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PubMedDate not supplied

1,001 subclavian perivascular brachial plexus blocks: success with a nerve stimulator.

BACKGROUND AND OBJECTIVES: Among the supraclavicular approaches to the brachial plexus, the subclavian perivascular technique is a well-established method of anesthesia of the upper extremity. Ever since Kulenkampf described his technique, eliciting a paresthesia has been almost mandatory ("no paresthesia, no anesthesia"). Lately, nerve stimulators have become more popular. However, up to the present time, clinical studies involving the nerve stimulator have failed to show success rates comparable to paresthesia techniques. METHODS: Data from 1,001 consecutive, subclavian perivascular blocks were prospectively gathered over 2.5 years. All blocks were performed according to Winnie's technique, but using a nerve stimulator instead of a paresthesia. When an adequate response was obtained, 35 to 40 mL of local anesthetic solution was injected. RESULTS: Nine hundred seventy-three blocks (97.2%) were completely successful; 16 blocks (1.6%) were incomplete and needed supplementation; and 12 blocks (1.2%) failed and required general anesthesia, giving a success rate for regional anesthesia of 98.8%. CONCLUSIONS: The subclavian perivascular block consistently provides an effective block for surgery on the upper extremity. At the site of injection with this technique, the plexus is reduced to its smallest components and the sheath is reduced to its smallest volume, which explains in great part the success obtained with this block. We believe that we have demonstrated a nerve stimulator technique that is both highly successful and safe; no clinical pneumothorax was found nor did any other major complications develop.

Adolescent↗
PubMed2001

Patient-controlled interscalene analgesia with ropivacaine 0.2% versus bupivacaine 0.15% after major open shoulder surgery: the effects on hand motor function.

UNLABELLED: We compared the effects of patient-controlled interscalene analgesia with ropivacaine 0.2% and patient-controlled interscalene analgesia (PCIA) with bupivacaine 0.15% on hand grip strength after major open shoulder surgery. Sixty patients scheduled for elective major shoulder surgery were prospectively randomized to receive in a double-blinded fashion either ropivacaine or bupivacaine through an interscalene catheter. Before surgery, all patients received an interscalene block (ISB) with either 40 mL of 0.6% ropivacaine or 40 mL of 0.5% bupivacaine. Six h after ISB, the patients received a continuous infusion of either 0.2% ropivacaine or 0.15% bupivacaine for 48 h. In both groups, the PCIA infusion rate was 5 mL/h plus a bolus of 4 mL with a lockout time of 20 min. Strength in the hand was assessed preoperatively, 24 h, and 48 h after ISB and 6 h after stopping the infusion of local anesthetic. The presence of paresthesia in the fingers was checked. Pain relief was assessed using a visual analog scale; side effects were noted, and the patients rated their satisfaction 54 h after the block. A significant decrease of strength in the hand was observed in the Bupivacaine group 24, 48, and 54 h after ISB (P < 0.05). Paresthesia was more frequently reported in the Bupivacaine group for the second and third fingers 48 h after ISB (P < 0.05) and in the first three fingers 6 h after discontinuation of the local anesthetic infusion (P: < 0.05). The pain score was similar in the two groups at all times, and patient satisfaction was comparable between the two groups. We conclude that the use of the PCIA technique with ropivacaine 0.2% or bupivacaine 0.15% provides a similar pain relief after major shoulder surgery. However, ropivacaine 0.2% is associated with better preservation of strength in the hand and less paresthesia in the fingers. IMPLICATIONS: We compared the patient-controlled interscalene analgesia technique with ropivacaine 0.2% and bupivacaine 0.15% after major open shoulder surgery. For similar pain control ropivacaine is associated with better preservation of strength in the hand and less paresthesia in the fingers.

Adolescent↗
PubMed1998

Prospective, randomized comparison of deep or superficial cervical plexus block for carotid endarterectomy surgery.

