Study of variant anatomical structures (bony canals, fibrous bands, and muscles) in relation to potential supraclavicular nerve entrapment

Since the definition of supraclavicular nerve entrapment syndrome by Gelberman et al. (Gelberman et al. [1975] J. Bone Joint Surg. Am. 57:119) a number of clinical cases of this specific entrapment neuropathy have been reported. In all these cases, the nerve injury has been attributed to the location of the supraclavicular nerve branch in a narrow canal in the clavicle. However, in the anatomical literature, variations in the course of the supraclavicular nerves have not only been ascribed to bony canals but also to abnormal fibrous and muscular structures. Considering the fact that the existence of a narrow site with rigid walls along the course of a nerve is essential for the development of an entrapment neuropathy, our study examines all the variant anatomical structures with a possible role in supraclavicular nerve entrapment. We describe three groups of anatomical structures with close relation to the course of the supraclavicular nerves-transclavicular canals, fibrous bands, and unusual muscular structures. Based on the characteristics of the variations found, for the first time, we suggest that in addition to the bony canals through the clavicle certain fibrous and muscular structures could also be an anatomical basis for supraclavicular nerve entrapment syndrome.     

The role of fasciae in Civinini–Morton's syndrome

This study evaluates the pathogenetic role of the perineural connective tissue and foot fasciae in Civinini–Morton's neuroma. Eleven feet (seven male, four female; mean age: 70.9 years) were dissected to analyse the anatomy of inter‐metatarsal space, particularly the dorsal and plantar fasciae and metatarsal transverse ligament (DMTL). The macrosections were prepared for microscopic analysis. Ten Civinini–Morton neuromas obtained from surgery were also analysed. Magnetic resonance images (MRIs) from 40 patients and 29 controls were compared. Dissections showed that the width of the inter‐metatarsal space is established by two fibrous structures: the dorsal foot fascia and the DMTL, which, together, connect the metatarsal bones and resist their splaying. Interosseous muscles spread out into the dorsal fascia of the foot, defining its basal tension. The common digital plantar nerve (CDPN) is encased in concentric layers of fibrous and loose connective tissue, continuous with the vascular sheath and deep foot fascia. Outside this sheath, fibroelastic septa, from DMTL to plantar fascia, and little fat lobules are present, further protecting the nerve against compressive stress. The MRI study revealed high inter‐individual variability in the forefoot structures, although only the thickness of the dorsal fascia represented a statistically significant difference between cases and controls. It was hypothesized that alterations in foot support and altered biomechanics act on the interosseous muscles, increasing the stiffness of the dorsal fascia, particularly at the points where these muscles are inserted. Chronic rigidity of this fascia increases the stiffness of the inter‐metatarsal space, leading to entrapment of the CDPN.     

石榴皮总多酚脂质体制备工艺参数的统计学分析

目的:探究应用超临界CO2流体沉析技术制备石榴皮总多酚脂质体的工艺条件,为该制剂的工业化生产提供参考。方法:以包封率为评价指标,通过Plackett-Burman试验筛选主要影响因素,利用最陡爬坡试验和Box-Behnken试验优选石榴皮总多酚脂质体的制备工艺。结果:原药与膜材的质量比、反应温度和反应压力是影响总多酚脂质体包封率的显著性因素,最佳制备工艺条件为原药-膜材的质量比1∶21.15,反应温度48.3℃,反应压力23.88 MPa。包封率实测值80.295%和预测值81.379%的偏差1.33%,有效粒度168.5 nm,Zeta电位-73.8 m V。结论:该试验模型设计达到要求,工艺具有可行性。石榴皮总多酚脂质体体外释放速度缓慢,缓释效果明显,稳定性良好。     

肌皮神经卡压的解剖学研究

目的 探讨肌皮神经易卡压因素的解剖学基础.方法 对4例尸体、8侧双上肢进行解剖,观察肌皮神经易卡压点处解剖关系,体位变化对测量长度影响(经t检验).结果 肌皮神经喙肱肌入肌点、前臂外侧皮神经穿出点易卡压.上肢内收、外展位时,喙肱肌入肌点至喙突距离:(8.74±1.24) cm、(10.49±1.29) cm,距离改变差异有统计学意义(t=2.765,P＜0.05),喙肱肌出肌点至喙突距离:(10.74±1.23) cm、(12.52±1.32) cm,距离改变差异有统计学意义(t=2.786,P＜0.05).结论 肌皮神经易卡压点为喙肱肌人肌点、前臂外侧皮神经肘部穿出点.上肢体位变化是肌皮神经的卡压因素之一.     

Lifetime risk of symptomatic carpal tunnel syndrome in Type 1 diabetes.

