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PubMed1991

Partial median nerve entrapment in the distal arm because of an accessory bicipital aponeurosis.

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.

Adult↗
PubMed1990

[A case of delayed radiation lumbo-sacral plexopathy].

We report a 47-year-old woman who developed a slowly progressive lumbosacral plexopathy with mixed sensorimotor losses in the lower extremities. The symptoms were apparent 8 years after x-ray irradiation for an ovarian carcinoma. Neurological examination showed mild weakness and absent deep tendon reflexes of bilateral lower extremities, and hypesthesia to all modalities in anterior aspects of bilateral lower thighs, in dorsum pedis and soles. Extensive investigations regarding the possibility of tumor recurrence were negative. Computed tomography of pelvis showed abnormal soft tissue densities around the lumbosacral plexus. Intravenous pyelography showed bilateral hydronephrosis and narrowed ureters at the first sacral vertebra level. These findings are consistent with radiation-induced fibrosis rather than tumor infiltration. The results suggest the entrapment lumbosacral plexopathy due to surrounding fibrosis after irradiation. We speculated the sensorimotor losses caused by entrapment of the lumbosacral plexus.

Female↗
PubMed2005

[Popliteal vein entrapment in patients with unspecific symptoms of venous insufficiency].

Popliteal vein entrapment must be taken in consideration in patients with symptoms of venous insufficiency. Leg edema, swelling, calf pain, and muscle cramps are all unspecific signs. Most patients thus far have presented with deep vein thrombosis or chronic venous insufficiency. Popliteal entrapment syndrome must be taken into account in younger patients in whom predisposing factors are absent and chronic calf swelling is notable. Diagnosis is easily confirmed by noninvasive stress testing with duplex imaging and pencil Doppler probe placed over the posterior tibial artery. Additionally, digital subtraction angiography with the foot in neutral and dorsi plantarflexion is recommended for arterial entrapment. Surgery is advisable for treatment and can be done without significant morbidity. In asymptomatic patients, we suggest using the term "popliteal vein entrapment phenomenon." We describe different etiologies of popliteal vein entrapment in three cases and present a review of the literature.

Adult↗
PubMedDate not supplied

A light and ultrastructural study of rice bodies recovered from a case of date thorn-induced extra-articular synovitis.

Rice bodies are most commonly found in inflammatory joints of patients with rheumatoid arthritis and have traditionally been considered to be a nonspecific response to inflammatory synovial disease. In the present study 18 rice bodies were found in the tibialis tendon sheath of a nine-year-old Omani boy subsequent to a date thorn injury. The rice bodies consisted of three major components: fibrin, collagen, and fibroblasts. In contrast to the findings of other authors there were no type A, B, or C synoviocytes, cartilage, or vascularisation of the rice body. At this extra-articulate site it would appear that rice bodies are composed chiefly of fibrin and that the fibrosis of the rice body occurs as a result of the entrapment of fibroblasts, which subsequently produce collagen. These findings shed doubt on the synovial origin of rice bodies and suggest that rice bodies may have multiple origins, depending on their location. This is the first ultrastructural study of rice bodies associated with a date thorn injury.

Child↗
PubMed1989

[Popliteal artery entrapment syndrome in our experience].

Six cases of popliteal entrapment syndrome are presented with emphasis on the diagnostic difficulties related to this disease in its initial functional phase. The utility of Doppler ultrasonography associated with dynamic angiography is underlined. Normally surgical treatment of the disease is problem-free. The important determining factor seems to be medial gemellus hypertrophy. In this case the procedure of choice is thought to be vascular reconstruction associated with the disinsertion of this muscle followed by its reimplantation in a lower and medial position on the semi-membranous tendon muscle in order to avoid any secondary arterial compression.

Adult↗
PubMed1999

Anterior hip pain.

Anterior hip pain is a common complaint with many possible causes. Apophyseal avulsion and slipped capital femoral epiphysis should not be overlooked in adolescents. Muscle and tendon strains are common in adults. Subsequent to accurate diagnosis, strains should improve with rest and directed conservative treatment. Osteoarthritis, which is diagnosed radiographically, generally occurs in middle-aged and older adults. Arthritis in younger adults should prompt consideration of an inflammatory cause. A possible femoral neck stress fracture should be evaluated urgently to prevent the potentially significant complications associated with displacement. Patients with osteitis pubis should be educated about the natural history of the condition and should undergo physical therapy to correct abnormal pelvic mechanics. "Sports hernias," nerve entrapments and labral pathologic conditions should be considered in athletic adults with characteristic presentations and chronic symptoms. Surgical intervention may allow resumption of pain-free athletic activity.

Adolescent↗
PubMed1997

[Fundamentals, possibilities and limitations of sonography of osteofibrous tunnels in the shoulder area. 2].

