Compression neuropathies of the forearm: anatomy, clinical features and management

2021 ◽  
pp. 1-10
Author(s):  
Alexander Scarborough ◽  
Robert J MacFarlane ◽  
Michail Klontzas ◽  
Rui Zhou ◽  
Mohammad Waseem
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Peripheral Nerves ◽  
Clinical Presentation ◽  
Permanent Damage ◽  
Peripheral Nerve Lesions ◽  
Clinical Presentations ◽  
Wide Range ◽  
Prompt Diagnosis

The upper limb consists of four major parts: a girdle formed by the clavicle and scapula, the arm, the forearm and the hand. Peripheral nerve lesions of the upper limb are divided into lesions of the brachial plexus or the nerves arising from it. Lesions of the nerves arising from the brachial plexus are further divided into upper (proximal) or lower (distal) lesions based on their location. Peripheral nerves in the forearm can be compressed in various locations and by a wide range of pathologies. A thorough understanding of the anatomy and clinical presentations of these compression neuropathies can lead to prompt diagnosis and management, preventing possible permanent damage. This article discusses the aetiology, anatomy, clinical presentation and surgical management of compressive neuropathies of the upper limb.

Computer-Aided Localisation of Peripheral Nerve Lesions

1991 ◽  
Vol 16 (1) ◽  
pp. 19-24 ◽  
Author(s):  
P. BURGE ◽  
B. TODD
Keyword(s):  
Retrospective Study ◽  
Peripheral Nerve ◽  
Computer Program ◽  
Simulation Model ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Clinical Findings ◽  
Nerve Lesions ◽  
Peripheral Nerve Lesions ◽  
Computer Aided

The clinical localisation of peripheral nerve lesions can sometimes be difficult, particularly following injury to the brachial plexus when multiple lesions are often present. In this situation, computers may be of assistance in interpreting the complicated patterns of clinical findings. This paper describes the evaluation of a computer program that uses a simulation model of the consequences of nerve injury, based on a representation of the relevant anatomy. A retrospective study of 26 patients with upper limb nerve lesions was carried out. The computer program compared favourably with three clinicians in interpreting the findings correctly. It is suggested that this approach may be transferable to other applications.

Physiology of Spinal Cord, Nerve Root and Peripheral Nerve Compression

1956 ◽  
Vol 185 (1) ◽  
pp. 217-229 ◽  
Author(s):  
Samuel Gelfan ◽  
I. M. Tarlov
Keyword(s):  
Spinal Cord ◽  
Peripheral Nerve ◽  
Nerve Root ◽  
Peripheral Nerves ◽  
Compressive Force ◽  
Mechanical Deformation ◽  
Dorsal Column ◽  
Neuronal Structure ◽  
Mechanical Pressure ◽  
Wide Range

The reversible conduction block produced by maintained mechanical pressure around small segments of spinal cord, nerve root or peripheral nerve (dog) is due to mechanical deformation of the neuronal tissue and not to lack of O2. The compressed segment, although ischemic, is not anoxic; O2 from adjacent nonischemic tissue reaches it, presumably by diffusion. The entire pattern of modification of neuronal responses by compression and the postdecompression recovery pattern are distinctly different from the patterns observed during anoxia and recovery from the latter, indicating the difference in mechanisms by which mechanical deformation and O2 lack block conduction. The largest fibers in dorsal columns, roots and peripheral nerves are most susceptible to pressure and the smallest ones are relatively most resistant. Secondary neurons are less vulnerable than the primary afferent ones to light and moderate, but suprasystolic, circumferential spinal cord pressure. All components of the composite spinal cord potential are blocked at about the same time by larger compressive forces. Anoxia, on the other hand, always inactivates secondary neurons before dorsal column fibers and blocks smaller A fibers in peripheral nerves before the larger ones. The latency for complete blocking in each neuronal structure is specific and irreducible in the case of anoxia, whereas in compression it varies over a wide range, depending upon the magnitude of the compressive force.

scholarly journals Ultrasound guided interscalene brachial plexus block via lower approach for upper limb surgeries

2018 ◽  
Vol 5 (5) ◽  
pp. 1304
Author(s):  
Roopal R. Garaniya ◽  
Sheetal Shah ◽  
Noopur Prajapati
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Upper Limb ◽  
Brachial Plexus Block ◽  
Interscalene Block ◽  
Ultrasound Guided ◽  
Peripheral Nerve Stimulator ◽  
Interscalene Brachial Plexus Block ◽  
Plexus Block

