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PubMed2002

Cubital tunnel syndrome associated with medial elbow Ganglia and osteoarthritis of the elbow.

BACKGROUND: Medial elbow ganglia have been reported in association with cubital tunnel syndrome. This lesion is thought to occur rarely and has not been emphasized in the literature. The purposes of the present study are to report our experience with this lesion in order to elucidate its prevalence as well as its clinical and radiographic features, to describe our operative findings, and to present the results of surgical treatment. METHODS: Four hundred and eighty-seven elbows in 472 patients were treated for cubital tunnel syndrome between 1980 and 1999. We performed a retrospective study of the thirty-eight patients who had a medial ganglion. All of the ganglia were excised, and the ulnar nerve was translocated subcutaneously. Thirty-two patients were followed for a mean of thirty-seven months. RESULTS: Medial elbow ganglion was the third most common causative factor associated with cubital tunnel syndrome, with an overall prevalence of 8%. Resting pain in the medial aspect of the elbow was reported by twenty-five of the thirty-eight patients, and a sudden onset of numbness in the ring and little fingers or of medial elbow pain without prior symptoms was reported by twenty-nine patients. The symptoms lasted two months or less in thirty-one patients. All ganglia originated from the medial aspect of the ulnohumeral joint, and radiographs of that joint showed degenerative changes in thirty-seven patients. At the time of follow-up, all measurements of sensory and motor function of the ulnar nerve had improved and no recurrence of nerve palsy was found. CONCLUSIONS: Although uncommon, medial elbow ganglia have a strong association with osteoarthritis of the elbow and can cause a relatively acute onset of cubital tunnel syndrome. A patient with cubital tunnel syndrome associated with elbow osteoarthritis who complains of medial elbow pain or severe numbness within two months after the onset of the syndrome should be strongly suspected of having a ganglion. Most ganglia are occult, and ultrasonography and magnetic resonance imaging can assist in the preoperative diagnosis. Careful excision of the ganglion performed concurrently with subcutaneous anterior transposition of the ulnar nerve can produce satisfactory results.

Adult↗
PubMed1990

[How to discriminate between vibration syndrome and local fatigue of motorcyclists].

Motorcyclists who work in some offices sometimes complained of coldness, pain and numbness of upper limbs. We studied how to discriminate between vibration syndrome and local fatigue of the motorcyclists. Subjects are 42 motorcyclists of an office in Aichi prefecture. 25 of them held several letters in their left hand when they delivered the letters. They complained of coldness, pain and numbness in the left upper limbs more than in the right limbs (p less than 0.01). We think that it is the local fatigue rather than the disorder of vibration syndrome that causes such symptoms. So it is very important to recognize the existence of local fatigue in order to know how to discriminate between vibration syndrome and local fatigue of the motorcyclists.

Adult↗
PubMed1993

Peripheral nerve injuries in athletes. Treatment and prevention.

Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete's safe return to sports. Early, accurate anatomical diagnosis is essential. Nerve lesions may be due to acute injury (e.g. from a direct blow) or chronic injury secondary to repetitive microtrauma (entrapment). Accurate diagnosis is based upon physical examination and a knowledge of the relative anatomy. Palpation, neurological testing and provocative manoeuvres are mainstays of physical diagnosis. Diagnostic suspicion can be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. Proper equipment, technique and conditioning are the keys to prevention. Rest, anti-inflammatories, physical therapy and appropriate splinting are the mainstays of treatment. In the shoulder, spinal accessory nerve injury is caused by a blow to the neck and results in trapezius paralysis with sparing of the sternocleidomastoid muscle. Scapular winging results from paralysis of the serratus anterior because of long thoracic nerve palsy. A lesion of the suprascapular nerve may mimic a rotator cuff tear with pain a weakness of the rotator cuff. Axillary nerve injury often follows anterior shoulder dislocation. In the elbow region, musculocutaneous nerve palsy is seen in weightlifters with weakness of the elbow flexors and dysesthesias of the lateral forearm. Pronator syndrome is a median nerve lesion occurring in the proximal forearm which is diagnosed by several provocative manoeuvres. Posterior interosseous nerve entrapment is common among tennis players and occurs at the Arcade of Froshe--it results in weakness of the wrist and metacarpophalangeal extensors. Ulnar neuritis at the elbow is common amongst baseball pitchers. Carpal tunnel syndrome is a common neuropathy seen in sport and is caused by median nerve compression in the carpal tunnel. Paralysis of the ulnar nerve at the wrist is seen among bicyclists resulting in weakness of grip and numbness of the ulnar 1.5 digits. Thigh injuries include lateral femoral cutaneous nerve palsy resulting in loss of sensation over the anterior thigh without power deficit. Femoral nerve injury occurs secondary to an iliopsoas haematoma from high energy sports. A lesion of the sciatic nerve may indicate a concomitant dislocated hip. Common peroneal nerve injury may be due to a direct blow or a traction injury and results in a foot drop and numbness of the dorsum of the foot. Deep and superficial peroneal nerve palsies could be secondary to an exertional compartment syndrome. Tarsal tunnel syndrome is a compressive lesion of the posterior tibial nerve caused by repetitive dorsiflexion of the ankle--it is common among runners and mountain climbers.(ABSTRACT TRUNCATED AT 400 WORDS)

Accessory Nerve Injuries↗
PubMed1996

Asymptomatic hypothalamic hamartoma associated with an arachnoid cyst--case report.

A 42-year-old male presented with the complaint of mild left facial numbness. Magnetic resonance imaging demonstrated a solid tumor in the interpeduncular cistern and a huge arachnoid cyst in the left middle cranial fossa. The tumor appeared isointense to the surrounding cerebral gray matter on T1-weighted images and hyperintense to that on T2-weighted images. The tumor was partially resected. Histological findings were characteristic of hamartoma. The mild left facial numbness was probably due to compression of the left trigeminal nerve by the arachnoid cyst. Asymptomatic hypothalamic hamartomas may occur in adults with atypical clinical presentations.

Adult↗
PubMed1998

Prevalence of somatic indicators of distress in diabetes patients: comparison to psychiatric patients and community nonpatients.

OBJECTIVE: Because psychiatric screening methods are usually developed using psychiatric samples but not medical samples, they often include distress indicators that overlap with medical illness. This potentially inflates psychopathology estimates for medically ill patient groups. The objective of this study was to determine whether somatic distress indicator base rates are elevated in diabetes patients. METHOD: The occurrence of Symptom Checklist 90-R (SLC-90-R) somatic symptoms was studied in fifty-six diabetes mellitus patients (27 insulin dependent, 29 non-insulin dependent) with non-elevated SLC-90-R profiles, as compared to both community nonpatient and psychiatric patient norms. RESULTS: Of the fifteen SCL-90-R items rated by endocrinologists as most likely to be diabetes-related, nine were endorsed more frequently by diabetes patients than by nonpatients: faintness/dizziness (endorsed by 36% of diabetics), reduced libido (endorsed by 41%), anenergia (68%), memory problems (66%), trembling (18%), numbness (55%), weakness (39%), overeating (59%), and somatic concerns (41%). Anergia and faintness/dizziness were endorsed more frequently by psychiatric patients than diabetes patients, whereas numbness was endorsed more often by diabetes patients. CONCLUSIONS: Conservatism is warranted when applying these somatic indicators of distress to diabetes patients. Further studies are needed to determine whether such illness overlap biases case classification.

Adult↗
PubMed2001

Neurosensory function and implant survival rate following implant placement with nerve transpositioning: a case study.

In patients with extensive bone resorption, implant placement posterior to the mental foramen is a problematic surgical procedure. This paper reports the results in 6 patients (aged 20-61) with edentulous areas in the posterior part of the mandible, in whom 26 Nobelpharma implants were placed, including 17 with transposition of the inferior alveolar nerve allowing the use of implant fixtures of at least 10 mm in length. Subsequent neurosensory function, based on British Medical Research Council definitions, and implant survival rate were examined. In all cases, postoperative numbness occurred in the lower lip and mental area. Three years after surgery, while one patient had completely recovered neurosensory function, five patients still experienced partial numbness, although this was not perceived as a problem by those patients. The implant survival rate was 100% approximately three years after surgery. The results suggest that a higher implant survival rate is likely when longer fixtures are used, but this is also more likely to lead to slight long-term neurosensory dysfunction.

