Biomedical subjects
Publications and source records attributed to R J Spinner.
Compression of the ulnar nerve can be understood in terms of the anatomic and dynamic factors. Although the ulnar nerve may be compressed at any point along its course, it is particularly susceptible at the elbow and the wrist. Clinically relevant anatomy will be reviewed in an attempt to provide the reader with a logical framework for successfully diagnosing and managing typical and atypical ulnar nerve compression lesions.
Although myositis ossificans is a well-known sequela of elbow trauma, reinjury to the affected region can also occur, resulting in acute symptoms from a fracture of the myositis ossificans. An 18-year-old man presented with localized pain, soft-tissue swelling, and a bony mass along the anterolateral distal humerus with restricted elbow range of motion after injury to his elbow during football. One year earlier he had sustained a similar crush injury to his elbow that resulted in a limited, although painless, arc of motion. Radiographs and tomograms established the diagnosis of a fractured supracondylar humeral myositis ossificans. Surgical excision of the large mature ossified fragment confirmed the diagnosis and restored a full range of motion of the elbow.
A 24-year-old woman with a history of hereditary spherocytosis and oral contraceptive use presented with a spontaneous, isolated loss of great toe extension. She had clinical and electrodiagnostic evidence of a localized lesion affecting the nerve supply to the extensor hallucis longus (EHL). Full clinical recovery was apparent within 6 months with nonoperative therapy. Isolated EHL weakness may occur as a rare neurologic complication of procedures such as high tibial osteotomies, but, to our knowledge, this has not been reported in the absence of trauma or surgery. While the coexistence of hereditary spherocytosis and a peripheral neuropathy may have been purely coincidental, it is plausible that the isolated lesion in this patient was due to ischemic changes from underlying rheologic conditions, possibly in association with a variation in the neural or nutrient vessel supply to the EHL.
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The supracondylar process of the humerus is a relatively rare but well-known anatomic variant that can be associated with other anomalies. While it usually remains clinically silent, the spur can be responsible for a wide spectrum of symptoms. We present 3 patients with fractures of the supracondylar process and review 12 other cases in the literature. The supracondylar process has potential for fracture and important neurovascular sequelae.
Mycoplasma hominis is normally a commensal of humans. When the organism is pathogenic, it primarily causes disease in the genitourinary tract. Septic arthritis caused by M. hominis is a rare condition that occurs chiefly in the postpartum period, in immunosuppressed hosts, or in patients who have recently undergone urinary tract manipulation. Arthritis caused by M. hominis is clinically indistinguishable from septic arthritis caused by other bacteria. Diagnosis is often delayed because infection with this organism is not suspected or because it grows slowly, if at all, in routine culture media. Appropriate therapy often leads to a good outcome, although relapses and resistance have been reported.
OBJECTIVE: The authors introduce thoracic intrathymic thyroid as a clinical entity. SUMMARY BACKGROUND DATA: Although accessory aberrant thyroid has not been found in other tissues in the mediastinum, a thoracic intrathymic location has not been described previously. It is believed that mediastinal thyroid tissue represents accessory ectopic tissue from the median thyroid anlage. Moreover, the close association of the thymus and thyroid supports the theory that mediastinal ectopic thyroid tissue develops from abnormal descent of these structures during embryogenesis. METHODS: Benign thoracic intrathymic thyroid lesions are described in patients with mediastinal masses. CONCLUSION: Thoracic intrathymic thyroid is a distinct entity. Its occurrence is supported both clinically and embryologically.
Five patients presented with classic symptoms diagnostic of intermittent claudication that were exacerbated by strenuous activity. Examination demonstrated localized tenderness over the lacertus fibrosus (bicipital aponeurosis), as well as increased pain and an obliterated radial pulse with forearm pronation and resisted elbow flexion. All 5 were athletes who had hypertrophied forearm muscles. Patients were diagnosed with brachial artery compression by the lacertus fibrosus. Release of the lacertus fibrosus restored normal pulses in all cases. Followup ranged from 6 months to 25 years. Full clinical recovery was achieved in 3 patients. One patient had a good result and 1 a fair result. Although the lacertus fibrosus has been well described as a cause of neural compression and compartment syndrome, it has been reported only once to cause intermittent arterial compromise. Hypertrophy of the muscles and the lacertus fibrosus related to excessive use is an important factor in the development of isolated vascular, neural, or combined neurovascular lesions.
Posterior interosseous nerve compression is a well-described clinical entity with many aetiologies. Fewer than 12 documented cases of the condition due to an enlarged bicipital bursa exist in the literature. We describe a case in which magnetic resonance imaging (MRI) was used in the preoperative assessment of a mass in the proximal forearm with a clinical diagnosis of partial posterior interosseous nerve compression.