In the second part of this study on osteo-fibrous pathways within the shoulder region, new ultrasound (US) possibilities for showing these tunnels are described. Following two pilot studies (clarifying the choice of transducers and frequencies, relevance of US-related measurements), 97 volunteers were investigated bilaterally (57 women and 40 men, aged between 18 and 39). The normal sonoanatomy for areas which had not been explored by US for the most part is demonstrated, as are the limits and pitfalls of this method. Types of scapular notches as determined in part one have been confirmed by US. Type V (with a "partially ossified ligament") was hardly ever found in the sample, whereas a true foramen could not be observed at all. Neither of these have any influence on the development of a "scapular notch syndrome", according to the results of this study. As expected from anatomical observations, a very narrow nerve passage was usually associated with type II ("shallow") and type IV ("V-shaped") scapular notches. These types should be regarded as a potential threat to the suprascapular nerve. When identifying the parameters (16 in all), care was taken to see that they approximated to those of the basic anatomical investigation. There was a good match between measurement results in both parts of this study. In addition, there were no significant differences of data between the two sides (even in the same individual). In contrast, women showed significantly lower values for the following measurements: width and depth of the spinoglenoid notch, width and depth of the intertubercular groove, breadth and thickness of the long head of the biceps brachii, and thickness as well as length of the coracoacromial ligament. Comparable data from the sonographic literature are only available for the long head of the biceps brachii. The calculated mean thickness of this tendon is 2.5 mm, thus being far lower than the results previously reported. Overall, US can be regarded as a very precise and reliable method for evaluating the osteo-fibrous passages within the shoulder region. Normal sonoanatomy and standard values of the structures mentioned can be used as a basis for resolving diagnostic problems. The author considers that US, as a prelude to more sophisticated imaging techniques, provides a significant non-invasive contribution to the checking of pre-existing factors or alterations at an early stage of entrapment syndromes of the shoulder.

Adult↗
PubMed1986

Chronic sesamoiditis of the thumb: pathomechanics and treatment.

Entrapment of the sesamoids within the metacarpophalangeal joint can result in irreducible dislocations; however, dysfunction from trauma-induced, chronic sesamoiditis is unfamiliar. Twenty-five patients with intractable posttraumatic pain of the metacarpophalangeal joint of the thumb are reported. The mechanisms of the palmar plate injury included hyperextension, direct compression, shear forces, and lateral stress. Sesamoidectomy achieved good results in 80% of patients as evidenced by return to preinjury activities. Residual joint stiffness was present in 20% of patients, and 8% had significant residual pain. Traumatic microtears appear to produce pathologic findings in the perisesamoid tendon and/or sesamoid-metacarpal articulation.

Chronic Disease↗
PubMed1991

Saphenous nerve entrapment caused by pes anserine bursitis mimicking stress fracture of the tibia.

Numerous studies have addressed saphenous nerve entrapment at the level of the adductor canal. In this case, we report an entrapment syndrome located further distally occurring as part of an athletic overuse injury. Distal tibial pain, initially managed as a stress fracture, resolved when a pes anserine bursitis was treated. This was associated with return of saphenous nerve potentials along the tibia.

Adult↗
PubMed2007

Axillary arch in Bulgarian population: clinical significance of the arches.

In order to study the incidence of the axillary arch in the Bulgarian population, we examined the axillary regions of 56 formol-carbol fixed human cadavers and observed two cases with a unilateral axillary arch. In the first case, the variant structure was situated on the right side of a 58-year-old female cadaver. The axillary arch extended from the lateral border of the latissimus dorsi to the posterior layer of the pectoralis major tendon. In the second case, the axillary arch was found on the left side of a 63-year-old male cadaver and had the same attachment points as in the first case. The innervation and blood supply of the arches are discussed. We have also reviewed extensive information concerning the clinical importance of the axillary arch, and for the first time, it was summarized clearly for clinicians. The summary consists of three parts: "diagnosis" of the axillary arch by physical investigation or imaging techniques; the axillary arch and surgical interventions in the region of the axilla; the axillary arch as an entrapment site for the axillary vessels and nerves.

Axilla↗
PubMed1996

Non-traumatic paralysis of the posterior interosseous nerve.

We treated 31 patients with non-traumatic paralysis of the posterior interosseous nerve over 15 years. There were 10 men and 21 women of mean age 40.3 years (17 to 71). Six were managed conservatively, and 25 by operation. In 14 patients entrapment occurred at the supinator, including three who had double compression at both the entrance and exit from the muscle. In four it was caused by a ganglion, in one by a lipoma, in one by a dislocated radial head and in two by a marked constriction in the nerve of unknown cause. The remaining three patients were retrospectively diagnosed as having neuralgic amyotrophy, the only observable change at operation being slight oedema of the nerve. Paralysis recovered in 24 out of the 25 patients at between 2 to 18 months (mean 5.6) after operation, and the one failure was treated later by tendon transfer.

Adolescent↗
PubMedDate not supplied

Endoscopic decompression for intermetatarsal nerve entrapment--the EDIN technique: preliminary study with cadaveric specimens; early clinical results.

The authors have developed an endoscopic approach to the surgical treatment of Morton's neuroma. This technique is based on the premise that the condition is primarily a nerve entrapment disease. As with other endoscopically assisted procedures, the authors believe that this technique will be less traumatic, allowing an earlier return to normal activity, with less patient discomfort than with traditional surgical techniques.

Dissection↗
PubMed1987

[Entrapment syndrome of the superficial posterior sural aponeurosis].