Background: Brachial plexus block via interscalene approach is an excellent option for upper limb surgeries, but due to sparing of ulnar nerve (lower trunk, C8-T1) and its’ complications, it is not so popular. To overcome this problem, interscalene block via lower approach has been tried which has more advantage in view of ulnar nerve blockage and also less complications. In addition, ultrasound provides reliability, ease, rapidity and also patient comfort during block procedure. This prospective study was performed to evaluate the anaesthetic effect of lower approach interscalene block with the help of ultrasound and peripheral nerve stimulator.Methods: Ultrasound guided interscalene brachial plexus block via lower approach was given in randomly selected 30 patients, undergoing upper limb orthopaedic surgeries. After localisation of brachial plexus with ultrasound, the nerve roots were confirmed with the help of peripheral nerve stimulator, before injecting drug. At 5 and 15 min after block, all patients were assessed for the effect. Postoperatively they were assessed for any complication and also for their satisfaction level by Likert’s scale.Results: In territories of ulnar, radial and musculocutaneous nerve there was 100% effect while in median nerve territory 92.8% motor block was there. There was no need of analgesics during intra operative period in any patient and there were no major complications with this approach.Conclusions: Ultrasound guided interscalene block via lower approach is an excellent alternative for upper limb surgeries over classical approach in view of ulnar nerve blockage without any major complication.

scholarly journals Cervical intradural extramedullay vascular schwannoma in a thirty eight year old male

2019 ◽  
Vol 6 (7) ◽  
pp. 2634
Author(s):  
Shipra Singhal ◽  
Sufian Zaheer ◽  
Rashmi Arora
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Neck Region ◽  
The Body ◽  
Vascular Changes ◽  
Vascular Tissues ◽  
Clinical Presentations ◽  
Cervical Swelling ◽  
Head Neck

Schwannomas are benign peripheral nerve sheet tumours that may arise almost anywhere in the body but are commonly seen in the head, neck region and in the extremities. They may be associated with variable clinical presentations depending on their location. The peripheral nerves are closely related to vascular tissues morphologically and physiologically and therefore schwannomas may be associated with vascular changes like vascular hyperplasia and vascular dilation. Here authors represent one such case where a 38-year-old patient presented with a cervical swelling which on histopathology was diagnosed as vascular schwannoma.

scholarly journals Elective amputation of the upper limb is an option in the treatment of traumatic injuries of the brachial plexus?

2017 ◽  
Vol 75 (9) ◽  
pp. 667-670 ◽  
Author(s):  
Mário Gilberto Siqueira ◽  
Roberto Sérgio Martins ◽  
Carlos Otto Heise ◽  
Luciano Foroni
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Limb Amputation ◽  
Brachial Plexus Palsy ◽  
Traumatic Injuries ◽  
Upper Limb Amputation ◽  
Pros And Cons ◽  
Post Traumatic ◽  
Active Patients

ABSTRACT The treatment of complete post-traumatic brachial plexus palsy resulting in a flail shoulder and upper extremity remains a challenge to peripheral nerve surgeons. The option of upper limb amputation is controversial and scarcely discussed in the literature. We believe that elective amputation still has a role in the treatment of select cases. The pros and cons of the procedure should be intensely discussed with the patient by a multidisciplinary team. Better outcomes are usually achieved in active patients who strongly advocate for the procedure.

scholarly journals High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma

2009 ◽  
Vol 26 (2) ◽  
pp. E13 ◽  
Author(s):  
Ralph W. Koenig ◽  
Maria T. Pedro ◽  
Christian P. G. Heinen ◽  
Thomas Schmidt ◽  
Hans-Peter Richter ◽  
...  
Keyword(s):  
High Resolution ◽  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Imaging Modality ◽  
Nerve Entrapment ◽  
Nerve Lesions ◽  
Peripheral Nerve Lesions ◽  
Continuous Progress ◽  
Number Of Publications ◽  
High Resolution Ultrasonography

High-resolution ultrasonography is a noninvasive, readily applicable imaging modality, capable of depicting real-time static and dynamic morphological information concerning the peripheral nerves and their surrounding tissues. Continuous progress in ultrasonographic technology results in highly improved spatial and contrast resolution. Therefore, nerve imaging is possible to a fascicular level, and most peripheral nerves can now be depicted along their entire anatomical course. An increasing number of publications have evaluated the role of high-resolution ultrasonography in peripheral nerve diseases, especially in peripheral nerve entrapment. Ultrasonography has been shown to be a precious complementary tool for assessing peripheral nerve lesions with respect to their exact location, course, continuity, and extent in traumatic nerve lesions, and for assessing nerve entrapment and tumors. In this article, the authors discuss the basic technical considerations for using ultrasoniography in peripheral nerve assessment, and some of the clinical applications are illustrated.

Ebstein’s Anomaly

2007 ◽  
Vol 26 (3) ◽  
pp. 197-208 ◽  
Author(s):  
Sarah Pashia
Keyword(s):  
Heart Failure ◽  
Tricuspid Valve ◽  
Congenital Heart ◽  
Clinical Presentation ◽  
Ebstein’S Anomaly ◽  
Ebstein's Anomaly ◽  
Clinical Presentations ◽  
Wide Range ◽  
Pathologic Findings ◽  
The Right

EBSTEIN’S ANOMALY IS A RARE congenital heart defect characterized by displacement of the tricuspid valve leaflets into the right ventricle.1The defect was first described by Wilhelm Ebstein in 1866.2This anomaly of the tricuspid valve causes the right atrium to thin and become enlarged, resulting in a wide range of clinical presentations.3Clinical presentation depends on the severity of the pathologic findings, which vary considerably from patient to patient. Some infants may present with cyanosis, respiratory distress, heart failure, and even death, whereas others may not present with mild symptoms until adolescence or adulthood.