Adult↗
PubMed1995

Vulnerability Scale scores in female inpatients diagnosed with self-injurious behaviour, dissociative identity disorder, and major depression.

For three groups of predominantly female inpatients scores on the Glover Vulnerability Scale were compared with each other and with those of a control sample. The four groups included individuals who were diagnosed with self-injurious behavior, females diagnosed with Dissociative Identity Disorder, females whose predominant diagnosis was Major Depressive Disorder, and female controls. Females with a trauma-related diagnosis (Groups 1 and 2) scored higher on the Glover Vulnerability Scale than Group 3. History of exposure to trauma or childhood abuse most clearly discriminated higher scores within the control sample. The findings highlighted the close relationship between histories of exposure to trauma and high scores on this scale. Additional analysis of these scores and those on the Glover Numbing Scale showed a close association between feelings of vulnerability and the numbing response.

Adult↗
PubMed2001

Association of alexithymic characteristics and posttraumatic stress responses following medical treatment for children with refractory hematological diseases.

Recent research has examined posttraumatic stress disorder (PTSD) following medical treatment for children with refractory hematological diseases such as leukemia. However, much remains unknown. This study examined the association of alexithymic characteristics on the manifestation of posttraumatic stress responses in 33 children with refractory hematological diseases. Of 33 children, 27 (81.8%) exhibited posttraumatic stress responses following medical treatment for refractory hematological diseases. The frequency of posttraumatic stress responses was significantly higher than with children who experienced severe flood disaster. Also, the severity of posttraumatic stress responses was significantly stronger than for children who experienced severe flood disaster. Moreover, children with refractory hematological diseases were more likely to exhibit alexithymic characteristics. The alexithymic characteristics were significantly and positively correlated with avoidance and emotional numbing among posttraumatic stress responses. The results suggest the possibility that alexithymic characteristics may be predictive of the manifestation of avoidance and emotional numbing among posttraumatic stress responses following medical treatment for refractory hematological diseases.

Affective Symptoms↗
PubMed1992

A study on the vibration-dose limit for Japanese workers exposed to hand-arm vibration.

To obtain a vibration-dose limit for Japanese workers exposed to hand-arm vibration, the prevalences of vibration-induced white finger (VWF) and numbness of the hand were studied in 5 different groups of workers exposed to segmental vibration. In addition, the prevalence of primary Raynaud's phenomenon (PRP) in the general population without occupational vibration exposure was computed. The vibration levels in the exposed groups (except chain saw operators) ranged from 124.1-129.2 dB (reference value, 10(-6) m/s2). The prevalence of VWF in these groups was 2.2-4.8%. This value was not statistically significant (p greater than 0.05) when compared to the prevalence of PRP in the general Japanese population (2.7-2.9% in our study and 0.5-4.6% in other surveys in Japan). Although the prevalence of numbness of the hands fluctuated among the groups, no significant differences could be demonstrated. Our results were then compared to those of previous reports by literature study [319 papers on hand-arm vibration syndrome (HAVS) and 25 reports on PRP]. At a glance the Japanese population showed a lower prevalence for PRP compared to other countries, which suggested that exposure to cold and biological abilities should also be considered to assess vibration syndrome. A comparison of the vibration characteristics of different tools and the occurrence of VWF in the hands of workers in the literature with those of our data suggested that a daily hand-arm vibration exposure at a level lower than 2.5 m/s2 (128 dB, reference value 10(-6) m/s2) could possibly decrease the risk of VWF among workers exposed to segmental vibration.

Adult↗
PubMed1998

Finger skin temperature and laser-Doppler finger blood flow in subjects exposed to hand-arm vibration.