BACKGROUND: Carotid endarterectomy may be performed under cervical plexus block with local anesthetic supplementation by the surgeon as necessary during surgery. It is unclear, however, whether deep or superficial cervical plexus block offers the best operating conditions or patient satisfaction. Therefore, the authors compared the two in patients undergoing carotid endarterectomy. METHODS: Forty patients undergoing carotid endarterectomy were randomized to receive either a superficial or a deep cervical plexus block with 20 ml bupivacaine, 0.375%. Outcomes subjected to statistical analysis included supplemental anesthetic supplementation with lidocaine, 1%, by the surgeon, dermatomes affected by the block, paresthesia during block placement, postoperative pain scores, and analgesic requirements. RESULTS: Median supplemental lidocaine requirements were 6 ml (range, 0.5 to 20 ml) in the deep block group and 6 ml (range, 0 to 20 ml) in the superficial block group (P = 0.7323). Patients in the deep block group who reported paresthesia during block placement required less lidocaine supplementation (median, 2; range, 0.5 to 20 ml) than the 9.5 ml (range, 6 to 15.5 ml) required by those who did not experience paresthesia (P = 0.0113). Compared with patients in the superficial block group, those in the deep block group were less likely to need analgesia in the first 24 h after operation (P = 0.047), and those who required analgesia received it later (6.6 +/- 4.1 vs. 3.9 +/- 1.4 h after operation; Student's t test, P = 0.02). One patient in each group expressed dissatisfaction with the technique. CONCLUSIONS: Carotid endarterectomy may be performed satisfactorily during superficial or deep cervical plexus block placement with no differences in terms of supplemental local anesthetic requirements, although this is influenced by whether paresthesia is elicited during placement of the deep block. Therefore, the clinician's decision to use one block rather than another need not be based on any assumed superiority of one block based on intraoperative conditions or patient satisfaction.

Aged↗
PubMed1996

Thalamic stimulation-evoked sensations in chronic pain patients and in nonpain (movement disorder) patients.

1. Little is known about the effect of central and peripheral nervous system injury on the processing of somatosensory information at the thalamic level in humans. The role of the human thalamic ventrocaudal nucleus (Vc) in nociception is not well understood because reports of nociceptive neuronal responses and stimulation-evoked pain are rare. In this study, we have characterized effects of microstimulation in the tactile region of Vc. Specifically, we investigated the incidence of painful sensations evoked by thalamic microstimulation in patients with and without chronic pain. 2. Data were obtained during stereotactic thalamic procedures for relief of pain or motor disorders. Patients were divided into three groups, those with 1) central poststroke pain (PSP, n = 13); 2) nonstroke pain (NSP, n = 23); and 3) movement disorders (controls, n = 24). Most (15 of 23) of the NSP patients had peripheral nerve damage. Tungsten microelectrodes were used to record neuronal responses in the thalamus and to deliver stimuli. Localization of tactile Vc was determined according to stereotactic coordinates and neuronal responses to innocuous somatic stimuli. At selected sites, microstimulation (1-s trains, 300 Hz, 0.1-0.2 ms pulses, < 100 microA) was performed and the patient was requested to describe the quality of the sensation and its peripheral location (projected field, PF). 3. Microstimulation in tactile Vc commonly evoked paresthesia-type sensations. Threshold stimulation never evoked pain in the NSP patients and evoked pain at only 2% of Vc sites in the movement disorder patients. In these latter 2 groups of patients, stimulation at > 98% of Vc sites evoked paresthesia. By contrast, in the PSP patients, 28% of Vc sites stimulated evoked painful sensations at threshold. Suprathreshold stimuli evoked painful sensations at 46% of Vc sites in the PSP patients but at only 8% of Vc sites in NSP patients and 12% of Vc sites in the movement disorder patients. 4. The thresholds to evoke paresthesia in the NSP and movement disorder patients were significantly lower than the thresholds in the PSP patients. However, stimulation thresholds to elicit pain were similar in all patient groups. 5. All patients were capable of differentiating stimulation-evoked paresthesia from pain. Stimulation-evoked painful sensations in the PSP patients were often described as burning and sometimes as "sharp," "shocking," or "unpleasant." By contrast, the quality of pain evoked in the other patient groups was typically described as unpleasant or shocking. Pain could be evoked at sites throughout tactile Vc, although most sites were located in the ventral 2/3 of the nucleus. 6. In the movement disorder patients, the location of the projected sensation usually corresponded to the location of the receptive fields of the tactile neurons recorded at the same site. By contrast, in both groups of pain patients there was a high incidence of mismatches between the projected and receptive fields. 7. These results suggest that the effective thalamic output from Vc to the cortex is affected by somatosensory deafferentation in pain patients. In addition, in the PSP patients there are also changes in the thalamocortical processing of noxious information. The increased incidence of thalamic-evoked pain in PSP patients may be due to 1) loss of low-threshold mechanoreceptive thalamic neurons such that nociceptive neuronal output is now prominent, 2) reduced tonic inhibition of thalamic or cortical nociceptive neurons, and/or 3) unmasking or strengthening of nociceptive pathways.

