炎1例,肘关节不稳1例。最多见为一过性神经损伤36例,其中累及桡神经7例,尺神经7例,腋神经1例,肢体远端末梢神经感觉障碍21例;迟发性尺神经炎5例;伤口术后渗液1例,皮下血肿1例;残留游离体5例。2例肘关节发生了2种并发症。结果36例一过性神经损伤患者中的32例在术后1—7天内缓解,最迟1例桡神经深支损伤术后8个月好转。3例迟发性尺神经炎行尺神经前移术,1例伤口血肿行血肿清除术,2例游离体残留行游离体二次取出术,余保守治疗,均治愈。结论肘关节镜的并发症以一过性神经损伤最多见,还有迟发性尺神经炎、伤口并发症、游离体残留。这些并发症绝大多数都是轻微可逆的,故肘关节镜是一种安全有效的技术。     

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.     

Intraosseous median nerve entrapment following pediatric posterior elbow dislocation

Intra-articular entrapment of the median nerve following reduction of a pediatric posterior elbow dislocation is a rare complication but has been reported in the literature.This article describes a case of a 7-year-old girl who sustained a posterior elbow dislocation associated with a medial epicondyle fracture and the subsequent intraosseous entrapment of her median nerve. The entrapment is believed to have resulted from new bone formation over the nerve that went unrecognized for nearly 2 years following injury. Routine imaging studies failed to detect the entrapment prior to exploratory surgery. Intra-articular entrapment of the median nerve must be suspected following pediatric elbow dislocation when concentric reduction fails, postreduction images demonstrate joint widening, or the patient has persistent clinical symptoms. This case demonstrates the potential for delay in diagnosis of the cause for neurological impairment following a relatively common injury in the pediatric population.Objective intraoperative findings and intraoperative micropathology aided in limiting the amount of nerve resected to nonviable portions. Our case demonstrates the potential use of a cable nerve graft to bridge segmental defects in peripheral nerves.     

Incarcération du nerf médian après luxation négligée du coude : à propos d’un cas

Entrapment of the median nerve is a rare complication following dislocation of the elbow. The authors report a case of incarceration of the median nerve in a neglected dislocation of the elbow in an 18-year-old right-handed boy. The patient sustained a closed injury of the right elbow during a game. The initial treatment was performed by a traditional bonesetter and consisted of attempts at reduction followed by immobilization in extension. There was persistent pain and limitation of movement in the elbow and paraesthesiae in the long finger. This led the patient to consult us at 45 days postinjury. Radiographs showed a posterolateral dislocation of the elbow. Surgical reduction was carried out 6 months posttrauma. After opening of the capsule, we discovered the median nerve blocking the olecranon fossa, passing at the level of the groove of the trochlea where it was wedged between the latter anteriorly and the olecranon posteriorly before resuming its normal course. Reduction was obtained and the nerve replaced in its normal position. The postoperative course was uneventful with disappearance of the paresthesiae and restoration of a good range of movement of the elbow. The authors discuss the mechanism, the clinical forms and propose a new type according to the classification of Fourrier.     

The Martin-Gruber innervated hand

Two patients with a complete ulnar nerve lesion at the elbow and a median nerve lesion at the wrist secondary to leprosy neuropathy retained good function of the first dorsal interosseous and flexor pollicis brevis muscles. One patient also lacked the typical finger clawing associated with ulnar and median paralyses. These findings were attributed to the presence of Martin-Gruber anastomoses that were confirmed by nerve-conduction studies.     

Sciatic nerve entrapment in a child. Case report

A child was brought for evaluation of signs of unilateral chronic progressive sciatic nerve dysfunction found to be due to nerve entrapment in the thigh by a fibrovascular band. Sectioning of the band was followed by marked improvement in the nerve function. Compression by a band is a rare but treatable cause of sciatic neuropathy.     

Proximal median nerve compression.