OBJECTIVES: This study was aimed to assess the peripheral circulatory functions of forestry workers exposed to hand-arm vibration, using simultaneous measurements of finger skin temperature (FST) and finger blood flow (FBF). METHODS: The subjects were five men with vibration-induced white finger (VWF), four subjects with numbness in their hands and five exposed controls without any signs or symptoms related to vibration syndrome. Simultaneous measurements of FST and laser-Doppler FBF were performed before, during and following a 10-min recovery period after the hand was immersed in cold water (10 degrees C, 10 min). Partitional measurements of finger blood flows could be made between the capillaries and deeply located vessels using two laser-Doppler flow probes having narrower and wider optic fiber separations. RESULTS: The FST as well as the FBF of the capillary and deeply located vessels during and following the cold immersion test in those with VWF and in the subjects with numbness had a slight increase immediately following the cold immersion and no tendency to be augmented as the time span increased. After the cold immersion test, the control group had significantly greater FST and FBF compared to other groups. Particularly, from the 5th to the 10th min after the cold provocation, the values of FBF of the deeply located vessels in those with VWF were significantly lower than the controls. During the course of observation, the FST had significantly linear relationship with the recorded capillary and deep FBF values, and that was much closely correlated with the deep FBF (i.e., P < 0.01 in each selected condition). The slope of the regression lines in the capillary were steeper and shallow in the deep FBF. CONCLUSIONS: In addition to the measurement of capillary FBF, more detailed and accurate information on the peripheral circulatory functions of vibration-exposed subjects can be obtained by including the assessment of the deep FBF.

Aged↗
PubMed1999

A four-year follow-up study on subjective symptoms and functional capacities in workers using hand-held grinders.

Fifty-three grinders in the metal industry were re-examined 4 years after their first examination. Information about age, occupation, daily vibration exposure, drinking and smoking habits, and presence of subjective symptoms such as vibration-induced white finger (VWF), and numbness and pain in the fingers was collected during the first and second examination. Cold provocation test (10 degrees C/10 min) was also employed to evaluate disturbances in the peripheral circulatory and peripheral nerves in all subjects. The frequency-weighted vibration acceleration of various types of hand-held tools was measured. There was no subject with VWF at the first examination; however, during the course of follow-up, two cases (3.8%) of VWF with latent interval of more than 25 years were diagnosed. Prevalence of numbness in the fingers and shoulder stiffness was significantly higher at the second examination. When the prevalence of subjective symptoms was tested by the subjects' total operating time (TOT) during the 4-year follow-up period, those whose TOT was equal to or more than 2500 hours showed higher prevalence compared to the other subgroup. The paired values of recovery rate of finger skin temperature and vibration sensation threshold after the cold water immersion test were significantly different at the first and second examination. On average, the diminution of hand-grip force during the 4-year follow-up course was 7.4%; the difference being significant at 0.01 level. Significant differences in the paired data of pinching power and tapping ability could be detected. The frequency-weighted vibration acceleration of various tools was in the range of 1.1-4.6 m/s2. It was concluded that: (1) prolonged occupational exposure to the vibration of hand-held grinding tools should be considered as a risk factor causing disturbances in the hand-arm system of the operators; (2) the results of recovery rate of finger skin temperature and the vibration sensation threshold seemed to be appropriate indicators for the assessment of peripheral vascular and peripheral nerve disturbances in workers exposed to hand-arm vibration; and (3) to reduce the subjects' physical stress, attention should be paid to ergonomic factors.

Adult↗
PubMedDate not supplied

The prevalence, predictors, and consequences of peripheral sensory neuropathy in older patients.

