scholarly journals Ultrasonographic evaluation of the median nerve: normal and variant anatomy and appearance

2021 ◽  
Vol 21 (87) ◽  
pp. 318-325
Author(s):  
Kitija Nulle ◽  
Aija Jaudzema
Keyword(s):  
Median Nerve ◽  
Motor Nerve ◽  
Anatomical Variations ◽  
Sensory Innervation ◽  
Lateral Part ◽  
Anatomical Structures ◽  
Anterior Compartment ◽  
Flexor Muscles ◽  
Patients With Diabetes ◽  
Median Nerve Neuropathy

The median nerve is a mixed sensory and motor nerve that innervates part of the flexor muscles in the anterior compartment of the forearm and muscles in the lateral part of the hand; palmar cutaneous and digital cutaneous nerves branch from the median nerve, which provides sensory innervation to the skin on the radial side of the palm. Also, the median nerve is an object of interest because neuropathy of the median nerve at the level of the carpal tunnel is the most common entrapment neuropathy which increases dramatically in patients with diabetes. Neuromuscular ultrasound provides extensive diagnostic information and has proved itself as a useful complementary test to electrodiagnostic examinations in cases involving median nerve neuropathy. It often happens that the cause of nerve entrapment and neuropathy are variants of several anatomical structures along the course of the median nerve. It is important to be aware and report such anatomical variations of the median nerve in order to avoid damaging the nerve during surgical treatment. Despite the frequently documented abnormalities in the pathway of the brachial plexus and the median nerve, the anatomical variations are unusual to see and are rarely reported. Moreover, there are variations that do not fit under any of the classifications described in the literature.

scholarly journals Traumatic Rupture and Herniation of the Peroneus Tertius Muscle Leading to Compartment Syndrome and Entrapment of the Superficial Peroneal Nerve: A Case Report

2021 ◽  
Vol 07 (03) ◽  
pp. e154-e157
Author(s):  
Jussi Repo ◽  
Mikko Ovaska ◽  
Eetu N. Suominen ◽  
Henrik Sandelin ◽  
Jani Puhakka
Keyword(s):  
Case Report ◽  
Compartment Syndrome ◽  
Peroneal Nerve ◽  
Anatomical Variations ◽  
Traumatic Rupture ◽  
Lateral Part ◽  
Superficial Peroneal Nerve ◽  
Operating Theater ◽  
Anterior Compartment ◽  
The Right

AbstractWe present a patient with compartment syndrome and entrapment of the superficial peroneal nerve due to a direct hit to the lateral part of the right lower extremity. The diagnosis of evolving compartment syndrome was made without delay and the patient was quickly taken to the operating theater. Intraoperatively, the entrapment of the superficial peroneal nerve caused by rupture and herniation of the peroneus tertius muscle was surprisingly observed at the site, where the nerve pierces the anterior compartment. The nerve was successfully released in conjunction with fasciotomies of the anterior and lateral compartments. Meticulous diagnosis of compartment syndrome is critical to prevent ischemic injury to muscles and nerves. Recognition of anatomy and anatomical variations is important to prevent iatrogenic injury in unusual circumstances.

scholarly journals Duplication in the formation of median nerve - a case report

2015 ◽  
Vol 04 (01) ◽  
pp. 043-045
Author(s):  
Gyata Mehta ◽  
Varsha Mokhasi
Keyword(s):  
Case Report ◽  
Median Nerve ◽  
Lateral Root ◽  
Axillary Artery ◽  
Anatomical Variations ◽  
Upper Arm ◽  
Present Case Report ◽  
Lateral Cord ◽  
Two Stages ◽  
Different Levels

AbstractThe median nerve is formed in the axilla by fusion of the two roots from the lateral and medial cords. The present case report describes an anomalous presentation of double formation of median nerve and its relation with axillary and brachial arteries. The median nerve was formed in two stages at different levels, first in the axilla and then in the upper arm by receiving double contribution from the lateral root of the lateral cord, which fuse with the medial root of the medial cord to form the median nerve. The formation took place medial to the axillary artery in the axilla and antero-medial to the brachial artery in the arm. Such anatomical variations and their relation with the arteries are important for the surgeons and anesthesiologists and of great academic interest to the anatomists.

scholarly journals Electroneurographic parameters in patients with metabolic syndrome

2014 ◽  
Vol 4 (1) ◽  
pp. 45-49
Author(s):  
Suljo Kunić ◽  
Emir Tupković ◽  
Mediha Nišić ◽  
Semiha Salihović
Keyword(s):  
Diabetes Mellitus ◽  
Metabolic Syndrome ◽  
Glycemic Control ◽  
Action Potential ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Sensory Nerve ◽  
Group I ◽  
Patients With Diabetes ◽  
Group Ii

Introduction: The aim of this study was to measure electroneurographic (ENG) parameters of the median and ulnar nerve in patients with metabolic syndrome and to determine whether the large imbalance in glycemic control came to neuropathic changes to the template.Methods: The study included 100 patients with metabolic syndrome diagnosed according to the criteria of the National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III). The patients were divided into two groups. Group I – patients with normal glycemic control and Group II - patients with diabetes mellitus for up to five years. We measured sensory conductive velocity (SCV), the amplitude of sensory nerve action potential (SNAP), motor conductive velocity (MCV), terminal motor latency (TML) and compose muscle action potential after distal stimulation (CMAP-I) and after proximal stimulation (CMAP-II) for the ulnar and median nerve.Results: Sensory and motor parameters in Group II were amended to neuropathic pattern compared to Group I. There were significant differences in: SNAP amplitude for all tested nerves, SCV values for both left and right median and ulnar nerve; MCV and TML for left median nerve; MCV, TML and CMAP-I for right median nerve area; MCV and TML for left ulnar nerve; MCV, CMAP-I and CMAP-II for right ulnar nerve area.Conclusion: Patients with metabolic syndrome and diabetes mellitus duration of five years have the significant changes in sensory and motor peripheral nerves. Neuropathic changes are possible in patients with metabolic syndrome and normal glycemic control.

