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Peripheral nerve entrapment

Luca Padua, Daniele Coraci, Carmen Erra, Costanza Pazzaglia, Ilaria Paolasso, Claudia Loreti, Pietro Caliandro, Lisa D Hobson-Webb
Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome worldwide. The clinical symptoms and physical examination findings in patients with this syndrome are recognised widely and various treatments exist, including non-surgical and surgical options. Despite these advantages, there is a paucity of evidence about the best approaches for assessment of carpal tunnel syndrome and to guide treatment decisions. More objective methods for assessment, including electrodiagnostic testing and nerve imaging, provide additional information about the extent of axonal involvement and structural change, but their exact benefit to patients is unknown...
November 2016: Lancet Neurology
Yi-Ming Ren, Xi-Shan Wang, Zhi-Jian Wei, Bao-You Fan, Wei Lin, Xian-Hu Zhou, Shi-Qing Feng
BACKGROUND: Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disease. Either surgical or conservative intervention for CTS patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical efficacy, safety, and cost of surgical versus nonsurgical intervention. METHODS: The eligible studies were acquired from PubMed, Medline, Embase, Web of Science, Google, and Cochrane Library. The data were extracted by 2 of the coauthors independently and were analyzed by RevMan5...
October 2016: Medicine (Baltimore)
Adeniyi A Borire, Ria Arnold, Bruce A Pussell, Natalie C Kwai, Leo H Visser, Luca Padua, Neil G Simon, Matthew C Kiernan, Arun V Krishnan
OBJECTIVE: We explored the nerve ultrasound (US) characteristics of 15 patients with end-stage kidney disease (ESKD) and correlated these findings with clinical severity and electrophysiological parameters of neuropathy. METHODS: 15 ESKD patients on thrice-weekly high-flux haemodialysis and 15 healthy controls were enrolled. Sonographic and electrophysiologic studies were conducted before and after a single session of haemodialysis. Serial measurements of median nerve cross-sectional area (CSA) and hypoechoic fraction (HF) were performed at the same non-entrapment site in the mid-forearm...
October 1, 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Georgios Tsivgoulis, Andrei V Alexandrov
PURPOSE OF REVIEW: Low cost, avoidance of irradiation, and high temporal resolution are inherent advantages of ultrasound imaging that translate into multiple clinical uses in many domains of neurology. This article presents clinical uses of ultrasound examination in cerebrovascular, neurodegenerative, and peripheral nervous system diseases. RECENT FINDINGS: Modern treatment and prevention of ischemic stroke rely on prompt diagnosis. Ultrasonography has found a place as a noninvasive screening test and bedside technique that provides estimates of the degree of stenosis as well as hemodynamic and structural information about intracranial and extracranial vessels in real time...
October 2016: Continuum: Lifelong Learning in Neurology
J Laulan
Neurogenic thoracic outlet syndrome (TOS) is one of the most controversial pain syndromes of the upper limbs. The controversies revolve around both the diagnosis and treatment of the non-specific or subjective subtypes. Their diagnosis rests on a combination of history, suggestive symptoms and clinical examination. Proximal pain is primarily muscular in origin, while distal symptoms may be the result of intermittent nerve compression and/or myofascial pain syndrome. Stringent clinical criteria are required to confirm the diagnosis of subjective TOS...
June 2016: Hand Surgery and Rehabilitation
Vibhor Wadhwa, Aws S Hamid, Yogesh Kumar, Kelly M Scott, Avneesh Chhabra
Pudendal neuralgia is being increasingly recognized as a cause of chronic pelvic pain, which may be related to nerve injury or entrapment. Due to its complex anatomy and branching patterns, the pudendal nerve abnormalities are challenging to illustrate. High resolution 3 T magnetic resonance neurography is a promising technique for the evaluation of peripheral neuropathies. In this article, the authors discuss the normal pudendal nerve anatomy and its variations, technical considerations of pudendal nerve imaging, and highlight the normal and abnormal appearances of the pudendal nerve and its branches with illustrative case examples...
September 23, 2016: Acta Radiologica
Eugenia Rota, Nicola Morelli
Neuropathy is a common complication of diabetes mellitus (DM) with a wide clinical spectrum that encompasses generalized to focal and multifocal forms. Entrapment neuropathies (EN), which are focal forms, are so frequent at any stage of the diabetic disease, that they may be considered a neurophysiological hallmark of peripheral nerve involvement in DM. Indeed, EN may be the earliest neurophysiological abnormalities in DM, particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy...