Cerebrovascular Disorders↗
PubMedDate not supplied

[Diagnosis of peripheral neuropathies: a clinical and neurophysiological study].

INTRODUCTION: The diagnosis of peripheral neuropathy is based on clinical and neurophysiological features. This study aims to establish the diagnostic validity of different symptoms and clinical signs, as well as its correlation with electroneurography (ENG), to determine its sensitivity (SE), specificity (SP), positive (PLR) and negative likelihood ratio (NLR) for every peripheral neuropathies type. PATIENTS AND METHODS: A sample of 108 patients with clinical suspicion of peripheral neuropathy (pain, paresthesias, loss of strength, areflexia) was studied. ENG (nerve conduction velocity and response amplitude values in 208 nerves [Median and Posterior Tibial]) was used to confirm the diagnosis, classifying the sample in axonal group (A), demyelinating (D) and normal (N). It was made descriptive statistics of this sample, studies of SE, SP, PLR and NLR of symptoms, and association (contingency tables [Chi square] and Odds Ratio) between symptoms and clinical features. RESULTS: The patients with paresthesias, loss of strength or pathologic reflexes have larger motor latency (p< 0.01). Those with paresthesias, areflexia or pain have fewer sensitive conduction velocity (p< 0.05). Symptoms's value for sensory damage's diagnosis is (SE= 0.92, SP= 0.48, PLR= 1.78, NLR= 0.14). For motor damage (SE= 0.72, SP= 0.68, PLR= 2.25, NLR= 0.41). For axonal damage (SE= 0.83, SP= 0.44, PLR= 1.49, NLR= 0.37). And for demyelinating damage (SE= 0.92, SP= 0.44, PLR= 1.66, NLR= 0.16). CONCLUSIONS: The symptoms's combination is much more sensitive and has fewer NLR than each isolated symptom in all neuropathic damage's types. Paresthesias's presence is more indicative of sensory damage and loss of strength of motor damage. Pain is the only symptom that can aim for axonal damage than demyelinating.

Cross-Sectional Studies↗
PubMed2003

An increased frequency of carpal tunnel syndrome in sarcoidosis. Results of a study based on nerve conduction study.

Sarcoidosis is a systemic disease which affects the musculoskeletal system; however, its association with carpal tunnel syndrome (CTS) has been reported only rarely. In our study, we tried to determine the prevalence of CTS in our consecutive sarcoidosis patients based on their symptoms and nerve conduction study (NCS). Fifty-six patients (mean age: 45.2) who were followed up with the diagnosis of sarcoidosis at our center and who gave informed consent for NCS were included into the study. The patients were questionned for the presence of hand symptoms: paresthesia, pain, nocturnal paresthesia and/or pain, and, they underwent NCS. Ten (17.9%) patients had recurrent paresthesia, 12 (21.4%) had pain, and 8 (14.3%) had nocturnal paresthesia and/or pain. The results of NCS showed that 41% of the patients had findings compatible with CTS. Extrapulmonary involvement was significantly more frequent in these patients when compared to patients without CTS (p=0.04). Also, patients with CTS were older than the others and CTS-associated symptoms were more frequent in them although this was not significant (p>0.05). In this study, by performing NCS we detected quite a high prevalence of CTS in our sarcoidosis patients. The fact that most of the patients were asymptomatic was interesting.