BACKGROUND: The prevalence, predictors, and consequences of peripheral neuropathy in the elderly have not been well defined. METHODS: Seven hundred ninety-five noninstitutionalized patients 65 years of age and older, recruited from the practices of family physicians, completed questionnaires and underwent peripheral neurologic examinations and tests of gait and balance. Variables included sociodemographic information, medical conditions, symptoms (numbness, pain, trouble with balance or walking, and restless legs), quality of life measures, ankle reflexes, position sense, vibratory sense, fine touch sensation, Tinnetti balance examination, and a 50-foot timed walk. RESULTS: The prevalence of at least one bilateral sensory deficit rose from 26% for 65- to 74-year-olds to 54% for those 85 and older. The most common deficit was loss of ankle reflex followed by loss of fine touch. Only 40% of those with bilateral deficits reported having a disease known to cause peripheral neuropathy. Predictors of bilateral deficits included increasing age, income less than 15,000 dollars, a history of military service, increasing body mass index, self-reported history of diabetes mellitus, Vitamin B12 deficiency or rheumatoid arthritis, and absence of a history of hypertension. Deficits were associated with numbness, pain, restless legs, trouble walking, trouble with balance, and reduced quality of life. CONCLUSIONS: Peripheral sensory deficits are common in the elderly. In most cases, a medical cause is not obvious. Their consequences may not be as benign as often supposed.

Aged↗
PubMedDate not supplied

Successful treatment of chronic erythema nodosum with vitamin B12.

A 38-year-old woman presented with painful lesions on both shins that first appeared a few days earlier. Physical examination revealed multiple red tender nodules on both legs. The patient had been treated with nonsteroidal anti-inflammatory drugs for having a few months without any improvement. The patient was referred to a dermatologist and a rheumatologist, who confirmed our diagnosis of chronic erythema nodosum (EN). She returned to the clinic 3 months later complaining of having numbness in the soles of her feet for a few weeks. Her serum vitamin B12 level was 118 pg/mL (normal range 135 to 911). After 4 weeks of twice weekly injections of vitamin B12 at a dose of 1000 mcg, there was a clear alleviation of the numbness, and the EN completely resolved without evidence of recurrence on follow-up. Because it seems that vitamin B12 caused resolution of EN in this case, we recommend that physicians consider testing for vitamin B12 deficiency in patients with EN.

Adult↗
PubMed2001

[A case of chronic bromvalerylurea intoxication due to habitual use of commercially available nonsteroidal anti-inflammatory drugs presenting an indefinite hyperchloremia].

A 75-year-old man was admitted to our hospital with disorientation and progression of speech disturbance and gait disturbance. He had been given a diagnosis of cervical spondylosis about four years previously, and gait disturbance and numbness in his extremities have been gradually increasing. Hyperchloremia and a careful history taking, which led to the discovery of habitual use of an analgesic containing bromvalerylurea, suggested bromism. A high level of bromide in serum yielded a diagnosis of bromism. Disorientation and speech disturbance were treated and improved by infusion diuresis. Gait disturbance only partly improved. There is a possibility that not only cervical spondylosis, but also chronic bromvalerylurea intoxication, may have contributed to the neurological disturbance resulting in gait disturbance and numbness. Bromvalerylurea, which is contained in many commercially available analgesics, should be noted as a possible cause of neurological disturbance.

Aged↗
PubMed2003

Sacral hemangioblastoma in a patient with von Hippel-Lindau disease. Case report and review of the literature.

Hemangioblastomas are histologically benign neoplasms that occur sporadically or as part of von Hippel-Lindau disease. Hemangioblastomas may occur anywhere along the neuraxis, but sacral hemangioblastomas are extremely rare. To identify features that will help guide the operative and clinical management of these lesions, the authors describe the management of a large von Hippel-Lindau disease-associated sacral hemangioblastoma and review the literature. The authors present the case of a 38-year-old woman with von Hippel-Lindau disease and a 10-year history of progressive back pain, as well as left lower-extremity pain and numbness. Neurological examination revealed decreased sensation in the left S-1 and S-2 dermatomes. Magnetic resonance imaging demonstrated a large enhancing lesion in the sacral region, with associated erosion of the sacrum. The patient underwent arteriography and embolization of the tumor and then resection. The histopathological diagnosis was consistent with hemangioblastoma and showed intrafascicular tumor infiltration of the S-2 nerve root. At 1-year follow-up examination, pain had resolved and numbness improved. Sacral nerve root hemangioblastomas may be safely removed in most patients, resulting in stabilization or improvement in symptomatology. Generally, hemangioblastomas of the sacral nerve roots should be removed when they cause symptoms. Because they originate from the nerve root, the nerve root from which the hemangioblastoma originates must be sacrificed to achieve complete resection.