AIMS: To determine the lifetime risk of developing symptomatic carpal tunnel syndrome (CTS) in subjects with Type 1 diabetes and to investigate the effect of glycaemic control, body mass index (BMI), gender and age of onset of diabetes. METHODS: One hundred and twenty-two consecutive subjects with Type 1 diabetes seen by a single investigator, over 1-year, were questioned about previous surgery for, or current symptoms of CTS. Those with current symptoms were referred for nerve conduction studies (NCS). Those with previous surgery and/or diagnostic NCS were classified as having CTS. Lifetime risk was calculated by the Kaplan-Meier method. RESULTS: Twenty six out of 122 patients had CTS, 18 of whom (69%) had undergone median nerve decompression surgery. The predicted lifetime risk of CTS reached 85% after 54 years of Type 1 diabetes (95% confidence interval: 72-97%). The duration of diabetes was greater in those who had developed CTS than in those who had not (29 vs. 19 years, P=0.0001). In those diagnosed with diabetes before the age of 20 there was a lag time of at least 19 years before the development of CTS, whereas patients with later onset of diabetes, began to develop CTS from as early as 5 years diabetes duration. There was no demonstrable effect of glycaemic control, obesity, gender or retinopathy on the appearance of CTS. CONCLUSION: The lifetime risk of developing symptomatic CTS with Type 1 diabetes is high, and is related to age and duration of diabetes, but not to the development of microvascular complications.     

Workplace ergonomic factors and the development of musculoskeletal disorders of the neck and upper limbs: a meta-analysis.

In the past 10 years there has been growing awareness among occupational health professionals worldwide of the large burden of illness associated with musculoskeletal disorders of the neck and upper limbs. It has been suggested that these disorders are associated with highly repetitive work and are due, at least in part, to ergonomic factors. This review examines the epidemiologic evidence of the relationship between workplace ergonomic factors such as repetition, force, static muscle loading, and extreme joint position and the development of muscle, tendon, and nerve entrapment disorders of the neck and upper limbs of exposed workers. An extensive search for relevant studies was undertaken. Of 54 potentially relevant studies identified, three met the a priori inclusion criteria. The validity of these studies was assessed, and one study was found to have major flaws. Criteria to demonstrate causality were also applied and were met in the most rigorously conducted study. When the results of these studies are compared and aggregated where appropriate, they provide strong evidence of a causal relationship between repetitive, forceful work and the development of musculoskeletal disorders of the tendons and tendon sheaths in the hands and wrists and nerve entrapment of the median nerve at the carpal tunnel. The comparison of exposed to controls for hand/wrist tendinitis gives an unadjusted common odds ratio of 9.1 (95% CI 4.9-16.2). The adjusted odds ratio for carpal tunnel syndrome is 15.5 (95% CI 1.7-141.5) based on the most rigorous study.     

Prospective randomized comparison of transobturator suburethral sling (Monarc) vs suprapubic arc (Sparc) sling procedures for female urodynamic stress incontinence

The aims of this trial were to compare the attendant complications and postoperative voiding function of the Monarc and suprapubic arc (Sparc) suburethral sling procedures. This is the first article in English literature to compare different suburethral sling procedures using prosthesis of the same material and the same weave. Sixty women with urodynamic stress incontinence alone or combined with pelvic prolapse less than International Continence Society stage II were randomly allocated to either the Monarc or Sparc group. A comparison of the peri- and postoperative results comprising complications and symptoms of voiding function revealed no significant differences between the two groups in a follow‐up ranged from 6 to 14 months (median, 9 months). However, the nonsignificant increase in tendency of inadvertent vaginal perforation and disability/pain of thigh (Monarc 12.9 vs Sparc 0.0%, p=0.112 and Monarc 12.9 vs Sparc 0.0%, p=0.112, respectively) has clinical significance. Based on the analyses of the comparison of Blaivas obstruction nomograms, postoperative voiding function was not significantly different between the two surgical groups. We concluded that Monarc and Sparc suburethral taping proved to be equally safe and posed no remarkable impact on voiding function in a short term postoperative follow up. However, intraoperative urethrocystoscopy is recommended for safety in both the Monarc and Sparc procedures.This study had no conflicts of interest as regards any commercial association.     

腘血管陷迫综合征的MR诊断(附5例报告)

目的：探讨MRI在胭血管陷迫综合征诊断（PVES）中的应用价值。方法：回顾性分析5例经手术病理证实的PVES患者的删资料，其中3例行DSA检查。结果：5例MRI图像均可清晰显示胭血管与周围组织之间的关系，均可见异常走行的肌肉、肌腱或纤维组织束压迫胭动脉，明确病因诊断。结论：MRI能很好的反映胭动脉的狭窄闭塞的部位、范围、程度及侧枝循环形成的情况，并且能清晰显示胭血管与周围组织间的关系，明确病因诊断明显优于DSA。     

Ulnar entrapment neuropathy along the medial intermuscular septum in the midarm

We report a patient with primary ulnar entrapment neuropathy in the midarm. Stimulation of multiple sites along the ulnar nerve showed a motor conduction block at a distance of 7.5–10 cm proximal to the medial epicondyle, where the nerve was compressed by the medial intermuscular septum. Anatomically, the possibility of ulnar nerve entrapment in this segment has long been suggested, and stimulation at least 10 cm above the medial epicondyle may reveal the entrapment. Muscle Nerve 39: 707–710, 2009