Lunate dislocation causing median nerve entrapment

Lunate dislocation is an uncommon injury occurring in young adults due to high-energy trauma. The volar displacement of the bone may result in compression of the median nerve within the carpal tunnel and is an uncommon cause of entrapment neuropathy.     

High-resolution ultrasound in etiological evaluation of ulnar neuropathy at the elbow

ObjectiveUlnar neuropathy at the elbow (UNE) involves mechanical compression and irritation of the ulnar nerve (UN) caused by environmental and dynamic abnormalities that can however also be found in asymptomatic patients. Using high-resolution ultrasound, we aimed to assess and compare the relevance of morphological and dynamic variants of the UN and its surrounding structures (UN abnormalities) in symptomatic and asymptomatic patients.MethodUN abnormalities in patients with UNE were assessed using high-resolution ultrasound and compared against unaffected arms (patients or healthy volunteers).ResultsWe studied 234 arms of 117 individuals (89 with UNE and 145 control). Eighty-one percent of the arms with UNE compared to 40% of control (p = 0.00001) showed UN abnormalities. While it was dislocated in 49% of arms with UNE compared to in 23% of control (p = 0.004).ConclusionThe two-fold higher frequency of occurrence of UN abnormalities in arms with UNE indicates their causative or at least contributory role in such neuropathies. High-resolution ultrasound should be part of the initial evaluation of UNE in order to assess the etiology of the conflict.     

Monoparesis with complex regional pain syndrome-like symptoms due to brachial plexopathy caused by the varicella zoster virus: a case report

Viral invasion of the motoneurons and the subsequent inflammation in the anterior horn cells by the varicella zoster virus results in a weakness in the area of the cutaneous eruption. The exact mechanism of zoster paresis is uncertain. The occurrence of symptoms resembling complex regional pain syndrome (CRPS) is common in subjects where the herpes zoster (HZ) outbreak affects an extremity, particularly if it is the distal extremity that is involved. We report the case of a 54-year-old man with monoparesis, hyperalgesia, allodynia, edema, and both color and skin-temperature changes in his left arm after a skin eruption. Electrophysiologic examination revealed the partial degeneration of the superior, middle, and inferior truncus in the brachial plexus, with evidence of HZ infection. Magnetic resonance imaging of the cervical spine and brachial plexus showed degenerative changes without any evidence of nerve root compression. Brachial plexopathy may be the direct cause of the reversible upper-limb paresis resulting from HZ with CRPS-like symptoms.     

Mixed latency difference for diagnosis of ulnar neuropathy at the elbow

OBJECTIVE: To provide reference values and to compare this technique with the standard motor conduction velocity (MCV) of the ulnar nerve. DESIGN: Retrospective unmasked study. SETTING: Private and institutional practice. PARTICIPANTS: The reference group included 57 healthy volunteers. Patients included 100 subjects with suspected ulnar neuropathy at the elbow (UNE) referred for neurophysiologic evaluation. This group was subdivided into 2 groups: group A was composed of 45 patients with UNE confirmed by MCV of the ulnar nerve, and group B included 55 patients with suspected UNE in whom the diagnosis could not be established by MCV of the ulnar nerve. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Differences between peak latencies of ulnar and median mixed nerve action potentials at the arm, after stimulating these nerves at the wrist. This was called mixed latency difference. RESULTS: The upper normative limit of the mixed latency difference was 1.1 ms, and there was a significant correlation with height. In group A, the mixed latency difference was abnormal in 80% of the cases and could not be calculated in 18%. In group B, the mixed latency difference was abnormal in 8 (15%) patients. All of these had abnormal "inching" of the ulnar nerve across the elbow. CONCLUSIONS: The mixed latency difference was particularly useful in cases of mild UNE.     

糖尿病神经病变病人末梢感觉定量检查方法的探讨与临床应用

目的 探讨糖尿病(DM)病人末梢感觉定量检测方法(QST)及其在临床应用的价值。方法 采用计算机辅助感觉定量检查仪，检测120名正常人与92例DM病人四肢末梢的冷、热感觉，冷、热痛觉和振动觉等5项。结果 检测结果，临床常规检查有糖尿病神经病变(DPN)病人的检测数值100％异常，常规检查无神经病变的，与同时采用四肢末梢5项检测的数值比较，差异无显著意义(X^2-0．922，P=0．631)；DM病人QST检测结果与正常人数值比较，温度觉与振动觉明显减退；QST检查发现的DM末梢感觉异常人数比临床常规检查发现的明显增多(X^2=10．985，P=0．001)，这两种检查的异常人数又都与DM病程相关。结论 DM病人QST可选择足部作常规检查；计算机辅助感觉定量检测是早期发现DPN的良好指标。     

