Nerve Entrapment Syndromes at the Wrist and Elbow by Sonography

2018 ◽  
Vol 22 (03) ◽  
pp. 344-353 ◽  
Author(s):  
Andrea Klauser ◽  
Mihra Taljanovic ◽  
Sylvia Strobl ◽  
Stefan Rauch ◽  
James Teh ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Clinical Presentation ◽  
Linear Array ◽  
Dynamic Assessment ◽  
Correct Diagnosis ◽  
Nerve Entrapment ◽  
Diagnostic Modality ◽  
Morphological Aspects ◽  
Structural Abnormalities ◽  
Entrapment Syndromes

AbstractNerve entrapment syndromes of the upper extremity are associated with structural abnormalities or by an intrinsic abnormality of the nerve. Nerve entrapment syndromes generally have a typical clinical presentation, and findings on physical examination and in conjunction with electrodiagnostic studies imaging is used to evaluate the cause, severity, and etiology of the entrapment. With the development of high-frequency linear array transducers (12–24 MHz), ultrasound (US) is incomparable in terms of spatial resolution to depict morphological aspects and changes in nerves. US can identify the abnormalities causing entrapment, such as fibrous bands, ganglia, anomalous muscles, and osseous deformities, with the advantage of dynamic assessment under active and passive examination. US is a unique diagnostic modality that allows superb visualization of both large and small peripheral terminal nerve branches of the upper extremity and enables the correct diagnosis of various nerve entrapment syndromes.

Cervical Disc Disease and Extremity Pain

2018 ◽  
Author(s):  
Jeffrey D. Petersohn
Keyword(s):  
Upper Extremity ◽  
Clinical Presentation ◽  
Correct Diagnosis ◽  
Cervical Disc ◽  
Imaging Studies ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Surgical Methods ◽  
Anatomic Basis ◽  
Entrapment Syndromes

This chapter reviews the anatomic features producing extremity pain, discusses the clinical presentation of cervical disc and spondylotic disease, and explores the differential diagnosis of upper extremity pain. Clinically relevant findings are emphasized in the history and physical examination. Electrodiagnostic and imaging studies necessary to establish a correct diagnosis are highlighted. Common upper extremity nerve entrapment syndromes are discussed. Following a discussion of the anatomic basis for pain, interventional and surgical methods for treatment are briefly compared.

The Role of Dynamic Ultrasound in the Assessment of the Pathological Changes of Acromioclavicular and Sternoclavicular Joints

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Zeinab Yousif Ishag Abdelhafiz ◽  
Khalid Ahmed Mohammed Ali ◽  
Safaa Kamal Mohammed Badraldeen
Keyword(s):  
Shoulder Pain ◽  
Dynamic Assessment ◽  
Cost Comparison ◽  
University Hospital ◽  
Patient Comfort ◽  
Radiology Department ◽  
Control Group ◽  
Diagnostic Modality ◽  
Presenting Symptoms ◽  
Dynamic Ultrasound

Abstract Background Sonography is a useful imaging tool for the examination of musculoskeletal pathology. There are many advantages to this technique, including easy accessibility, low cost, comparison with the asymptomatic limb, and patient comfort. Unlike other available modalities, dynamic assessment is readily performed using sonography. Furthermore, the use of Doppler technique allows assessment of vascularity, inflammation, and anatomical relationships of the structure in question to adjacent vessels. Aim of Study This study investigates the value of dynamic ultrasound in the evaluation of AC and SC joints abnormality in comparison with the asymptomatic limb. Patients & Methods This prospective study included fifty cases, thirty patients were clinically positive for shoulder pain. Twenty healthy persons examined as control group. The patients were referred from Rheumatology and Immunology Department of Ain Shams University.US evaluation was performed at the Radiology Department of Ain –Shams University Hospital in period from January to June2018, to characterizing the AC and SC joints, their pathogenesis and sequelae. Dynamic US examination was also performed in all the cases. Results This study included 30 patients. The most common presenting symptoms in the primary care were shoulder pain which present in all 30 patients. Appropriate history and physical examination coupled with correct radiographs usually lead to an accurate diagnosis, we add that dynamic US which served a role in directing the management plan in 18 patients, this further confirmed with a positive clinical examination, in contrast to the other 12 patients for whom there was negative clinical findings. Conclusion High-resolution US technology, coupled with good anatomical knowledge and proper technique, has become valuable in the assessment of ACJ pathology as can be a useful initial diagnostic modality in SCJ osteoarthritis. Using US as a first line investigative tool can eliminate the need for further more expensive investigation like CT/ MRI and serve as a guide for further imaging and management.

scholarly journals Clinical profile of cardiac myxoma: 11 years’ experience of 90 cases

2016 ◽  
Vol 31 (1) ◽  
pp. 18-22
Author(s):  
Md Toufiqur Rahman ◽  
Md Zulfikar Ali ◽  
Md Humayun Kabir ◽  
STM Abu Azam ◽  
AAS Majumder ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Primary Tumour ◽  
Correct Diagnosis ◽  
Cardiac Myxoma ◽  
Benign Neoplasm ◽  
Clinical Feature ◽  
Duration Of Symptoms ◽  
Pedal Oedema ◽  
Mechanical Interference ◽  
The Mean

