Compression Neuropathies

2020 ◽  
Author(s):  
Todd A. Theman ◽  
Kodi Azari
Keyword(s):  
Early Recognition ◽  
Clinical History ◽  
Clinical Problem ◽  
Detailed Examination ◽  
Cubital Tunnel Syndrome ◽  
Electrodiagnostic Testing ◽  
Pronator Syndrome ◽  
Tunnel Syndrome ◽  
Anatomic Locations ◽  
Common Clinical Problem

Compression neuropathies result from entrapment at specific anatomic locations. They are a common clinical problem, particularly in the upper extremity, where a patient’s underlying medical conditions can affect the likelihood of symptoms. Early recognition from the clinical history and a detailed examination, including provocative maneuvers, combined with electrodiagnostic testing or imaging modalities is imperative to guide treatment and prevent permanent dysfunction.   This review contains 7 figures, 2 tables, and 45 references. Keywords: carpal tunnel syndrome, cubital tunnel syndrome, radial tunnel syndrome, ulnar tunnel syndrome, pronator syndrome, anterior interosseous syndrome, entrapment neuropathy, electrodiagnostic studies  

Evaluation of a Child with Spells: A “Prefixed” Approach

2019 ◽  
Vol 18 (01) ◽  
pp. 007-012
Author(s):  
Jatinder S. Goraya
Keyword(s):  
Clinical Practice ◽  
Electrical Activity ◽  
Cortical Neurons ◽  
Diagnostic Errors ◽  
Clinical History ◽  
Clinical Problem ◽  
Detailed Account ◽  
History Taking ◽  
Clinical Events ◽  
Common Clinical Problem

AbstractSpells are a common clinical problem in children and can be broadly classified into epileptic and nonepileptic spells. Epileptic spells are clinical events that result from abnormal, excessive, and synchronous electrical activity of the cortical neurons. All other spells are included under the category of nonepileptic events. Precise differentiation between epileptic and nonepileptic spells, and their final characterization depend chiefly on obtaining a detailed account of the episode from the patient and/or witness. Physical and neurological examinations are generally non-revealing. In clinical practice, however, misdiagnosis of nonepileptic spells as epilepsy is fairly common and often is a result of incomplete history-taking. Explicit guidelines to elicit a thorough history in children who present with spells are lacking. The purpose of this article is to describe an instinctive and easy-to-remember approach to clinical history-taking in children with spells so as to minimize diagnostic errors.

scholarly journals The pathology of the ulnar nerve in acromegaly

2008 ◽  
Vol 159 (4) ◽  
pp. 369-373 ◽  
Author(s):  
Alberto Tagliafico ◽  
Eugenia Resmini ◽  
Raffaella Nizzo ◽  
Lorenzo E Derchi ◽  
Francesco Minuto ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Clinical History ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Control Group ◽  
Cross Sectional ◽  
Sensory Disturbances ◽  
History Of ◽  
Tunnel Syndrome ◽  
Written Informed Consent

ContextAcromegalic patients may complain of sensory disturbances in their hands. Cubital tunnel syndrome, the ulnar nerve neuropathy at the cubital tunnel (UCT), in acromegalic patients has never been reported.ObjectiveTo describe and assess the prevalence of UCT in acromegalic patients and the effects of 1 year of therapy on UCT.PatientsWe examined prospectively 37 acromegalic patients with no history of polyneuropathy, acute trauma at the elbow, no diabetes or hypothyroidism with clinical examination, nerve conduction studies (NCS), and high-resolution ultrasound (US). A control group was made by 50 volunteers. The local ethics committee approved the study and written informed consent was obtained from all subjects involved in the study.InterventionClinical history, physical examination, NCS, and US were used to diagnose UCT at the beginning of the study and after 1 year.ResultsIn 8 of 37 patients, a diagnosis of UCT was made at the beginning of the study reflecting a prevalence of 21%. After 1 year, 5 of 8 (62.5%) patients reported clinical and NCS improvements and evident US reduction of nerve cross-sectional area (CSA; 16.7±2.9 mm2 vs 12.2±3.1 mm2; P<0.001). In 3 of 8 (37.5%) patients, the UCT was unchanged. Ulnar nerve CSA was significantly increased in acromegalic patients with UCT (16.7±2.9 mm2 vs 11.1±2.3 mm2; P<0.047).ConclusionUlnar neuropathy could occur in acromegalic patients and can improve in 62% of cases with disease control. Due to the different management and therapeutic approach, it would be important to make differential diagnosis between cubital and carpal tunnel syndrome in acromegaly.

scholarly journals Medical and Surgical Management of Empyema

2019 ◽  
Vol 40 (03) ◽  
pp. 361-374 ◽  
Author(s):  
Mark S. Godfrey ◽  
Kyle T. Bramley ◽  
Frank Detterbeck
Keyword(s):  
Clinical Course ◽  
Disease Process ◽  
Clinical History ◽  
Clinical Problem ◽  
Pleural Space ◽  
Active Management ◽  
Multiple Factors ◽  
Imaging Characteristics ◽  
Initial Choice ◽  
Common Clinical Problem