September 15, 2016: World Journal of Diabetes
Wenqiang Yang, Zhuangli Guo, Yanbing Yu, Jun Xu, Li Zhang
Surgery had been shown to be effective for superimposed peripheral nerve entrapment syndrome in patients with diabetic peripheral neuropathy (DPN), with pain relief and sensation restored. Few studies, however, have reported the quality-of-life outcomes of surgery for the treatment of painful DPN (PDPN). The objective of the present study was to evaluate the effects of microsurgical decompression of multiple entrapped peripheral nerves on pain and health-related quality of life in patients with refractory PDPN of the lower limbs...
September 2, 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Ekin Şavk
Neurologic itch is defined as pruritus resulting from any dysfunction of the nervous system. Itch arising due to a neuroanatomic pathology is seen to be neuropathic. Causes of neuropathic itch range from localized entrapment of a peripheral nerve to generalized degeneration of small nerve fibers. Antipruritic medications commonly used for other types of itch such as antihistamines and corticosteroids lack efficacy in neuropathic itch. Currently there are no therapeutic options that offer relief in all types of neuropathic pruritus, and treatment strategies vary according to etiology...
2016: Current Problems in Dermatology
Robert R Hagan, Michael A Fallucco, Jeffrey E Janis
BACKGROUND: Supraorbital rim syndrome (SORS) is a novel term attributed to a composite of anatomically defined peripheral nerve entrapment sites of the supraorbital rim region. The SORS term establishes a more consistent nomenclature to describe the constellation of frontal peripheral nerve entrapment sites causing frontal headache pain. In this article, we describe the anatomical features of SORS and evidence to support its successful treatment using the transpalpebral approach that allows direct vision of these sites and the intraconal space...
July 2016: Plastic and Reconstructive Surgery. Global Open
Kai F Loewenbrück, Markus Dittrich, Josef Böhm, Jürgen Klingelhöfer, Petra Baum, Jochen Schäfer, Rainer Koch, Alexander Storch
The objective of this study is to compare the diagnostic accuracy of nerve ultrasound (US) and nerve conduction studies (NCS) for acquired non-entrapment peripheral neuropathies (PNP) and hereditary motor and sensory neuropathies (HMSN) in a routine clinical setting. The methods are based on a single-center, prospective, examiner-blinded cross-sectional study on three subject groups of healthy controls, PNP (both enrolled by a consecutive recruitment strategy), and HMSN patients (convenience sample). A clinical reference standard based on the neuropathy impairment (NIS) and neuropathy symptoms scores (NSS) was used for PNP as the external validation criterion...
November 2016: Journal of Neurology
Semra Işık, Akın Akakın, Murat Şakir Ekşi, Baran Yılmaz, Tamer Aksoy, Murat Konakçı, Zafer Orkun Toktaş, Türker Kılıç
Foot drop is an inability to dorsiflex the ankle and toe. Primary causes of foot drop are compression or lesion of the 5th lumbar nerve and entrapment of the peroneal nerve at the head of the fibula. Rarely, some central nervous system lesions lead to foot drop. A 16-year-old boy was admitted with blunt head trauma that had happened in an assault. The muscle strength of the bilateral tibialis anterior, bilateral extensor digitorum longus and bilateral extensor digitorum brevis were Medical Research Council grade 1...
July 19, 2016: Pediatric Neurosurgery
Jonathan Yun, Christopher J Winfree
INTRODUCTION: The differentiation of malignant peripheral nerve sheath tumors (MPNST) from benign nerve sheath tumors is critical to direct treatment. Although histopathological diagnosis remains the standard, clinical and radiographic assessments are key for lesions that present with diagnostic uncertainty. Previous studies exploring these criteria have been limited by low sensitivity and specificity. Here, we describe a scoring system based on clinical presentation, neurological examination, and MRI and apply it retrospectively to a single-surgeon series of peripheral nerve sheath tumors...
August 2016: Neurosurgery
Justin W Silverstein, T EP, CNCT, Ricky Madhok, Christopher D Frendo, Hargovind DeWal, George R Lee, MS
Somatosensory evoked potentials (SSEPs) are a valuable tool for assessing changes in peripheral nerve pathways caused by patient positioning during spinal surgeries. These changes, when left undiagnosed, may lead to postoperative neurological sequelae. Why an upper extremity SSEP attenuates due to positioning is not necessarily clear and can be multifactorial, affecting the peripheral nerves or elements of the brachial plexus. A conduction block can occur at any point along the course of the nerve secondary to entrapment, compression, and ischemia...