The development of a large circumscribed area of myositis ossificans at the junction of the aponeurosis of the tendo Achilles and the calf muscles may cause compression of the lateral saphenous nerve beneath the tight aponeurotic arch. The condition is usually encountered in athletes. Plantar flexion of the ankle will produce pain and diminution of sensation in the area served by the nerve. Treatment is by section of the tight band.

Achilles Tendon↗
PubMed2004

Worsening myelopathy masked by peripheral nerve disorders.

BACKGROUND/OBJECTIVE: Peripheral nerve disorders--whether due to peripheral nerve entrapment or to polyneuropathy--can alter the signs of myelopathy, masking both the sensory loss and distal hyperreflexia. Diagnosis of worsening myelopathy may be missed when there is a coexisting peripheral nerve disorder. METHODS: This study is a case description and analysis of 3 consecutive cases identified over 2 years. RESULTS: Three cases were identified in which the diagnosis of worsening myelopathy was missed and treatment was delayed because neurologic decline was attributed to a coexisting peripheral nerve disorder. This report describes 2 cases of posttraumatic syringomyelia masked by superimposed peripheral nerve entrapments and 1 case of cervical myelopathy due to cervical spinal stenosis from ossification of the posterior longitudinal ligament masked by diabetic polyneuropathy. CONCLUSION: It is important to continually question whether the working diagnosis of peripheral nerve disorder explains the clinical findings, given neurologic decline; or whether a superimposed worsening myelopathy may coexist. Early diagnosis of worsening myelopathy is important, because prompt treatment of syringomyelia and myelopathy due to cervical spinal stenosis may yield better outcomes. Early diagnosis is aided by (a) considering alternative and multiple diagnoses, (b) assessing spinothalamic as well as posterior column sensation and assessing these sensory modalities for proximal as well as distal limbs, (c) assessing tendon hyperreflexia of proximal as well as distal limb muscles, and (d) utilizing electrodiagnostic tests that can identify myelopathy.

Adult↗
PubMed1993

Functional study of hands among patients dialysed for more than 10 years.

Sixty-six haemodialysed (HD) in centre patients (24 h/m2/week, acetate bath, cuprophane membrane), with a mean age of 59.2 years, treated for 16.7 +/- 4.5 years, underwent clinical examination of their hands to determine anatomical and functional alterations. For each hand a functional score was calculated from a medicolegal technique based on sensitivity and angulation amplitude (rating from 0 to 100). Dialysis-related arthropathy (DRA), including carpal-tunnel (CT) syndrome, was scored as well as hand muscle amyotrophia. Trigger fingers, abnormal synovial hypertrophy, and one or more non-functional tendons were found in 15, 26, and 33% of the patients respectively. Thirteen percent had pseudoporphyria. Amyotrophy was moderate or severe in 39%. The global functional score (mean of the two unilateral functional scores) decreased with time spent on haemodialysis and was correlated with the DRA score. The unilateral functional score was linked to tendinous lesions, amyotrophy, and presence of pulses, but not to CT surgery or presence of AV fistula. Hands with ulnar insult at the elbow shown by electromyography had significantly lower functional scores. Repercussions of hand functional alteration may have an important social and psychological impact in daily life. The responsibility of amyloidosis is evidenced by tendinous lesions and nervous entrapment. Ulnar palsy is also important because of the vital motor role of that nerve in hand function.

Aged↗
PubMed1995

Musculocutaneous nerve entrapment: a case report.

Atraumatic isolated musculocutaneous nerve problems are uncommon but have been cited in the literature with increasing frequency since the initial cases discussed in 1978. There appear to be two clinically distinct syndromes involving this nerve--a lesion of the musculocutaneous before its division into the lateral cutaneous nerve, causing a mixed motor and sensory syndrome, and a lesion of the sensory portion, which causes pure sensory findings of the lower radial aspect of the volar forearm. The diagnosis of the more proximal lesion is made by the findings of biceps weakness with no deltoid or other muscle involvement, with the possible exception of the coracobrachialis. There may also be a small area of numbness on the radial aspect of the distal volar forearm, which can be missed unless careful examination is carried out. The lateral cutaneous nerve syndrome is characterized by numbness in the radial half of the volar forearm with some diffuse tenderness over the elbow crease just lateral to the insertion of the biceps tendon. Treatment of the mixed lesion is based on absolute rest for a period of 8-12 weeks. Treatment of the lateral cutaneous nerve syndrome is based on small studies but has included splinting, cortisone injections, and decompression of the nerve.

Action Potentials↗
PubMed1994

[Differential surgical therapy of popliteal entrapment syndrome 1967 to 1992].

From 1967 to 1992 at the University Hospital of Zurich 16 patients (14 male, 2 female) with 22 popliteal artery entrapment syndromes underwent a surgical treatment. In this period several different operation procedures were used. The modern operative procedure depends on the degree of the arteries wall compression. The procedure of choice for minimal compression of arterial wall is a musculo-tendinous decompression with a medial replacement of the popliteal artery. In the cases of severe compression we used autologous venous bypass from femoropopliteal I to popliteal III.

Adult↗