Magnetic resonance neurography for the evaluation of peripheral nerve, brachial plexus, and nerve root disorders

2010 ◽  
Vol 112 (2) ◽  
pp. 362-371 ◽  
Author(s):  
Rose Du ◽  
Kurtis I. Auguste ◽  
Cynthia T. Chin ◽  
John W. Engstrom ◽  
Philip R. Weinstein
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Nerve Root ◽  
Consecutive Series ◽  
Brachial Plexopathy ◽  
Magnetic Resonance Neurography ◽  
Nerve Lesions ◽  
Peripheral Nerve Lesions

Object Treatment of spinal and peripheral nerve lesions relies on localization of the pathology by the use of neurological examination, spinal MR imaging and electromyography (EMG)/nerve conduction studies (NCSs). Magnetic resonance neurography (MRN) is a novel imaging technique recently developed for direct imaging of spinal and peripheral nerves. In this study, the authors analyzed the role of MRN in the evaluation of spinal and peripheral nerve lesions. Methods Imaging studies, medical records, and EMG/NCS results were analyzed retrospectively in a consecutive series of 191 patients who underwent MRN for spinal and peripheral nerve disorders at the University of California, San Francisco between March 1999 and February 2005. Ninety-one (47.6%) of these patients also underwent EMG/NCS studies. Results In those who underwent both MRN and EMG/NCS, MRN provided the same or additional diagnostic information 32 and 45% of patients, respectively. Magnetic resonance neurograms were obtained at a median of 12 months after the onset of symptoms. The utility of MRN correlated with the interval between the onset of symptoms to MRN. Twelve patients underwent repeated MRN for serial evaluation. The decrease in abnormal signal detected on subsequent MRN correlated with time from onset of symptoms and the time interval between MRN, but not with resolution of symptoms. Twenty-one patients underwent MRN postoperatively to assess persistent, recurrent, or new symptoms; of these 3 (14.3%) required a subsequent surgery. Conclusions Magnetic resonance neurography is a valuable adjunct to conventional MR imaging and EMG/NCS in the evaluation and localization of nerve root, brachial plexus, and peripheral nerve lesions. The authors found that MRN is indicated in patients: 1) in whom EMG and traditional MR imaging are inconclusive; 2) who present with brachial plexopathy who have previously received radiation therapy to the brachial plexus region; 3) who present with brachial plexopathy and have systemic tumors; and 4) in patients under consideration for surgery for peripheral nerve lesions or after trauma. Magnetic resonance neurography is limited by the size of the nerve trunk imaged and the timing of the study.

scholarly journals Microsurgery of peripheral nerve injuries: Analysis of twenty-five year experiences

2003 ◽  
Vol 50 (1) ◽  
pp. 7-14
Author(s):  
Miroslav Samardzic
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Peripheral Nerves ◽  
The Other ◽  
Surgical Results ◽  
Operating Microscope ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Microsurgical Technique ◽  
Factors Influencing

Microsurgical procedures on injured peripheral nerves have been performed in Institute of neurosurgery in Belgrade for twenty-five years. During this period 1284 procedures, including 1029 on peripheral nerves, and 255 on brachial plexus were done. In this paper we analyze surgical results of individual procedures and the other factors influencing the outcome. Despite advances caused by introduction of the operating microscope, there are numerous controversies mainly in microsurgical technique that are discussed.

scholarly journals Microsurgical procedures for peripheral nerve lesions: Choice of anesthesia

2003 ◽  
Vol 50 (1) ◽  
pp. 27-31
Author(s):  
Valentina Stevanovic ◽  
Branko Milakovic ◽  
Zorica Stanimirovic ◽  
Mila Stosic
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Sural Nerve ◽  
Brachial Plexus Block ◽  
Body Position ◽  
Nerve Lesions ◽  
Axillary Approach ◽  
Peripheral Nerve Lesions ◽  
Plexus Block ◽  
Endotracheal Anesthesia

Microsurgical procedures on peripheral nerve lesions have their own specifics. Those are: duration and extent of operation, and need to change body position during operation. General endotracheal anesthesia has been used for operations on brachial plexus lesions with neural transpher; on peripheral nerve lesions with sural nerve autotransplantations; on all extracranial lesions (facial n. and lesion hypoglossal n.); for lesions of plexus lumbalis and sciatic nerve. These operations are requesting turning of patient on the lateral or ventral position or they are performed on head and neck. Because operation and anesthesia last longer, general ET anesthesia is more suitable for neurosurgens and anesthesiologist's interventions. Regional anesthesia, i.e. neural plexus block, is suitable for operations on upper extremity. Then we perform brachial plexus block with more approaches. There has been frequently in use axillary approach which is easier to perform, has minimum of complications and is suitable for procedures at cubital region, forearm and hand.

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