Compression neuropathies of the median nerve in the proximal forearm are unusual lesions. Many patients have vague symptoms for many months or even years prior to confirming the diagnosis of either pronator syndrome or anterior interosseous syndrome of the forearm. Serial examinations clinically and electrodiagnostically may be necessary at intervals of 6 to 8 weeks as required for the evaluation of the patient's symptoms. As with other compression neuropathies, the diagnosis is solely dependent on the diagnosis of neuropathy of the median nerve using whatever parameter satisfies the surgeon's diagnostic criteria and then having made that diagnosis, localizing the site of that neuropathy by physical examination or electrodiagnosis with the support of radiographic techniques as appropriate. Surgical exploration of proximal median nerve compression is normally followed by prompt and predictable recovery from the median neuropathy and clinical symptoms between 8 and 12 weeks after surgical exploration. Prolonged symptom complexes after surgical exploration of the proximal median nerve are, in my experience, due to either (1) extremely severe median nerve injury secondary to pronator syndrome with prolonged recovery and distal nerve axomnetic recovery into the hand, or (2) sensory nerve dysesthesis of the small sensory nerves on the proximal volar surface of the forearm. The symptoms of either of these postoperative findings normally improve with time.     

Extrinsic compression neuropathy of the tibial nerve secondary to accessory soleus muscle in a young teenager

Compression neuropathy of the tibial nerve or one of its terminal branches (tarsal tunnel syndrome) is relatively uncommon. Accessory musculature on the posteromedial aspect of the ankle is a rare extrinsic cause of compression. Therefore, it should be considered in patients with prolonged manifestations of tibial nerve compression. A detailed history and physical examination, together with proper radiological evaluation, allow for accurate diagnosis. In this case report, a 13-year old female teenager on history, physical examination, and imaging studies was diagnosed as compression neuropathy of the tibial nerve secondary to accessory soleus muscle. After surgical excision of the accessory soleus muscle with no tarsal tunnel release, the patient presented with complete resolution of her manifestations continued free of symptoms for one and half year postoperatively. The accessory soleus muscle is a potential extrinsic cause for tibial nerve compression neuropathy.Level of Clinical Evidence5.     

Schwannoma of median nerve at the elbow. Case report and short review of the literature

The Authors present a case of rare elbow localization of schwannoma of the median nerve, in 42 year old woman. The surgical treatment and the short follow-up are presented.     

Acute compression of the median nerve at the elbow by the lacertus fibrosus

Chronic compression of the median nerve at the elbow has been described as resulting from a number of structures including the lacertus fibrosus. Symptoms of chronic compressive peripheral neuropathy consist predominantly of an achy feeling, paresthesias, numbness, and a sense of weakness or fatigue, with the onset being insidious and frequently without a precipitating cause. In this series, 7 consecutive cases of acute median nerve compression in the antecubital fossa resulted from an extremely forceful injury to the elbow. In all 7 cases, a sudden, severe attempt at elbow flexion was performed against a substantial counterforce, resulting in immediate severe pain radiating from the elbow down into the forearm. Pain was persistent and unremitting in all 7 until the time of diagnosis and treatment. Surgical decompression was performed in all cases. At the time of surgery, we found evidence of partial rupture of the myotendinous junction of the biceps brachii creating increased tension across the median nerve by a tethered lacertus fibrosus. Surgical decompression resulted in complete relief of symptoms in all 7 cases.     

Compression neuropathy of the radial palmar thumb nerve

Compression neuropathy of a single digital nerve is a rare entity. We report the case of a patient with numbness in the distribution of the radial digital nerve of the thumb caused by the use of a walking stick. The nerve was compressed between the handle of the stick, the loop and the radial sesamoid bone of the first metacarpophalangeal joint. The site of the lesion was confirmed by electrophysiologic examination. Orthodromic recording of the sensory response from the radial palmar digital nerve of the thumb documented a complete absence of nerve action potential whereas the ulnar digital thumb nerve showed a normal response. Sensory function was restored when a padded ski glove was used to protect the area of the metacarpophalangeal joint whilst using the stick.