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.     

Median and ulnar nerve compression at the wrist caused by anomalous muscles

Compression of the median and ulnar nerves at the wrist is frequently encountered. Carpal tunnel syndrome usually occurs without any obvious extrinsic cause; several cases have however been reported caused by anomalous or hypertrophic muscles. A survey of the literature shows that compression neuropathy of the median nerve has been reported in relation with anomalies affecting three muscles: the first (or second) lumbrical, the palmaris longus and its anatomic variants and the superficial flexor of the index finger. In the ulnar tunnel the situation is thoroughly different: so-called idiopathic ulnar tunnel syndrome is rare and an extrinsic compressing structure can usually be disclosed. Anomalous muscles belong to the palmaris longus/abductor digiti minimi group; the flexor carpi ulnaris is sometimes involved. One can suspect the presence of such an anomalous muscle when the compression syndrome concerns a patient who is not within the "usual" age group with symptoms initiated or aggravated by physical exercise.     

Accessory palmaris longus muscle causing ulnar nerve compression at the wrist

An accessory palmaris muscle that arose from the base of the fifth metacarpal passed proximally and inserted into the palmaris longus tendon. In its course it compressed the ulnar nerve and vessels. It was detached proximally and folded on itself to provide hypothenar bulk. The entrapment symptoms were relieved.     

Pseudomalignant myositis ossificans of the wrist causing compression of the ulnar nerve and artery. A case report

Myositis ossificans (MO) is a condition characterised by focal, benign and self-limited idiopathic heterotopic bone formation. It is extremely rare in the hand and wrist and may lead to concomitant nerve compression. Because of the rare incidence of pseudomalignant MO at the wrist and hand, we found it of interest to report a case of this condition localised to the wrist. A 31-year-old female patient presented with swelling and pain of her left wrist. The physical examination findings, magnetic resonance imaging and Tc-99m bone scan suggested acute osteomyelitis or a tumoral condition. Incisional biopsy and pathological examination was done. The microscopic findings confirmed that the lesion was pseudomalignant MO. The lesion was removed totally and decompression of the ulnar nerve and artery was achieved. The patient regained full asymptomatic range of motion of all digits and wrist and the numbness of the fourth and fifth digits had subsided at follow-up five months later.     

Double compression of the ulnar nerve at the elbow and at the wrist (double-crush syndrome). Case report and review of the literature

Double compression of a peripheral nerve is not rare in medical practice. This article describes an ulnar neuropathy along the elbow and the wrist segments with electro-diagnostic examination (EDX). The proximal compression was an ulnar entrapment at the olecranon-epitrochlear semi-canal; the distal one was after the canal of Guyon, due to an arthro-synovial cyst arising from the pisohamatum joint. There aren't analogous clinical reports in the literature.     

Case report: intraneural ganglion cyst of the ulnar nerve at the wrist

We report a case of a 69-year-old male who presented with pain, weakness, and clumsiness of his right hand. Initial evaluation suggested possible neoplastic process affecting his cervical spine, which was fortunately ruled out by bone biopsy. Subsequent electrodiagnostic studies and magnetic resonance imaging confirmed a lesion of the deep ulnar motor branch. Exploration of Guyon’s canal was performed, and an intraneural ganglion involving the deep motor branch of the ulnar nerve was found and excised. Despite more than 14 months of symptomatic duration, the patient made a near-complete recovery with virtually no functional limitations. This provides supporting evidence for a functional benefit of intraneural ganglion excision and nerve decompression even in cases of chronic muscle atrophy.     

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.     

Unusual complication of an opposition tendon transfer at the wrist: ulnar nerve compression syndrome

Restoration of thumb opposition by tendon transfer may be necessary in cases of severe thenar atrophy caused by long-standing carpal tunnel syndrome. Routing the extensor indicis proprius transfer subcutaneously around the ulna to reanimate thumb opposition is an accepted procedure and is considered safe. Ulnar nerve compression leading to palsy is possible, however, as shown in the patient presented. Neurolysis failed to improve the palsy. Rerouting of the transfer deep to the ulnar nerve was necessary to treat the iatrogenic condition. Possible nerve compression should be kept in mind when planning a tendon transfer around the ulnar side of the forearm or carpus and when following up with the patient. Early intervention is necessary to prevent permanent sequelae.     

Anomalous muscle causing ulnar nerve compression at Guyon's canal

Abstract We report a rare anatomical variation of an anomalous supernumerary muscle in a male cadaver. It was crossing Guyon's canal, superficial to the ulnar nerve and ulnar artery, and inserted into the aponeurosis of the little finger. This muscle could potentially cause entrapment of the ulnar nerve in Guyon's canal.     

