Excursion of the median nerve in patients with and without cervical radiculopathy during a contra-lateral cervical lateral glide movement

Abstract Background Cervical radiculopathy is a pathology of the cervical nerve root and mostly caused by a cervical disk herniation leading to chronic pain and disability. Objectives This study was conducted to show the effect of the combined application of intermittent cervical traction with median nerve mobilization on flexor carpi radialis (FCR) muscle H-reflex latency of median nerve in patients with unilateral cervical radiculopathy due to disk lesion in a pre-post design. Methods Fifteen patients (10 females and 5 males) with a mean age of 38.07 ± 5.85 years received simultaneous application of intermittent cervical traction and median nerve mobilization. Six sessions were given every other day for 2 weeks. Also, patients perormed chin in exercises and upper back extension with scapular retraction. FCR H-reflex latency was measured pre- and post-treatment. Results Statistical analysis showed that there was a significant reduction of H-reflex latency at post-treatment in comparison to pretreatment (t = 5.447, p value = 0.0001*). Conclusion Simultaneous application of intermittent cervical traction and median nerve mobilization are effective in improving FCR H-reflex latency in patients with unilateral cervical radiculopathy.

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Excursion of the median nerve during a contra-lateral cervical lateral glide movement in people with and without cervical radiculopathy

Musculoskeletal Science and Practice ◽

10.1016/j.msksp.2021.102349 ◽

2021 ◽

Vol 52 ◽

pp. 102349

Author(s):

Erik Thoomes ◽

Richard Ellis ◽

Andrew Dilley ◽

Deborah Falla ◽

Marloes Thoomes-de Graaf

Keyword(s):

Median Nerve ◽

Cervical Radiculopathy

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The Myth of Median Nerve in Forearm and Its Role in Double Crush Syndrome: A Cadaveric Study

Frontiers in Surgery ◽

10.3389/fsurg.2021.648779 ◽

2021 ◽

Vol 8 ◽

Author(s):

Sahar A. Abdalbary ◽

Mohamed Abdel-Wahed ◽

Sherif Amr ◽

Mostafa Mahmoud ◽

Ehab A. A. El-Shaarawy ◽

...

Keyword(s):

Median Nerve ◽

Carpal Tunnel ◽

Cervical Radiculopathy ◽

Nerve Trunk ◽

The Mean ◽

Osmium Oxide ◽

Percent Area ◽

Age Range ◽

Double Crush ◽

Area Percent

Purpose: This study aims to histologically compare the median nerve in the arm, forearm, and wrist, to help understand how cervical radiculopathy in a double crush phenomenon causes distal nerve dysfunction at the carpal tunnel and median nerve with concurrent absence of symptoms at the forearm.Methods: The study was performed on 12 fresh cadaveric upper limbs free from any injury or operation. Male cadavers in the age range of 35–40 years were used. The dissection of the median nerve and the histological examination of the specimens from the arm, forearm, and wrist were conducted to evaluate variations in the epineurium thickness (μm), perineurium thickness (μm), number of fascicles per nerve trunk, area percent of myelin covering, and area percent of neurolemmal sheath.Results: Morphometric and statistical results of the cadaveric median nerve trunk revealed that the mean epineurium and perineurium thickness measured in H&E-stained sections in the forearm were significantly greater than those in the arm and wrist specimens. Further, the mean percent area of the myelin covering in the forearm was significantly lower than that in the arm and wrist specimens in the sections stained with osmium oxide (p < 0.001). There were, however, no significant differences in the neurolemmal sheath among the arm, forearm, and wrist specimens in the silver-stained sections.Conclusion: The histological differences explained the high concomitant occurrence of carpal tunnel syndrome (CTS) and cervical radiculopathy and the concurrent absence of symptoms at the forearm. Hence, we suggest cautious evaluation of patients with upper limb symptoms, since the management of these conditions requires a different approach.

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The role of motor nerve conduction: in cervical radiculopathy patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20193629 ◽

2019 ◽

Vol 7 (9) ◽

pp. 3276

Author(s):

Meenakshi Garg ◽

Saurabh Gupta ◽

Sushma Sood ◽

Mohita Singh

Keyword(s):

Median Nerve ◽

Ulnar Nerve ◽

Nerve Root ◽

Nerve Conduction ◽

Motor Nerve ◽

Cost Effective ◽

Cervical Radiculopathy ◽

Neurological Deficits ◽

Specific Test ◽

Motor Nerve Conduction

Background: Cervical radiculopathy is the clinical description of when a nerve root in the cervical spine becomes inflamed or damaged, resulting in a change in neurological function. Neurological deficits, such as numbness, altered reflexes, or weakness, may radiate from the neck into the shoulder, arm, hand, or fingers. Patient also complains of tingling, numbness or loss of sensation along with the nerve root dermatome. It is a substantial cause of disability and morbidity, and its cost-effective evaluation and treatment are crucial so there is a definite need to establish a cost effective, reliable, and accurate means for establishing the diagnosis of cervical radiculopathy. Electrodiagnostic tests are the closest to fulfil these criteria out of which nerve conduction tests are one of the electrodiagnostic test.Methods: In this study motor nerve conduction of ulnar and median nerve done in 30 clinically proven cervical radiculopathy patientsResults: There are significant decrease in the conduction velocity of both nerve (median nerve (51.60±7.5), Ulnar nerve (50.60±5.6)) and significantly increased in the mean latency of both nerve (median nerve (6.02±2.4), ulnar nerve (5.8±1.8)).Conclusions: Authors concluded that MNC is the specific test for the diagnosis of cervical radiculopathy. At least the MNC of both nerves included in diagnostic criteria of cervical radiculopathy.

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CARPAL TUNNEL RELEASE IN PATIENTS WITH NEGATIVE NEUROPHYSIOLOGICAL EXAMINATIONS

Neurosurgery ◽

10.1227/01.neu.0000343546.21265.88 ◽

2009 ◽

Vol 65 (suppl_4) ◽

pp. A171-A173 ◽

Cited By ~ 13

Author(s):

Massimo Lama

Keyword(s):

Median Nerve ◽

Nerve Injury ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Cervical Radiculopathy ◽

Clinical Findings ◽

Work Related ◽

Persistent Symptoms ◽

Operative Findings ◽

Median Nerve Injury

Abstract OBJECTIVE In 16% to 34% of patients with classic symptoms of carpal tunnel syndrome (CTS), neurophysiology is negative. Few studies have concentrated on patients with symptoms compatible with CTS with normal examinations. The purpose of our study was to examine the clinical and surgical characteristics of this subtype of CTS in order to clarify a correct approach toward these patients. METHODS We studied a subpopulation of 25 patients (31 hands) with typical CTS symptoms despite normal neurophysiological examinations. All of the patients were initially treated with conservative therapy, and patients with work-related symptoms were advised to change their duties. In patients with persistent symptoms, wrist ultrasound and radiographic and blood examinations with rheumatic screenings were performed. Cervical magnetic resonance imaging was performed in some cases to exclude cervical radiculopathy. Other pathologies were found in 5 cases. Nine patients improved with nonsurgical therapy. Six months later, electric examinations were repeated and 3 patients with a confirmed median nerve injury underwent surgery. Eight patients with negative examinations underwent surgery (10 hands). All patients were advised of the possibility of incomplete pain remission after surgery. RESULTS All patients improved after surgery. Median nerve injury was confirmed by operative findings according to Tuncali grading. CONCLUSION A combination of clinical findings and instrumental procedures is required when selecting patients for successful surgery.

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