Adult↗
PubMedDate not supplied

Sites of action of subarachnoid lidocaine and tetracaine: observations with evoked potential monitoring during spinal cord stimulator implantation.

BACKGROUND: The precise sites of action of local anesthetics on the spinal cord remain speculative. Monitoring spinal cord conduction during spinal anesthesia may provide a more precise localization of anesthetic action. METHODS: Fifteen patients admitted for elective surgical implantation of spinal cord stimulators for treatment of chronic pain participated in the study. Lidocaine (mean dose, 90 mg) was used in 14 patients; one patient received 7.5 mg tetracaine. To assess spinal cord conduction, paresthesias elicited by spinal cord stimulation were monitored during onset and maintenance of spinal anesthesia. In eight patients, evoked potential monitoring was used to further assess cord conduction. RESULTS: Despite complete motor block of the lower extremities and sensory levels to upper thoracic dermatomes (T1-8), all patients felt trial stimulator-induced paresthesias during spinal anesthesia. In addition, cortical evoked potentials from cord stimulation were maintained during spinal anesthesia. However, attenuation of cortical evoked potential amplitudes and paresthesias occurred, which were restored by increasing stimulus intensity. In contrast, even at maximum stimulus intensity, paresthesias and somatosensory evoked potentials from tibial nerve stimulation were abolished during spinal anesthesia. CONCLUSION: Based on these observations, the predominant site of action of subarachnoid lidocaine and tetracaine appeared to be at spinal rootlets, although partial block of afferent cord conduction also occurred.

Adult↗
PubMed1980

Late-life migraine accompaniments as a cause of unexplained transient ischemic attacks.

Occasionally patients in the stroke age-bracket over 40 have unexplained transient cerebral ischemic attacks in association with normal cerebral angiograms. From this group 120 have been collected in whom the transient episodes resembled the neurological accompaniments of migraine. According to symptoms, the patients were categorized as follows: Visual accompaniments (patients with only ordinary scintillating scotoma were excluded), 25; visual and paresthesias, 18; visual and speech disturbance, 7; visual, and brain stem symptoms, 14; visual, paresthesias, and speech disturbance, 7; visual, paresthesias, speech disturbance and paresis, 25; recurrence of old stroke deficit, 9; miscellaneous, 8. In establishing the diagnosis angiography is advisable in all but classical cases. Typical of migrainous accompaniments are the buildup and migration of visual scintillations, the march of paresthesiae, and progression from one accompaniment to another, characteristics that do not occur in thrombosis and embolism. Diagnosis facilitated when 2 or more similar episodes have occurred or migraine-like scintillations are present. Headache occurred in 50% of cases. Other cerebrovascular processes, coagulation disorders, and cerebral seizures must be ruled out.

Adult↗
PubMed1997

[A case of Guillain-Barré syndrome treated with plasma exchange and intravenous high-dose immune globulin].

We describe a 69-year-old female with Guillain-Barré syndrome (GBS) whose paresthesia and weakness improved after plasma exchange (PE) and intravenous high-dose immune globulin (i.v.I.G.). She felt a paresthesia in her right arm, and 7 days later she noticed right arm weakness followed by gait disturbance within 2 days. She received a series of 6 PEs, but paresthesia and weakness did not improve. Following the last PE trial of this series, she was treated by i.v.I.G. (0.4 g/kg) for 5 days. After i.v.I.G., paresthesia and weakness improved in a few days. After 2nd series of 6 PEs, she was able to walk. In this clinical course, the treatment of i.v.I.G. after PE seemed to be effective. This case raises the possibility that i.v.I.G. might be the treatment in GBS patients with insufficient effect of PE.

Aged↗
PubMed2006

Nerve conduction and sensorineural function in dental hygienists using high frequency ultrasound handpieces.