Adult↗
PubMed2004

Cauda equina syndrome as a postoperative complication of lumbar spine surgery.

OBJECT: The term "cauda equina syndrome" (CES) has been used to describe the signs and symptoms in patients with compressive neuropathy of multiple lumbar and sacral roots. This syndrome is well known as an indication for surgical intervention in treating lumbar spine disease, but relatively unknown as a postoperative complication following surgery for disease. In this study the author describes two cases of CES that occurred following uneventful lumbar spine procedures--one microdiscectomy and one decompressive laminectomy. METHODS: Preoperative, operative, and postoperative management is discussed and the relevant literature reviewed. One patient suffered perineal numbness and bowel and bladder difficulty following a decompressive laminectomy. Postoperative imaging studies were negative for residual lesion and the treatment goal pursued was partial long-term resolution of symptoms. The second patient had progressive numbness and weakness in the lower extremities. Results of urgent postoperative magnetic resonance imaging studies were inconclusive and repeated exploration was performed within hours of the initial procedure. The patient made a full recovery, although the intraoperative findings did not reveal a clear cause of the patient's symptoms. CONCLUSIONS: Postoperative symptoms of partial or complete CES represent a medical emergency, especially if they are progressive. It is necessary to perform urgent postoperative imaging in patients, but the results are not always helpful. Surgical exploration is warranted if a mass lesion is demonstrated on imaging studies or if symptoms progress and the disease origin is not clear based on available information.

Adult↗
PubMed2004

Recurrent spinal hydatidosis in North America. Case report and review of the literature.

Spinal hydatidosis is an uncommon manifestation of the parasite Echinococcus, affecting fewer than 1% of patients with hydatid disease. The authors report on a 34-year-old Turkish woman who presented with recurrent primary spinal hydatid disease. The patient originally presented with progressive numbness and paraparesis that was reversed after T5-6 laminectomy and cyst removal. Pathological findings indicated parasitic infection and she underwent treatment for cysticercosis. Nevertheless, she returned 4 years later with back pain, numbness, and monoparesis. Neuroimaging studies revealed spinal cord compression with multiple cysts that were again resected. Pathological findings were consistent with Echinococcus. Although this disease is uncommon, particularly in North America, the authors conclude that spinal hydatidosis should be considered in the differential diagnosis of any patient who has lived or traveled within endemic areas and who presents with spine lesions and cord compression. The authors review the literature pertaining to the epidemiological features, presentation, diagnosis, neuroimaging characteristics, recommended treatments, and overall prognosis of spinal hydatidosis.

Adult↗
PubMed1978

Spectrum of complications in the use of intrathecal fluorescein.

The authors describe a case in which 0.5 cc of 5% fluorescein diluted in 10 cc of cerebrospinal fluid (CSF) was injected at the L4-5 level for evaluation of nasal CSF leakage. Within minutes, tone increased in lower extremities accompanied by knee and ankle clonus and subjective numbness up to the waist. Non-preserved saline irrigation of the lumbar CSF was administered until it became clear, and the patient's head was elevated to retard the developing symptomatology. Although a transient temperature elevation was observed with negative CSF cultures, all signs and symptoms cleared within 48 hours. In a survey of the members of the Americal Association of Neurological Surgeons regarding frequency of use and complications stemming from intrathecal fluorescein, the response rate was 58.3% (1111) of the 1907 members, of which 6.8% (76) had used intrathecal fluorescein, and among those, 25% (19 of the 76) had observed complications involving lower extremity weakness, numbness, generalized seizure activity, opisthotonos, and cranial nerve deficit. No complications were permanent. The authors recommend caution if intrathecal fluorescein must be used. Means should be available to clear the CSF of the agent and elevate the head if complications arise.

Adolescent↗