AbstractInfection of the pleural space is an ancient and common clinical problem, the incidence which is on the rise. Advances in therapy now present clinicians of varying disciplines with an array of therapeutic options ranging from thoracentesis and chest tube drainage (with or without intrapleural fibrinolytic therapies) to video-assisted thoracic surgery (VATS) or thoracotomy. A framework is provided to guide decision making, which involves weighing multiple factors (clinical history and presentation, imaging characteristics, comorbidities); multidisciplinary collaboration and active management are needed as the clinical course over a few days determines subsequent refinement. The initial choice of antibiotics depends on whether the empyema is community-acquired or nosocomial, and clinicians must recognize that culture results often do not reflect the full disease process. Antibiotics alone are rarely successful and can be justified only in specific circumstances. Early drainage with or without intrapleural fibrinolytics is usually required. This is successful in most patients; however, when surgical decortication is needed, clear benefit and low physiologic impact are more likely with early intervention, expeditious escalation of interventions, and care at a center experienced with VATS.

scholarly journals Compression Neuropathies of the Upper Extremity: A Review

Surgeries ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 320-334
Author(s):  
Carter J. Boyd ◽  
Nikhi P. Singh ◽  
Joseph X. Robin ◽  
Sheel Sharma
Keyword(s):  
Cubital Tunnel Syndrome ◽  
First Line ◽  
X Ray ◽  
First Line Therapy ◽  
Line Therapy ◽  
Endoscopic Release ◽  
Pronator Syndrome ◽  
Tunnel Syndrome ◽  
Inflammatory Drugs ◽  
Patients Experience

Compressive neuropathies of the forearm are common and involve structures innervated by the median, ulnar, and radial nerves. A thorough patient history, occupational history, and physical examination can aid diagnosis. Electromyography, X-ray, and Magnetic Resonance Imaging may prove useful in select syndromes. Generally, first line therapy of all compressive neuropathies consists of activity modification, rest, splinting, and non-steroidal anti-inflammatory drugs. Many patients experience improvement with conservative measures. For those lacking adequate response, steroid injections may improve symptoms. Surgical release is the last line therapy and has varied outcomes depending on the compression. Carpal Tunnel syndrome (CTS) is the most common, followed by ulnar tunnel syndrome. Open and endoscopic CTS release appear to have similar outcomes. Endoscopic release appears to incur decreased cost baring a low rate of complications, although this is debated in the literature. Additional syndromes of median nerve compression include pronator syndrome (PS), anterior interosseous syndrome, and ligament of Struthers syndrome. Ulnar nerve compressive neuropathies include cubital tunnel syndrome and Guyon’s canal. Radial nerve compressive neuropathies include radial tunnel syndrome and Wartenberg’s syndrome. The goal of this review is to provide all clinicians with guidance on diagnosis and treatment of commonly encountered compressive neuropathies of the forearm.

Entrapment Neuropathies: Electrodiagnostic Criteria

2019 ◽  
Vol 24 (6) ◽  
pp. 12-15
Author(s):  
Jay Blaisdell ◽  
James B. Talmage
Keyword(s):  
Nerve Conduction ◽  
Task Force ◽  
Conduction Block ◽  
Cubital Tunnel Syndrome ◽  
Conduction Delay ◽  
Test Results ◽  
Sixth Edition ◽  
Entrapment Neuropathies ◽  
Axon Loss ◽  
Tunnel Syndrome

Abstract Like the diagnosis-based impairment (DBI) method and the range-of-motion (ROM) method for rating permanent impairment, the approach for rating compression or entrapment neuropathy in the upper extremity (eg, carpal tunnel syndrome [CTS]) is a separate and distinct methodology in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. Rating entrapment neuropathies is similar to the DBI method because the evaluator uses three grade modifiers (ie, test findings, functional history, and physical evaluation findings), but the way these modifiers are applied is different from that in the DBI method. Notably, the evaluator must have valid nerve conduction test results and cannot diagnose or rate nerve entrapment or compression without them; postoperative nerve conduction studies are not necessary for impairment rating purposes. The AMA Guides, Sixth Edition, uses criteria that match those established by the Normative Data Task Force and endorsed by the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM); evaluators should be aware of updated definitions of normal from AANEM. It is possible that some patients may be diagnosed with carpal or cubital tunnel syndrome for treatment but will not qualify for that diagnosis for impairment rating; evaluating physicians must be familiar with electrodiagnostic test results to interpret them and determine if they confirm to the criteria for conduction delay, conduction block, or axon loss; if this is not the case, the evaluator may use the DBI method with the diagnosis of nonspecific pain.

A Case of Work-Related Cubital Tunnel Syndrome Due To Repetitive Motions

2000 ◽  
Vol 12 (2) ◽  
pp. 310
Author(s):  
Jung Won Kim ◽  
Insun Won Park ◽  
Youngjoon Won Lee ◽  
Yu Chang Kim ◽  
Pilja Chang Kim ◽  
...  
Keyword(s):  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Work Related ◽  
Tunnel Syndrome
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