BACKGROUND: Oscillatory vibration from industrial power tools poses a well-recognized risk of peripheral nerve injury. There have been reports of elevated vibrotactile perception thresholds (VPT) among dentists, dental technicians, and dental hygienists, using rotary devices and ultrasonics. Elevated VPTs are an indicator of small fiber nerve or mechanoreceptor injury, but the high frequencies associated with dental instruments are presumed by the ISO to exceed physiological response upper thresholds. This study examines nerve conduction and sensorineural deficits in dental hygienists. METHODS: A cross-sectional study of 94 experienced dental hygienists was conducted to assess peripheral nerve function and clinical signs and symptoms. Specialized testing included measurement of VPTs for three different categories of mechanoreceptors, sensory nerve conduction tests with fractionated digit and palmar segments, and measurement of calibrated pinch force with force sensitive resistors (FSRs) during a simulated procedure. RESULTS: Chronic hand paresthesias were described by 44.7% of experienced dental hygienists. Sensory nerve conduction velocity (SNCV) across the wrist-palm segment of the median nerve. VPTs were particularly elevated at the FAII mechanoreceptor among experienced dental hygienists. Compared to participants without carpal tunnel syndrome (CTS), as defined by study criteria, 14 experienced hygienists with diagnosed CTS had almost twice the average weekly use of vibratory instruments -8.3 hr versus 4.5 hr, and had SNCV deficits along the digit -47.11 m/sec (+8.70) versus 42.57 m/sec (+8.25), and across the wrist -44.04 m/sec (+7.15) versus 41.36 m/sec (+9.27). There was a distinct subset of dental hygienists (27%) with a combination of low calibrated pinch force in simulations, subjective loss of strength and elevated VPTs, especially in the FAII mechanoreceptor population -110.82 db (+8.57) versus 104.84 db (+6.80) in the rest of the cohort. This subset also had a higher prevalence of paresthesias (67% vs. 39%) and greater cumulative vibration exposure (OR = 1.206 [CI 1.005-1.448]), than other hygienists. CONCLUSIONS: The high levels of paresthesias observed among dental hygienists appear to be attributable to several pathophysiological mechanisms, including, sensory nerve demyelination at the carpal tunnel and intrinsic to the digits, and dysfunction of fingertip mechanoreceptors. A distinct sub-population appears to exhibit a high level of accumulated abnormality.

Adult↗
PubMed1995

Significance of the spinal cord position in spinal cord stimulation.

The effects of the antero-posterior and medio-lateral positions of the spinal cord in the dural sac on the perception threshold and paresthesia coverage in spinal cord stimulation were analyzed. The distributions of the dorsal cerebrospinal fluid (CSF) layer thickness, measured from transverse MR scans of normal subjects at various spinal levels, were used to calculate the distributions of threshold voltages for the stimulation of spinal nerve fibers by a computer model. These theoretical threshold distributions were shown to fit well to the corresponding distributions of perception threshold measured in patients. It is concluded that the thickness of the dorsal csf layer is the main factor determining the perception threshold and paresthesia coverage in spinal cord stimulation: an increasing thickness raises the threshold and reduces the coverage, and vice versa. The effects of an asymmetrical electrode position with respect to the spinal cord midline were also analyzed by computer modeling. It is concluded that a lateral asymmetry of less than 1 mm gives a significant reduction of perception threshold and may result in unilateral paresthesiae.

Adult↗
PubMed2002

Prevalence of carpal tunnel syndrome in patients with fibromyalgia.

This study was planned to investigate the prevalence of carpal tunnel syndrome (CTS) in patients with fibromyalgia (FM) and the normal population. Paresthesia in the hands, sensory and motor deficits, and atrophy of the thenar muscles of 50 patients with FM and 50 matched control subjects were evaluated. Tinel's and Phalen's signs and bilateral electrophysiological studies of the median nerves were performed. The differences between the groups in terms of paresthesia (13 FM patients, two control subjects, P<0.01) and sensory deficits (four FM patients, 0 control subjects, P<0.05) were statistically significant. In the FM and the control groups, a total of five (10%) and two (4%) cases of CTS were documented electrophysiologically, respectively. However, the difference between the groups in CTS prevalence was not statistically significant ( P>0.05). In conclusion, paresthesias are a common symptom and associated condition of FM patients. Together with sensory deficits in the hands, they should remind the physician of the possibility of undiagnosed CTS.

Adult↗
PubMed1998

Neurological and functional effects of short-term exposure to hand-arm vibration.