α-硫辛酸联合前列腺素E1治疗糖尿病性周围神经病变疗效观察

目的评价α-硫辛酸联合前列腺素E1对2型糖尿病合并周围神经病变的治疗效果。方法将60例糖尿病性周围神经病变患者随机分为2组,治疗组给予α-硫辛酸600 mg、前列腺素E110μg治疗2周,对照组每日给予前列腺素E110μg治疗2周。治疗前后分别进行神经病变症状TSS评分及感觉定量比较。结果经过2周治疗后,两组患者的TSS评分及感觉定量明显改善(P<0.05),无严重药物不良反应。与对照组相比,治疗组改善更明显(P<0.05)。结论临床使用α-硫辛酸联合前列腺素E1治疗糖尿病合并周围神经病变安全有效。     

同型半胱氨酸及其相关酶基因多态性与糖尿病周围神经病变的关系

研究对象为 2型糖尿病 (DM )有周围神经病变组 (60例 )、2型DM无周围神经病变组 (4 6例 )和正常对照组 (5 0例 )。分别测定 3组血浆同型半胱氨酸 (Hcy) ,血清叶酸、维生素B12 水平及Hcy代谢关键酶亚甲基四氢叶酸还原酶 (MTHFR)的基因型。结果显示 ,高Hcy及低叶酸、维生素B12 水平与 2型DM患者伴发周围神经病变相关 ,而MTHFR的基因多态性只与DM有关而与DM周围神经病变无相关性。     

Role of ankle mobility in foot rollover during gait in individuals with diabetic neuropathy

Background

The purpose of this study was to investigate the ankle range of motion during neuropathic gait and its influence on plantar pressure distribution in two phases during stance: at heel–strike and at push-off.

Methods

Thirty-one adults participated in this study (control group, n = 16; diabetic neuropathic group, n = 15). Dynamic ankle range of motion (electrogoniometer) and plantar pressures (PEDAR-X system) were acquired synchronously during walking. Plantar pressures were evaluated at rearfoot, midfoot and forefoot during the two phases of stance. General linear model repeated measures analysis of variance was applied to investigate relationships between groups, areas and stance phases.

Findings

Diabetic neuropathy patients walked using a smaller ankle range of motion in stance phase and smaller ankle flexion at heel–strike (P = 0.0005). Peak pressure and pressure–time integral values were higher in the diabetic group in the midfoot at push-off phase when compared to heel–strike phase. On the other hand, the control group showed similar values of peak pressure in midfoot during both stance phases.

Interpretation

The ankle mobility reduction observed could be associated to altered plantar pressure distribution observed in neuropathic subjects. Results demonstrated that midfoot and forefoot play a different role in subjects with neuropathy by receiving higher loads at push-off phase that are probably due to smaller ankle flexion at stance phase. This may explain the higher loads in anterior areas of the foot observed in diabetic neuropathy subjects and confirm an inadequate foot rollover associated to the smaller ankle range of motion at the heel–strike phase.     

福欣康林与维生素B12治疗糖尿病周围神经病变的疗效比较

2型糖尿病伴糖尿病肾病患者应用福欣康林（46例）和维生素B12（46例）治疗4周。福欣康林改善自发性疼痛、肢体麻木、神经反射和神经传导速度的好转率均明显高于维生素B12且未引起明显的不良反应。     

Na/K ATP酶活性及其ATP1A1基因多态性与2型糖尿病周围神经病变的相关性

目的研究大连地区汉族人Na／KATP酶活性及ATP1A1基因多态性与2型糖尿病（T2DM）周围神经病变（DPN）的关系。方法用聚合酶链反应-限制性片段长度多态性方法对大连地区的106例T2DM患者和45例正常对照者（NC）的ATP1A1基因进行扩增，对其基因多态性进行研究，并用比色法测定其红细胞的Na／KATP酶活性。结果与NC组相比，T2DM组红细胞Na／KATP酶活性降低，在伴有DPN组，Na／KATP酶活性的降低更为明显。在T2DM患者中，有DPN组与无DPN组相比，基因型分布差异有统计学意义（P〈0．05）。T2DM患者携带有限制性等位基因A与非携带者Na／KATP酶活性的差异有统计学意义（P〈0．05）。结论Na／KATP酶活性的降低在DPN的发病中起重要作用，Na／KATP酶的基因ATP1A1多态性与T2DM患者发生DPN相关。T2DM携带有限制性等位基因A的患者DPN的发生率低于非携带者。