June 2016: Neurodiagnostic Journal
Ke-Vin Chang, Chih-Peng Lin, Chen-Yu Hung, Levent Özçakar, Tyng-Guey Wang, Wen-Shiang Chen
Imaging of the nerves in the cervical region is more complicated than those of the extremities. Although high-resolution ultrasound enables the depiction of peripheral nerves' morphology and their associations with the adjacent soft tissues, precise identification of the nerves in the neck is still challenging. Familiarization with the cervical nerve tracking techniques can help interventional physiatrists explore/treat relevant entrapment syndromes, so does guiding proper electrode placement during nerve conduction studies...
November 2016: American Journal of Physical Medicine & Rehabilitation
Cristina Alba-Delgado, Alberto Cebada-Aleu, Juan Antonio Mico, Esther Berrocoso
Anxiety frequently appears in patients with diabetic neuropathic pain, a highly prevalent clinical condition. However, the neurobiological mechanisms of this comorbidity are poorly known. Anxiogenic phenotype has been associated with alterations of the noradrenergic locus coeruleus (LC) after peripheral nerve entrapment. We have examined the sensorial (pain) and affective (anxiety) behaviors, and the LC activity in streptozotocin (STZ)-induced diabetic rats. A comparative study with the chronic constriction injury (CCI) model of sciatic nerve was also carried out...
November 3, 2016: Progress in Neuro-psychopharmacology & Biological Psychiatry
Masoud Mehrpour, Zahra Mirzaasgari, Mohammad Rohani, Mahdi Safdarian
BACKGROUND: Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy in patients with hypothyroid. The diagnosis of CTS is usually clinical and confirmed by electrodiagnostic (EDX) procedures. This study aimed to describe the diagnostic accuracy of high-resolution ultrasonography (US) as an alternative method to nerve conduction study (NCS) for the diagnosis of subclinical CTS in patients with hypothyroidism. METHODS: Between April 2013 and November 2014, from the patients with the diagnosis of hypothyroidism referring to the institute of endocrinology and metabolism of Firoozgar Hospital, Tehran, Iran, those who met our inclusion criteria entered this cross-sectional study...
April 3, 2016: Iranian Journal of Neurology
Sravisht Iyer, Han Jo Kim
Cervical radiculopathy is a common clinical scenario. Patients with radiculopathy typically present with neck pain, arm pain, or both. We review the epidemiology of cervical radiculopathy and discuss the diagnosis of this condition. This includes an overview of the pertinent findings on the patient history and physical examination. We also discuss relevant clinical syndromes that must be considered in the differential diagnosis including peripheral nerve entrapment syndromes and shoulder pathology. The natural history of cervical radiculopathy is reviewed and options for management are discussed...
September 2016: Current Reviews in Musculoskeletal Medicine
Wen Quan Ding, Jian Hui Gu, Yong Yuan, Dong Sheng Jin
BACKGROUND: Peripheral nerves at the elbow region are prone to entrapment neuropathies and injuries. To make accurate assessment, clinicians need stereoscopic display of the nerves to observe them at all angles. OBJECTIVES: To obtain a stereoscopic display of the peripheral nerves at the elbow region based on magnetic resonance (MR) diffusion tensor imaging (DTI) data using three post-processing methods of volume rendering (VR), maximum intensity projection (MIP), and fiber tractography, and to evaluate the difference and correlation between them...
January 2016: Iranian Journal of Radiology: a Quarterly Journal Published By the Iranian Radiological Society
Kyongsong Kim, Toyohiko Isu, Naoya Emoto, Rinko Kokubo, Daijiro Morimoto, Naotaka Iwamoto, Shiro Kobayashi, Akio Morita
PURPOSE: Many patients with diabetes mellitus (DM) experience numbness in the extremities. This DM neuropathy may be complicated by peripheral entrapment neuropathy. We prospectively investigated the cause(s) of limb numbness in DM patients. MATERIALS AND METHODS: We enrolled 23 patients with uni- or bilateral limb numbness who were treated in our DM clinic. They were 10 men and 13 women; their average age was 63 years. The average duration of their neurological symptoms was 28...
April 2016: No Shinkei Geka. Neurological Surgery
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