OBJECTIVE: The aim of the present study was to quantify the sensory and functional effects resulting from a short-duration (30 min) exposure to hand-arm vibration. SUBJECTS AND METHODS: Nine subjects went through nine laboratory experiments. For 32 min they grasped a handle vibrating at three different amplitudes (5, 20, and 80 ms-2) and at three frequencies (31.5, 125, and 500 Hz). Additionally, a reference experiment was conducted in which the handle did not vibrate. Three sensory tests [vibration perception threshold (VPT), pressure perception threshold (PPT), and distal sensory latency time (DSL)], two functional tests [Purdue peg-board (PPB) and maximal voluntary force (MVF)], and a questionnaire concerning the perceived paresthesia and numbness were completed before, during, and after exposure. RESULTS: A 32-min period of exposure to vibration leads to a temporary threshold shift (TTS) of the VPT and to the development of paresthesia and numbness. The VPT appears to vary with the exposure duration according to a first-order model with a time constant about equal to 3 min. The TTS increases with the vibration acceleration amplitude and is greater for an exposure frequency of 125 Hz than for that of 31.5 or 500 Hz. It is also greater at the test frequency 125 Hz than at 31.5 Hz. The other tests do not demonstrate any significant variation. In particular, the PPB test does not demonstrate any loss of dexterity. CONCLUSION: After some 30 min of exposure to vibration the VPTs are increased and paresthesia and numbness develop. However, these do not appear to influence significantly the capacity or performance at work.

Adult↗
PubMed1983

Alterations of facial sensitivity induced by percutaneous thermocoagulation for trigeminal neuralgia.

Sixty patients with essential trigeminal neuralgia underwent selective percutaneous thermocoagulation of the gasserian ganglion. Immediate and long-term modifications of pain and tactile facila sensitivity, recurrences of pain, and occurrences of facial paresthesias were evaluated. Pin-prick and von Frey hair tests and somatosensory-evoked potentials were used to study facila sensitivity. Patients with mild alterations of sensitivity-treated with low temperatures of coagulation (60 degrees-70 degrees C)--had a lower incidence of paresthesias, although a higher risk of recurrence. Patients with severe alterations of sensitivity--a consequence of a temperature of coagulation above 70 degrees C--had a high incidence of paresthesias and a low risk of recurrence. In our opinion, the first kind of results are better.

Adult↗
PubMed2005

Advancing an epidural catheter 10 cm then retracting it 5 cm is no more effective than advancing it 5 cm.

STUDY OBJECTIVE: To determine whether threading an epidural catheter 10 cm then retracting it 5 cm affects its intravascular placement and paresthesias. DESIGN: Prospective randomized study. SETTING: Labor and Delivery Unit, University Medical Center. PATIENTS: Eighty parturients. INTERVENTIONS: All patients received epidural anesthesia. Patients were randomized to 1 of 2 groups: threading the epidural catheter 5 cm (5-cm group) or threading the epidural catheter 10 cm and retracting 5 cm (10-cm group). In the 10-cm group, the epidural catheter was threaded 10 cm and pulled back 5 cm. In the 5-cm group, the epidural catheter was threaded 5 cm. MEASUREMENTS AND MAIN RESULTS: Placement of the epidural catheter intravascularly, the presence of a paresthesia, and bilateral sensory levels were measured. There was no difference in the frequency of intravascular placement between 10- and 5-cm groups, 10.2% vs 7.5%, respectively. Although not statistically significant, there was a trend toward a higher frequency of paresthesia in the 10-cm group, 15.4% vs 7.5%, and a lower frequency of uneven sensory levels in the 10-cm group, 15% vs 2.6%. CONCLUSIONS: There is no clear clinical benefit or disadvantage to threading an epidural catheter 10 cm into the epidural space then withdrawing it 5 cm. Further study is warranted.

Adult↗
PubMed2005

Radiographic proximity of the mandibular third molar to the inferior alveolar canal.