Anomalous muscle causing ulnar nerve compression at Guyon's canal

Abstract

We report a rare anatomical variation of an anomalous supernumerary muscle in a male cadaver. It was crossing Guyon's canal, superficial to the ulnar nerve and ulnar artery, and inserted into the aponeurosis of the little finger. This muscle could potentially cause entrapment of the ulnar nerve in Guyon's canal.     

Ulnar nerve compression at the wrist. Ulnar tunnel syndrome.

Compression neuropathy of the ulnar nerve at the wrist can be caused by several lesions. The most common cause is a carpal ganglion followed by occupational repeated trauma to the hypothenar area. This process is in contrast to carpal tunnel syndrome in which the majority of the cases are idiopathic in nature with no local cause found except for synovitis of the flexor tendons. The site of the lesion will determine the clinical picture whether it is both motor and sensory abnormalities, only motor paralysis or only sensory abnormality. The latter is rare. If the abnormality is purely motor, then the compression is distal in the ulnar tunnel and the hypothenar muscles are usually spared. Carpal ganglia must be sought and removed. After an extensive search through the literature, I found only one report in which thickening of the volar carpal ligament was found to be the cause of ulnar nerve compression. I encourage the use of the term "ulnar tunnel syndrome" to discuss these lesions and the classification outlined by Shea to determine the site of the lesion. Patients with type 2 syndrome usually present late because of the lack of sensory changes. Average delay in obtaining a diagnosis of 5 months was found in my patients. The condition should be suspected if spontaneous clumsiness or awkwardness of the use of the hand occurs in a middle-aged patient.     

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.     

Injection injuries to the median and ulnar nerves at the wrist.

Carpal tunnel syndrome is often treated nonoperatively with temporary wrist immobilization and local steroid injections. A direct injection into a peripheral nerve can result in permanent damage. Two cases of median nerve injection injury and one involving the ulnar nerve are presented; all were treated with neurolysis and debridement of the injected material. At follow-up ranging from 1 to 11 years, all patients showed significant improvement, but with some functional loss. The literature is confusing because of the variety of injection techniques used for the treatment of carpal tunnel syndrome, some of which put the median nerve at risk. We recommend that the injection be made midway between the palmaris longus tendon and the flexor carpi ulnaris tendon just proximal to the proximal edge of the transverse carpal ligament in a line with the superficialis tendon of the ring finger. The injection should be stopped and redirected if the patient experiences paresthesia of any kind.     

Median nerve compression at the wrist.

Median nerve decompression at the wrist is one of the most common operative procedures performed by hand surgeons, yet studies report surgical failure rates of 7% to 20%. Symptoms must be coordinated with diagnostic studies. Initial paresthesias should be documented with delayed sensory conduction time. Threshold tests of sensibility, such as the Semmes-Weinstein monofilaments, are more consistent and reliable tests of decreased sensibility than innervation density tests, such as the Weber two-point discrimination test. Thenar atrophy should be documented with electromyographic studies. The median nerve should be evaluated from the fingertips to the cervical spine. Basic laboratory studies should test for collagen disease, thyroid or renal disorders, and diabetes mellitus. Appropriate roentgenograms must be obtained. Patients with normal laboratory and diagnostic studies should be offered nonoperative treatment. Factors that are important in predicting the patient's response to nonoperative treatment include: age over 50 years, constant paresthesias, intermittent paresthesias of more than 10 months duration, stenosing flexor tenosynovitis, and a wrist flexion test (Phalen) that is positive in less than 30 seconds. Fewer than 10% of patients with three or more of these factors present have been cured by nonoperative management. Surgical decompression of the carpal tunnel is done with tourniquet control and optical magnification. A longitudinal "zig-zag" incision is preferred that extends along the thenar crease, then proceeds ulnarly to reach the distal palmar crease at a point in line with the long axis of the ring finger, and then proceeds radially to the tendon of the palmaris longus. After release of the transverse carpal ligament, the motor branch should be explored and decompressed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Solitary osteochondroma of the elbow causing ulnar nerve compression: a case report

We report ulnar nerve compression caused by solitary osteochondroma of the right elbow in a 34-year-old man. Two osteochondromas were detected originating from the olecranon and medial humeral epicondyle, respectively. The patient had severely restricted elbow motion, pain, and hypoesthesia of the forth and fifth fingers. The lesions were surgically removed, together with subcutaneous anterior transposition of the ulnar nerve. At the end of the postoperative eight months, complaints of the patient disappeared except for slight hypoesthesia in the fingers. Literature search revealed only a single case of solitary osteochondroma associated with peripheral nerve compression.