scholarly journals Anatomical variations of median nerve formation, distribution and possible communication with other nerves in preserved human cadavers

2017 ◽  
Vol 76 (1) ◽  
pp. 38-43 ◽  
Author(s):  
C. N. Mat Taib ◽  
S. N.A. Hassan ◽  
N. Esa ◽  
M. A. Mohd Moklas ◽  
A. A. San
Keyword(s):  
Median Nerve ◽  
Anatomical Variations ◽  
Human Cadavers

scholarly journals Ultrasound Assessment of the Median Nerve Does Not Adequately Discriminate the Carpal Tunnel Syndrome among Patients Diagnosed with Diabetes

Diabetology ◽  
2021 ◽  
Vol 2 (4) ◽  
pp. 226-231
Author(s):  
Carlos Antonio Guillen-Astete ◽  
Monica Luque-Alarcon ◽  
Nuria Garcia-Montes
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Cross Sectional Area ◽  
Diabetic Patients ◽  
Sectional Area ◽  
Cross Sectional ◽  
Patients With Diabetes ◽  
Ultrasound Assessment ◽  
Tunnel Syndrome

Background: Carpal tunnel syndrome is the most prevalent peripheral nerve entrapment condition of the upper limb. Among metabolic risk factors, diabetes is considered the most relevant. Although wrist ultrasound assessment of the median nerve has demonstrated a good correlation with the gold standard for the diagnosis of this syndrome, neurophysiological study, its usefulness in patients with diabetes is questionable because the compressive phenomenon is not the predominant one. Method: We conducted a retrospective study to compare the clinical and median nerve ultrasound features of patients with carpal tunnel syndrome previously diagnosed or not diagnosed with diabetes. Additionally, a linear multivariate regression analysis was performed to determine to what extent the cross-sectional area of the median nerve was dependent on the condition of diabetes by fixing other variables such as sex, age, or time of evolution. Results: We included 303 records of patients (mean age 44.3 ± 11.7 years old, 57.89% female, mean of time of evolution 13.6 ± 8.3 months) from 2012 to 2020. The cross-sectional area of the median nerve was 10.46 ± 1.44 mm2 in non-diabetic patients and 8.92 ± 0.9 mm2 in diabetic patients (p < 0.001). Additionally, diabetic patients had a shorter time of evolution (7.91 ± 8.28 months vs. 14.36 ± 0.526 months, p < 0.001). In the multivariate analysis, the resultant model (fixed R-square = 0.659, p = 0.003) included a constant of the following four variables: the evolution time (Beta coeff. = 0.108, p < 0.001 95% CI 0.091 to 0.126, standardized coeff. = 0.611), the condition of diabetes (Beta coeff. = −0.623, p < 0.001 95% CI −0.907 to −0.339, standardized coeff. = −0.152), the severity (Beta coeff. = 0.359, p = 0.001 95% CI 0.147 to 0.571, standardized coeff. = 0.169), and the masculine sex (Beta coeff. = 0.309, p = 0.003, 95% CI 0.109 to 0.509, standardized coeff. = 0.103). Conclusions: Ultrasound assessment of the median nerve in patients with diabetes is not a useful tool to confirm whether carpal tunnel syndrome should be diagnosed or not diagnosed.

scholarly journals Normal neurophysiologic parameters of the median nerve among adult healthy Sudanese population

2020 ◽  
Vol 10 (4) ◽  
pp. 136-141
Author(s):  
Mohammed Salah Elmagzoub ◽  
Ahmed Hassan Ahmed ◽  
Hussam M A Hameed
Keyword(s):  
Action Potential ◽  
Median Nerve ◽  
Conduction Velocity ◽  
Nerve Conduction ◽  
Compound Muscle Action Potential ◽  
Motor Nerve ◽  
Sensory Nerve ◽  
Peak Latency ◽  
Muscle Action Potential ◽  
Sensory Nerve Action

Background: Nerve conduction studies (NCSs) help in delineating the extent distribution of neural lesion, and the diagnosis of peripheral nerve disorders. Because normative nerve conduction parameters were not yet established in Sudan EMG laboratories, this study aims towards having our own reference values, as we are using the American and British parameters. This will allow avoiding the discrepancies that might be induced by many factors. Methods: NCSs were performed in 200 Median nerves of 100 adult healthy Sudanese subjects using standardized techniques. Results: The median SNAP (sensory nerve action potential) values were as follows: distal latency, 2.6±3 ms with a range of (2.3-2.9); peak latency, 3.5±0.5 ms (3.0-4.0); amplitude, 47.7±18.0μV (29.7-65.7); conduction velocity, 53.0±7.8 m/s (45.2-60.8). The following values were obtained for the Median nerve CMAP (compound muscle action potential) at wrist stimulation: distal latency, 3.5±0.5 ms with a range of (3.0-4.0); peak latency, 9.4± 1.0 ms (8.4-10.4); duration, 5.9±0.9 ms (5.0-6.8); amplitude, 12.3±2.5 mV (9.8-14.8); area, 43.0±10.4 mVms (32.6-53.4); conduction velocity, 63.6±6.2 m/s (57.4-69.8). The F wave was 28.4±1.8 ms (26.6-30.2). Conclusion: The overall mean sensory and motor nerve conduction parameters for the tested nerve compared favorably with the existing literature with some discrepancies that were justified.

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