OBJECTIVE: To determine the panoramic radiographic distance from the mandibular third molar tooth to the inferior alveolar canal. STUDY DESIGN: Five hundred sixty mandibular third molars were evaluated by panoramic radiography. The teeth were grouped into erupted vs unerupted and further subdivided by tooth angulation. The distance from the most inferior aspect of the mandibular third molar tooth to the superior border of the inferior alveolar canal was measured with digital calipers. A t test was performed to compare erupted and unerupted teeth, and ANOVA was used to determine if a significant difference exists based upon tooth angulation. A record review was performed to assess the incidence of inferior alveolar nerve paresthesia based upon measured distances. RESULTS: The mean distance from erupted mandibular third molar teeth to the inferior alveolar canal is 0.88 mm. This distance was significantly different from unerupted teeth (P=.002). The mean values for unerupted teeth indicated that the most inferior portion of all teeth measured was below the superior border of the canal (negative values) as follows: mesioangular (-0.97 mm), vertical (-0.61 mm), distoangular (-0.31 mm), and horizontal (-0.24 mm). The position of mesioangular impactions were significantly different than all other impaction groups (P=.0125). The incidence of inferior alveolar nerve paresthesia was 3.33% (18/541), most commonly associated with mesioangular impactions (-0.66 mm) in female patients. CONCLUSIONS: Unerupted mandibular third molar teeth are closer to the inferior alveolar canal than are erupted teeth. Mesioangular mandibular third molar impactions are most closely positioned to the inferior alveolar canal, and this may represent an independent risk factor for postoperative paresthesia.

Adult↗
PubMed1997

Unusual sensory disturbance in the thoracic region after stroke: relationship to cheiro-oral and cheiro-oral-pedal syndrome.

Three patients with unusual unilateral sensory disturbances in the thorax, in addition to hand and mouth, hand and foot, and hand, mouth and foot regions, respectively, after stroke, are described. Magnetic resonance imaging (MRI) showed a causative lesion in the ventral posteromedial and ventral posterolateral nucleus of the contralateral thalamus in two patients and the contralateral thalamocortical projections in one patient. Symptoms in three patients were due to infarction. Objective sensory loss was not found, but subjective paresthesia was observed in the thorax, in addition to the hand and mouth, hand and foot, and hand, mouth and foot regions, respectively. Paresthesia recovery time was evaluated in these three patients in addition to seven patients with cheiro-oral syndrome and eight patients with cheiro-oral-pedal syndrome. All thirteen patients who demonstrated recovery showed regional improvement of paresthesia in the following sequences: thorax, foot, mouth and then hand, which suggests that the detection threshold, from highest to lowest, occurs in the following sequences: thorax>foot>mouth>hand. These three cases with thoracic sensory disturbance form the explanatory links between the cheiro-oral syndrome and the cheiro-oral-pedal syndrome; cases with sensory disturbance in the hand, mouth, foot or thorax could be regarded as cases of sensory hemisyndrome in which the subjective experience of symptoms was restricted to the hand, mouth, foot or thorax. These symptoms may possibly be attributable to differential detection thresholds.

Aged↗
PubMed1995

[Vasomotor disorders of the hand and carpal tunnel syndrome].

Clinical electrophysiological and chronothermodynamic examinations were performed on 71 patients with paresthesiae and pain of the hands. In 35 patients, the electromyographic examination confirmed the diagnosis of carpal tunnel syndrome on the basis of clear signs of chronic compression of the median nerve at the carpal tunnel. In the other 36 patients, the electro-physiological findings were normal. Twenty-nine patients with bilateral (n = 24) or unilateral (n = 5) carpal tunnel syndrome, and 29 patients without, this syndrome had chronothermodynamic abnormalities demonstrating the vascular origin of the disorders of the hands; in 18 patients, a Raynaud's syndrome was suspected on the basis of severe dysthermia. In 7 patients, the origin of pain and paresthesiae remained unknown. This study shows that (i) vascular disorders of the hand are very frequent in patients with paresthesiae and pain of the hands and may mimic a carpal tunnel syndrome, and (ii) clinical examination is insufficient to assess the diagnosis of carpal tunnel syndrome. Before deciding on any kind of therapy, this diagnosis has to be assessed on electrophysiological and chronothermodynamic examinations performed according to precise protocols.

Adult↗