Introduction: Cardiac myxoma is a benign neoplasm that represents the most common primary tumour of the heart. Because of nonspecific symptoms, early diagnosis may be a challenge. Although the left atrium is the most commonly involved site of origin in 75% of cases, it can arise from any of the cardiac chambers. Symptoms from a cardiac myxoma are more pronounced when the myxomas are left-sided, racemosus, and over 5 cm in diameter. Symptoms are produced by mechanical interference with cardiac function or embolization. Being intravascular and friable, myxomas account for most cases of tumor embolism. The site of embolism is dependent upon the location (left or right atrium) and the presence of an intracardiac shunt. Most atrial myxomas are benign and can be removed by surgical resection.Objectives: To see clinical presentation and echocardiographic profile of cardiac myoxomas.Methods: 90 cardiac myxoma patients who admitted both in cardiology and cardiac surgery departments of National Institute of Cardiovascular Diseases (NICVD), Dhaka from August 2003 to July, 2014 were studied clinically and by echocardiogram. Clinical histories were reviewed, noting age, gender, and clinical presentation.Results: There were 30 males and 60 females, ages ranged from 17 to 76 years. The commonest clinical feature was dyspnoea (94.44%), followed by palpitation (76.67%), chest discomfort (74.44%), constitutional symptoms (50%), pedal oedema (20%), syncope (14.44%), and embolization (7.7%). The mean duration of symptoms was 09.7 months.Conclusion: The clinical presentation of cardiac myxoma is often nonspecific, so high index of clinical suspicion is important for its early and correct diagnosis. The size and appearance of the myxomas correlated with the presenting symptoms.Bangladesh Heart Journal 2016; 31(1) : 18-22

scholarly journals Modern Diagnosis and Surgical Management of Thoracic Outlet Syndrome: A Comprehensive Review

2021 ◽  
pp. 27
Author(s):  
Keyword(s):  
Upper Extremity ◽  
Subclavian Vein ◽  
Transverse Process ◽  
Venous Hypertension ◽  
Cervical Rib ◽  
First Rib ◽  
Extrinsic Compression ◽  
Robotic Resection ◽  
Entrapment Syndromes ◽  
Neurogenic Tos

Conventionally TOS has been thought to represent a group of diverse disorders that result in compression of the neurovascular bundle exiting the thoracic outlet. Until recently, TOS classification has been based on symptoms, rather than the underlying pathology, with the subgroups consisting of neurogenic (NTOS), venous (VTOS or PSS), and arterial (ATOS). Neurogenic TOS accounts for over 95% of the cases, followed by venous (3–5%) and arterial (1–2%). Neurogenic TOS (NTOS) has been further divided into True NTOS (TNTOS) and Disputed NTOS (DNTOS), with DNTOS reportedly representing 95–99% of all neurogenic cases. In order to decrease confusion and to improve therapeutic results with TOS, the disease should be classified based on the underlying pathologic entity. Acquired and traumatic abnormalities of the clavicle and first rib should be classified separately. Clearly after the more common and objectively supported diagnoses of conditions that result in neurovascular symptoms of the upper extremity, such as cervical spine disease, carpal tunnel disease, and nerve entrapment syndromes, have been ruled out, there remains a group of patients who are suspected of having TOS. In these patients, rather than the more usual classification such as arterial, venous, or neurogenic, the more accurate approach from a diagnostic and therapeutic approach is to classify them as: Cervical Rib Disease: Patients with cervical rib syndrome (CRS) can have complications relating to compression of the subclavian artery (previously referred to as ATOS) and the brachial plexus(previously referred to as True NTOS) secondary to a well-formed cervical rib, or to an incompletely formed first rib, fibrous band associated with a rudimentary cervical rib, or a giant transverse process of C7. Thoracic Outlet Disease or “Subclavian Vein Compression Syndrome”: In these patients an abnormal first rib at its junction with the sternum results in compression of the subclavian vein at the subclavian-innominate junction. Compression of the vein results in venous hypertension in the upper extremity and resultant neurologic symptoms. With prolonged compression of the subclavian-innominate junction, the vein clots giving rise to Paget–Schroetter syndrome. Therefore, patients who have been previously classified as Disputed Neurogenic and Venous TOS represent a variable symptomatic presentation of the same pathologic entity, which affects the subclavian vein. Presently MRA of the thoracic outlet with arm maneuvers is the test of choice in patients suspected of having TOS. This test shows the abnormal bony tubercle on the first rib with extrinsic compression of the subclavian innominate junction, which is exacerbated with elevation of the arm above the shoulder. Robotic resection of the medial aspect of the first rib along with disarticulation of the costo-sternal joint has the best reported results to date.

Axillary nerve entrapment in the quadrilateral space

1987 ◽  
Vol 66 (6) ◽  
pp. 932-934 ◽  
Author(s):  
H. Carson McKowen ◽  
Rand M. Voorhies
Keyword(s):  
Upper Extremity ◽  
Shoulder Pain ◽  
Posterior Approach ◽  
Axillary Nerve ◽  
Nerve Entrapment ◽  
Neutral Position ◽  
Circumflex Artery ◽  
Content Type ◽  
Radiographic Features ◽  
Fine Print

✓ The quadrilateral space syndrome is a recently established entity with seemingly consistent pathological and radiographic features. An example of this syndrome is reported. In this patient, entrapment of the axillary nerve by fibrous bands in the quadrilateral space caused shoulder pain with paresthesias in the upper extremity. Subclavian angiography provided the diagnosis by demonstrating that the posterior humeral circumflex artery, which was normal when the arm was in a neutral position, was occluded when the arm was abducted and externally rotated. Axillary neurolysis through a posterior approach resulted in relief of symptoms.

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