We describe 4 patients who had episodic localized swelling of an extremity, 2 of the hand and 2 of the foot, in combination with peripheral eosinophilia and a biopsy characteristic of eosinophilic fasciitis (EF). Surgical excision produced marked improvement in the patients' symptoms. Whether these patients, despite a characteristic biopsy, can be included in the spectrum of EF remains uncertain.
The chondroepitrochlearis muscle is an extremely rare muscle, arising from the pectoralis major, crossing over the neurovascular bundle in the axilla and inserting into the brachial fascia and medial epicondyle of the humerus. This paper presents the first known neurological complication due to the chondroepitrochlearis muscle.
We present a newly described entrapment of the median nerve caused by compression in the distal arm because of an accessory bicipital aponeurosis. It is characterized by the paresis or paralysis of muscles innervated by the anterior interosseous branch of the median nerve--the flexor pollicis longus, the flexor digitorum profundus, and the pronator quadratus--as well as other more proximal median nerve innervated muscles, namely, the pronator teres and flexor carpi radialis. Sensibility is intact. The site of the Tinel's sign in the distal arm and the clinical appearance of an accessory bicipital aponeurosis help to localize the lesion. Electrodiagnostic studies are also important in establishing the site of the entrapment. The clinical and surgical findings are correlated with the internal topography of the median nerve at its site of compression. It is important to differentiate this syndrome from the classic anterior interosseous syndrome and other nerve entrapments at the elbow and arm. Surgical exploration is indicated if there is no clinical or electromyographic improvement in three to four months after the onset of symptoms.
A case of bilateral median nerve compressions in the distal arm is described. The patient was seen initially with the spontaneous onset of paresis of the anterior interosseous nerve innervated muscles, as well as more proximal median nerve innervated muscles. There was no shoulder-girdle weakness or sensory abnormality. No systemic symptoms were identified. Surgical exploration in each extremity revealed enlarged communicating veins directly compressing the median nerve in the distal arms. Clinical improvement began 6 months after operation and was complete by 18 months.
Carpal tunnel syndrome, a common and well-described clinical disorder, usually has been considered a chronic disorder with a fixed set of symptoms and typically affecting middle-aged women. Because of the many variations in its initial clinical manifestations, however, its diagnosis at times can be difficult. In this review, we describe nonclassic manifestations of carpal tunnel syndrome and discuss the differential diagnosis, the importance of electrodiagnostic studies, and treatment modalities.
Medial and lateral snapping (dislocation) of the distal triceps over the epicondyle during elbow flexion has been reported but is frequently misdiagnosed and is not well understood. In this study a mathematical model was designed to simulate the effect that bony abnormalities at the distal humerus and soft tissue variations of the distal triceps have on the line of pull of the triceps. The predictions were then tested on prefabricated and fabricated plastic elbow models, as well as 8 cadaveric elbows. When the bony alignment was altered, varus angulation had the greatest effect: 30 degrees varus malalignment of the distal humerus displaced the centroid of the triceps vector medially by approximately 2.0 cm. Valgus malalignment had a lesser effect: 30 degrees valgus displaced it laterally by 1.5 cm. Negligible effects on the triceps line of pull were seen with internal or external malrotation and with flexion or extension malalignment. Of the soft tissue alterations, displacement of the triceps insertion had a greater effect than movement of the triceps origin. The triceps vector was displaced by approximately 70% of the amount of translation of the triceps insertion. The relationship between the triceps line of pull and the bony alignment is represented by the triceps (T) angle. Our use of the T angle to understand snapping triceps is analogous to the use of the quadriceps (Q) angle for patellar subluxation/dislocation. Treatment should aim to restore normal triceps biomechanics with soft tissue or bony procedures.
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We report the case of a patient who presented with right arm and shoulder pain due to compression of the infraclavicular brachial plexus due to benign metastasizing leiomyomatosis (BML). She was initially and had been repeatedly misdiagnosed as having neurofibromatosis type 1 (NF 1). The diagnosis of BML was not obvious due to its rare nature, the patient's not detailing the specifics of her gynecologic history of having undergone resection of a large uterine leiomyoma and followed by disseminated pelvic leiomyomatous nodules, histologic misinterpretation of an extrauterine lesion of the spine and the brachial plexus as a neurofibroma and the radiologic diagnosis of lung nodules as being "non-specific" in nature. In addition and importantly, no clinical, radiographic or histologic features of NF 1 were present. Although a rare condition, BML should be considered in the differential diagnosis of NF and in patients having a history of uterine leiomyoma. The remarkable, selective involvement of the brachial plexus in this case is unexplained.